PONE-D-22-02095Exploring the experiences and views of doctors working with Artificial Intelligence in English healthcare; a qualitative studyPLOS ONE

Dear Dr. Ganapathi,

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 Apr 16 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,

Angeliki Kerasidou

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. In your Data Availability statement, you have not specified where the minimal data set underlying the results described in your manuscript can be found. PLOS defines a study's minimal data set as the underlying data used to reach the conclusions drawn in the manuscript and any additional data required to replicate the reported study findings in their entirety. All PLOS journals require that the minimal data set be made fully available. For more information about our data policy, please see http://journals.plos.org/plosone/s/data-availability.

Upon re-submitting your revised manuscript, please upload your study’s minimal underlying data set as either Supporting Information files or to a stable, public repository and include the relevant URLs, DOIs, or accession numbers within your revised cover letter. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. Any potentially identifying patient information must be fully anonymized.

Important: If there are ethical or legal restrictions to sharing your data publicly, please explain these restrictions in detail. Please see our guidelines for more information on what we consider unacceptable restrictions to publicly sharing data: http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. Note that it is not acceptable for the authors to be the sole named individuals responsible for ensuring data access.

We will update your Data Availability statement to reflect the information you provide in your cover letter.

3. 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: Yes

Reviewer #2: Partly

**********

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: When I began reading this paper I thought it was going to be about healthcare professionals’ views of using /implementing AI in clinical practice, it is more than this. Its interesting focus is on how a particular group of people, all trained in medicine many now working in Industry ( a small group still working sometime in medicine), think about their role in the development of this technology and its potential for implementation more widely. Indeed, theme 1 of the analysis talks about how interviewees came to be working in the field of AI and theme 2 explains how different and what the challenges are to them personally working in/with industry, and some of the problems of interdisciplinary working, themes 3 was a little bit more of what I expected the paper to be about from the introductory review although there is still a focus on getting HCPS to become involved in implementation and design not just using AI . While I realise from line 115ff this is stated (although it only became clear to me once I started reading the analysis) I think you need to make it much clearer your project was looking at experiences of AI clinician developers from the outset.

That said this is interesting data about collaboration with industry in the medico-industrial complex and the paper adds to the debate about the implementation of AI in healthcare, given that it involves those who have extensive medical and knowledge of AI, they are involved in its design to a greater or lesser extent in every case. However, I think that in addition to making the purpose of the paper less ambiguous up front, it also needs a background that considers the barriers/drivers for those who work in medicine and industry, it seems to me that this in many ways is the bedrock of the paper. In relation to this the discussion really just reiterates the findings, it does not really discuss the very interesting data in light of the literature to any degree. I would have liked to see more literature cited regarding clinical industrial collaboration and moving across this boundary. I do not know this literature, but I am sure it exists.

I have some minor comments/observations

Intro: Maybe explain what Topol review is to the uninitiated.

Re ethics : I think it might be advisable to roughen the data in table one a little clearly there may be only one or two ear nose and throat surgeons who are working in the tech sector in the UK, so maybe just call them surgeon, unless the speciality is really important for subsequent points you are making (I don’t think it is) , same for other types of physicians

Discussion : Is surely the wrong way around you discuss findings of theme 3 first, but the bulk of the paper is about the ways in which these individuals moved into industry/industrial collaborations and how they experience this. As written the discussion of this aspect of the data comes after the theme three discussion, i.e how they perceive clinical colleagues will perceive and cope with this technology and what sort of tech training they need.

Does your study have any shortcomings?

some typos

Line 59 word missing; studies?

Line 86 sentence starting whilst may be missing words

Line 234 – system level barriers to what, implementation, working with AI – please expand

362 I assume you mean the concept of “AI” was used ……

Reviewer #2: I find that this paper has the potential to make a valuable contribution to the field. The authors argue that the uptake of AI in healthcare is dependent on adequate clinician engagement. They use interview data to show that there is currently an unstructured pathway for doctors to enter the field of AI and they identify the barriers preventing doctors to engage with the development of AI in healthcare. The authors recommend that current and future doctors must have the opportunity to be educated and would benefit from increased flexibility allowing for part-time industry work, without losing clinicians to full-time non-clinical jobs.

The empirics section is clear and well structured. However, I found that the introduction/literature review section would benefit from a revision. It could be a lot more focused, narrowed down, with clear definitions of terms and a clear outline and justification of the objectives of the research.

First, the introduction does not lay out clearly and specifically what the empirics section is trying to answer. The research aim is vague, and the introduction does not clarify the aims adequately. Several expressions are being used to refer to clinicians interacting with AI in some capacity:

• Engagement with AI (p.1, line 18 and 20)

• Doctors working with AI within the NHS (p.2, line 24)

• How engagement with AI may increase (p.2, line 26)

All these expressions are very vague and could refer to many things. When the authors talk about engagement or working with AI, what exactly does it refer to? does it refer to the use of AI tools in clinicians’ own clinical practice? Engagement with data science in medical education? This is not made clear in the introduction, and it is only when reaching the empirics section that the reader understands that the authors are talking about clinicians getting involved in the industry, either instead of their clinical role, or in addition to it.

Secondly, and related to the first point, instead of explaining at length in the third paragraph how COVID-19 impacted AI development and adoption, the paper could focus more on the literature addressing why AI adoption in healthcare is slow and limited, and single out and explain why the lack of involvement of doctors in the industry is a key determinant. Ultimately, there is a lack of a justification for why the authors decide to interview this group of people specifically. For example, why not clinicians working with AI in their everyday practice? If the argument is that NHS staff should be involved with AI in order to, in turn, persuade colleagues, clinicians who use AI tools are arguably also well placed to persuade their colleagues that technology-supported service is safe.

Smaller comments:

• Page 5 line 102: it is not immediately obvious how the engagement and education of healthcare professionals supports Greenhalgh et al’s theory (there is a typo in her name, no "u"). It might be helpful to add an explanatory sentence.

• Page 13 line 210: the paragraph about work-life balance does not seem directly relevant to the title of the sub-section “the route to working with AI”. This should perhaps become a different/additional section.

**********

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: No

Reviewer #2: Yes: Aurelia Sauerbrei

[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.

Exploring the experiences and views of doctors working with Artificial Intelligence in English healthcare; a qualitative study

PONE-D-22-02095R1

Dear Dr. Ganapathi,

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,

Dorothy Lall

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 #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: this is much improved and a really important addition to the literature I enjoyed reading it once again.

Reviewer #2: Thank you very much for the opportunity to comment on the revised version of this paper. The authors have made a substantial effort to improve the manuscript and I am happy with the way all comments have been addressed.

**********

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

**********