Effectivity of Distance Learning in the Training of Basic Surgical Skills—A Randomized Controlled Trial

Round 1

Reviewer 1 Report

1) Instead of using umbrella term (line 67) for e-learning you can cite more articles to describe distant education and e-learning models. You can refer to some of below articles:

Akcil, U., & Bastas, M. (2021). Examination of University Students' Attitudes towards E-learning during the COVID-19 Pandemic Process and the Relationship of Digital Citizenship. Contemporary Educational Technology, 13(1), ep291. https://doi.org/10.30935/cedtech/9341

Shagiakhmetova, M. N., Bystritskaya, E. V., Demir, S., Stepanov, R. A., Grishnova, E. E., & Kryukova, N. I. (2022). Primary Teachers Difficulties Related to Compulsory Distance Education During COVID-19. Contemporary Educational Technology, 14(2), ep357. https://doi.org/10.30935/cedtech/11589

Dwedar, D. (2022). Learning Online: The Student Experience. Contemporary Educational Technology, 14(2), ep360. https://doi.org/10.30935/cedtech/11687

Salas-Rueda, R.-A., De-La-Cruz-Martínez, G., Eslava-Cervantes, A.-L., Castañeda-Martínez, R., & Ramírez-Ortega, J. (2022). Teachers’ Opinion About Collaborative Virtual Walls and Massive Open Online Course During the COVID-19 Pandemic. Online Journal of Communication and Media Technologies, 12(1), e202202. https://doi.org/10.30935/ojcmt/11305

E-learning, in general, can be imagined as an “umbrella term” which refers to educa- 67
tion and training that occurs on a digital medium, for example as mobile phones, tablets 68
or computers [13].Web-based learning, online learning, distributed learning, virtual 69
learning, mobile learning and computer-based education is also frequently used synony- 70
mously for e-learning, however, they are not completely the same, they have different 71
characteristics, advantages and disadvantages [13,14] .

2) Starting paragraph of the discussion needs to give pro and con arguments but clearly starts with harsh negative comments without any references in lines 275-279. Some supportive references are needed there.

3) Study protocol and overall methodology seems very well designed and clearly supported with tables and figures. My suggestion is to add that a triangulation (qualitative +quantitative analysis) is done. And pretest-posttest scoring is done in a sequential mixed method design. Therefore in the starting of the methodology paragraph those details will make the outlook of the design academicly stronger. (You can look Creswell, Plano and clark methodology book)

Author Response

Respected Reviewer,

Thank you very much for your time and effort carefully reviewing our manuscript. We are really grateful for your valuable feedback and comments. Please, see our answers one-by-one below.

1.) Question

“Instead of using umbrella term (line 67) for e-learning you can cite more articles to describe distant education and e-learning models. You can refer to some of below articles:

• Akcil, U., & Bastas, M. (2021). Examination of University Students' Attitudes towards E-learning during the COVID-19 Pandemic Process and the Relationship of Digital Citizenship. Contemporary Educational Technology, 13(1), ep291. https://doi.org/10.30935/cedtech/9341
• Shagiakhmetova, M. N., Bystritskaya, E. V., Demir, S., Stepanov, R. A., Grishnova, E. E., & Kryukova, N. I. (2022). Primary Teachers Difficulties Related to Compulsory Distance Education During COVID-19. Contemporary Educational Technology, 14(2), ep357. https://doi.org/10.30935/cedtech/11589
• Dwedar, D. (2022). Learning Online: The Student Experience. Contemporary Educational Technology, 14(2), ep360. https://doi.org/10.30935/cedtech/11687
• Salas-Rueda, R.-A., De-La-Cruz-Martínez, G., Eslava-Cervantes, A.-L., Castañeda-Martínez, R., & Ramírez-Ortega, J. (2022). Teachers’ Opinion About Collaborative Virtual Walls and Massive Open Online Course During the COVID-19 Pandemic. Online Journal of Communication and Media Technologies, 12(1), e202202. https://doi.org/10.30935/ojcmt/11305

 E-learning, in general, can be imagined as an “umbrella term” which refers to educa- 67
tion and training that occurs on a digital medium, for example as mobile phones, tablets 68
or computers [13].Web-based learning, online learning, distributed learning, virtual 69
learning, mobile learning and computer-based education is also frequently used synony- 70
mously for e-learning, however, they are not completely the same, they have different 71
characteristics, advantages and disadvantages [13,14] .”

Thank you very much for this suggestion. We agree, using e-learning as an „umbrella term” is not appropriate enough and it is too general. We are really grateful for the suggested articles, they helped us a lot to describe the relevant terminology in more details. Please see lines 67-73 and 84-91, also, we have made extension to the Discussion part as well.

2.) Question

“Starting paragraph of the discussion needs to give pro and con arguments but clearly starts with harsh negative comments without any references in lines 275-279. Some supportive references are needed there.“

We really appreciate your suggestion. Undoubtedly, the staring paragraph in the Discussion was not highlighting the positive impact of COVID-19 on education. We have extended it, and added the necessary publications. Please, see lines 322-339.

3.) Question

“Study protocol and overall methodology seems very well designed and clearly supported with tables and figures. My suggestion is to add that a triangulation (qualitative +quantitative analysis) is done. And pretest-posttest scoring is done in a sequential mixed method design. Therefore in the starting of the methodology paragraph those details will make the outlook of the design academicly stronger. (You can look Creswell, Plano and clark methodology book)”

Thank you for your recommendation! We have highlighted this fact in the Materials and Methods section.

Reviewer 2 Report

This research is valuable for medical education. There are several suggestions for the authors:

1. It is suggested that the authors may have to do more discussion on the basic surgical skills. It is very important that the assessment instruments are required to be connected to the basic surgical skills. Evaluation results of each basic surgical skill are required to be discussed in the manuscript.
2.  It is suggested that there should be a table to compare the teaching conditions of study and control groups.
3. To my understanding, evaluation of the learning effectiveness of basic surgical skills should include procedure knowledge and the mastery in performing the skills. Is there any evaluation in the mastery? The authors may have more discussion on the issue.
4. OSATS is an important focus of this research. It is suggested that the authors may have more discussion on this issue. There had been many research papers and review articles about OSATS. The authors may have more discussion on OSATS in Introduction and Materials and Methods sections.

Author Response

Dear Reviewer,

thank you for your time and for all the valuable comments and recommendations! We made significant efforts to revise our manuscript accordingly. Please find our detailed answers below!

1.) Question

“It is suggested that the authors may have to do more discussion on the basic surgical skills. It is very important that the assessment instruments are required to be connected to the basic surgical skills. Evaluation results of each basic surgical skill are required to be discussed in the manuscript.”

Thank you for your suggestion! A paragraph was added to the introduction about the definition of basic surgical skills (line 127-130), and the discussion was also supplemented with the disputation of each technique’s results (line 350-358 and 364-365).

2.) Question

“It is suggested that there should be a table to compare the teaching conditions of study and control groups.”

Thank you for your recommendation. We have added an extra Table (Table 1, line 258) to the manuscript to summarize the teaching conditions.

3.) Question 
“To my understanding, evaluation of the learning effectiveness of basic surgical skills should include procedure knowledge and the mastery in performing the skills. Is there any evaluation in the mastery? The authors may have more discussion on the issue.”

Thank you for your question!

The students involved in the study had completed the ‘Basics of Surgery’ course. This course takes place in third-year pre-clinical curriculum. It is 42 x 45 minutes long, and covers the theoretical and manual fundamentals of surgery and operation techniques (e.g. structure of an operating room, basics of asepsis, physiology and pathology of wound healing, surgical instruments, basics of knotting, suturing and laparoscopy etc.).

Basically our course is an optional course for the students. Its aim is to give the students additional opportunity to deepen their knowledge and improve their manual skills. The course is focused on hands-on training covering just the totally necessary theoretical knowledge. Accordingly, we have not examined the procedure knowledge of the students, only the manual skills were assessed.

For this study the participating students could not accomplish the surgery summer practice or any other obligatory or facultative course to improve their basic surgical skills. Therefore, we believe the students had the same opportunity to practice and get the mastery of the examined skills. For this reason, we have not examined the mastery of the students during the course.

We have modified the materials and methods and limitations section to highlight these facts.

4.) Question

“OSATS is an important focus of this research. It is suggested that the authors may have more discussion on this issue. There had been many research papers and review articles about OSATS. The authors may have more discussion on OSATS in Introduction and Materials and Methods sections.”

Thank you for your recommendation. We agree, OSATS is one of the key points in this research. We have supplemented the introduction, Materials and Methods, and Discussion sections to explore this topic further (line 131-137 and 343-349).

Reviewer 3 Report

Good morning,

First of all, thank you very much for your work. In general terms, it is of high quality and deals with a topical subject.

However, taking into account that this is a distance learning course, it would be interesting to dedicate a little more space to talk about the digital skills required by both students and teachers.

In any case, good work.

Author Response

Respected Reviewer,

We really appreciate your kind feedback on our manuscript, and we are grateful the the positive review. Please, see our answer for your question below.

“However, taking into account that this is a distance learning course, it would be interesting to dedicate a little more space to talk about the digital skills required by both students and teachers.”

Thank you very much for your feedback, your comment highlighted a very important aspect of distance learning. We have added a paragraph in the Introduction section regarding the importance digitals skills, please, see 89-97.

Round 2

Reviewer 2 Report

The authors had done a proper revision on the manuscript. In addition, there are proper responses for the comments.