Competency in Orthopaedic Surgery: Student Perceptions and Objective Knowledge Assessment

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for this submission on a worthwhile topic.

Can you identify in your respondent cohort what percentage of the full cohort this was - any particular reason for the presumed drop off in participation in 3rd year (12 vs 20).

Does everyone who wants to do an orthopedic elective get the opportunity to do one?

Can you put the actual question on Figure 1 - can you add error bars?

Please drop a decimal point throughout this - 

It seems reasonable to me that 4th year students would have the most knowledge and 2nd year the least - 

I think you have made a fair presentation of your findings, limitations, and suggestions for moving forward

 

 

 

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Reviewer 2 Report

Comments and Suggestions for Authors

Thank you for allowing me to review the paper titled: “Competency in Orthopaedic Surgery: Are Medical Students Adequately Prepared?

Title:

Include the words "student perceptions" and "objective knowledge assessment" in the title to provide clearer and more specific context regarding the aspects investigated in the paper.

Abstract

Explain more directly the importance of addressing gaps in orthopedic surgery education, emphasizing their impact on medical practice.

Introduction

Include more previous studies documenting deficiencies in MSK and orthopedic surgery training at various institutions, providing a broader context.

Explicitly define the specific aims of the study, such as assessing students’ subjective confidence, comparing their performance with objective assessment, and identifying educational gaps (in the last paragraph of the introduction): “we aimed to find specific 78 curricular gaps and suggest targeted improvements to MSK educational strategies, bet-79 ter preparing medical students for clinical practice.

Include brief definitions of terms such as "subjective competence" and "objective assessment".

Briefly integrate the educational theories that support the study, such as Kolb’s experiential learning theory, to show how this research addresses existing learning gaps.

Methodology

Explain the type of sampling used and the participant selection process. Provide details on the instruments used in Surveys A and B, explaining their relevance and any validation performed for measuring subjective and objective competence in orthopedic surgery.

Statistical Analysis

Verify the assumptions of statistical tests and apply nonparametric tests when appropriate. Perform a normality test before using parametric tests. Adjust p-values for multiple comparisons using methods such as Bonferroni.

Report the effect size (e.g., Cohen’s d) along with p-values to measure the magnitude of differences and the reliability of results. Present confidence intervals to provide accurate estimates.

Compare students’ subjective confidence with their objective performance using paired tests such as the paired t-test or the Wilcoxon signed-rank test.

Provide full details of the regression analysis and subgroup selection, specifying all variables and statistical tests used. This will ensure accurate interpretation and a robust analysis of the data.

Results

Clearly describe how results were measured, specifying the scores obtained on the objective test and the method used to calculate differences between students from different academic years.

Highlight significant differences in scores between second, third, and fourth year students, particularly the performance gap between second and fourth year students.

Explain in more detail the results of the statistical analyses, such as the linear regression, and present survey findings more clearly (knowledge gaps and curriculum topics needing attention).

Ensure that graphs and tables include explanatory legends and titles that clearly indicate their purpose.

Discussion

Relate the findings to previous studies on gaps in orthopedic surgery and MSK training. Expand on the implications of the observed discrepancy between students’ subjective confidence and their objective performance.

Connect the findings to relevant educational theories, such as experiential learning theory elf-assessment training theory.

Discuss educational interventions needed to improve both competence and confidence in orthopedic surgery, such as early clinical exposure, simulation-based training, and structured feedback.

Conclusion

Emphasize that this study identified a significant discrepancy between medical students’ subjective confidence in orthopedic surgery and their objective competence.

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Reviewer 3 Report

Comments and Suggestions for Authors

I read with interest the manuscript entitled "Competency in Orthopedic Surgery: Are Medical Students Adequately Prepared?"

In the introduction, it is necessary to emphasize what proportion of the curriculum is devoted to MSK medicine. Would increasing the proportion of MSK medicine take away a significant part of the curriculum from other important areas?

The Dunning-Kruger effect results from the psychological profile of the individual and not the group of students as a whole!

Please address the question of whether the curriculum's content is adequate, as we are aware that teachers do not put in enough effort to impart knowledge, both theoretically and practically. How were the teachers who teach MSK medicine evaluated?

Please submit Appendix A and B as supplementary materials.

The surveys needed to be validated. Please state the same in the limitation of the study.

Please do not start a sentence with "Figure 1..., Table 1…".

Do you think the sample is adequate and sufficient for this type of research? Why didn't you do a power analysis? Please explain.

It would be visually better to mark columns of interest, such as orthopedic surgery, in a special color on the figures.

Please submit the tables according to the MDPI template. Furthermore, it would be interesting to show p-values in the tables to see whether the responses differ statistically significantly.

Figure 2 is unnecessary. Throw it out.

In the materials and methods section, you must list everything that follows in the results (e.g., you mention a correlation in the results that we do not find in the data analysis section, etc.).

Is it justified to draw pessimistic conclusions? There are also specialties in which students show even lower knowledge and self-confidence. Try to discuss the results as objectively as possible!

Have you considered developing additional online modules, videos, and interactive tools to complement your MSK medicine curriculum? Do you seek constructive feedback from students to improve your teaching? How satisfied are they with the faculty in the field?

What do you think about artificial intelligence? Can it improve learning outcomes and student satisfaction? Please touch on that topic as well.

Please provide more concrete solutions for the future through discussion. How would you specifically, at your faculty, form the curriculum. What should it look like? Would you make some other courses of lower quality at the expense of MSK medicine? Please discuss.

Please search the databases in more detail on the topic mentioned, as there are a number of articles of interest that you did not include in your manuscript.

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

The manuscript has improved in clarity, rigor, and depth, and the effort invested by the authors in strengthening the study is commendable.

Reviewer 3 Report

Comments and Suggestions for Authors

Thank you for your answers. The manuscript has now been significantly improved.