Perspectives and experiences of the first geriatricians trained in Canada

Eric Kai-Chung Wong; Alexander Day; Maria Zorzitto; Joanna E. M. Sale

doi:10.1371/journal.pone.0287857

Peer Review History

Original SubmissionFebruary 24, 2023
10 May 2023 Decision Letter - Mario Ulises Pérez-Zepeda, Editor PONE-D-23-05523 Perspectives and experiences of the first geriatricians trained in Canada PLOS ONE Dear Dr. Wong, 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 Jun 24 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. 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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 ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know 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- despite being an easy read -addresses a very important perspective to young physicians considering a geriatric specialty. It also may help physicians thinking about establishing a geriatric specialty in their countries (Geriatrics is not yet present in many countries). Authors stated that data are not fully disclosed and are not being shared publicly. Is it possible to share after removing any personal details? The manuscript is well-written. Apart from a typo in table 1 section about advice for trainees- distance them themselves, there are no other remarks. Reviewing appendix 1: the questionnaire included a question about what the participants found something missing from the training of current geriatric trainees, this was not mentioned in the manuscript and could provide meaningful insight to anyone involved in the establishment of training programs for geriatricians. Reviewer #2: This a very interesting study aiming to examine the perspectives and experiences of the first cohorts of geriatricians in Canada. Through structured interviews experienced geriatricians told their impressions of the specialty. The main topics discussed were the role of advocacy for older people and geriatrics as the less taken road. I found it very compelling and interesting, I only have some minor comments. In the introduction, you could complement it by adding evidence on the subject from Canada or elsewhere. Is there any information on perspectives from geriatricians? Show there is a gap of knowledge, and why this would be relevant to know. In the discussion, it might be worth it to compare the reasons to choose geriatrics mentioned by the respondents with younger geriatricians. Also is there any evidence that geriatricians can decrease ageism? ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). 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Revision 1
29 May 2023 Author Response Comments Author’s responses Editor’s comments 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The manuscript has been formatted to meet PLOS ONE’s requirements. We could not find instructions for file naming – please let us know if the file names are incorrect and we will correct them. 2. Please provide additional details regarding participant consent. In the ethics statement in the Methods and online submission information, please ensure that you have specified what type you obtained (for instance, written or verbal, and if verbal, how it was documented and witnessed). If your study included minors, state whether you obtained consent from parents or guardians. If the need for consent was waived by the ethics committee, please include this information. Our study included practicing physicians; no minors were included. We have added detail about the consent in Methods section. “Informed consent was obtained in writing from each participant and interviews were conducted by phone or video conference.” – page 4 3. We note that the grant information you provided in the ‘Funding Information’ and ‘Financial Disclosure’ sections do not match. When you resubmit, please ensure that you provide the correct grant numbers for the awards you received for your study in the ‘Funding Information’ section. We have corrected the funding information in both locations to: “The Julius and Marie Molinaro Elder Care Education Fund” 4. 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. We have carefully considered the data sharing requirement. The main issue is that the participants (Canada’s first geriatricians) is a very small group. Their accounts and experiences are relatively unique, making the transcripts readily identifiable by certain audiences, even with deidentification. Some of the accounts are personal, so we have not received consent for release of the transcripts. However, we would be able to provide data to support the manuscript based on reasonable requests. For data requests, authors could contact the Research Ethics Board at Unity Health Toronto. 5. 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. The reference list is correct and none of the articles have been retracted to our knowledge. Reviewer’s comments Reviewer #1: This manuscript- despite being an easy read -addresses a very important perspective to young physicians considering a geriatric specialty. It also may help physicians thinking about establishing a geriatric specialty in their countries (Geriatrics is not yet present in many countries). Thank you. Authors stated that data are not fully disclosed and are not being shared publicly. Is it possible to share after removing any personal details? We have considered this. Since the pool of original geriatricians is small, their accounts and encounters are relatively unique. Even if we removed personal identifiers, their experiences alone may allow them to be identified. We have therefore decided not to release the original transcripts, some of which contain very personal information. See data sharing response above. The manuscript is well-written. Apart from a typo in table 1 section about advice for trainees- distance them themselves, there are no other remarks. Thank you. We corrected the error. The line from table 1 now reads: “I would encourage [trainees] to not distance themselves too far from acute care, because that really keeps you up on your internal medicine.” – Participant 8 Reviewing appendix 1: the questionnaire included a question about what the participants found something missing from the training of current geriatric trainees, this was not mentioned in the manuscript and could provide meaningful insight to anyone involved in the establishment of training programs for geriatricians. Added line in results: “Participants also noted gaps in the training programs included limited community practice exposure and administrative management skills.” – page 11 Also added 2 quotes in Table 1. “Gaps in current training programs” under “the training process” “I think the biggest gap is how to set up a practice. It depends where you are going to practice, but if you are going to community, it takes a lot to carve out the resources that you need… And I’m not sure how well we provide trainees with the [knowledge] to do that.” – Participant 3 “There are those of us who come to medicine with a different background. I wonder if [we are] losing out on applicants who’ve had challenges in their life, and I’m not just talking financial [challenges], but academic or otherwise who actually would make amazing physicians, but they don’t get the opportunity because their CV just doesn’t match that template… That’s sometimes how I feel when I look at the applicants: I see very accomplished individuals… but I’m not sure how much diversity we are attracting.” – Participant 6 Reviewer #2: This a very interesting study aiming to examine the perspectives and experiences of the first cohorts of geriatricians in Canada. Through structured interviews experienced geriatricians told their impressions of the specialty. The main topics discussed were the role of advocacy for older people and geriatrics as the less taken road. In the introduction, you could complement it by adding evidence on the subject from Canada or elsewhere. Is there any information on perspectives from geriatricians? Show there is a gap of knowledge, and why this would be relevant to know. We have added the following line to introduction: “Despite this, the perspectives of geriatrician pioneers have rarely been reported in a qualitative study.” – page 3 We could not find any similar studies interviewing geriatricians directly on their career and perspectives. In the discussion, it might be worth it to compare the reasons to choose geriatrics mentioned by the respondents with younger geriatricians. Also is there any evidence that geriatricians can decrease ageism? We could not find data to support a geriatrician’s role in reducing ageism and we agree this is an important future research direction. We also agree with the point about seeking perspectives from younger geriatricians. We have added the following to the manuscript: “However, studies investigating the role of geriatricians in reducing ageism are lacking.” Page 15 Under limitations, we have added: “We also did not include younger geriatricians to determine if their experiences are different, a topic which could be addressed in future studies.” – Page 16 Attachments Attachment Submitted filename: FirstGeri_Response to reviewer comments_29May2023.pdf https://doi.org/10.1371/journal.pone.0287857.r002
14 Jun 2023 Decision Letter - Mario Ulises Pérez-Zepeda, Editor Perspectives and experiences of the first geriatricians trained in Canada PONE-D-23-05523R1 Dear Dr. Wong, 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, Mario Ulises Pérez-Zepeda, M.D., Ph.D. Academic Editor PLOS ONE Additional Editor Comments (optional): Dear Authors, thank you very much for your revised version. I personally enjoyed very much reading this work; in addition, you have addressed the reviewers' suggestions and I am happy to move forward with your work. I would love to see more works like this, since they are urgently needed in geriatrics. Reviewers' comments: https://doi.org/10.1371/journal.pone.0287857.r003
Formally Accepted
26 Jun 2023 Acceptance Letter - Mario Ulises Pérez-Zepeda, Editor PONE-D-23-05523R1 Perspectives and experiences of the first geriatricians trained in Canada Dear Dr. Wong: 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. Mario Ulises Pérez-Zepeda Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0287857.r004

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