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PONE-D-20-24393

Becoming the temporary surgeon: A grounded theory examination of anaesthetists performing emergency front of neck access in inter-disciplinary simulation-based training.

PLOS ONE

Dear Dr. Silverio,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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• The manuscript is too lengthy. It would be easier to be followed if it has been abstracted. 

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Academic Editor

PLOS ONE

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'Ethical approvals were sought from and granted by Health Research Authority with IRAS project ID: 226720 and REC reference: 18/HRA/0122, with both University and Hospital permissions, subsequently granted.'

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'Sergio A. Silverio (King’s College London) is supported by the National Institute for Health Research Applied Research Collaboration South London [NIHR ARC South London] at King’s College Hospital NHS Foundation Trust.  The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.  '

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Additional Editor Comments:

Dear Authors

Thank you very much for your interest in the Plos One. The two expert reviewers have raised interesting suggestions to improve the quality of the manuscript. Can you please kindly address all comments in the next version of the manuscript. I would highlight the followings

1. The generalizability and logistics for including FONA in the curriculum of training in anaesthesia.

2. The need to reduce the length of the manuscript.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: N/A

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Thanks for this interesting study and study approach;

however, there are some concerns.

I do support the idea to use structured interviews and identify frames of action the study participants. However the manuscript has an incredible length; as well documented, adults (and even kids with different devices) can use scales to grade certain expressions describing feelings / ideas etc. this might help to grade the progress in the training. The bites from the interviews are interesting to read, but too long ; you should put those in a supplemental file

I understand that this longitudinal study in this setting cannot be designed to train hundreds of residents. Is you approach applicable for larger groups?

Please straighten the manuscript; it is way too long; this accounts for all parts of the document.

Reviewer #2: Congratulations for the very interesting study.

I have just one suggestion, although it is very probably not even fairly related to the context.

First of all, the addition of FONA into the curriculum of anaesthesia should be set a precedent in other countries. During the process I think one of the most important steps is medico-legal and more importantly "self-ethical" issues. (To explain my concern: If an anaesthesist has to apply a FONA, she/he should have no concerns about the possible question "if I do something wrong, will I be sued?"; and in the second , more important step, the more important question: "if I do something wrong, will I ask myself that it would be better to let the surgeon do it?"....

I think these questions deserve also to be discussed.

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Reviewer #1: No

Reviewer #2: No

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Becoming the temporary surgeon: A grounded theory examination of anaesthetists performing emergency front of neck access in inter-disciplinary simulation-based training.

PONE-D-20-24393R1

Dear Dr. Silverio,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Mohamed R. El-Tahan, MD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Dear authors, thanks for the work in the mausncript. I really appreciate the table with the statements- it gives now a good overview.

Kindes regards Christian Brülls

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No