PONE-D-25-05850Shaping the Future of Medical Education: A Cross-Sectional Study on ChatGPT Attitude and Usage Among Medical Students in Sudan, 2024PLOS ONE

Dear Dr. Abdalmotalib,

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Academic Editor

PLOS ONE

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Additional Editor Comments:

There are some major concerns raised by the reviewer 1 and 3. Kindly address them in detail. Considering the importance of the topic, we are giving a chance to the authors to revise the article.

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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: Partly

Reviewer #2: Yes

Reviewer #3: Partly

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: 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

Reviewer #3: 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

Reviewer #3: 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:  I must congratulate whole team for their excellent effort to put this issue in a setting with a limited resources touching upon the complex issue of demographic profiles. The issue narrates the local issue very relevantly and appears pertinent for their geographical are and definitely is issue for the policy makers so that in an era where AI is going to replace the people who do not use the AI.

The limitations in use is definitely marred by the variety of demographic and societal issues including the financial constraints. These issues have been brought by many in the literature. These issues might not be of added value to the medical students and scientist but definitely of immense help to the social engineers, policy makers and government agencies.

Also for the medical curriculum a study that explores the outcome of AI tools in the performance and enhancement of their performance will be a great help so that it can be an integral part of the curriculum.

Reviewer #2:  This study presents an original investigation into the awareness, attitudes, and usage of ChatGPT among Sudanese medical students using a cross-sectional survey design. The manuscript benefits from a large sample size and a clear focus on a contemporary issue in medical education. However, several concerns regarding the conceptual framing, methodology, and reporting must be addressed.

Major Comments

1. Research Gap and Objectives

The introduction does not clearly articulate the specific research gap. While the manuscript discusses AI’s potential in medical education broadly, it fails to specify what prior studies have overlooked, particularly in the context of Sudan. Revise the introduction to explicitly define the research gap and justify the need for this study.

2. Claims and Supporting Evidence

The manuscript describes ChatGPT as a transformative force in medical education and highlights its broad applicability (e.g., clinical decision support) without sufficient empirical evidence or rigorous literature support. Distinguish between potential benefits and established outcomes.

3. Methodological Design

The use of a cross-sectional design limits causal inferences. Additionally, reliance on convenience sampling may introduce selection bias, potentially over-representing students with better digital access. Acknowledge these limitations explicitly in the manuscript. Consider suggesting future research with longitudinal or randomized sampling designs. The rationale behind the use of non-parametric tests and linear regression analysis should be explicitly stated.

4. Data Collection and Instrument Validation

The survey was distributed exclusively through online channels. This digital-only approach risks excluding students with poor or inconsistent internet access. Moreover, while the questionnaire was adapted from previous work, there is no mention of local reliability or validity testing (e.g., Cronbach’s alpha). Authors should provide details on any pilot testing, reliability, and validity analyses performed for the adapted questionnaire. If such analyses have not been conducted, consider including them or discussing this as a limitation.

5. Discussion and Interpretation of Findings

The discussion presents results without connecting them to prior studies.

The discussion section presents the findings largely in isolation, without a cohesive narrative that integrates methodological limitations, contextual factors (e.g., socio-economic and infrastructural challenges in Sudan), and actionable recommendations. The authors need to enhance the discussion by contextualizing your findings within existing literature. Explore the implications of observed trends (such as gender differences) in more depth, and propose concrete strategies for addressing identified challenges in medical education and digital access.

Minor Comments

1.Ensure consistency in terminology when referring to ChatGPT and other AI tools.

2.Clarify any abbreviations (e.g., SDGs for Sudanese currency) when first introduced.

3.Review the overall structure to maintain a logical flow from the introduction through to the conclusions.

The study addresses an important and timely topic in medical education. However, before further consideration, the manuscript requires revisions to clearly define its research gap, strengthen methodological reporting, and provide a more integrated discussion of the findings. Addressing these points will enhance the scientific rigor and clarity of your work.

Reviewer #3:  The paper is well-written and provides valuable insights into the awareness, usage, and identification of economical and socio-demographic indicators related to the use of large language models, particularly ChatGPT. We offer several comments to enhance this work further.

1. The introduction lacks adequate citations.

2. The authors statement “In countries like Sudan, where disparities in access to advanced technology are profound, the adoption of AI tools such as ChatGPT is shaped not only by technological factors but also by socio-economic conditions, geographic location, and institutional resources.”, connotes a conclusion without citation. Moreso, these issues are what the authors have indicated to investigate among medical student in Sudan. A critical look should be given to this point.

3. The study failed to offer explicit justifications for selecting ChatGPT as the large language model (LLM) of interest, despite acknowledging its use in medical contexts. Specifically, it did not address why alternatives like Glass Health or Med-PaLM, which are tailored for healthcare applications, were not considered. Furthermore, while large language models (LLM) are widely integrated with major search engines and web browsers such as Google and Brave, the study did not elaborate on the choice of ChatGPT.

4. The equations should be rewritten and cited in the paper.

5. Tables should be redrawn, and figures could be used to improve presentation results.

6. In Table 1, participants were asked about their interaction with ChatGPT. The data reveals that 838 individuals reported using ChatGPT, while only 494 respondents indicated they had not heard of it at all. This significant difference needs clarification to ensure the accuracy and completeness of the information presented.

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Reviewer #1: Yes:  RAJIV GARG

Reviewer #2: Yes:  Varchasvi Mudgal

Reviewer #3: No

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Shaping the Future of Medical Education: A Cross-Sectional Study on ChatGPT Attitude and Usage Among Medical Students in Sudan, 2024

PONE-D-25-05850R1

Dear Dr. Abdalmotalib,

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,

Sujita Kumar Kar

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

The article is acceptable.

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 #3: 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 #1: Yes

Reviewer #3: Yes

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

Reviewer #1: Yes

Reviewer #3: 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 #1: Yes

Reviewer #3: (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 #3: 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: (No Response)

Reviewer #3: (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 #1: No

Reviewer #3: No

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