Medical students’ attitudes toward psychiatry in Indonesia

Fransiska Kaligis; Ribka Hillary; Nabilla Merdika Putri Kusuma; Helisa Rachel Patricie Sianipar; Camilla Sophi Ramadhanti; Ardi Findyartini; Madhyra Tri Indraswari; Clarissa Cita Magdalena; Garda Widhi Nurraga

doi:10.1371/journal.pone.0265605

Peer Review History

Original SubmissionJune 2, 2021
26 Oct 2021 Decision Letter - Muhammad Aziz Rahman, Editor PONE-D-21-18251Medical students’ attitudes toward psychiatry in Indonesia: a pilot studyPLOS ONE Dear Dr. Kaligis, 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, address the comments made by both reviewers. Please submit your revised manuscript by Dec 10 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: 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, Associate Professor Dr Muhammad Aziz Rahman, MBBS, MPH, CertGTC, GCHECTL, PhD 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. We note that you have stated that you will provide repository information for your data at acceptance. Should your manuscript be accepted for publication, we will hold it until you provide the relevant accession numbers or DOIs necessary to access your data. If you wish to make changes to your Data Availability statement, please describe these changes in your cover letter and we will update your Data Availability statement to reflect the information you provide. [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: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes 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: Yes 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: No 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: 1. Conclusion part is missing 2. English language proficiency needs to be upgraded. 3. In the Discussion Part: I think that the whole discussion part may be written under a single point 'Discussion' with different paragraphs. Reviewer #2: Title: Medical students’ attitude toward psychiatry in Indonesia: a pilot study Reviewer’s comments: TITLE: This is not clear why this is being called “a pilot study”. I have not found any explanation of this while reading through the paper ABSTRACT: The result segment of the abstract is poorly written. There has been some repetitions and the results were not succinctly present. INTRODUCTION: • Several statements were identified that were not provided with in-text citations. The authors should revisit the introduction. For example, line 59-61, page 3 states, “Factors influencing this stigma among the society may be related to the lack of knowledge and information regarding the course of mental illness and its treatment” does not have any citation. • Some portions of the introduction require rephrasing. For instance, line 72-75, page 4 states, “The media, culture, personality, and even history played part in the formed images of psychiatry. Another factor is the influences of training for medical students. Doctors usually have criticisms of how psychiatry lacks on science and evidence-based theory, as well as demands too much emotion, and criticism of how psychiatrists are not apt to be role models.” This seems unclear and complicated. The authors should try to make it easily understandable. Another sentence in the same page (line 81-82) is ambiguous. MATERIALS AND METHODS: • This is not clear why 2nd and 3rd year students were excluded • The data collection process was not explained well • There was no section that explained the sample size of the study RESULTS: • The socio-demographic characteristics seem incomplete • In line 128-129 this was mentioned that the mean age of both categories was 21.29 with the same standard deviation. I am not sure whether this is correct or not • Table 2 and Table 3 could be merged, and again to limit the table size the pre-psychiatry rotation group and post-psychiatry rotation groups can be analysed. • The differences between pre-rotation and post-rotation groups could be provided as well • In some cases, there was repetition of findings in narratives and table. This should be avoided DISCUSSION: • Discussion is well written OVERALL COMMENTS: • This paper is interesting but needs quite a lot of revision. The authors should think how the data could be presented in a more interesting way. ****** 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:** AHMK BakiBillah 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. Attachments Attachment Submitted filename: PLOS ONE_REV_PONE_D_21_18251.docx https://doi.org/10.1371/journal.pone.0265605.r001
Revision 1
9 Dec 2021 Author Response Reviewer’s comments: TITLE: This is not clear why this is being called “a pilot study”. I have not found any explanation of this while reading through the paper In Indonesia itself, no research has been conducted about how the negative stigma is circulating and how it affects medical students' future decisions and preferences. The authors assumed it was appropriate to say pilot study as the first conducted study in Indonesia. However, since it has been done in other countries, the authors decided to remove the title “a pilot study”. ABSTRACT: The result segment of the abstract is poorly written. There has been some repetitions and the results were not succinctly present. A mix of positive and negative perceptions towards psychiatry was identified. The overall response was favorable to both before and after psychiatric rotation groups. We have modified the abstract to clarify and highlight the significant result. INTRODUCTION: • Several statements were identified that were not provided with in-text citations. The authors should revisit the introduction. For example, line 59-61, page 3 states, “Factors influencing this stigma among the society may be related to the lack of knowledge and information regarding the course of mental illness and its treatment” does not have any citation. Factors influencing this stigma in society may be related to the lack of knowledge and information regarding the course of mental illness and its treatment [3]. • Some portions of the introduction require rephrasing. For instance, line 72-75, page 4 states, “The media, culture, personality, and even history played part in the formed images of psychiatry. Another factor is the influences of training for medical students. Doctors usually have criticisms of how psychiatry lacks on science and evidence-based theory, as well as demands too much emotion, and criticism of how psychiatrists are not apt to be role models.” This seems unclear and complicated. The authors should try to make it easily understandable. Another sentence in the same page (line 81-82) is ambiguous. The public's perspectives toward psychiatry have been primarily formed by the portrayal in the media, culture, and history. These images have also influenced how medical students are being trained. For example, it was found that doctors would criticize how psychiatry lacks evidence-based theories and demands emotions more than scientific understanding, as well as criticism of how psychiatrists are not apt to be role models [7,8]. Medical students were reported to have minimal knowledge in psychiatry with large amount of stigma prior to being exposed to psychiatric patients [8]. However, the same study also suggested that the level of stigma decreases as students enter psychiatry clinical rotation and meet psychiatric patients [8]. Another study in 2005 by Bulbena et al. [9] found that the percentage of students who were willing to choose psychiatry as their specialty increased to 10.4% after the exposure to psychiatric rotation. The factors contributed to these findings are not only subjective to the clinical rotation, but other factors unrelated to psychiatric training as well. Cutler et al. [10] showed that the preference of medical students in choosing psychiatry as a career was often affected by their own family members. Students who are surrounded by families with negative perspectives toward psychiatry would less likely choose psychiatry as their future career. MATERIALS AND METHODS: • This is not clear why 2nd and 3rd year students were excluded We recruited students who can represents the 4 groups (before any psychiatric modules; after neuropsychiatry pre-clinical module but before clinical psychiatry rotation, after clinical psychiatry rotation, and fresh graduate of medical students). In Universitas Indonesia, pre-clinical neuro-psychiatry module is given in the last two months of the third year, whereas the psychiatry clinical rotation is done in the fifth year. Hence, we included the subject from: (1) first-year medical students before any exposure to psychiatry module, (2) fourth-year medical students who have passed pre-clinical psychiatry module but prior to clinical psychiatric rotation, (3) fifth-year medical students after the exposure to psychiatric rotation, (4) fresh graduate alumni. • The data collection process was not explained well A simple random sampling method was used to acquire samples. The subjects were randomly selected from a list of student ID numbers. The inclusion criteria were: (1) first-year medical students, (2) fourth-year medical students prior to psychiatric rotation, (3) fifth-year medical students after the exposure to psychiatric rotation, (4) fresh graduate alumni who were in the one-year mandatory medical service assignment (Internship). A total of 224 participants were recruited between February and June 2017, with 56 students in every group. The subjects were chosen by simple random sampling and were asked to sign informed consent to use the questionnaires. Each subject filled the questionnaires through online forms, and the results attained from the questionnaires were statistically processed and analyzed. • There was no section that explained the sample size of the study A total of 224 participants were recruited between February and June 2017, with 56 students in every group. RESULTS: • The socio-demographic characteristics seem incomplete The authors assume the socio-demographic characteristics are in accordance with the obtained data as per initial recruitment. • In line 128-129 this was mentioned that the mean age of both categories was 21.29 with the same standard deviation. I am not sure whether this is correct or not The mean age of 21.29 ± 2.00 refers to all subjects of 224 samples. • Table 2 and Table 3 could be merged, and again to limit the table size the pre-psychiatry rotation group and post-psychiatry rotation groups can be analysed. Table 2 and Table 3 have been merged into new Table 2 (line 146). We also managed to differ pre- and post-psychiatry rotation in the Table 2. • The differences between pre-rotation and post-rotation groups could be provided as well Already written. Please refer to the new Table 2 in the article. • In some cases, there was repetition of findings in narratives and table. This should be avoided We already paraphrased the narrative findings not to be repetitive from the Table. DISCUSSION: • Discussion is well written All parts, including the discussion, have been paraphrased for a better academic reading. OVERALL COMMENTS: • This paper is interesting but needs quite a lot of revision. The authors should think how the data could be presented in a more interesting way. We already altered the data presentation, including the merged findings in the Table. Not to mention, we have checked the use of English to be more academic and avoid any ambiguity. Attachments Attachment Submitted filename: 041221 PLOS ONE_REV_PONE_D_21_18251.docx https://doi.org/10.1371/journal.pone.0265605.r002
7 Mar 2022 Decision Letter - Sonia Brito-Costa, Editor Medical students’ attitudes toward psychiatry in Indonesia PONE-D-21-18251R1 Dear Dr. Kaligis, 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, Sonia Brito-Costa, Ph.D. 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 #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 #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? 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 #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 #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 #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 #2: No https://doi.org/10.1371/journal.pone.0265605.r003
Formally Accepted
17 Mar 2022 Acceptance Letter - Sonia Brito-Costa, Editor PONE-D-21-18251R1 Medical students’ attitudes toward psychiatry in Indonesia Dear Dr. Kaligis: 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. Sonia Brito-Costa Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0265605.r004

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 .