Learning outcomes of structured perioperative teaching based on adult learning

Nan-Chieh Chen; Yu-Tang Chang; Po-Chih Chang; Cheng-Sheng Chen; Chung-Sheng Lai

doi:10.1371/journal.pone.0262872

Peer Review History

Original SubmissionSeptember 30, 2021
12 Nov 2021 Decision Letter - Hans-Peter Simmen, Editor PONE-D-21-31480Learning Outcomes of Structured Perioperative Teaching Based on Adult LearningPLOS ONE Dear Dr. Chen, 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. Both reviewers made an effort to give recommendations to improve your manuscript.You are kindly invited to seek help of a native speaker. Reviewer 1 summarizes details you should follow for the revision. Please submit your revised manuscript by end of january, 2022. 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. 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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: 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: • “shortage of systemic didactics in perioperative training”, that is quite a general assumption. Can u provide some references? • , which should indeed provide students with more information about knowledge and skills for operating so that more interest and intention to being surgeons might be aroused. o Rephrase please. • “. However, to improve the working environment by reducing working hours might lead to inadequate training in the operating room.” o What are the standard working hours and what are the average real working hours? What about lack of work quality due to overworked stuff? • It is necessary to develop an effective learning environment to balance learning and teaching effectiveness and working load. o How does reduce the work load? • “Traditional curriculum design and didactic approach in surgical education tend to be teaching strategies with little structure where the content of teaching is not well organized” o That’s also a really general assumption which would need further explanation of the implemented system and the lack of it. • Traditional curriculum design and didactic approach in surgical education tend to be teaching strategies with little structure where the content of teaching is not well organized. and the learners play the role more as absolute passive observers than the ones with active participation, even under a highly tense atmosphere in the operating room. o Rephrase and check gramma. o What do u mean with a “tense atmosphere”? • “Consequently, a disparity might exists between learners and teaching faculty in terms of perioperative teaching” o I can’t find prove of that statement and the references included. • “Adult learning itself is distinguished by having been put forward from childhood learning, in which the learners develop self-directed learning both in learning goals and strategies. The theory points out that adults learn best when they clearly know their motivation for learning. o Rephrase and inset citation • This study was conducted in a medical center in Taiwan o What kind of center? Which level? • The intention was that the written record would allow learners to become aware of adult learning principles , then the teacher would closely review the written record and give direct feedback to the learners immediately after operation Application of the problem centered clinical reasoning through Questions and Answers (Q &A) interaction related to the patients’ condition could evoke the awareness of learning needs. Therefore, the structural learning model with written record designed in the teaching study based on adult learning pattern and clinical reasoning of teaching and learning. o Rephrase • “ The questionnaire was conducted after completing the perioperative training” o Where is the control group in this setting when u only asked participant’s after the training? • ; however, possibly at the expense of training effectiveness and quality. o this is a very bold and generalized statement. Please discuss here the advantages and disadvantages of regulated working hours and regarding teaching, time for self-study and preparation and overwork. • In the structural perioperative teaching, the learners were briefed with the preoperative preparation, operative indications, and objectives of surgery by the attending surgeon at the scrubbing time o Scrubbing time is usually not more than 3 minutes. Please discuss if that is a appropriate timeframe for teaching. ****** 6. 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Revision 1
1 Jan 2022 Author Response Responses to reviewer’s Questions Reviewer #1: 1. “shortage of systemic didactics in perioperative training”, that is quite a general assumption. Can u provide some references? Response: Thanks for the suggestion. Two references (ref 1 and 2) suggested a shortage of systemic didactics in perioperative training have been added. 2. • , which should indeed provide students with more information about knowledge and skills for operating so that more interest and intention to being surgeons might be aroused. o Rephrase please. Response: Thanks for the suggestion. The sentence has been rephrased. Please see the first paragraph of the introduction section. 3. • “. However, to improve the working environment by reducing working hours might lead to inadequate training in the operating room.” o What are the standard working hours and what are the average real working hours? What about lack of work quality due to overworked stuff? Response: The government regulated the maximum working hours of 80 hours per week, however, the real working hours possibly exceeded 110 hours per week before the law establishment. To prevent lack of work quality due to overworked stuff, the government has set the working hours restriction as one of teaching hospital accreditation standards. 4. • It is necessary to develop an effective learning environment to balance learning and teaching effectiveness and working load. o How does reduce the work load? Response: Work loading could be probably reduced by duty hour restriction. The government has required all hospitals to follow the law in our country. 5. • “Traditional curriculum design and didactic approach in surgical education tend to be teaching strategies with little structure where the content of teaching is not well organized” o That’s also a really general assumption which would need further explanation of the implemented system and the lack of it. Response: Thanks for the suggestion. The sentence has been rephrased and a few references cited to support the background. Please see the second paragraph of the introduction section in the revised manuscript. 6. • Traditional curriculum design and didactic approach in surgical education tend to be teaching strategies with little structure where the content of teaching is not well organized. and the learners play the role more as absolute passive observers than the ones with active participation, even under a highly tense atmosphere in the operating room. o Rephrase and check gramma. o What do u mean with a “tense atmosphere”? Response: We rethink the term “tense atmosphere” which seems to be subjective and misleading. The phrase has been deleted in the revised manuscript. The grammatical error of the whole sentence has been also corrected. Thank you for the suggestion. 7. • “Consequently, a disparity might exists between learners and teaching faculty in terms of perioperative teaching” o I can’t find prove of that statement and the references included. Response: The sentence has been rewritten more clearly. A reference has been removed because it could not be found in the online literature database has been removed. Thank you for the suggestion. 8. • “Adult learning itself is distinguished by having been put forward from childhood learning, in which the learners develop self-directed learning both in learning goals and strategies. The theory points out that adults learn best when they clearly know their motivation for learning. o Rephrase and inset citation Response: Thanks for the suggestion. The sentence has been rephrased and one reference (ref 12) has been cited in the revised manuscript. 9. • This study was conducted in a medical center in Taiwan o What kind of center? Which level? Response: It should be a university teaching hospital. We had made it clearer in the revised manuscript. 10. • The intention was that the written record would allow learners to become aware of adult learning principles , then the teacher would closely review the written record and give direct feedback to the learners immediately after operation Application of the problem centered clinical reasoning through Questions and Answers (Q &A) interaction related to the patients’ condition could evoke the awareness of learning needs. Therefore, the structural learning model with written record designed in the teaching study based on adult learning pattern and clinical reasoning of teaching and learning. o Rephrase Response: Thanks for the suggestion. The sentences have been rephrased. Please see the last paragraph of the 2.1 section. 11. • “ The questionnaire was conducted after completing the perioperative training” o Where is the control group in this setting when u only asked participant’s after the training? Response: This medical education study was a quasi-experiment design without a control group. The limitation of such study design has been clearly mentioned in the discussion section. Please see the last paragraph of the discussion section. 12. • ; however, possibly at the expense of training effectiveness and quality. o this is a very bold and generalized statement. Please discuss here the advantages and disadvantages of regulated working hours and regarding teaching, time for self-study and preparation and overwork. Response: Thanks for the suggestion. This was indeed a bold and generalized statement and easily misunderstood. As the duty hours policy is not the main point of this study, we decided to delete the part of the discussion. 13. • In the structural perioperative teaching, the learners were briefed with the preoperative preparation, operative indications, and objectives of surgery by the attending surgeon at the scrubbing time o Scrubbing time is usually not more than 3 minutes. Please discuss if that is a appropriate timeframe for teaching. Response: Thanks for the correction. “At the scrubbing time” did not exactly describe what it was. Instead, the briefing started at the scrubbing time and continued after scrubbing to the beginning of the operation. It usually took 10 minutes. Please see the second paragraph of the discussion section. Attachments Attachment Submitted filename: response to reviewer_1st_PONE-D-21-31480.docx https://doi.org/10.1371/journal.pone.0262872.r002
7 Jan 2022 Decision Letter - Hans-Peter Simmen, Editor Learning Outcomes of Structured Perioperative Teaching Based on Adult Learning PONE-D-21-31480R1 Dear Dr. Chen, 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, Hans-Peter Simmen, M.D., Professor of Surgery Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0262872.r003
Formally Accepted
13 Jan 2022 Acceptance Letter - Hans-Peter Simmen, Editor PONE-D-21-31480R1 Learning Outcomes of Structured Perioperative Teaching Based on Adult Learning Dear Dr. Chen: 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. Hans-Peter Simmen Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0262872.r004

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