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Dear authors,
I am happy to let you know that we reached a stage where your manuscript can now be accepted for publication. Many congratulations!
Authors have now addressed comments made during first and second review
Authors have now addressed comments made during first and second review
Authors have now addressed comments made during first and second review
Dear authors, I have made a weighted decision regarding your manuscript, and we must emphasize that failing to adequately address the reviewers' feedback can lead to a rejection decision. The changes you have made to the manuscript are minimal and insufficient. Specifically, the only change noted is the inclusion of the comment "combined teaching method of CBL and clinical pathway," which does not reflect a genuine effort to undertake the major revisions suggested.
While you have provided the additional data requested, it has only been made available for the reviewers and not incorporated into the revised manuscript. The manuscript represents your body of work, and it is essential that you take the reviewers' comments seriously and present your research in the best possible way. Dismissing these comments or making minimal changes does not demonstrate the necessary commitment to improving the quality of your work.
We strongly urge you to revise your manuscript comprehensively, taking into account all the feedback provided, to enhance its clarity, completeness, and overall impact.
'no comment"
'no comment"
'no comment"
'no comment"
Thanks.
Each section will include my initial comments, followed by the authors rebuttal followed by my follow up comments:
1. Raw data. The questionnaire data was not included.
Response: We sincerely appreciate these valuable comments. It was remiss of us that we did not upload the questionnaire data. When revising, we will upload the questionnaire and relevant data.
Follow up comments: It was helpful to see the questionnaire and how it relates to the data in table 2 & 3. It would be helpful to include as supplementary data so that anyone wishing to use such a survey in the future understood exactly which questions were asked.
2. Figure/Table legends. These need improving. They are not sufficiently detailed. This is a particular problem with the tables. It is not clear exactly what is being described and how it was analysed.
Response: We are grateful for your professional comments on the deficiencies of our manuscript. We have provided detailed Figure/Table legends in the revised manuscript which have been highlighted in red.
Follow up comments: I'm afraid I do not see any particular changes made to the figure/table legends. This work needs to be done. As an example, table 1 shows a mixture of demographic data, student performance data and data from the pre-internship questionnaire. As a result, the very generic table legend is not sufficient. Table 3 should also note that this is the post-internship questionnaire on attitude to the process of internship.
3. No hypothesis. The authors provide a description of what they did, which is mostly a precis of the methods, but they did not provide a specific hypothesis they intended to test.
Response: We apologize for our insufficient explanation. In our hospital, the traditional practical gynecological teaching is based mainly on observing teachers’ operation and listening to teachers’ lectures, and in this approach, students lack perceptual cognition of diseases, which often affects their understanding of theoretical knowledge. Therefore, to change the traditional teaching method and to improve the teaching quality, we designed this study, which took senior undergraduates majoring in clinical medicine as research subjects. These students were randomized into two groups that separately received either the traditional teaching method or the combined teaching method of CBL and clinical pathway. So, our hypothesis is that the new teaching method can effectively improve the teaching quality. We hope that our explanation will satisfy you. If there are any other modifications we could make, we would like very much to do so, and we truly appreciate your help.
Follow up comments: This hypothesis needs to be incorporated into the manuscript so that readers understand clearly what you are trying to test.
Experimental design
1. Research question/hypothesis - a description of their methods but not really a hypothesis to test. The authors did mention that this research filled an identified knowledge gap.
Response: Again, we apologize for our insufficient explanation. In our hospital, the traditional practical gynecological teaching is based mainly on observing teachers’ operation and listening to teachers’ lectures, and in this approach, students lack perceptual cognition of diseases, which often affects their understanding of theoretical knowledge. Therefore, to change the traditional teaching method and to improve the teaching quality, we designed this study, which took senior undergraduates majoring in clinical medicine as research subjects. These students were randomized into two groups that separately received either the traditional teaching method or the combined teaching method of CBL and clinical pathway. So, our hypothesis is that the new teaching method can effectively improve the teaching quality. We hope that our explanation will satisfy you. If there are any other modifications we could make, we would like very much to do so, and we truly appreciate your help.
Follow up comments: As above - the hypothesis needs to be clearly articulated in the article.
2. Methodology - it was a little confusing to combine case based learning and clinical pathway based teaching. It makes it difficult to determine whether any impact is due to one method or the other or both. It seems to me that this method primarily focuses on clinical pathway based teaching, so this should probably be the focus. I think the presentation style case based learning component could easily be incorporated into the clinical pathway based teaching method.
Response: Again, we apologize for our insufficient explanation. According to the internship syllabus, they just need to master common gynecological diseases, such as uterine leiomyoma, adenomyosis, benign ovarian tumor, missed abortion, and ectopic pregnancy, so we selected these cases as deep learning diseases. We sent representative cases and relevant questions related to the teaching disease to students for independent learning in advance. During the internship, patients suffering from these diseases are the focus of their management. In summary we think the combined teaching method of CBL and clinical pathway could improve the teaching quality. We hope that our explanation will satisfy you. If there are any other modifications we could make, we would like very much to do so, and we truly appreciate your help.
Follow up comments: The only real change in the revised article is the inclusion of the phrase 'combined teaching method of case-based learning (CBL) and clinical pathway'. At a basic level, this addresses the point I was making above.
3. Questionnaire - it is not clear how the questionnaire was created and exactly which questions were asked. Was the questionnaire evidence based at all? If so, which reference is relevant? If it is not evidence based, how were the questions decided upon? Were the only questions asked clearly shown in the tables? If so, please add that information to the legend.
Response: Again, we apologize for our insufficient explanation. we conducted a self-made questionnaire to explore students’ views of internship in gynecology before the internship and to investigate students’ knowledge, attitudes, and satisfaction with the education after the internship. The questionnaires were developed on the results of a literature review, such as reference 13,17.
Follow up comments: It was useful to see the actual questionnaires, although they are still not included in the revised manuscript. As a result, the reader cannot tell which questions were included in the results and which were not. Is this data going to be included in the final manuscript? The authors have not included any information in the methods on how the questionnaires were developed, that they were evidence based (as noted in comment above) and also how many questions were included in each of the questionnaires.
4. Skills test - were the examiners blinded to the cohort they were examining? If not, then this could clearly bias the results.
Response: Yes, the examiner did not know which group the participants belong to.
Follow up comments: Please make this clear in the manuscript.
Validity of the findings
1. It is very important to know whether skills test examiners were blinded or not, to ensure that no bias was introduced into the data.
Response: Again, we apologize for our insufficient explanation. The skill test examiner did not know which group the participants belong to.
Follow up comments: As above, please make this clear in the manuscript.
2. The complete questionnaire data have not been included.
Response: It was remiss of us that we did not upload the questionnaire data. When revising, we will upload the questionnaire and relevant data.
Follow up comments: How will readers access the questionnaire information? There is no reference to it in the revised document.
3. Point 1 of the discussion - The CBL- and clinical pathway-based teaching method standardizes the teaching process and improves teaching quality. The authors allude to the data that students performed better which is a marker of teaching quality, but there is no data to show the the teaching process is more standardised.
Response: We are grateful for your professional comments on the deficiencies of our manuscript. We apologize for our one-sided understanding and insufficient explanation. We acknowledge that there is no data indicating that the new teaching process is more standardized. However, by adopting the clinical pathway teaching method in gynecological teaching, the teaching process needs to follow the requirements of clinical one by one, rather than just do whatever the teachers want to. And the clinical pathways have been proved to be effective and efficient approaches that can standardize treatment progress, support patient care, and facilitate clinical decision-making, so we believe that The combined teaching method of CBL and clinical pathway standardizes the teaching process. In the future, we will conduct relevant surveys to collect data to show the the teaching process is more standardised.
Follow up comments: My response has not really been addressed in the revised manuscript. You accept that you have provided insufficient explanation, so please can you include a more detailed explanation within the manuscript.
4. Point 3 of the discussion - The CBL and clinical pathway-based teaching method enables students to quickly master the diagnosis and treatment process of various diseases. The data demonstrates that students have significantly improved their diagnosis skills, but the data does not demonstrate 'mastery' which is a different concept.
Response: We greatly appreciate your professional review work on our article. We apologize for our ill-conceived discussion. We have changed the Point 3 of the discussion to ‘The combined teaching method of CBL and clinical pathway have significantly improved students’ diagnosis skills.’ in the revised manuscript.
Follow up comment: Thank you for addressing this comment.
Several of the points made within my initial review have been addressed within the rebuttal but have not been incorporated into the revised manuscript. These need to be addressed to help any potential readers understand exactly what has been done.
Dear authors, thank you for your submission. In order to be accepted for publication your work requires EXTENSIVE revisions, particularly in terms of methodology description and what can be seen as a completion of your 'data' presentation. Please, refer to the reviewers' comments for further details.
**PeerJ Staff Note:** Please ensure that all review, editorial, and staff comments are addressed in a response letter and that any edits or clarifications mentioned in the letter are also inserted into the revised manuscript where appropriate.
the manuscript is suitable.
its suitable.
my comments:
The authors have stated that they used two methods for the test group, CBL and clinical pathway-based teaching. Despite the thorough explanation of the process, the two methods are not completely separated.
How the control group was trained?
its suitable.
---
Main issues:
1. Raw data. The questionnaire data was not included.
2. Figure/Table legends. These need improving. They are not sufficiently detailed. This is a particular problem with the tables. It is not clear exactly what is being described and how it was analysed.
3. No hypothesis. The authors provide a description of what they did, which is mostly a precis of the methods, but they did not provide a specific hypothesis they intended to test.
Main issues:
Research question/hypothesis - a description of their methods but not really a hypothesis to test. The authors did mention that this research filled an identified knowledge gap.
Methodology - it was a little confusing to combine case based learning and clinical pathway based teaching. It makes it difficult to determine whether any impact is due to one method or the other or both. It seems to me that this method primarily focuses on clinical pathway based teaching, so this should probably be the focus. I think the presentation style case based learning component could easily be incorporated into the clinical pathway based teaching method.
Questionnaire - it is not clear how the questionnaire was created and exactly which questions were asked. Was the questionnaire evidence based at all? If so, which reference is relevant? If it is not evidence based, how were the questions decided upon? Were the only questions asked clearly shown in the tables? If so, please add that information to the legend.
Skills test - were the examiners blinded to the cohort they were examining? If not, then this could clearly bias the results.
It is very important to know whether skills test examiners were blinded or not, to ensure that no bias was introduced into the data.
The complete questionnaire data have not been included.
Point 1 of the discussion - The CBL- and clinical pathway-based teaching method standardizes the teaching process and improves teaching quality. The authors allude to the data that students performed better which is a marker of teaching quality, but there is no data to show the the teaching process is more standardised.
Point 3 of the discussion - The CBL and clinical pathway-based teaching method enables students to quickly master the diagnosis and treatment process of various diseases. The data demonstrates that students have significantly improved their diagnosis skills, but the data does not demonstrate 'mastery' which is a different concept.
The authors should be commended in establishing a consistent, reproducible student centred approach to learning relevant gynaecological skills. However, in terms of adding to established literature the questions highlighted above need to be addressed.
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