Enhancing Authentic Learning in Simulation-Based Education Through Electronic Medical Record Integration: A Practice-Based Commentary

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for the opportunity to review your manuscript. The topic is highly relevant and timely, particularly given the increasing digitalization of healthcare and the pedagogical need to prepare learners for contemporary EMR-driven clinical environments. Your commentary clearly highlights the challenges associated with relying on paper-based documentation in simulation and provides a compelling rationale for introducing academic electronic medical records (AEMRs) as a more authentic alternative. The manuscript is generally well written, conceptually sound, and draws on appropriate literature. Below, I offer comments intended to strengthen the clarity, structure, and contribution of your manuscript:

• The commentary effectively contrasts fidelity and authenticity and demonstrates how AEMRs can bridge the gap between educational simulation and real clinical workflows.
• Your institutional experience provides valuable practical insight; however, clarifying the unique contribution of your commentary (e.g., recommendations, lessons learned, or a conceptual model) would enhance its scholarly impact.
• Consider adding an explicit statement outlining the purpose and intended contribution of the commentary earlier in the section to orient the reader.
• The explanation of authenticity versus fidelity is clear and well supported. You may consider strengthening the connection between these concepts and specific learning outcomes (e.g., clinical reasoning, digital competency, competency-based education).
• Some sections are lengthy and could be streamlined to maintain narrative focus.
• You reference feedback from learners and educators, but it is unclear whether these insights stem from informal observations, structured evaluation, or other methods. A brief clarification would improve transparency.
• To enhance readability, consider condensing repetitive points or grouping them under subheadings (e.g., data governance, technical rigidity, workflow misalignment).
• The argument for choosing an AEMR is persuasive; however, expanding on the pedagogical implications (e.g., scaffolding, case progression, debriefing alignment) would strengthen the educational perspective.
• You may consider adding explicit recommendations or guidelines for institutions considering EMR or AEMR integration, as this would significantly enhance the commentary’s practical utility.
• A short statement on future directions (e.g., research needs, vendor collaboration opportunities, assessment implications) could further strengthen the final section.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

You address an important issue in simulation-based education, and your discussion of EMR versus academic EMR use is clear and relevant for an international audience. The manuscript is generally well written, thoughtfully structured, and well supported by the literature. The framework you propose has clear practical value for educators and simulation centres.

The main area that needs revision is clarity about the nature of the work. Although you present the paper as a commentary, some sections read as if a formal evaluation was conducted, without sufficient methodological detail. I encourage you to clearly frame the manuscript as a practice-based commentary, briefly explain how your insights were developed, and soften language that suggests formal data collection or analysis. Adding a short limitations paragraph would help ensure that your conclusions are well aligned with the evidence you present.

Please see my detailed comments on the manuscript.

Comments for author File: Comments.pdf

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

This commentary tries to address a very important topic of education, that is, to incorporate electronic medical records (EMRs) into simulation-based education (SBE) to enhance authenticity.

The manuscript is clearly written, logically structured, and appropriately sectioned, and it provides strong engagement with recent scholarship. However, some improvements can further strengthen the manuscript.

The central argument concerns the distinction between fidelity and authenticity. For that reason, a more detailed dialogue with the existing literature could substantially strengthen the authors’ argument. Moreover, authors present several claims that are underpinned by institutional experience, without, though, supporting evidence. For instance, lines 174-192 could be further strengthen by describing the way that this “informal feedback from both learners and educators” was collected (e.g. focus groups etc) or discussing the absence of relevant systematic evaluation. Another interesting idea is on lines 188-191 where the claims "increase extraneous cognitive load" and limit "transferability of learning” can be further supported by testable hypotheses that lie their foundations on the work of cognitive load theorists.

Some minor suggestions/issues include the following:

The notion "digital fluency" (line 24) is not further developed in the manuscript.

The statement "several terms are used to describe the approximation" (lines 95-96) could benefit from examples beyond fidelity and authenticity

The mention of AI-enhanced AEMRs is intriguing but underdeveloped (lines 265-270) and this could be an interesting addition to the overall discussion of this interesting commentary

 

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

Thank you for your thorough revision and detailed response to my revision requests.

Now your commentary seems to be the top quality.

Author Response

Thank you again for your review and feedback.