Medical Students’ Participation in Social Studying and Learning during COVID-19

1

The topic in question – SSL – is not a topic with impact outside the medical or medical student communities, so I suggest you to be more detailed in the introduction. Most importantly, make it clear on what is the relevance of this topic and this research is in the field of medical education.

In combination with feedback from Reviewer 4, we have expanded the introduction. The new first paragraph aims to better contextualise the research for the reader.

1

Your objectives are very loosely defined, but the results and discussion are very detailed and defined by sections. You should therefore review your objectives.

Thank you for this feedback. The authors have discussed the overall layout of the study in conjunction with feedback from Reviewer 2. We believe that we have now made significant changes to the introduction and methods regarding the objectives of the study – that is “how” [1] and “why” [2]. The “how” part of our study is deliberately very open-ended – the research instruments, which are now detailed much more clearly in the “Research instruments” section of the Materials and Methods, were designed to explore the “how” at a very basic level (i.e. “who, what, where and when”). The results were then synthesised based on the data that we received, rather than the other way around. We think that revising our objectives now would misrepresent the open-ended approach that we initially took to data collection during our study.

1

Methodologically it remains unclear how many research members were involved, how many, researchers did the interviews etc. If more than one person was involved, how was it ensured that interactions were equivalent?

The following line has been edited in the “Data collection” subheading of the Materials and Methods: “The audio-recorded interviews were conducted by the first author using…”. No other authors were involved in conducting the interviews.

1

How many times was the questionnaire circulated? What reasons might point to such low participation?

We have made two changes to clarify these points. Firstly, “totalling three distributions of the survey” has been added to the “Data collection” subheading of the Materials and Methods. Secondly, the low participation rate has been discussed in much greater depth in the “Limitations and Future Recommendations” section of the Discussion.

1

Who designed the questionnaire? Was it validated? Who designed the interview protocol? Was it validated?

In combination with feedback from Reviewer 2, we have restructured the Materials and Methods to include a “Research instruments” subheading. Under this subheading, we have clarified the design and validation of both the survey and interview protocol.

1

Why did you not opt for content analysis of the interviews using specific software?

We have added the following line to the “Data analysis” subheading of the Materials and Methods: “Due to the small sample size, all data was analyzed without using computer software [37].”

1

It is not clear whether the students who answered the questionnaire are represented in proportion to the years of the study programme

We have made clarifications to the “Response rates” section of the Results: “38 responses were from pre-clinical students in the first two years of the degree and 19 responses were from clinical students in the last two years of the degree.”

2

Abstract: L7-8 - mixed quantitative-qualitative approach, should be “mixed method approach”

In combination with feedback from Reviewer 4, we have changed the description of our approach in the abstract to “mixed method convergent-parallel approach”.

2

Abstract: L12-15 – too long for a sentence, kindly rephrase

This sentence has been rephrased into two sentences.

2

Introduction: L27-30 – avoid single sentence paragraph, combine with previous/following paragraph (wherever coherent)

In combination with feedback from Reviewer 4, the introduction has been expanded significantly, meaning that this paragraph is no longer a single sentence.

2

Materials and Methods: L62 – for better comprehension of the methodology, the sequence of relevant subheadings should be considered; Research Design, Research Respondents/Participants, Research Instruments, Data Gathering Procedure and Data Analysis

We have restructured our Materials and Methods section using the following five subheadings: Research design, Participants, Research instruments, Data collection, and Data analysis. These headings have greatly helped us expand on how our research instruments were designed and how our qualitative analysis was conducted.

2

Materials and Methods: L63, 75, 84, 93, 101, 109 – subheadings can be narrated/described in 1 paragraph each

Three of the five subheadings have been combined into single paragraphs. The new “Research instruments” subheading is two paragraphs – one for the survey and one for the interview protocol, and the “Data analysis” subheading is still two paragraphs – one for the quantitative analysis and one for the qualitative analysis.

2

Results: presentation of results should be aligned with the purpose of the study (describe how[1] and why[2] SSL conducted by medical students changed when learning transitioned online)

Thank you for this feedback. The authors have discussed the layout of the results in conjunction with your subsequent feedback regarding the possibility of a summary table. We believe that our results are mostly structured as suggested – that is, covering the how before the why.

At a high level, the ”How” sections are “Participation in SSL”, “Medium and location”, “Frequency, length and organisation”, “Composition of SSL group”, and “Subjects and activity type”. The “Why” sections are “Reasons for participating”, “Factors suggested to influence participation” and “Other barriers to participating in SSL”.

We do note that at times, the “why” is integrated into the “how”, particularly when a quote is used to outline both. When considering how to synthesise the results, we found that presenting these findings separately would mean that the results do not flow well for the reader.

2

Results: L24 & L266 –Tables1&2 can be combined as summary table

Thank you for the suggestion to create a summary table. This was a point of discussion between all three authors. We constructed a draft of the manuscript with one summary table instead of two. However, we found that the volume of data meant that the summary table was difficult to decipher and interpret. We would prefer to keep them as two separate tables.

2

Discussion: L280-281 – give plausible explanation/s to the “no significant difference in the overall SSL participation rate…”

The lack of change in the overall SSL participation rate is one of the main findings of our study and forms the basis for the following seven paragraphs of the discussion. We have added the following to the start of the discussion to clarify: “In what follows, we discuss the changes found and potential reasons why the overall SSL participation rate did not change, and conclude that…”

2

Discussion: L351-353 – avoid single sentence paragraph….

In combination with feedback from Reviewer 4, we have greatly expanded the “Limitations and Future Recommendations” section.

2

Conclusion/Implication and Recommendation: provide subheadings for both

In combination with feedback from Reviewer 4, we have added three subheadings to the end of the Discussion: Conclusions, Implications, and Limitations and Future Recommendations.

4

Your manuscript is severely lacking in references. Please enhance your manuscript with additional, pertinent references to reach at least 40. The absence of references compromised the overall quality of the article.

Thank you for this overarching feedback. All the feedback that we received was helpful in making major revisions to our manuscript. Some of the major revisions included further literature review, justification of methods, and discussion of limitations. The reference count has been increased to 41.

4

Your sample size for the quantitative section is insufficient. Which 57 response is typically unacceptable in surveys. Please provide a well-written rationale for why 57 is an acceptable sample size.

(and)

Response Rate - How do you demonstrate that 57 responses are sufficient?

Thank you for this feedback. The authors are aware that this is a major limitation of our study that was likely not clearly discussed in the final parts of our original discussion. We have now discussed our low sample size in a dedicated paragraph in the “Limitations and Future Recommendations” section, including acknowledgement that our sample size is unlikely to be representative of our entire medical school population.

However, as we state in the discussion, we still believe that our data is a valuable initial picture of how medical students participated in SSL during COVID, and provide the suggestion of focusing on a larger sample size in further research.

4

Abstract – Please describe the combination method you employed. Sequential explanatory? Sequential exploratory?

In combination with feedback from Reviewer 2, we have edited the abstract to accurately describe our method as a “mixed method convergent-parallel approach.”

4

Abstract – Write down the number of samples for the questionnaire and the number of participant for the interview.

We have added two new lines to the abstract: “87 survey responses were collected. Following exclusion of incomplete response, 57 responses were analysed, and 9 follow-up interviews were conducted.”

4

Abstract – Please explain the significance and implications of your research.

We have added the following to the abstract: “Understanding how medical students study away from the classroom allows medical educators to support all aspects of student learning.”

4

Setting and participant – Instead of revealing the name and location of the institution involved once the work has been published, I urge that the author just label the institution for ethical reasons.

The name and location of the institution has now been included in the revised manuscript (The Australian National University, Canberra).

4

Data collection - What is the required minimum sample size for the survey? How is the sample size calculated? Does the writer address Krejcie and Morgan? What exactly is a Confidence Interval? What is the error margin? What sampling technique is utilised?

Thank you for these comments regarding our data collection. We have been able to clarify each item in our manuscript:

·   The sample size and Krejcie and Morgan has now been discussed extensively as a major limitation of our study in the “Limitations and Future Recommendations” section of the Discussion.

·   The new subheadings of the Materials and Methods section mean that the sampling method of the survey is more clearly described in the “Data collection” subheading: “All enrolled students (n = 422) were invited to participate…”.

·   Convenience sampling was used to recruit interview participants – this is described in the “Data collection” subheading: “Participants who provided their email address at the end of the survey were invited to attend a 20-minute interview.” The use of convenience sampling is now address in the “Limitations and Future Recommendations” section of the Discussion.

4

Survey - The questionnaire requires extensive clarification, including the number of items included. How many constructs are involved? What is the instrument's reliability? Why use a 5-point Likert scale? Why not seven?

Thank you for these comments regarding our survey. We have been able to clarify some of them in our manuscript:

·   In combination with feedback from Reviewer 2, we have added a more detailed description of the survey, including the total number of items in the new “Research instruments” subheading of the Materials and Methods.

·   With respect to constructs involved, the method refers to Keren et al. (2020) as the basis for the Likert scale questions. The other questions were constructed with the intention to detail all aspects of how SSL was conducted (in basic terms – “who, what, when, where”).

·   In combination with feedback from Reviewer 1, we added the following lines to the “Research instruments” subheading: “The face validity of the survey was assessed by all three authors to ensure that the questions effectively characterised all aspects of how and why SSL was conducted before and during online learning, and that the questions were simple, clear and non-leading.”.

·   We have added a justification for choosing a five-point Likert scale to the “Research instruments” subheading: “The Likert scales were chosen to be five-points to reduce confusion and encourage survey completion [36]”.

4

Follow up interview - What form of interview protocol is utilised? Does it open? Structured?

In combination with feedback from Reviewer 2, we have restructured the Materials and Methods section to include a “Research instruments” subheading. This section now describes the interview protocol in more detail (e.g. Semi-structured).

4

Discussion - Please create a new subtopic for the theoretical and practical implications of your work.

In combination with feedback from Reviewer 2, we have added three subheadings to the end of the Discussion: Conclusions, Implications, and Limitations and Future Recommendations.

4

Discussion - Limitations and Future Research Suggestions should get their own subtopic.

4

I cannot identify any conclusion. It should be a conclusion-related topic.

4

Discussion - More suggestions are required for future research.

In combination with feedback from Reviewer 2, we have greatly expanded the “Limitations and Future Recommendations” subheading.

4

The Appendix was not cited or cross-referenced in any section of the manuscript. Please include an internal cross-reference to the appendix.

Appendix A is now referenced in the “Research instruments” subheading of the Materials and Methods. It was mislabelled as Appendix 1 in the submitted version and has been corrected to Appendix A.

4

The conclusion of the abstract seems unfinished. Please modify the sentence so that it is consistent with the previous sentence and complements the entire abstract.

The final sentence of the abstract has been modified to reflect the re-organised conclusions and implications at the end of the manuscript:

“Given that medical school will always involve some periods of online learning, understanding of the nature of and driving factors behind how medical students engage in SSL during online learning may enable medical educators to support all aspects of student learning.”.

4

Regarding my comment related to the identification of the institution engaged in this study, I believe the authors misread it. I had advised labelling to assure the authors’ adherence to ethical standards and reduce the likelihood of future problems.

I urge the authors to designate the university as a university in Australia/ a university in the southeast of Australia/ a university from the eastern region of Australia/ a university in New South Wales of Australia, etc. That conceals the institution's exact name and identifies it solely by its approximate location.

The same holds true for Table 1's ANU and Canberra campuses. In addition to the first paragraph on page 7 regarding Canberra Hospital and ANU campus.

Thank you for the clarification on this comment. We now understand your original comment and have made further changes to the manuscript to reflect your feedback.

·   In the body, ANU has been labelled as “a medical school in Australia”.

·   References to the university and hospital in Table 1 has been reverted to the original placeholders – [University] and [City] Hospital.

·   The ethics statement has been amended to: “…approved by the Human Research Ethics Committee of our University (protocol code 2020/317…”.

4

The conclusion should appear at the end of the manuscript. Please transfer it to a location after the limitations and future recommendations.

We have now re-arranged the end of our discussion – Limitations and Future Recommendations is now before the Conclusions section. The Conclusions section now includes the original conclusions and implications subheadings.