Evidence-Based Action Plan for Integrating Artificial Intelligence in an Academic Medical Centre-A Multidisciplinary Approach

PLOS ONE

Dear Dr. Jafri,

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We look forward to receiving your revised manuscript.

Kind regards,

Syed Hani Abidi

Academic Editor

PLOS ONE

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Dear Dr. Jafri,

Specifically, the authors should revise the abstract to provide a concise scientific summary that includes a clear justification for the chosen methods, a brief description of the analytic procedures, and concrete, validated outcomes. Additionally, restructure the introduction to clearly articulate a specific research gap and validate the selection of the SWITCH model over alternative frameworks.

In the methods section, adopt a coherent qualitative design by clearly defining whether you are using a grounded-theory approach or alternate method. Provide a justification for the prospective sample size and address aspects of researcher reflexivity, along with triangulation through explicit procedures.

Finally, deepen the results and action plan sections by incorporating richer, analytically driven themes, including illustrative quotations and a validated, prioritized implementation framework. The discussion must also critically reflect on methodological limitations and ethical considerations around AI usage, power dynamics, structural constraints.

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.. 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.. 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.. 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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We look forward to receiving your revised manuscript.

Kind regards,

Syed Hani Abidi

Academic Editor

PLOS One

Journal Requirements:

If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: (No Response)

Reviewer #2: (No Response)

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2. Is the manuscript technically sound, and do the data support the conclusions??>

Reviewer #1: Yes

Reviewer #2: Partly

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

Reviewer #1: Yes

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.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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5. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: No

Reviewer #2: Yes

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Reviewer #1: Abstract-The abstract is largely descriptive and reads more like a project summary than a scientific abstract. Critical elements are missing, including a clear justification for methodological choices, explicit analytic procedures, and concrete outcomes beyond thematic labels. Claims of providing a “structured strategic action plan” are not supported by evidence of validation, implementation, or evaluation.

Introduction-The introduction provides a generic overview of AI in healthcare and change management theories but lacks a sharply articulated research gap. The rationale for selecting the SWITCH model over other established frameworks remains underdeveloped and largely asserted rather than justified. The novelty of the study is unclear, particularly given the abundance of conceptual papers on AI integration and leadership in healthcare.

Methods-This is the weakest section of the manuscript.

• The study is labeled as “qualitative cross-sectional,” yet the design blends interviews, workshops, and consensus meetings without a coherent qualitative methodological framework.

• Claims of using grounded theory are not supported by methodological rigor (e.g., no constant comparison, no theory generation, no memoing).

• Sample size justification is post-hoc and conceptually weak; reliance on a pilot of two interviews to justify adequacy is not defensible.

• The role of researchers (many of whom are institutional insiders and co-authors) raises significant concerns regarding reflexivity, positionality, and social desirability bias, which are insufficiently addressed.

• Triangulation is asserted but not demonstrated analytically.

Results-The results are largely descriptive and repetitive.

• Themes are broad, unsurprising, and closely aligned with existing literature, offering limited analytical depth.

• Coding appears largely confirmatory, reinforcing pre-existing assumptions about AI rather than generating new insights.

• Quotations are sparse and selectively illustrative rather than analytically rich.

• Tables function more as checklists than as vehicles for theory building or interpretive synthesis.

Action Plan (Phase III)-The action plan is extensive but essentially prescriptive and aspirational.

• It resembles a policy or institutional guideline rather than a research output.

• No prioritization framework, feasibility testing, stakeholder validation beyond authors, or implementation metrics are provided.

• The plan is not empirically evaluated, piloted, or compared against alternatives, limiting its scholarly contribution.

Discussion-The discussion reiterates results without critically engaging with methodological limitations or alternative interpretations.

• Claims of scalability and transferability are speculative and not supported by comparative data.

• The discussion conflates relevance with rigor; importance of topic does not compensate for methodological weakness.

• Engagement with critical AI ethics, power dynamics, and structural constraints in LMIC contexts remains superficial.

Limitation-Although a limitations section is present, it is largely formulaic and understated.

• Key issues such as insider bias, lack of independent validation, and absence of outcome assessment are not adequately acknowledged.

• The implications of these limitations for the credibility of the action plan are not discussed.

Reviewer #2: The paper has a relevant and timely focus on AI inclusion in medical education and research, and action plan using the SWITCH model), which could be attractive if methodological rigor, clarity, and positioning are strengthened. The core issues now are precision and depth in the qualitative methodology, sharper articulation of novelty, and substantial tightening of language and structure. These will enhance the article and will benefit wider audience.

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Reviewer #1: No

Reviewer #2: Yes:Srinivasa Rao BollaSrinivasa Rao BollaSrinivasa Rao BollaSrinivasa Rao Bolla

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Attachments

Attachment

Submitted filename: PONE-D-25-46411R1.docx

Dear Dr. Jafri,

Please submit your revised manuscript by Apr 24 2026 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.. 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.. 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.. 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.

• A 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 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 . 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 . 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 . 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,

Syed Hani Abidi

Academic Editor

PLOS One

Journal Requirements:

If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise.

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.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: (No Response)

Reviewer #2: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions??>

Reviewer #1: Yes

Reviewer #2: Yes

**********

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

Reviewer #1: N/A

Reviewer #2: 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.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

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #2: No

**********

Reviewer #1: The manuscript addresses a timely and contextually important issue; however, before it can be considered for publication, several substantive concerns require further attention. In particular,

1. The study should explicitly and consistently define its methodological orientation (e.g., exploratory qualitative study using reflexive thematic analysis) and ensure alignment between research questions, data collection methods (interviews, workshop, meetings), and analytic procedures.

2. Provide a clearer step-by-step account of how codes were generated, how themes were refined, and how decisions were made during analysis. A visual analytic map or thematic development table would enhance transparency.

3. Move beyond descriptive summaries of what participants said. For each theme, include interpretive commentary that explains why these patterns matter, how they relate to existing literature, and what tensions or contradictions emerged.

4. Integrate quotations analytically rather than illustratively. Each quote should be followed by interpretation that demonstrates how it advances conceptual understanding rather than merely exemplifying a theme.

5. Given the insider status of several authors, include a more explicit reflexivity statement detailing positionality, power dynamics, and how potential bias was managed throughout data collection and analysis.

6. Specify how interview findings, workshop discussions, and planning meetings were compared, reconciled, and synthesized into the final action plan. The analytic integration process requires clearer articulation.

7. Provide a more critical comparison with alternative change-management frameworks, explaining precisely what conceptual gap the SWITCH model fills in this context.

8. Clearly distinguish the action plan from a policy guideline by articulating the theoretical insights derived from the data. Consider presenting a prioritization matrix or conceptual model that demonstrates analytic synthesis rather than listing components.

9. Explicitly acknowledge insider bias, absence of external validation, lack of pilot testing, and absence of outcome evaluation, and discuss how these limitations affect the credibility and applicability of the proposed framework.

Reviewer #2: Major strengths

• Timely, practice‑oriented topic in an LMIC

• Focus on AI integration in a large academic medical centre in Pakistan addresses a real gap, as most AI‑change papers are conceptual or from HICs.

• Multi‑source qualitative design

• Three phases (leadership interviews, multidisciplinary workshop, then action‑plan development) create a coherent, developmental trajectory from perceptions → co‑design → framework.

• Inclusion of leaders, faculty, and students increases the breadth of perspectives despite a single‑site limitation.

• Explicit change‑management lens (SWITCH)

• Clear mapping of findings to “Direct the Rider / Motivate the Elephant / Shape the Path” gives the action plan a structured and theoretically anchored form.

Recommended modifications

• In Abstract and Methods, standardize to one primary descriptor, e.g.: “We conducted an exploratory qualitative study using reflexive thematic analysis of interviews and a co‑design workshop, followed by collaborative development of an action plan.”

At the start of Methods, add a short “Study design and phases” paragraph that clearly lists:

Phase I: Individual semi‑structured interviews with institutional leaders and faculty.

Phase II: Co‑design workshop with multidisciplinary participants, using SWITCH as a sensitizing framework.

Phase III: Collaborative development of a SWITCH‑aligned action plan based on Phases I–II.

• In the discussion, there are many repetitions about the SWITCH model's benefits; keep it once at the beginning.

• Break the limitations into bullet points or paragraphs

• Check the conflict of interest statement and correct

• Check for spelling mistakes (pliot, emperical, effectiveness, particpants)

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what does this mean?). If published, this will include your full peer review and any attached files.). If published, this will include your full peer review and any attached files.). If published, this will include your full peer review and any attached files.). 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 For information about this choice, including consent withdrawal, please see our For information about this choice, including consent withdrawal, please see our For information about this choice, including consent withdrawal, please see our Privacy Policy..-->

Reviewer #1: No

Reviewer #2: Yes:Srinivasa Rao BollaSrinivasa Rao BollaSrinivasa Rao BollaSrinivasa Rao Bolla

**********

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NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications.

Evidence-Based Action Plan for Integrating Artificial Intelligence in an Academic Medical Centre-A Multidisciplinary Approach

PONE-D-25-46411R3

Dear Dr. Jafri,

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,

Syed Hani Abidi

Academic Editor

PLOS One

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions??>

Reviewer #1: Yes

**********

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

Reviewer #1: N/A

**********

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.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

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

**********

Reviewer #1: No furthere comments.The paper address all the comments.

The manuscript is now technically sound, ethically robust, and provides a valuable contribution to the field of AI integration in healthcare. I find no further concerns regarding dual publication or research ethics. All previous queries have been successfully addressed, and I recommend the paper for immediate acceptance

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what does this mean?). If published, this will include your full peer review and any attached files.). If published, this will include your full peer review and any attached files.). If published, this will include your full peer review and any attached files.). 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.

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Reviewer #1: No

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