PONE-D-21-25125Application of the skills network approach to measure physician competence in shared decision making based on self-assessmentPLOS ONE

Dear Dr. Kriston

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PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewers’ comments

he article focuses on the assessment whether using the skills network approach allows for predicting observer-rated shared decision making (SDM) competence of physicians from their self-reported SDM skills. The article is well written, methodologically well done, and focuses on an important topic. However, I would like to suggest some points that should be added or slightly changed.

Abstract - Conclusion: You conclude that SDM skill ratings offer new theoretically and empirically grounded opportunities for the assessment of SDM competence in routine medical care. Please add practical implications.

Introduction:

The introduction is written very well. I only suggest to add some sentences with regard to the worth of shared decision making (SDM) in medical consultations.

Methods:

I suggest to display your study design and measures graphically. This would give the reader a good overview on the design and the different measures.

Results

The presentation of results is well done and well implemented in tabular and graphical form. No further suggestions.

Discussion:

From my point of view the discussion section should be widened. I suggest to add some practical implications that can be drawn from your results.

Please discuss collinearity between network parameters in more detail.

Conclusion

From my point of view, I suggest leaving out the references in the summary. They should rather appear in the discussion and support it.

Data Availability: Please give some more explanations for the restrictions that apply.

I am wondering why your analyses are based on data collected in 2009/2010. Could you shortly explain the time delay.

PONE-D-21-25125R1Application of the skills network approach to measure physician competence in shared decision making based on self-assessmentPLOS ONE

Dear Dr. Kriston

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 30, June. 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:

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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,

Edris Hasanpoor

Academic Editor

PLOS ONE

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.

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Originally, this research was a quite interesting article. However, I note several points that can be improved

1 Based on their previously published method, they aimed to to measure physician competence in shared decision making based on self-assessment. However, in my opinion, they should put some practical or real-world application based on their newly claimed method especially in abstract, discussion, and conclusion. This article was only provide many theoretically methods without their application in the real-world setting.

2 The language used in the article perhaps will be difficult to be followed by most readers since it is full of technical words without explanation the function and meaning. I suggest they can revise the language used

PONE-D-21-25125R2Application of the skills network approach to measure physician competence in shared decision making based on self-assessmentPLOS ONE

Dear Dr. Kriston,

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.

I am aware that you have waited a long time for this decision, and I apologise for this. Unfortunately, the original Academic Editor and reviewers became unavailable, apart from reviewer 1, who has reassessed the manuscript and is very happy with the result, but asks only that all data is shared, as per PLOS ONE data sharing policies. As such, two new reviewers were invited, who only have minor suggestions to improve the strength of the manuscript. 

Reviewer 5 provides detailed comments, which we ask that you consider carefully.

Reviewer 4 suggests that the manuscript might be difficult for a layperson to utilise. This limitation would not preclude consideration for publication in PLOS ONE, and I leave this with you to assess whether you prefer to address this in the revised manuscript, or whether you choose to otherwise make the findings from your study accessible to a layperson audience or clinicians interested in the topic, such as through a preprint, on your own website, Figshare etc. You may also add this information as a "Comment" on the final paper at a later stage, should it be published in PLOS ONE.

Please submit your revised manuscript by Jan 26 2023 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,

Hanna Landenmark

Staff 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 #4: (No Response)

Reviewer #5: (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 #4: Partly

Reviewer #5: Yes

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

Reviewer #1: Yes

Reviewer #4: I Don't Know

Reviewer #5: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available?

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Reviewer #1: No

Reviewer #4: No

Reviewer #5: (No Response)

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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 #4: Yes

Reviewer #5: Yes

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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: All comments have been addressed. Perhaps, complete data can be shared using data sharing platform such as figshare, etc

Reviewer #4: The authors indicate that they have added real world practical value, but it's not easy to glean. There remains a lot of technical and statistical jargon that would be difficult for a layperson to access.

Reviewer #5: The paper has very interesting data and a well-organized analysis. The goal is to improve the SDM definition by understanding how physicians' behavioral skills could be organized into patterns to help patients make medical decisions.

Measures

Their description of qualitative analysis is only briefly described. For instance, could you please elaborate on OPTION-5 and OPTION-12 measures? OPTION-5 is a shorter version of OPTION-12 what was the rationale to use both measures? What are the examples of the items?

Results

Could you please report the qualitative results of transcript coding using the standard guidelines (O’Brien et al., 2014)? What is interrater reliability? What were the key examples of observed competencies?

O’Brien, Bridget C. PhD; Harris, Ilene B. PhD; Beckman, Thomas J. MD; Reed, Darcy A. MD, MPH; Cook, David A. MD, MHPE. Standards for Reporting Qualitative Research: A Synthesis of Recommendations. Academic Medicine: September 2014 - Volume 89 - Issue 9 - p 1245-1251 doi: 10.1097/ACM.0000000000000388

SDM Q9 and Option 5; Option 12; Are created based on Ewyn’s model of SDM. How do the clusters identified in network analysis speak to this model?

How stable are discovered patterns in the network? If physician rating is regressed only on transcripts data of patients with diabetes, or only with depression, do you see the same patterns?

Discussion

Network analysis shows that relationships between skills need to be considered to ensure that skills could predict observable competencies. To what extent do specific patterns matter in this analysis versus the presence or absence of skills? How could the discovery of patterns in the physicians’ skills contribute to physicians’ education and practice?

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Reviewer #1: Yes: Edwin Njoto

Reviewer #4: No

Reviewer #5: No

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Application of the skills network approach to measure physician competence in shared decision making based on self-assessment

PONE-D-21-25125R3

Dear Dr. Kriston,

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.

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Kind regards,

Hanna Landenmark

Staff Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: