PONE-D-21-37240The flipped classroom is effective for medical students to improve deep tendon reflex examination skills: A mixed-method studyPLOS ONE

Dear Dr. Uchida,

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. Based on the review results, a major revision has been suggested in the paper before making any final decision. Please kindly revised the manuscript based on the reviewers' comments. 

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We look forward to receiving your revised manuscript.

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Di Zou

Academic Editor

PLOS ONE

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Reviewers' comments:

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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: No

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

Reviewer #1: Yes

Reviewer #2: No

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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: Overall well written and well constructed study. Sample demographics should be discussed in the Methods (as should use of SD for statistics, when appropriate). The limitations of the study should also include the male sex bias in the sample demographics.

Reviewer #2: Line 86

The participants were allocated to the intervention or control groups.

Comments: How the participants were divided into experimental and control group. was it randomly or quota method?

One group consisted of five to six students who practiced for two weeks in this department.

Comment: This is not clear authors are talking about control / experimental group or Focus group.

Line 90

Participants: A total of 83 medical students participated in the study. They were fifth-year students who participated in a clinical clerkship at the Department of General Medicine, Chiba University Hospital, from November 2018 to July 2019.

Comment: How the study participants were recruited; by using probably sampling or non-probably method. How many students were in each group, this is not clear.

Line93

One group consisted of five to six students who practiced for two weeks in this department. (Confusing statement to the reader)

Line 132

This sample size was more than 27, which is the required sample size for a two-tailed test of the difference in means between the two groups

Comment: If the population size is 83 then with 95% confidence level and 3 margins of error, the sample size should be 68

Line 137

The 15 groups were allocated to the intervention or control groups. The allocation was not blinded to the participants or the evaluators

Comment: How they are allocated the group this is not clear. If authors say, the allocation was not blinded to the participants, it could be bias that could alter the results.

Looking at table 1

Self-confidence in DTR examinations (Pretest), mean (SD)*

Self-confidence in DTR examinations (Post-test), mean (SD)*

Comment: Then authors must use paired t - test and they should add t value also in the table

Yes if they want to analyze experimental and control group after intervention ( e learning and face to face practice ) [not pre and post ]then they can use unpaired ( Independent ) t test .

Line 151

In the intervention group, focus group interviews (FGI) [11-13] were conducted for a qualitative assessment.

Comment: Why the focus group was chosen, they could chose randomly from both groups.

Remove errors in sampling method, use tests to check normality of the data then if data is normally distributed then use paired t test ( Pre and Posttest for each group ) 2nd option use unpaired t test but just post test data for each group

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Reviewer #1: No

Reviewer #2: No

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Attachments

Attachment

Submitted filename: PLOS One.docx

PONE-D-21-37240R1The flipped classroom is effective for medical students to improve deep tendon reflex examination skills: A mixed-method studyPLOS ONE

Dear Dr. Uchida,

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 Jul 11 2022 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,

Di Zou

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.

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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: (No Response)

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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

Reviewer #2: No

**********

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

Reviewer #1: Yes

Reviewer #2: No

**********

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: No

**********

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: The authors have successful revised the paper according to my concerns, hence it is now acceptable for publication.

Reviewer #2: Methods Page 13 Line 128-29

Page 14 Line 136

The faculty development was conducted to improve inter-observer reliability before this study.

Comment: There is no table for this statement authors should add Cohen's kappa values.

Line 146

A total of 83 medical students (15 groups) participated in the study. Each group comprised more than 26 participants

Comment: delete 15 groups it is confusing to the reader. Let ‘s suppose one group comprising 26 participants, then total should be 26 x 15 = 390 participants, it is incorrect because the authors said earlier 83 students of 5th year medical program ….

Line 152

The 15 groups were allocated to ……..

Comment: medical students (n=83) were allocated into experimental (group A =43 or control groups (group B = 39) randomly

Results page Line 188-89

A total of 39 participants (7 groups) were allocated to the intervention group; 44 participants (8 groups) were allocated to the control group.

Comment: authors could say experimental group n= 39 and control group n =44

Table 1 ( authors cannot analyse two groups with different intervention element ) I think I suggested earlier they can choose Posttest values of

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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

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.

The flipped classroom is effective for medical students to improve deep tendon reflex examination skills: A mixed-method study

PONE-D-21-37240R2

Dear Dr. Uchida,

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.

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Kind regards,

Di Zou

Academic Editor

PLOS ONE