PONE-D-24-02400Expert decision-making in clinicians: An auto-analytic ethnographic study of operational decision-making in urgent carePLOS ONE

Dear Dr. Irvine,

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Asli Suner Karakulah, PhD

Academic Editor

PLOS ONE

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Additional Editor Comments:

Your manuscript has been reviewed and requires modifications prior to making a decision. The comments of the reviewers are included at the bottom of this letter. Reviewers indicated that introduction, methods and discussion sections should be improved. We would be glad to consider a substantial revision of your work, where the reviewer’s comments will be carefully addressed one by one.

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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: Yes

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

Reviewer #1: I Don't Know

Reviewer #2: Yes

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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: Dear Author,

Congratulation for conducting this study. I found your study valuable.

Please consider these comments:

Abstract:

1. It is important to briefly describe the setting of study since it influences readers understanding of the study.

2. As your context is specific, I think your study is focused Ethnography.

Methods:

1. Triangulation in method of data gathering, data sources and investigators is necessary. Please declare them as your limitations if they are not committed in your study.

2. Setting of the ward including number of beds, physicians, private or public, exact duration of spending time in the ward for study is necessary.

3. Diverse background of participants should be pointed out by more details.

4. You should have thick description in fact you should explain about relationships and events in addition to physical environment.

5. Detailed explanations about interviews are needed including time, being face-to-face and etc.

6. Was data analysis according to inductive or deductive methods?

7. Describe about considerations of rigor and also triangulation in analysis.

8. Please describe that data collection and data analysis happened simultaneously.

9. Conducting focus group should be described by more details including number of FGs, participants, time, questions, etc.

10. Please describe about participants characteristics.

Discussion:

Please explain about limitations of your work like possibility of social desirability bias or other biases.

Reviewer #2: Overall, this paper significantly contributes to our understanding of expert decision-making in urgent care settings. Addressing the above suggestions could further enhance its impact and clarity. It offers a fresh look at intuitive decision-making in expert clinicians within urgent care, a subject that's not been deeply explored before. Focusing on the cognitive processes behind early expert decision-making, especially in telephone triage, addresses a noticeable gap in current research. Combining analytic autoethnography with ethnographic observation is an innovative method that adds depth to the collected data. This dual approach provides a richer understanding of decision-making processes from both a personal and observational perspective, boosting the study's credibility. Creating a grounded theoretical model of expert decision-making using the Gioia methodology is an inventive way to categorize decision types and processes. This model has potential as a basis for future research and training programs.

The manuscript can be further enhanced if the authors consider the following comments:

1- Clarify the methodological details, particularly how the Gioia method was applied, to help readers better understand the thematic analysis and model development process.

2- Provide a broader contextualization by comparing the findings with decision-making processes in other high-stakes domains, strengthening the argument that intuitive decision-making is a universal skill among experts.

3-Discuss the study's limitations in more detail, including the small sample size and potential bias from the lead author’s dual role. Address the generalizability of the findings to other settings and specialties.

4- Expand on future research directions, particularly in developing training programs or AI systems, providing specific suggestions for experimental studies or simulations to build on these findings.

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Reviewer #1: No

Reviewer #2: No

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Expert decision-making in clinicians: An auto-analytic ethnographic study of operational decision-making in urgent care

PONE-D-24-02400R1

Dear Dr. Irvine,

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,

Asli Suner Karakulah, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

The authors addressed the reviewers' concerns and substantially improved the content of the manuscript. So, based on my own assessment as an academic editor, no further revisions are required and the manuscript can be accepted in its current form.

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 #2: All comments have been addressed

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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 #2: Yes

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

Reviewer #2: Yes

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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 #2: Yes

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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 #2: 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 #2: (No Response)

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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 #2: No

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