Development of a virtual classroom for pre-analytical phase of laboratory medicine for undergraduate medical students using the Delphi technique

Lena Jafri; Muhammad Abbas Abid; Javeria Rehman; Sibtain Ahmed; Ghazanfar Abbas; Howrah Ali; Fatima Kanani; Usman Ali; Nusrat Alavi; Farheen Aslam; Sahar Iqbal; Aamir Ijaz; Muhammad Usman Munir; Shabnam Dildar; Syed Haider Nawaz; Khushbakht Adnan; Aysha Habib Khan; Adnan Mustafa Zubairi; Imran Siddiqui

doi:10.1371/journal.pone.0264447

Peer Review History

Original SubmissionJuly 27, 2021
8 Sep 2021 Decision Letter - Gwo-Jen Hwang, Editor PONE-D-21-24285 Development of a Virtual Classroom for Pre-Analytical Phase of Laboratory Medicine for Undergraduate Medical Students Using the Delphi Technique PLOS ONE Dear Dr. Jafri, 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 Oct 23 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. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=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. Please amend your current ethics statement to address the following concerns: a) Did participants provide their written or verbal informed consent to participate in this study? b) If consent was verbal, please explain i) why written consent was not obtained, ii) how you documented participant consent, and iii) whether the ethics committees/IRB approved this consent procedure. [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: No Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: No Reviewer #2: No ****** 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: No Reviewer #2: Yes ****** 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 ******** 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: Dear author, -methods section, “rounds of Delphi were conducted. In the first round, based on the literature search, a questionnaire comprising of 16 learning objectives and their associated triggers for case vignettes was developed on Google Forms.” But the questionnaire item lack references support and reality and validity, moreover how the development of the study’s related questionnaire is unclear. -for more contributions, suggest authors add how to Virtual classroom development and are vague, please cite related references. -a big problem, the study lack a statistic analysis section, to provide the result section. Reviewer #2: The development of educational content for the pre-analysis phase using Delphi technology, it’s important and meaningful for patient safety. There are some suggestions before publishing. 1. In the first round of Delphi development phase. The authors claim based on the literature search for curriculum development. Finally, a questionnaire comprising of 16 learning objectives and their associated triggers for expert review. Please describe the process of developing the 16 learning objectives and their associated triggers or cite the reference. 2. Of the seventy-five triggers in round 1, 61 (81.3%) reached a consensus for inclusion. However, it is not clear how the triggers that are excluded be treated? Will it be included in the second round of discussion or deleted? As well as how did the 39 new triggers were proposed in 2nd round? In addition to the experts' votes, please describe why they were considered or removed from these triggers. 3. The content of Phase II: Virtual classroom development process is not clearly described. How have the 16 learning objectives and 78 triggers in Table 1 been applied to the learning material in the virtual classroom? How are they different from those of traditional online tests? https://doi.org/10.1371/journal.pone.0264447.r001
Revision 1
3 Nov 2021 Author Response 1. Reviewer #1: Dear author, -methods section, “rounds of Delphi were conducted. In the first round, based on the literature search, a questionnaire comprising of 16 learning objectives and their associated triggers for case vignettes was developed on Google Forms.” But the questionnaire item lack references support and reality and validity, moreover how the development of the study’s related questionnaire is unclear. Author’s response: Details about the development of the questionnaire are added in the methods section. Page 4, Line 26: “The learning objectives and triggers were extracted after a thorough review of literature on the most common pre-analytical errors in a Chemical Pathology lab. [15, 16] Extracted data was carefully reviewed for relevance to patient safety by the in-house Chemical Pathology faculty and were included as learning objectives.” 2. -for more contributions, suggest authors add how to Virtual classroom development and are vague, please cite related references. Author’s response: Details regarding the development of virtual classroom over Moodle have been added to the methods section. Page 5, Line 10: “Moodle is a user-friendly tool that can develop vibrant classrooms for active learning of students by increasing their participation through visually appealing question stems and explanations. [19, 20] The virtual classroom was developed by the faculty in the Section of Clinical Chemistry, Department of Pathology & Laboratory Medicine at AKU. The faculty received training for the use of Moodle for classroom development and was aided by the university’s information technology (IT) department in the process. The virtual classroom was developed using the H5P plugin and, consisted of a formative quiz of various items built within the content and learning material to stimulate learning and activate prior knowledge. Each case scenario was followed by an interactive quiz or game. The interactive quiz included multiple choice questions, fill in the blanks, drag and drop sequences and read-and-answer comprehensions. Specific learning points to reinforce and clarify the concepts were included added after each item and graphs and pictures were included for a vibrant experience.” 3. -a big problem, the study lack a statistic analysis section, to provide the result section. Author’s response: As suggested, the statistical analysis section has been appropriately added after the methods section. Page 5, Line 3: “The information was derived from Moodle after the completion of the classroom session. Data was transferred from Microsoft excel to SPSS. For statistical analysis IBM SPSS Statistics version 21 was used. We analyzed binary data and quantitative data separately. Frequencies, means and standard deviations were generated for quantitative data.” 4. Reviewer #2: The development of educational content for the pre-analysis phase using Delphi technology, it’s important and meaningful for patient safety. There are some suggestions before publishing. In the first round of Delphi development phase. The authors claim based on the literature search for curriculum development. Finally, a questionnaire comprising of 16 learning objectives and their associated triggers for expert review. Please describe the process of developing the 16 learning objectives and their associated triggers or cite the reference. Author’s response: Details about the development of the questionnaire are added in the methods section. Page 4, Line 26: “The learning objectives and triggers were extracted after a thorough review of literature on the most common pre-analytical errors in a Chemical Pathology lab. [15, 16] Extracted data was carefully reviewed for relevance to patient safety by the in-house Chemical Pathology faculty and were included as learning objectives.” 5. Of the seventy-five triggers in round 1, 61 (81.3%) reached a consensus for inclusion. However, it is not clear how the triggers that are excluded be treated? Will it be included in the second round of discussion or deleted? As well as how did the 39 new triggers were proposed in 2nd round? In addition to the experts' votes, please describe why they were considered or removed from these triggers. Author’s response: The proposed changes have been included the results section. Page 6, line 5: “Fourteen triggers did not reach the consensus after round one, while 22 triggers did not reach consensus after round two and were therefore eliminated after each round, respectively.” 6. The content of Phase II: Virtual classroom development process is not clearly described. How have the 16 learning objectives and 78 triggers in Table 1 been applied to the learning material in the virtual classroom? How are they different from those of traditional online tests? Author’s response: As suggested, the details about the development of the virtual classroom from the agreed-upon learning objectives and triggers have been included in the methods section. Page 5, Line 25: "Each learning objective was made into a clinical case scenario to represent the most common pre-analytical errors pertinent to that case, while all the triggers with that learning objective were included within each case and represented in the case scenarios. The purpose of developing the case scenarios was to create an engaging simulated environment for the students. With the help of learning objectives real or simulated managerial situations were created for the students to identify potential pre-analytical errors and take action. The questions for which clinical scenarios could not be developed were included as a drag-and-drop sequence. Information related to the learning objective and triggers was included in as a slide right after each question so students can review what they just answered. Visual aids, figures, cartoons and mnemonics were included as learning aid to ease the learning process as compared to the conventional lecture-based classroom.” Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0264447.r002
17 Jan 2022 Decision Letter - Vineet Kumar Rai, Editor PONE-D-21-24285R1Development of a Virtual Classroom for Pre-Analytical Phase of Laboratory Medicine for Undergraduate Medical Students Using the Delphi TechniquePLOS ONE Dear Dr. Jafri, 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 1st Feb 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. 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: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Vineet Kumar Rai, PhD Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] 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: (No Response) 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: (No Response) Reviewer #2: Partly ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: (No Response) Reviewer #2: N/A ****** 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: (No Response) 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: (No Response) 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: DEAR Authors, I suggest that the review’s add my initial opinion with the revised submission an itemized, point-by-point response to the comments of the reviewers. Thank you. Reviewer #2: (No Response) ****** 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 Reviewer #2: No [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. https://doi.org/10.1371/journal.pone.0264447.r003
Revision 2
1 Feb 2022 Author Response 1/27/2022 Vineet Kumar Rai, PhD Academic Editor PLOS ONE Subject: Rebuttal Letter-'Response to Reviewers': PONE-D-21-24285R1; Development of a Virtual Classroom for Pre-Analytical Phase of Laboratory Medicine for Undergraduate Medical Students Using the Delphi Technique Dear Editor, Please find point by point response to all comments and suggestions made by reviewers. • Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Author’s Response: All references have been verified. • 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: (No Response) Reviewer #2: All comments have been addressed Author’s Response: Not needed • 2. Is the manuscript technically sound, and do the data support the conclusions? Reviewer #1: (No Response) Reviewer #2: Partly Author’s Response: Not needed • 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: (No Response) Reviewer #2: N/A Author’s Response: Not needed • 4. Have the authors made all data underlying the findings in their manuscript fully available? Reviewer #1: (No Response) Reviewer #2: Yes Author’s Response: Not needed • 5. Is the manuscript presented in an intelligible fashion and written in standard English? Reviewer #1: (No Response)\\ Reviewer #2: Yes Author’s Response: Not needed • 6. Review Comments to the Author Reviewer #1: DEAR Authors, I suggest that the review’s add my initial opinion with the revised submission an itemized, point-by-point response to the comments of the reviewers. Thank you. Reviewer #2: (No Response) Author’s Response to Reviewer One: Dear Reviewer these were the suggestions and comments shared by you “ 1. We note you state consent was obtained from the participants of this study. However, you have not clarified the type of consent provided. Before we can proceed, please address the following prompts: a) Did participants provide their written or verbal informed consent to participate in this study? b) If consent was verbal, please explain i) why written consent was not obtained, ii) how you documented participant consent, and iii) whether the ethics committees/IRB approved this consent procedure.” We have below itemized point-by point response to your comments made then: Reviewer comment “ 1. We note you state consent was obtained from the participants of this study. However, you have not clarified the type of consent provided. Before we can proceed, please address the following prompts: a) Did participants provide their written or verbal informed consent to participate in this study? Author’s Response: Details about the written consent obtained from the participants was included in the manuscript in the methods section. “A written consent was obtained from all the panel members prior to their participation in the Delphi process. The consent was obtained via email which outlined the Delphi process, expectations from the panel members, and how the data will be used afterwards.” (Page 4; Line 35) b) If consent was verbal, please explain i) why written consent was not obtained, ii) how you documented participant consent, and iii) whether the ethics committees/IRB approved this consent procedure.” Author’s Response: We did not take verbal consent. Written informed consent was taken from all participants via email and permission from Ethical Review Committee was taken for written consent. • 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 Reviewer #2: No Author’s Response: Not needed 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. Author’s Response: We have uploaded and improved the figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic to ensure that figures meet PLOS requirements Thank you Dr Lena Jafri, MBBS, FCPS, FAIMER fellow Philadelphia Department of Pathology and Laboratory Medicine Medical College, Pakistan, The Aga Khan University Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0264447.r004
11 Feb 2022 Decision Letter - Vineet Kumar Rai, Editor Development of a Virtual Classroom for Pre-Analytical Phase of Laboratory Medicine for Undergraduate Medical Students Using the Delphi Technique PONE-D-21-24285R2 Dear Dr. Jafri, 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, Vineet Kumar Rai, PhD Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0264447.r005
Formally Accepted
9 Mar 2022 Acceptance Letter - Vineet Kumar Rai, Editor PONE-D-21-24285R2 Development of a Virtual Classroom for Pre-Analytical Phase of Laboratory Medicine for Undergraduate Medical Students Using the Delphi Technique Dear Dr. Jafri: 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. Vineet Kumar Rai Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0264447.r006

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