PONE-D-24-55482Exploring Confidence Development in Interprofessional Teams: A Pre-Post Analysis of a Health and Social Care Education ModulePLOS ONE

Dear Dr. Shanmugam,

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Academic Editor

PLOS ONE

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Dear authors,

Four reviewers have reviewed your manuscript and a Major Revision is recommended.

Please, respond to all these comments in your Response Letter.

Also, consider that Reviewer 2 comments have been attached separately.

We look forward to your responses.

Best regards.

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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

Reviewer #3: Yes

Reviewer #4: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: 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

Reviewer #4: 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

Reviewer #4: 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: 

1- The “Introduction” should be modified, rearranged and divided into some paragraphs based on scientific writing. Paragraph 1 needs to incorporate brief yet comprehensive introduction of Confidence Development in Inter professional Teams and the main question of the research work.

2- The author(s) should modify relevant key words based on MESH.

The “Methodology” should be modified, rearranged and divided into some paragraphs based on scientific writing. this section should mention the phases of study very clearly and justify the usage of any statistical tools and approaches one by one in this regard.

3- It is not mentioned how and by which statistical test the validity and reliability of questionnaire were examined.

4- The authors should mention and justify why The sample sizes across different professional groups are unequal, which could reduce the statistical power of subgroup analyses,

5- The authors should justify the low response rate (26% for post-test) that introduces nonresponse bias, meaning the results may not be representative of the entire student cohort.

6- In samples Among the 80 students 86% identified as female, Dose Gender have any influence on the result of the research? please mention it.

7- The authors should mention how they control the confounding factors in this research like time, prior experience, different motivation levels of student, etc.

8. The "Result", "discussion" and "Conclusion" should be written based on scientific writing approach and also arranged based on the main and specific objectives of the research work.

9. I found it hard to follow the paper, Consistency and coherency of whole manuscript is weak and should be improved.

Reviewer #2: 

Comments to the authors are provided in the attached document. The manuscript presents a pre-post study examining the impact of a 6-week academic interprofessional education (IPE) module on students’ self-perceived confidence in interprofessional teamwork.

See document attached.

Reviewer #3: 

1. Abstract

Strengths:

Clearly presents the aim, methods, results, and conclusions.

Inclusion of effect sizes and significance values is commendable.

Recommendations:

Avoid causative language like “suggesting the IPE intervention had a positive impact” unless supported by stronger experimental controls.

Suggested revision: “indicating an association between the IPE intervention and increased self-perceived confidence.”

2. Introduction

Strengths:

Comprehensive overview of IPC and IPE significance, backed by strong references.

Suggestions:

The introduction would benefit from sharper articulation of the knowledge gap. It currently blends motivation with background without clearly stating what this study adds.

Suggested addition: “Despite widespread endorsement of IPE, few studies have evaluated validated tools in pre-registration academic settings using robust pre-post designs.”

3. Background

Strengths:

Theoretical framework (self-efficacy, expectancy-value theory) is well-integrated.

Suggestions:

The background could be more concise. Some of the historical institutional information may be more appropriate for supplementary material unless critical for methodology.

4. Methods

Strengths:

Methodology is described in strong detail with ethical approvals, sampling, instruments, and analysis procedures clearly stated.

Use of a validated scale (IPE-ABC) and description of subscales adds robustness.

Recommendations:

Sampling bias is likely due to low response rates (26% post-test). This should be acknowledged more prominently in the methods or limitations.

Data matching by alias codes is creative, but the risk of participant error or dropouts affecting match quality should be noted.

5. Results

Strengths:

Clear presentation of results across subscales with robust statistical analysis (paired t-tests, Wilcoxon tests, ANOVA).

Use of both Cohen’s d and Pearson’s r for effect size is a good practice.

Suggestions:

Use of negative values for Cohen’s d (e.g., d = –0.888) is unconventional. Since effect size direction is not meaningful in pre-post designs where direction is known, report absolute values for clarity.

Discuss implications of high baseline scores and possible ceiling effects—several participants were already “very confident” pre-module.

Tables are comprehensive but visual aids (e.g., bar charts or boxplots) could help illustrate change distributions.

6. Discussion

Strengths:

Strong integration with previous studies

Addresses psychological theories (self-efficacy, overconfidence bias, SDRB), which adds analytical depth.

Suggestions:

The narrative is overly descriptive in places; streamline and focus on key implications (e.g., the need for continuous confidence calibration, not just confidence building).

Provide practical recommendations for educators: how might one modify IPE modules to address overconfidence or SDRB?

Highlight potential Type II error risk more explicitly in subgroup comparisons (e.g., small male sample).

7. Limitations

Strengths:

Thoughtfully acknowledges low response rate, sample imbalance, and SDRB.

Plans for longitudinal follow-up are commendable.

Additional Suggestions:

Add a statement on generalizability—results may not apply to students in non-academic or clinical IPE settings.

Clarify whether the low male participation is reflective of program enrollment or introduces potential gender bias in outcomes.

8. Conclusion

Strengths:

Accurately reflects the findings without overstating them.

Reinforces the contribution of validated tools to IPE evaluation.

Recommendation:

Emphasize the need for future research on the translation of academic confidence into clinical settings, especially during transition to practice.

9. Technical Aspects & PLOS ONE Fit

Fit for Journal:

The topic aligns well with PLOS ONE’s focus on interdisciplinary, educational, and public health research.

Writing & Structure:

Language is professional and generally clear, though some sections (e.g., Background, Discussion) are verbose and would benefit from editing for brevity.

Reviewer #4: 

I found the paper very interesting and well written and organized. I would like some more graphics but the information was still all there. Just a few small suggestions - to include a description of the acronym IPE in the abstract and I wasn't sure I completely understood the key of table 4, in particular: very confidence levels of confidence sounded odd. Also in the results for example it was stated that the confidence level in males was higher but only provided the value of confidence for males.

But they are very minor comments. Overall I found the paper very interesting and well written.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: Yes:  Juan Carlos Alvarado Gonzalez. MD

Reviewer #4: No

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Attachments

Attachment

Submitted filename: Revision of PONE-D-24-55482.docx

PONE-D-24-55482R1Exploring Confidence Development in Interprofessional Teams: A Pre-Post Analysis of a Health and Social Care Education ModulePLOS ONE

Dear Dr. Shanmugam,

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 Jul 19 2025 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,

Javier Fagundo-Rivera, PhD

Academic 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.

Additional Editor Comments:

Dear Authors,

I am pleased to inform you that two reviewers have recommended the publication of your manuscript, while the remaining two reviewers have suggested minor revisions (see attached document for Reviewer 2). Accordingly, we invite you to submit a revised version of your paper addressing the reviewers’ comments.

Please revise your manuscript to incorporate the requested changes and provide a point-by-point response to each reviewer’s remarks.

Thank you for your contribution, and we look forward to receiving your revised manuscript.

Sincerely,

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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 #2: 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 #2: Yes

Reviewer #3: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

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: No

Reviewer #3: 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

Reviewer #3: 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: ACCEPT

Reviewer #2: This manuscript presents an original empirical study that evaluates the impact of an interprofessional education module on the self-perceived confidence of students in health sciences and social services. The focus is relevant and timely, addressing a gap in literature using a validated tool and appropriate statistical analyses. The work is suitable for a journal like PLOS ONE, with some minor revisions that I provided in an attached document.

Reviewer #3: 

1. Response to Previous Comments

Authors provide a point-by-point response that is thorough and constructive.

Many suggestions (e.g., clarification of Likert scaling, sampling strategy, overconfidence bias) are explicitly addressed in both the revised manuscript and the rebuttal.

Areas Still Requiring Attention:

The language around causality in parts of the discussion and abstract could still be further softened to emphasize associative, not causal, findings.

2. Abstract

Revisions Assessed:

Added language to reflect pre-post design limitations.

Numerical clarity (e.g., effect sizes, significance) retained.

Remaining Suggestion:

Consider changing phrasing from “the module had a positive impact” to “the module was associated with increased confidence,” to maintain alignment with observational design.

3. Discussion

Improvements:

Discussion better balances self-efficacy growth with concerns about overconfidence.

Integration of previous studies is more concise and analytically relevant.

Still Needed:

Though improved, some speculative comments on “real-world applicability” (e.g., bridging to practice) could benefit from hedging language due to the study’s academic-only context.

Positive Additions:

Theoretical linkages to Vygotsky’s ZPD and Bandura’s social cognitive theory remain insightful and are now more clearly aligned with observed outcomes.

4. Conclusion

Improved Version:

Revised to reflect associative findings, rather than overstate intervention effects.

Emphasizes the utility of validated tools for evaluating IPE.

Optional Refinement:

Consider ending with a more actionable statement, such as: “Validated self-report tools such as IPE-ABC can support curriculum developers in measuring and adjusting pre-registration IPE design.”

5. Overall Structure and PLOS ONE Fit

Clarity and Organization:

The paper reads clearly and is logically structured. All sections are complete and professional.

Formatting and Ethics:

Ethical statements, data availability, and adherence to reporting standards (e.g., STROBE for observational designs) are well addressed.

Journal Scope Fit:

The manuscript remains a good fit for PLOS ONE under the categories of health education, interdisciplinary training, and public health implementation research.

**********

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

Reviewer #3: Yes:  Juan Carlos Alvarado Gonzalez MD, MSc.

**********

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Attachments

Attachment

Submitted filename: Revision of PONE-D-24-55482R1.docx

Exploring Confidence Development in Interprofessional Teams: A Pre-Post Analysis of a Health and Social Care Education Module

PONE-D-24-55482R2

Dear Dr. Shanmugam,

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,

Javier Fagundo-Rivera, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

The authors have properly responded to the Reviewers and this manuscript can be finally accepted.