A qualitative review of challenges in recruitment and retention in obstetrics and gynecology in Ireland: The consultants’ solution based perspective

Claire M. McCarthy; Sarah Meaney; Suzanne O’Sullivan; Mary Horgan; Deirdre Bennett; Keelin O’Donoghue

doi:10.1371/journal.pone.0279635

Peer Review History

Original SubmissionApril 21, 2022
27 Sep 2022 Decision Letter - Andrea Bernardes, Editor PONE-D-22-11704A qualitiative review of challenges in recruitment and retention in obstetrics and gynecology in Ireland: the consultants’ solution based perspective.PLOS ONE Dear Dr. McCarthy, 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 Nov 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. 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Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. [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: N/A Reviewer #2: N/A ****** 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: This manuscript is relevant to the specialty of Obstetrics and gynecology since the authors state the current difficulties on recruitment and retention of doctor in training. Through the qualitative approach of the research, they understood the reasons for the problem and even proposed solutions. Major points to consider in subsequent versions: Introduction The manuscript presents a delimitation of research problem, with a literature review on reasons and impact on specialty. I recommend present relevant controversies about the problem, such as, for example, adding data that demonstrate different realities with positive rates of recruitment and retention. Method However, the manuscript has points that meet the guidelines of qualitative review studies, recommend presenting with detail to other researchers can replicate the study. Therefore, recommend reviewing the manuscript and adhere to qualitative research studies guidelines as described in the submission guidelines - COREQ or SRQR. Insert details of data collection procedures and analysis: inclusion criteria of the participants; 11 main questions of the interview so that the method is reproducible; researchers' characteristics that may influence the research; start and stop dates of data collection and analysis; methods for processing data prior to and during analysis; techniques to enhance trustworthiness and credibility of data analysis. Results The manuscript presents the results organized into relevant themes and their respective categories. I suggest adding definition about The European Working Time Directive (EWTD) and how linked with problem of research, to allow readers outside the field to understand the significance. Discussion I recommend explain how the results relation to recent previous studies. Conclusion the conclusion this study was described only in the abstract, include in the full text. Reviewer #2: The aim of the study was to investigate the challenges faced by consultant obstetrician/gynecologists currently in employment in the Republic of Ireland with respect to their role, the current working climate, and the future of the specialty. It was qualitative research, using semi-structured interviews with 17 participants and applying deductive content analysis to identify themes and categories. The results present a unique perspective from consultants at the forefront of their specialty. The article presents logical chaining and the method was described clearly. For publication, I present the following minor revisions: (1) In the title, the use “qualitative review” suggests a literature review. I consider better the use of “qualitative view” or “qualitative study”. (2) In order to further the method, I suggest reviewing the COREQ checklist especially in the itens methodological orientation and theory, non-participation, study design, etc. (3) To switch the information related to the interview length from Results do Method: “The mean interview length was 26 minutes (range 17-36 minutes)” (4) Considering the participants were “consultant obstetricians/gynecologists in units around the Republic of Ireland”, I missed the information regarding where they were from. If the authors collect, it would be interesting to detail if the participants were from small cities, capital, rural areas, etc. ****** 6. 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Revision 1
16 Nov 2022 Author Response Cork University Maternity Hospital, Wilton, Cork, Ireland. 3 November 2022 Dear colleagues, Many thanks for the review of our recent article; we appreciate the comments and reviews, and we hope our amendments and responses are welcomed. We have responded to queries in italics below. Lines referenced refer to those in the clean, untracked version submitted. 1. Journal Requirements a. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. Same amended b. Please either amend your manuscript to change the affiliation or corresponding author Same amended c. Data availability statement/PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. The minimal data set consists of interviews with a number of practicing Obstetrician/Gynaecologists in the Republic of Ireland. There are multiple instances of identifiable information, as well as statements which could allow patients to be identifiable/scenarios which are utilised to allow examples. From an ethical perspective, the publication of this information is not permitted for this reason. We are able to submit this privately to PLOS ONE, but it is not permissible to publish this data. The Clinical Research Ethics Committee of the Cork Teaching Hospitals is the responsible ethical approval body for this study. 2. Reviewer 1 a. The manuscript presents a delimitation of research problem, with a literature review on reasons and impact on specialty. I recommend present relevant controversies about the problem, such as, for example, adding data that demonstrate different realities with positive rates of recruitment and retention. In our manuscript, as you note, we present the problem of recruitment and retention in our speciality. We have mostly discussed the negative connotations associated with recruitment and retention, as this is largely what our hypothesis and study findings illustrated. However, as per your recommendation, we have included a paragraph on alternative trends and patterns that can be found in the literature: Inserted at Line 167-171 b. Recommend reviewing the manuscript and adhere to qualitative research studies guidelines as described in the submission guidelines - COREQ or SRQR. COREQ Checklist utilised and included. c. Insert details of data collection procedures and analysis: i. Inclusion criteria of the participants; those who were “registered as trainers with the national training body”; noted in the methodology of the text ii. 11 main questions of the interview so that the method is reproducible Included as Supplementary File 1 iii. Researchers' characteristics that may influence the research It is noted that the interviewing author was a working obstetrician/gynaecologist at the time of the interviews, and known to interviewees. In order to limit against bias in reporting, two independent researchers (CMC/SM) conducted the analysis. CMC is an Obstetrician/Gynaecologist and SM is a qualitative researcher. This is noted in the methodology (page 9) iv. Start and stop dates of data collection and analysis Added to manuscript: Data was collected between 19th February 2019 and 9th May 2019; data was analysed by CMC/SM in October 2020. v. Methods for processing data prior to and during analysis Added to manuscript on page 8/9 vi. Techniques to enhance trustworthiness and credibility of data analysis. This information is referenced in page 8/9; different authors analysed the data, from two different backgrounds, with one author having a background in qualitative research (and working as a post-doctoral researcher). d. I suggest adding definition about The European Working Time Directive (EWTD) and how linked with problem of research, to allow readers outside the field to understand the significance. Explanation and reference to EWTD, including significance; in line 134-138 Research on EWTD included as references. e. I recommend explain how the results relation to recent previous studies. Comparisons with previous studies are noted by references 3, 8, 33, 37, 38, 42, 45. Comparisons are included with other research groups findings on workplace morale, challenges with litigation and media scrutiny, work-life balance, poor support from representative bodies. The solutions have also been compared to those in other studies (references 46, 47). f. The conclusion this study was described only in the abstract, include in the full text. Conclusion paragraph denoted with heading. 3. Reviewer 2 a. In the title, the use “qualitative review” suggests a literature review. I consider better the use of “qualitative view” or “qualitative study”. Title changed to “…qualitative study…” b. In order to further the method, I suggest reviewing the COREQ checklist especially in the items methodological orientation and theory, non-participation, study design, etc COREQ Checklist utilised and included. c. To switch the information related to the interview length from Results to Method: “The mean interview length was 26 minutes (range 17-36 minutes) Moved to Methods section d. Considering the participants were “consultant obstetricians/gynecologists in units around the Republic of Ireland”, I missed the information regarding where they were from. If the authors collect, it would be interesting to detail if the participants were from small cities, capital, rural areas, etc. As per the first paragraph in results, the interviewees were from a mix of secondary and tertiary units. Information added to clarify that these would be both urban and rurally located. We have not included this in the Table “Demographic details of participants” as this may lead to clinicians being identifiable and compromise anonymity. With the inclusion of these changes, we feel that our article provides information on the ongoing topic of recruitment and retention in Obstetrics and Gynaecology, and indeed medicine. Therefore, we appreciate your further reviews, and hope to receive favourable news in the coming weeks. We look forward to your review. Kind regards, _________ Dr Claire McCarthy Corresponding author https://doi.org/10.1371/journal.pone.0279635.r002
12 Dec 2022 Decision Letter - Andrea Bernardes, Editor A qualitiative study of challenges in recruitment and retention in obstetrics and gynecology in Ireland: the consultants’ solution based perspective. PONE-D-22-11704R1 Dear Dr. McCarthy, 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, Andrea Bernardes, Ph.D. Academic Editor PLOS ONE Additional Editor Comments (optional): Dear authors, Thank you for reviewing and improving the paper that made it possible for publication in this Journal. We hope to receive new submissions in the future. Regards, Andrea Bernardes 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: N/A 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: 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 Response) 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: Yes: José Luís Guedes dos Santos ******** https://doi.org/10.1371/journal.pone.0279635.r003
Formally Accepted
16 Dec 2022 Acceptance Letter - Andrea Bernardes, Editor PONE-D-22-11704R1 A qualitative review of challenges in recruitment and retention in obstetrics and gynecology in Ireland: the consultants’ solution based perspective. Dear Dr. McCarthy: 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. Andrea Bernardes Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0279635.r004

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