Review Reports

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The manuscript presents a solid and timely cross-sectional study on the definition of perceived thresholds for the acquisition and maintenance of competencies in gastrointestinal endoscopy nursing in Italy. The topic is relevant, underexplored in the European literature, and of interest for professional standardization in a field where training variability is widely recognized.

I comment on several points that need to be resolved:

Dependence exclusively on self-perception: the manuscript acknowledges this limitation, but the discussion should more explicitly address its impact on the interpretation and applicability of the proposed competence thresholds.

Some sections of the discussion are extensive and repeat ideas already mentioned.

The ethics section presents inconsistencies: it states that ethics committee approval was not required, yet written informed consent is reported, which needs clarification.

The title does not reflect the psychometric approach or the methodological dimension of the study.

Specific comments by section

Title and abstract
The title is clear regarding the object of the study, but it could benefit from highlighting the psychometric approach, as this represents an innovative contribution.
Suggested example:
“Mapping Competence in Gastrointestinal Endoscopy Nursing: A Cross-Sectional Survey and Psychometric Analysis in Italy”.

Abstract
The structure is adequate; however, expressions of intention or alignment with recommendations (e.g., “in line with international recommendations”) should be avoided, and the focus should remain on what was done and what was found.

Introduction
Reduce excessive citations and improve cohesion between paragraphs describing professional roles, technical complexity, and personalized care.
Avoid overextending the international framework; a more concise synthesis would allow greater emphasis on the scientific reasoning leading to the research question.

Methods
The statement “ethics committee approval was not required” contradicts the report of written informed consent; this needs clarification.
The sampling section should acknowledge the limitations of the snowball approach and its impact on representativeness.
The manuscript does not describe how response rate or potential duplicates in the online survey were handled.
The criteria for categorizing experience as “Beginner/Uncertain” versus “Competent/Expert” should be clarified.

Results
The results are clear, complete, and consistent with the method.
A brief explanation should be included regarding what an outfit MSQ > 1.3 signifies in practical terms for item interpretation.
Clinically relevant findings should be highlighted (for example, why ERCP shows unusually low acquisition difficulty compared with other advanced techniques).

Discussion
The discussion is extensive, well supported, and includes international comparative analysis.
Comments:
Reduce redundancy in sections where the concepts of personalization, variability, and standardization appear repeatedly.
Avoid excessive extrapolations toward personalized medicine if the study’s data do not support them.
Define more precisely the practical applicability of the competence thresholds: can they be used as national standards, or only as exploratory reference points?
Structure the discussion into subthemes to improve readability.

Conclusions
Conclusions should be more concise and avoid broad statements such as “replicable to other nursing specialties” without direct supporting evidence.

Comments on the Quality of English Language

Minor issues include occasional redundancy, long sentences that could be streamlined, and some inconsistencies in terminology. A light to moderate language revision is recommended to enhance precision and overall fluency.

Author Response

Dear Peer,

thank you very much for your effort and time. We hope that in this version, according your precious comments, the manuscript will be suitable for publication.

Thank you again, all Authors

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

The manuscript addresses an important and timely topic: defining competency standards for gastrointestinal endoscopy nurses in Italy. The use of a survey-based approach and Partial Credit Models (PCM) provides a novel perspective on perceived competence thresholds. The article is generally well-structured, with clear objectives, robust methodology, and practical discussion. However, there are several areas that could be improved to enhance clarity, reproducibility, and interpretability.

1. Explicitly highlight gaps in Italian competency models to justify the research.
2. Make the study objectives more concise and place them clearly at the end of the introduction.
3. Justify the choice of snowball sampling and discuss its potential impact on representativeness.
4. Clarify whether the questionnaire was piloted or validated before distribution.
5. Specify how disagreements or inconsistencies in responses were managed during data processing.
6. Provide more detail on how Google Forms data were cleaned and screened for duplicates or incomplete responses.
7. Explain why only self-reported perceptions were collected and why no objective competence assessments were included.
8. Describe how missing responses were handled in statistical analyses.
9. Provide the rationale for classifying respondents into “Competent/Expert” vs. “Beginner/Uncertain” for DIF analysis.
10. Include a brief explanation of how ethical considerations, including consent and anonymity, were ensured beyond GDPR compliance.
11. Consider reporting sample size calculations or justification to show adequacy for the analyses performed.
12. Discuss how findings could inform the development of modular or adaptive training pathways in practical terms.
13. Consider adding limitations regarding potential selection bias due to voluntary participation.
14. Separate discussion of technical vs. relational skills more clearly to enhance readability.

Wish you luck and prosperity in revising the manuscript.

Author Response

Dear Peer,

Thank you very much for your effort and time. We hope that in this version, according your precious comments, the manuscript will be suitable for publication.

Thank you again, all Authors

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

I agree with the authors’ global revisions and consider the manuscript adequately addresses all substantive methodological and conceptual comments. The study is sound, clearly presented, and suitable for publication in its current form.

The following points are minor and purely editorial in nature and can be addressed during the copyediting stage. They do not affect the scientific content, interpretation, or conclusions of the manuscript:

Grammatical correction in the title: Replace “A Item Response Theory Analysis” with “An Item Response Theory Analysis”.

Terminological consistency: Unify the use of “competence” and “competency” throughout the manuscript, preferably adopting “competence” consistently.

Ethics section (Section 2.9): Correct the sentence “the study not required Ethical Statement” to “the study did not require ethics committee approval”.

Decimal separators in tables: Standardize numerical formatting by using decimal points instead of commas (e.g., 0.82 instead of 0,82).

Overall, I support acceptance of the manuscript, with the above points addressed as part of routine editorial revision.

Author Response

Dear Peer,

thank you for all and we hope the manuscript in this final version will be suitable for the publication.

Best.

All Authors

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Thank you very much for addressing all the comments provided.

Author Response

Dear Peer,

thank you for all and good luck.

Best.

All Authors