Peer Review History

Original SubmissionJanuary 25, 2021
Decision Letter - Gwo-Jen Hwang, Editor

PONE-D-20-37558

Effectiveness of blended learning in pharmacy education: A systematic review and meta-analysis

PLOS ONE

Dear Dr. Thunga,

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.

Please submit your revised manuscript by Apr 20 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

  • A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
  • A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
  • An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

We look forward to receiving your revised manuscript.

Kind regards,

Gwo-Jen Hwang

Academic Editor

PLOS ONE

Journal Requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

2. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please move it to the Methods section and delete it from any other section. Please ensure that your ethics statement is included in your manuscript, as the ethics statement entered into the online submission form will not be published alongside your manuscript.

3. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information.

[Note: HTML markup is below. Please do not edit.]

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: Partly

Reviewer #2: Yes

**********

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

Reviewer #1: No

Reviewer #2: Yes

**********

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: No

**********

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: No

**********

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: First, thank you for submitting this review and meta-analysis to the journal. Please consider the following during the peer review process:

1. Abstract - You can remove "This review follows the PRISMA guideline." - PRISMA is a reporting standard, not a methodology. In the full text, you can certainly say your review adheres to the reporting standards recommended by the PRISMA statement.

2. Eligibility (Page 3) - Please clarify. You state in (3) "pre-test score for single arm studies" and (5) "were two groups" - so did you included single group papers or not? Based on results, you included 2 single arm studies, so (5) doesn't appear to be an accurate inclusion criteria.

3. Acronyms - Spell out all acronyms for first use. For all tables, please include the abbreviations and acronym definitions as a key.

4. Page 13 - "face-to-face" and "face to face" (be consistent)

5. Quality Assessment - A significant majority of studies used prior year scores as control with few studies attempting to control for confounding. Is it appropriate to pool the results of analyses?

6. Unequal weighted test scores - It appears by focusing on the mean difference, you equally weight 1 point on a 100 point exam vs. a 50 point exam, despite the point value being worth twice as much on the latter.

Reviewer #2: This study was a SR and MA that sought to assess the effectiveness of blended learning teaching strategies compared to traditional lectures. The study was well done. Methods were clear. Technical writing and grammar need to be revised. Attached is a file with grammatical revisions.

**********

6. 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: Yes: T. Joseph Mattingly II

Reviewer #2: Yes: Alexandra Perez

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Attachments
Attachment
Submitted filename: PONE-D-20-37558_reviewer.pdf
Revision 1

Reviewers comments:

Reviewer 1:

Abstract - You can remove "This review follows the PRISMA guideline." - PRISMA is a reporting standard, not a methodology. In the full text, you can certainly say your review adheres to the reporting standards recommended by the PRISMA statement-

Answer:

Corrected as per reviewer

2. Eligibility (Page 3) - Please clarify. You state in (3) "pre-test score for single arm studies" and (5) "were two groups" - so did you included single group papers or not? Based on results, you included 2 single arm studies, so (5) doesn't appear to be an accurate inclusion criteria.

Answer:

Corrected.

We have included interventional studies like single group pretest and post test studies , two group controlled studies(randomized& non randomized). If it is single grouped, we have taken only those studies with pretest and post test); If it is two group studies, didactic teaching as control. 5 points in eligibility criteria is based on PICOS framework.

3. Acronyms - Spell out all acronyms for first use. For all tables, please include the abbreviations and acronym definitions as a key.

Corrected

4. Page 13 - "face-to-face" and "face to face" (be consistent)

Corrected

5. Quality Assessment - A significant majority of studies used prior year scores as control with few studies attempting to control for confounding. Is it appropriate to pool the results of analyses?

We have separately mentioned pooled effect size of studies with historical group as control and studies with RCT design. Based on previous literature, and Cochrane guideline, we understand nothing wrong to pool this way. We pooled both conditions separately to avoid or adjust this dissimilarity or heterogeneity in the form of a subgroup analysis. Also, we presented the result as an overall to know the effectiveness blended learning as whole. As per Cochrane recommendations, all eligible studies can be included in the meta-analysis, regardless of the risk of bias assessment. Indeed, since almost all studies have low score, Cochrane suggests to present an estimated intervention effect based on all available studies, together with a description of the risk of bias in individual domains.

Reference: (Higgins JPT, Green S. Cochrane Handbook for systematic reviews of interventions version 5.1.0.: the Cochrane collaboration 2011)

As per the Cochrane Guideline of systematic review (section 9.6), we need to perform a subgroup analysis by splitting the data according to some specific characters such as participant, intervention or publication characters etc., to explore the effect of that particular factor in the analysis.

As its educational intervention study in pharmacy education, practically it is difficult to conduct prospective controlled trial in same batch of students in same academic institution. That’s why most of the studies adopted historical group as control. Only three studies are RCTs. Out of 26 studies, we included 20 studies with no missing data for quantitative analysis. Among them 8 studies controlled confounding variables (please see quality assessment of studies by modified Ottawa scale). However, modified Ottawa scale requires controlling for subject characteristics by statistical covariate analysis. We have assigned “0” score for studies that tried to compare the baseline characteristics (adjusting confounders) by any method other than statistical covariate analysis. In all those studies, there were no statistically significant differences in students demographics / pre-test (Grade Point Average) between groups by t-test also.

6. Unequal weighted test scores - It appears by focusing on the mean difference, you equally weight 1 point on a 100 point exam vs. a 50 point exam, despite the point value being worth twice as much on the latter.

As per the Cochrane guideline, When studies have used different instruments to measure the same construct, a standardized means difference (SMD) may be used in meta-analysis for combining continuous data, hence we used SMD to combine our results. Reference link is provided.

https://handbook-5-1.cochrane.org/chapter_9/9_2_3_2_the_standardized_mean_difference.htm

Reviewer #2:

This study was a SR and MA that sought to assess the effectiveness of blended learning teaching strategies compared to traditional lectures. The study was well done. Methods were clear. Technical writing and grammar need to be revised. Attached is a file with grammatical revisions

Grammatical errors corrected.

Attachments
Attachment
Submitted filename: Reveiweres comment file.docx
Decision Letter - Gwo-Jen Hwang, Editor

Effectiveness of blended learning in pharmacy education: A systematic review and meta-analysis

PONE-D-20-37558R1

Dear Dr. Thunga,

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.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Gwo-Jen Hwang

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

Reviewer #2: All comments have been addressed

**********

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

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: 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

Reviewer #2: 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

Reviewer #2: 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: No additional comments. Thanks for your submission to the Journal!

Reviewer #2: The authors still need to made some minor grammatical edits. After these corrections are made, it is ok to fully accept.

Attachments
Attachment
Submitted filename: PONE-D-20-37558_R1_reviewer_resubmission.pdf
Formally Accepted
Acceptance Letter - Gwo-Jen Hwang, Editor

PONE-D-20-37558R1

Effectiveness of blended learning in pharmacy education: A systematic review and meta-analysis

Dear Dr. Thunga:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org.

If we can help with anything else, please email us at plosone@plos.org.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Gwo-Jen Hwang

Academic Editor

PLOS ONE

Open letter on the publication of peer review reports

PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .