-->PONE-D-25-54674-->-->Leveraging design thinking to tackle contemporary admissions challenges in health professions education-->-->PLOS One

Dear Dr. McLaughlin,

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Reviewer #1: Yes

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: No

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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: I appreciate the authors' approach to develop collaborative suggestions through design thinking to address concerns in student selection. The paper is focused on a structured process of brainstorming and shortlisting suggestions so adapt an admissions committee process. Overall, the summary is well-written, and I am hopeful that peers in admissions, recruitment, and enrollment will consider using a similar approach to thoughtfully tweak admissions processes. However, I would like to see more detail about the workshop design and strategic choices made to limit the scope of discussion to the three launch points as they relate to expressed concerns or reactions to policy or procedure changes.

While the introduction summarizes many challenges that provide background for the workshop, the authors should better define the specific topics covered by each launch point (page 6-7). I presume the term "Technology" is specific to generative AI, though strategic use of technology may extend to predictive AI based on curricular outcomes which should serve to inform admissions standards and expectations. Should virtual conferencing technology be included or considered? would the admissions committee consider recorded video interview technology (Kira Talent) or situational judgment assessments (Acuity Insights Casper/Duet)? Each launch point should be associated with a specific problem statement (challenge) that contextualizes each launch point. Launch point 2 (how to reliably compare candidates) is an ever-present challenge, so the authors should explicitly state that this point's urgency is due to the discontinuation of the PCAT or the concern of critical thinking deficiencies or math skills for entering students. The authors suggest that "statements" were crafted to define each launching point, so it may help the reader to know what those prompts were in their final form.

The authors should be more explicit in describing the constraints on the generated ideas (cost, geography, and equity, line 143). Examples of pros/cons of example ideas would be helpful to underscore how these constraints helped in shortlisting suggestions for the admissions committee's consideration.

The authors should comment about potentially disadvantaging candidates with disabilities that could affect an assessment under time pressure. For example, non-native English speaking/international applicants may find AI assistance helpful to better understand question prompts or articulate their opinions when writing essays. How will these suggestions be evaluated when it comes to fair comparison of candidate competencies and technical abilities? Are there protocols in place for those with dyslexia or dyscalculia, or those with impaired hearing who may require assistance? Were ADA university officers consulted before the shortlist suggestions were presented to the admissions committee? After they were presented?

I would like to see more information about the tenure of those participating in the DT workshop aside from their specific roles at the time the workshop was held (page 6 line 118). Specifically, what was the range of years serving on the admissions committee, as interviewers, or as file screeners. How many tenured faculty were included, or was there a balance between research-focused and practice-focused faculty? What proportions of the entire committee roster, admissions office, or student ambassador corps were represented? Did the authors serve as facilitators or participants in brainstorming?

I also think it is important to describe the race/ethnicity, education/expertise, gender (identity), disability, and language diversity of the assembled workshop participants to show the diversity of the group. This includes knowing the year each student ambassador has been enrolled at the school and/or served as an admissions volunteer ambassador (P2, P3, P4, graduate). Are alumni involved with candidate selection?

Finally, were there specific changes that were considered in screening, interview, or final file assessment criteria or rubrics as a result of the workshop? How did each suggestion affect the three stage file review process for entering students (academic review, comprehensive review, and post-interview decision? Is there a way to highlight suggestions within the context of the three-stage admissions process? How do these changes align with the intended mission and core values of the institution? As such, the conclusion of the results section seems unsatisfying ("challenged the utility and value of changing the process").

I appreciate the optimism of the authors to call upon their peers to consider similar approaches to design appropriate solutions. Many of the suggestions made line up with solutions suggested by other admissions committees who did NOT go through a DT process. I would appreciate more insight into the rationale, implementation, and assessment of each suggestion (for example, will the live assessments occur during the MMI period?). What happens if a candidate is found to be overreliant on AI tools (we had similar concerns about plagiarism over 10 years ago)? Tie the specific suggestions to the launch points and/or the context/challenge the launch point addresses.

I anticipate many admissions professionals may go directly to the suggestions mentioned in the table and try implementing them without going through a DT process. I would be interested in how to fairly present the suggestions and directly comment on the barriers to implementation or their assessment, including the nature of human oversight over results through AI tools.

Minor corrections/issues:

Page 16, Line 306: "Data Chowuration"

Reviewer #2: Thank you for this contribution to the field.

As someone who has worked on designing rubrics for holistic admissions in the biological and biomedical sciences, I see the need for the work this study presents. Overall, it is well done, but has a few areas in need of improvement/clarity.

First, in discussing the qualitative methodology beginning on Line 155, additional clarifications should be provided. I would start with Braun and Clark's work, and elucidate the chosen process for the qualitative coding of the data. Second, more explanation is needed to understand where the statistic 90.5% actually comes from when citing intercoder reliability. How was this measured since it is not presented as a Cohen's kappa?

Beginning on Line 190, it is unclear exactly which data are actually coded in the analysis. Is the analysis referring to the 76 initial ideas, or the 43 selected for further discussion? More information on this part of the process is necessary. Providing an n = #, next to each of the main themes, and the sub themes in the paragraph starting on Line 190 would be helpful to better contextualize the data. For example, was one of the 3 themes completely dominant with 40 responses (of 43? 76? other?), or were the three themes more equally distributed in the number of mentions they received? What ideas fell outside of the 3 main themes? What other possible themes were suggested during the coding process? Again, it would be helpful to know what data were actually coded for this reporting. This part of the paper will benefit from a revision of how the qualitative data are presented, and starting with Braun and Clark's model and presentation will be very beneficial here.

I would also revise the lines 201-202, instead of stating that participants "rated the workshop highly", the writing should reflect the actual question asked (which was a strongly agree to strongly disagree question). For example, participants strongly agreed on X, M= 4.8, SD = 0.4. The authors could also choose to represent this data in a different format, such as 95% of participants strongly agreed (or what was the next one at a rating of 4?) on X statement, M = 4.8, SD = 0.4. Also, on line 152 the authors should identify each of the likert scale points (what does a 2, 3 or 4 mean? slightly disagree? moderately? is selecting a 3 meaning "neither disagree or agree?" More specificity would be helpful.

Given that we dont know which of the data types were coded in the qualitative reporting section, I am assuming that there is no data presented from the open-ended post workshop question from the survey (with the other likert scale items). The paper presents its purpose as demonstrating how DT can support admissions challenges and collaborative brainstorming, but then doesn't say anything about how participants experienced the process of DT through the workshop. Revisiting those 15 open-ended responses (if they got that many to write in something), would be really revealing as to how the process of participating in the workshop went. That qualitative data can add nuance to the likert data. if no one responded to the open ended question, the authors could also state that.

Finally, there are a few small editorial fixes here:

1. Line 93: Add a comma after "work"

2. Line 132: Add a colon after "3"

3. Line 186 Add an s to the word "candidate"

I think this paper has great merit and once the authors address some of the qualitative data concerns, I hope to revisit this work! Thank you!

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Reviewer #1: Yes: Emil Chuck

Reviewer #2: No

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-->PONE-D-25-54674R1-->-->Leveraging design thinking to tackle contemporary admissions challenges in health professions education-->-->PLOS One

Dear Dr. McLaughlin,

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 see 'Additional Editor Comments' below.

Please submit your revised manuscript by Jun 06 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.

Please include the following items when submitting your revised manuscript:-->

• 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 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.

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We look forward to receiving your revised manuscript.

Kind regards,

Andrea Cioffi

Academic Editor

PLOS One

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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.

Additional Editor Comments:

The manuscript is clearly written and well organized. The description of the workshop design, including the articulation of launching points, the structured ideation process, and the integration of design constraints (cost, geography, equity), provides a useful and potentially transferable framework for other institutions. In addition, the transparency of the methods and the availability of the dataset in a public repository represent important strengths.

However, despite these positive aspects, there are several fundamental concerns that limit the extent to which the current manuscript meets the standards required for publication.

The primary concern relates to the nature of the evidence generated. The study is based on a single, short-duration workshop involving a small, purposively selected group of participants from one institution (n=15) . The outcomes reported are largely descriptive and exploratory, consisting of generated ideas, thematic categorizations, and participants’ perceptions of the workshop experience. While these findings are informative, they do not provide empirical evidence regarding the effectiveness, feasibility, or impact of the proposed strategies.

In particular, the quantitative component is limited to self-reported perceptions measured via Likert-scale responses, which are inherently subject to response and social desirability biases. The qualitative component, although appropriate in principle, is based on heterogeneous data sources (brainstorming outputs, facilitator notes, and reflection materials), and the analytical approach, while improved, remains relatively limited in methodological depth.

A further important limitation is the absence of any evaluation of implemented interventions. Although the manuscript discusses potential strategies and prototypes generated through the DT process, it does not assess whether these strategies were adopted, nor whether they resulted in measurable improvements in admissions processes or outcomes. As such, the manuscript primarily demonstrates that design thinking can facilitate idea generation, rather than providing evidence of its effectiveness as an intervention.

More broadly, the manuscript would benefit from clearer conceptual positioning. Clarifying this positioning is essential to ensure alignment between the study design, the claims made, and the expectations of the journal.

Finally, while the conclusions are generally reasonable, they should be more explicitly grounded in the exploratory nature of the data. Statements regarding the value and utility of design thinking should be appropriately tempered to reflect the absence of outcome-based evidence.

In summary, your manuscript addresses an important topic and presents a well-described and potentially useful approach to addressing complex admissions challenges. However, substantial revisions are required to strengthen the conceptual framing, appropriately calibrate the interpretation of findings, and clarify the contribution of the study.

I would be pleased to consider a revised version of your manuscript that addresses these concerns. In particular, I encourage you to explicitly acknowledge and integrate the methodological limitations into the interpretation, and moderate claims regarding effectiveness in the absence of outcome data.

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Reviewers' comments:

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-->Comments to the Author

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Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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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: (No Response)

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

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.-->

Reviewer #1: Yes

Reviewer #2: 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.-->

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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 #1: Thank you for addressing my comments! I wish you good luck to your admissions leadership and team with the adjustments to your process.

Reviewer #2: Thank you for addressing the original points! You do have a repeat sentence on Line 190 to remove. Thank you for this work!

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Reviewer #1: Yes: Emil T. Chuck, Ph.D., Health Professional Student Association

Reviewer #2: No

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Leveraging design thinking to tackle contemporary admissions challenges in health professions education

PONE-D-25-54674R2

Dear Dr. McLaughlin,

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,

Andrea Cioffi

Academic Editor

PLOS One

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