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PLOS ONE

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Additional Editor Comments:

Hello, dear authors

Please check the journal website for the style of writing articles, numbering, etc.

Recheck the numbers of tables and figures.

Try to write concisely, clearly, and documented.

I hope you will attach the file of similarity finding and the referees' responses completely and scientifically.

Thank you very much

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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?

Reviewer #1: Yes

Reviewer #2: Partly

Reviewer #3: Yes

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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

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??>

Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: Yes

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Reviewer #1: Dear Authors,

Thank you for your submission.

The authors investigated the effect of gamification on the medication knowledge, performance and satisfaction of nurses in continued medical education. The study used a quasi-experimental design. Nevertheless, some aspects can be improved to enhance the paper's readability. Proofreading is recommended as well.

Additional comments:

1- Method

Participants:

• The following exclusion criterion is not required as it does happen by default: “The exclusion criteria included not participating in the education session”

• Although the sample was convenient, the sample size is recommended to be calculated based on a rigorous statistical method.

• Data analysis:

The preliminary p-value should be added.

The inferential statistics used should be described.

Figures 1 and 2: The quality and resolution are poor.

2. Results:

• Table 3, please provide details about the mean of satisfaction before and after the intervention.

3. Discussion:

• Presenting the findings of the previous studies was narrative and not well synthesized in the results. The researchers are advised to consider this when revising the discussion section.

• The researchers did not reflect on their findings in comparison to previous studies, using their own words. This necessitates further improvement of the discussion section.

• The researchers are recommended to present recommendations for future research.

• The limitations of the study should be more specific in describing whether the internal validity of the survey was threatened or not.

• The strengths of the study should be presented.

Sincerely,

Reviewer #2: While the abstract mentions Kahoot, it might be beneficial to briefly state what Kahoot is (e.g., "a competitive educational software") in the abstract for readers unfamiliar with it, before explaining its game-based nature in the conclusion.

Consider adding a brief section on the practical implications of the findings for healthcare educators and administrators.

Ensure consistent use of "P-value" or "p-value" throughout the manuscript.

Double-check for any minor grammatical errors or typos.

Reviewer #3: Dear authors,

Congratulations on your work. Indeed, any innovative strategy in teaching and learning processes must be thoroughly studied for its implementation. Your study can contribute to this evidence.

Analyzing your submission in more detail...

Starting with the abstract, it seems good. Clearly indicative of the study. I suggest, however, changes to the keywords for health descriptors. For example, Mesh terms. Consider changing: "game base education"; "Performance" by "work performance" ; "Satisfaction" by "job satisfaction" or "personal satisfaction".

The introduction is consistent with the work. It introduces the topic clearly and accurately.The references used are current and relevant to frame the theme. Revise the word prescribe in the second line of introduction "nurses must prescribe the correct medicine". We think the verb administer would be better.

As far as the methods are concerned, in general they look good. However, they should be improved:

-Do not mention the name of the institution where the study was developed, as it identifies the services;

-Put "Convinience method" in lower case.

-Clarify the entire population of nurses in these services. Were there no nurses on holiday or absent due to illness? Did the nurses with management functions take part in the study?

-Explain how the randomisation method was carried out. Did you use any software? Did you draw lots?

-Clarify whether the Kahoot was carried out at the end of each session or only at the end of each session. Does this mean that there are more sessions, or were they carried out in the five planned sessions? Please clarify...

Did the participants know whether or not they were in the intervention group?

- Clarify whether the instrument in part 2 of the questionnaire was developed by Salami et al. (2019) or by Wakefield et al. (2005) Wakefield BJ, Uden-Holman T, Wakefield DS. Development and validation of the medication administration error reporting survey. In: Advances in Patient Safety: From Research to Implementation (Volume 4: Programs, Tools, and Products). Rockville (MD): Agency for Healthcare Research and Quality (US); 2005.

-Explain in this sentence "In order to check face validity and qualitative

content validity, the questionnaires were given to 10 faculty members and clinical

nurses, and after collecting their opinions, necessary modifications were made to

the questionnaires." whether they used the Delphi methodology; what criteria were used for selecting the panel of experts, if so considered; what changes were made to the initial questionnaire.

With regard to the results, consider putting the contents of the tables on a single page.

Do not use the author's name with et al in sentences.

The discussion is well done. Improve the writing according to the suggestions given.

In conclusion, consider the need to develop further studies that deepen the motivations of trainees and trainers in the use of new pedagogical strategies such as gamification, among others.

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Reviewer #1: Yes:  Saleh Al Omar

Reviewer #2: No

Reviewer #3: Yes:  Maria Cristina Bompastor Augusto

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The Effect of Gamification on the Medication Knowledge, Performance and Satisfaction of Nurses in Continued Medical Education: a Quasi-Experimental Study

PONE-D-25-29769R1

Dear Dr. Ghafouri,

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.

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Kind regards,

Amir Karimi, PhD

Academic Editor

PLOS ONE

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