Nontechnological Online Challenges Faced by Health Professions Students during COVID-19: A Questionnaire Study
Round 1
Reviewer 1 Report
Authors treat important issue in this paper. Overcoming technological concerns are critical but, as technology is only a tool, distinct categories of problems arise and need to be considered. They identified and classified those challenges to provide framework for developing instrument to collect empirical data.
Nevertheless, there are couple of weaknesses of the research paper that refers to the way authors presented instruments and results. Moreover, the research design is not clear, the paper lack of coherency since quantitative and qualitative aspect of the study is not clearly linked.
Major comments:
Although authors provide the instrument in the appendix, I believe that more detailed explanation and analysis of it is required. As it was stated that the instrument is developed based on different studies and have different elements (social, administration…), it is strongly recommended to provide some structural analysis using factor analysis (or analysis of principal components), to consider which item is relevant for what issue. Also, as the part of the instrument is conceived as Likert scale, it is recommended to analyze the internal reliability of the scale. So, metric characteristics of the scale should be given.
Similar, in results, the percentages are less informative if we have measures of central tendencies on Likert scale (which is its advantage), but authors emphasis percentages over mean and standard deviations in text, in conclusion and in the abstracts. Also, when giving measures as mean is, it is necessary to provide information about the standard deviations to see the variance of the results compared to central tendency.
Paper lack of coherency. In fact, authors combined quantitative and qualitative approach, but it is not clearly stated from the beginning when defining the research design. There is information about how quantitative part of the research is conducted in detailed, but all at once, some qualitative results emerged too. It leaves the impression that there are two different works.
Finally, there is an endeavor to integrate these parts of the research in one complex model, but it does not provide more understanding of the topic. It is not clear what aspect of the model is considered by which methodological approach. If authors wanted to provide some model, they might give at the beginning as the theoretical framework, and in the end some aspects of model might be tested empirically by SEM or some similar approach.
The same integration is needed in the final part, in conclusion. There are so many issues raised in the paper, but limited number of them are pointed on in the discussion and conclusion, with lack of integration.
Recommendations:
The research design should be stated more clearly. It must be clear from the beginning that there are to approaches to the problem: quantitative and qualitative. The explanation what will be analyzed in what way and why, should be also provided.
The theoretical framework given at the end in the Figure 1, might be given at the beginning, and some aspects of that might be seen as the model to be empirically tested.
Metric characteristics of the scale used in quantitative part of the research should be included.
Results obtained by the Likert scale should focus to the measures of central tendencies (rather than on percentages), with additional information about variances (standard deviations).
Also, conclusion might be written in the manner to encompass all mentioned issues. As previously said, lot of issues are tackled, and integration might be challenging but it should be given at least in conclusion.
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Author Response
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Reviewer 2 Report
The aim of this manuscript is to identify non-technological challenges, which faced Sultan Qaboos University Medical and Biomedical Sciences students, during the pandemic period. The authors conducted a survey-based, cross-sectional study, to detect non-technological challenges, by using Likert Scale, Multiple Choice and open-ended questions.
This manuscript shows rich content, providing a deep insight for some works: I found it to be well-written and accessible, providing sufficient information and details on this emerging topic, for the educational field. This is the additional point, which makes this manuscript original, in comparison to published literature. Even if the manuscript provides an organic overview, with a densely organized structure and based on well-synthetized evidence, I have some major points to mention, which may help to improve the quality of the current manuscript. For these reasons, the manuscript requires major changes.
Please find below an enumerated list of comments on my review of the manuscript:
INTRODUCTION:
LINE 27: The authors should absolutely extend this introductive paragraph, by discussing the pivotal role played by new methods of teaching during the pandemic period. Indeed, in university, there was a rapid reorganization of teaching activities in short time, in order to provide on-line lectures and re-plain the mid-term educational and teaching objectives (see, for reference: Bianchi, S., Gatto, R., Fabiani, L. (2020). Effects of the SARS-CoV-2 pandemic on medical education in Italy: Considerations and tips. Applied Sciences, 10(7), 2357). This is the major concern of this manuscript, which can be discussed in a more detailed and complete manner.
LINE 41: As regards the methodological challenges, which students faced during the pandemic period, a considerable aspect is linked to the relationship between patient and healthcare workers, which needs a parallel evolution of the assessment methods in education. Indeed, educational methods in this field are based on the combination of practical activities and competence to be acquired (see, for reference: Rose S. Medical Student Education in the Time of COVID-19. JAMA.2020 Mar 31, doi: 10.1001/jama.2020.5227). The authors should highlight this aspect, specifically in this section related to the non-technological online challenges, associated to SARS-CoV-2 pandemic.
As regards the main topic, it is interesting and certainly of great impact: in fact, this manuscript touches a significant area, by analyzing the non – technological online challenges, faced by Health Professions students, during SARS-CoV-2 pandemic. This is a significant contribute to the ongoing research on this topic, as it provides a survey-based, cross-sectional study, by using Likert Scale, Multiple Choice and open-ended questions. Overall, the contents are rich, and the authors also give their deep insight for some works.
As regards the section of methods, there is a specific and detailed explanation for the majority of methods used in this study: this is particularly significant, since the manuscript relies on a multitude of methodological and statistical analysis, to derive its conclusions. The methodology applied is overall correct, the results are reliable and adequately discussed.
The conclusion of this manuscript is perfectly in line with the main purpose of the paper: the authors have designed and conducted the study properly. As regards the conclusions, they are well written and present an adequate balance between the description of previous findings and the results presented by the authors.
Finally, this manuscript also presents a basic structure, properly divided and characterized by organic and detailed figures and tables. This manuscript looks like very informative since there is few evidence on this topic. As regards tables and figures, they are legible and easy to follow.
In conclusion, this manuscript is densely presented and well organized, based on well-synthetized evidence. The authors were lucid in their style of writing, making it easy to read and understand the message, portrayed in the manuscript. Besides, the methodology design was rigorous and appropriately implemented within the study. However, many of the topics are very concisely covered. This manuscript provided a comprehensive analysis of current knowledge in this field. Moreover, this research has futuristic importance and could be potential for future research. However, the most significant concern of this manuscript is with the introductive section: for these reasons, I have minor comments only for the introductive section, for improvement before acceptance for publication. The article is accurate and provides relevant information on the topic and I suggest minor changes to be made in order to maximize its scientific impact. I would accept this manuscript, if the comments are addressed properly.
Author Response
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Round 2
Reviewer 1 Report
Authors provide required additional information in the manuscript about the characteristics of the scale (internal reliability) and standard deviation information which is necessary to have when calculating central tendencies.
The internal reliability of the scale is not high but it is at the acceptable level.
Still, I would recommend when you have a scale to use central tendency measures in the comment along with percentages. I understand that authors are more interested with the majority of people claiming something but it is also interesting to see how strong this issue is.
The major recommendation in the review was concerned with the paper coherency. Authors made the research conception more clear in this version providing information how qualitative data were obtained along with quantitative. It is also followed by the comments.
I understood that the scheme of variables that authors gave in the Figure 1 are not provided by some quantitative analysis nor represent some theoretical conceptualization. Rather, it just illustrate the themes emerged in qualitative part of the research. Nevertheless, from my point of view it raises some questions. For example, students, communication and tutors are represented in the same vain, although there are different sort of problem sources. students and tutors are living agencies, communication is the process in which they engage. they are not the same nature of the problem. Also, students were the one who were asked about these non technological issues, as I understood, tutors are not asked, they are here defined as the possible issue (their quality). From my point of view, it does not make things clear. Especially, when we consider what was said below, that it represent the impact of poor communication and teaching materials on student`s motivation. We could not conclude that based on what we know and certainly it is not represented like that in this picture. Rather, it demonstrates that non-technological challenges might be seen from the three sources: students attitudes and circumstances they learn (but it should not be represented in the same manner at the picture - attitudes and circumstances are different kind of concepts), process of communication and tutorial issues. If I were to ask, I would reconsider how to present this relations to be more accurate.
But I strongly recommend to avoid this kind of statements that something (poor tutoring quality) influence students` motivation. Some of the respondents said something like that, and it might be truth but it is not a fact that is empirically tested. Also, when there are those kind of generalizations they have o be corroborated from the different sources and also referred to the previous studies (mainly experiments or qualitative research done in depth) that have found that the lack of (or non quality) information and teaching materials diminish students` motivation. It is certainly not clear from the Figure 1. It might be inferred in some statements of the respondents but it is not a strong evidence for having that kind of statements.
Also, it might be interesting to try to see it as some research framework, or same model of structure of relationship of different variables (while providing theoretical rationales for given linkages). In that way the integration between theoretical concepts, quantitative and qualitative data might be achieved. I understand that authors do not have these ambitions, so I do not insist to do it. Just it might be the idea for the further investigation, to try to make some framework based on the data obtained in research.
My final recommendation is to try to make Figure 1 more relevant and clear and comments concluded from qualitative part of the research should be more carefully presented. When we say something influences other thing it is very strong statement that has to have clear evidence about it and to connect it with previous researches (that have, for example, similar results).
I think that the easiest way to present these data schematically to be more clear, is to use different design of the boxes for different levels of issues. for example, the central point are non-technological challenges and they should not be in the same line (presented in the same manner) as students. Communication is also an issue but it is a process not an agent of it and so on.
Author Response
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Reviewer 2 Report
The authors properly improved the manuscript. Anyway, there is a mistake in the reference section. Specifically, the authors should check this reference and write it in a complete manner:
Bianchi, S., Gatto, R., Fabiani, L. (2020). Effects of the SARS-CoV-2 pandemic on medical education in Italy: Considerations and tips. Applied Sciences, 10(7), 2357).
In conclusion, I have no further comments, as the manuscript is really improved and ready for publication.
Author Response
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