Review Reports - Linking Knowledge Transfer and Competency Development: The Role of Lectures in a Family Medicine Curriculum

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This is a very nice and original research article. The research question stemmed from a surprising result of a curriculum evaluation: a closer relationship between experiences/reality and research needs is hardly possible.

The introduction is to the point and consequently built up towards the study topic. I have no further suggestions. Except that on line 91 abdominal shouldn't be with a capital letter.

Methodology: section 2.2 contains information that is maybe more related to the 'results' section (number of participants eg). Can you review that?

Results section: no further comments.

Discussion: Very nicely related to existing theories, literature. Also the take home messages are formulated to the point and useful for both institutions and lecturers.

Author Response

Revision: building bridges between conveying knowledge and competencies: The role of Lectures in a Family Medicine Curriculum

Dear Managing Editor Ms. Bommie Xiong,

Dear Editor in Chief Hideki Kasuya,

Thank you very much for the opportunity to publish our work. We sincerely appreciate the valuable comments and insightful advice, which have been instrumental in optimizing the quality of our manuscript.

On behalf of all authors, I would like to thank you for your support throughout this process.

Enclosed you will find our statements and comments on the concrete steps that were taken to incorporate your feedback into the revision. Statements/comments are marked differently for each reviewer: Reviewer 1, Reviewer 2. We highlighted all changes made to the text in the same colour, as the reviewer who suggested the improvement.

________________________________________________________________________________

Reviewer 1:

The introduction is to the point and consequently built up towards the study topic. I have no further suggestions. Except that on line 91 abdominal shouldn't be with a capital letter.

Thank you, we edited the mistake.

Methodology: section 2.2 contains information that is maybe more related to the 'results' section (number of participants eg). Can you review that?

You are absolutely right, we incorporated a section 3.1 (Study population) and moved the data to this section, while keeping the methodological details (e.g. method of random selection etc.) in point 2.2..

Results section: no further comments.

Discussion: Very nicely related to existing theories, literature. Also the take home messages are formulated to the point and useful for both institutions and lecturers.

Dear Reviewer 1, thank you for your kind and helpful feedback. We truly appreciate the time you devoted to reviewing our paper..

Reviewer 2:

Title:

The title is clear, relevant, and accurately reflects the article’s focus. The metaphor "building bridges" is engaging, though slightly informal for some academic contexts. Overall, the title is appropriate and acceptable for publication, with only minor stylistic improvements possible but not necessary.

Thank you, we appreciate the comment. You are absolutely right the title ist slighty informal, we tried to improve the title.

Abstract:.

The abstract is clear and well-structured, summarizing the study’s background, methodology, key findings, and conclusion effectively. The research aim is relevant and timely. I would recoment minor language revision e.g. : rephrasing “poor learning activities” to a more neutral or academically appropriate term, such as “less effective.” Additionally, several grammatical issues (e.g., “the extend” instead of “the extent”) should be corrected.

Thank you for your comment, we revised the language.

Introduction:

The introduction is theoretically rich and well-informed, providing a strong foundation for the article.

Here are my comments:

The transition from theoretical concepts (SDT, CoP) to the specific curriculum implementation at Saarland University is somewhat abrupt. A brief bridging sentence or paragraph summarizing how theory informs practice would help improve narrative coherence.

Thank you, We added a short bridging passage to clarify that the theoretical concepts described formed the basis for developing the curriculum at UdS.

Certain sections (e.g., lines 60–69) are dense and could be linguistically streamlined for better readability.

We separated the explanations of lectures, SDT theory, and the FM curriculum. This improves the readability and understanding of the curriculum.

Methods:

The methods are appropriate and generally well presented

Details on data analysis (e.g., coding process, number of coders, software used) are missing and should be added .

Thank you for your comment. We have now explained the data analysis in more detail.

Results:

Excessive quoting disrupts the flow and makes it harder for the reader to grasp key findings quickly. In a results section, quotes should support—not overshadow—the analytical narrative.

In analitic syntesis section there are more collection of testimonies than a structured qualitative analysis. The authors should more clearly summarize patterns, highlight contrasts, and explain why certain roles of lectures matter in the broader context of competency-based education.

Thank you very much. We revised the sections to summarize patterns more clearly, reduce direct quoting, highlight contrasts, and explain the content more precisely.

It is unclear how the themes (e.g., "entertaining role", "theory-complementing") were developed. Were they inductively derived or theory-driven? The coding or analytic process behind these categories should be briefly referenced or made more explicit in the results narrative.

Thank you for this helpful comment. We have clarified the inductive nature of our approach more explicitly in the revised manuscript.

Discussion:

The discussion largely repeats the results instead of interpreting them in depth. Please focus more on analysis rather than summarizing participant quotes.

The connection to existing literature is too surface-level. You mention SDT and CoP but don’t critically compare your findings with prior research. Strengthen the theoretical integration.

Language is occasionally repetitive and informal (e.g., repeated emphasis on “enthusiasm” and “preparation”). Consider condensing and sharpening your key arguments.

The limitations section is too general. Please address methodological concerns such as small sample size, potential selection bias, and the influence of moderators who were involved in the program.

The reference to the COVID-19 pandemic is vague. Instead of speculation, support claims about its long-term impact with citations or label them clearly as assumptions.

The suggestion to use a Delphi method is promising but underdeveloped. Clarify what specific questions it would address.

Thank you very much for these thoughtful and constructive comments. We have carefully revised the manuscript to address each of the points raised:

Thediscussion section has been substantially restructured to reduce repetition and to move beyond summarizing participant quotes. We now place greater emphasis on interpretation and analysis of the findings in light of relevant theoretical frameworks.
Theintegration of existing literature—particularly in relation to Self-Determination Theory (SDT) and Communities of Practice (CoP)—has been strengthened.
We have improved theacademic tone and clarity, condensing repetitive formulations and sharpening the key arguments, particularly in relation to lecturer enthusiasm and preparation.
Thelimitations section has been revised to explicitly address methodological issues, including small sample size, potential selection bias, and the influence of peer moderators who were involved in the program.
The reference to theCOVID-19 pandemic has been clarified.
Finally, thesuggestion to apply a Delphi method has been further developed.

We hope these revisions improve the clarity, depth, and academic rigor of the manuscript and appreciate your guidance in strengthening its overall quality.

Conclusions

Conclusions are too general and repeat earlier points. Try to present clear and actionable implications for curriculum design.

Avoid reiterating that lectures can be “interactive” and “entertaining”—this is already well established in the text. Focus instead on when and how lectures are most effective in competency-based education.

Acknowledge that student perspectives do not necessarily reflect actual learning outcomes—this is a key limitation.

Thank you for your valuable feedback regarding the conclusion section. In response, we have substantially revised the concluding paragraphs to reduce repetition and to avoid restating general points already addressed in the main text. We now focus more specifically on the implications for curriculum design within competency-based medical education (CBME), highlighting when and how lectures may be most effective in this context.

Furthermore, we have removed redundant references to lectures as “interactive” or “entertaining,” and instead emphasize their strategic use—for instance, in supporting clinical reasoning, contextualizing theoretical content, or promoting role identification.

Lastly, we have added a statement acknowledging that student perceptions, while informative for curriculum development, do not necessarily correlate with measurable learning outcomes. This limitation is now explicitly discussed to provide a more balanced interpretation of our findings.

References:

Some of the references cited in the manuscript are outdated. It is recommended that the authors include more recent and relevant literature (preferably from the last 10 years) to strengthen the theoretical foundation and demonstrate the current relevance of the study.

Thank you for this valuable comment. We have revised and expanded the bibliography by adding recent peer-reviewed sources and replacing outdated references where appropriate.

Comments on the Quality of English Language

There are minor grammatical errors (e.g., “student’s point of view” should be “sttudents' point of view”; “extend” should be “extent”)...

Thank you for your comment, we revised the language.

Reviewer 3

Dear authors,

Thank you for the opportunity to review your interesting paper. My major concern is the weak discussion based on only 4 articles. Please try to add some more international comparisons. I also suggest starting the discussion with a summary of your main findings.

ng, Erika Zelko

Dear Mrs. Zelko, thank you for your kind comments. We incorporated your suggestions into our edited discussion, which strengthens the whole part of the paper. We truly appreciate your review.

Reviewer 4

The article is well-structured and provides valuable insights into the role of lectures in competency-based medical education. Despite its limitations in study design and sample size, it gives a baseline for scholars to approach this topic with a larger sample size and a quantitative study. The following are my suggestions and comments for more improvement:

Title:

Line 2-3 "Building Bridges Between Conveying Knowledge and Competencies: The Role of Lectures in a Family Medicine Curriculum"
- Comment:The title is descriptive but overly long. Consider simplifying to "The Role of Lectures in Competency-Based Family Medicine Education" for clarity and conciseness.

Thank you for your comment, you are absolutely right. In addition, the title was slightly informal. However the linking of both processes (transfer and developement) is essential to our paper. We tried to shorten the title without losing its main meaning.

Abstract:

Line 10-12:"Medical education is moving from a cognition-based to a competency-based model in Germany. Traditional learning activities are questioned."
- Comment:This opening is strong but lacks depth. Why are traditional methods being questioned? Adding a brief mention of their limitations (e.g., lack of practical engagement) would provide better context.

Thank you for your we added a brief explanation of the key criticisms of traditional methods.

Introduction:

Line 33-34:"Medicine is learned by the bedside and not in the classroom."
- Comment:The quote is impactful, but could be followed by a brief explanation of how modern competency-based education builds on this principle. The historical context is valuable; however, it should be tied more explicitly to the study's focus.

Thank you for your comment, we revised the explanation to make it more clear, how the initial quote fits into todays competency based approach.

Line 36-41:"The national competency catalogue for undergraduate medical education (NKLM)... aims to foster the transfer of theoretical knowledge into a practical context."
- Comment:This is a strong contextualization of the shift in medical education. Consider elaborating on how NKLM specifically impacts lecture design and the integration of competency-based learning.

Thank you, very good suggestion, we edited the section. Explaining how the NKLM impacts teaching methods and links to competency-based learning makes the section clearer.

Line 49-51:"Changing the concept of medical education and building the right framework for competency-based learning often must be approached from different angles."
- Comment:This statement is broad. Adding specific examples of challenges faced by institutions (e.g., resistance to change, lack of resources, or faculty training) would make it more concrete.

Thank you, we added specific examples to make it more clear.

Methods:

Line 97-98:"This study follows an explorative qualitative approach, using semi-structured interviews as the source of data for qualitative content analysis."
- Comment:The methodology is clearly stated, but the rationale for choosing qualitative methods could be elaborated. Why were interviews chosen over surveys or observational studies? Were they the best fit for exploring student perspectives?

Thank you, we have outlined the reason why.

Results:

Line 135-137:"We clustered the possible functions of lectures into three main categories (main roles): The entertaining role, providing a social and physical learning environment, and the theory-complementing role of lectures."
- Comment:Clear categorisation, but the reasoning behind these specific clusters could be explained further. Were these categories derived from literature, or were they purely emergent from student feedback?
- Thank you, we clarified that the categories were derived inductively.

Line 241: Figure 1: Different forms of lectures and their characteristics are mentioned by interview participants.
- Comment:Clear description, but is this a data presentation figure or table? I suggest being labelled as a table on top of the columns.
- Thank you for pointing this out. We agree that the format is more consistent with a table and have accordingly revised the label.

Discussion:

Line 256-258:"Intrinsic motivation can emerge when experiencing pleasure that arises only from gaining knowledge or competencies during learning activities."
- Comment:This is a strong theoretical connection. Consider linking it more explicitly to the study's findings on interactive lectures and their role in fostering intrinsic motivation.
Line 267-269:"The transfer of knowledge from theory to a real-life situation can also take place in the classroom, e.g. when explanations and competencies are contextualized."
- Comment:This is a valuable insight. Adding examples from the study (e.g., real-life videos used in lectures) would make it more concrete and relatable.
Thank you for your valuable feedback. We have revised the discussion section, incorporating your suggestions as well as those of the other reviewers. In particular, we have addressed your helpful comment by more explicitly linking the theoretical framework to our empirical findings on interactive lectures and their role in fostering intrinsic motivation.

References:

Line 351-383:
- Comment:
- The references are comprehensive and relevant. However, some citations (e.g., [1], [3]) are web links. Consider including more peer-reviewed sources to strengthen the academic rigor…….. Accessed Day Month Year.
- Some references are old; they need to be updated with recently published studies.

Thank you for this valuable comment. We have revised and expanded the bibliography by adding recent peer-reviewed sources and replacing outdated references where appropriate. Furthermore, access dates have been included for all web-based citations."

Author Response File: Author Response.docx

Reviewer 2 Report

Comments and Suggestions for Authors

Dear Authors:

Thank you for your invitation to review this manuscript. here are my comments.

Title:

Abstract:.

Introduction:

The introduction is theoretically rich and well-informed, providing a strong foundation for the article.

Here are my comments:

Certain sections (e.g., lines 60–69) are dense and could be linguistically streamlined for better readability.

Methods:

The methods are appropriate and generally well presented

Details on data analysis (e.g., coding process, number of coders, software used) are missing and should be added .

Results:

Excessive quoting disrupts the flow and makes it harder for the reader to grasp key findings quickly. In a results section, quotes should support—not overshadow—the analytical narrative.

Discussion:

The discussion largely repeats the results instead of interpreting them in depth. Please focus more on analysis rather than summarizing participant quotes.

The connection to existing literature is too surface-level. You mention SDT and CoP but don’t critically compare your findings with prior research. Strengthen the theoretical integration.

Language is occasionally repetitive and informal (e.g., repeated emphasis on “enthusiasm” and “preparation”). Consider condensing and sharpening your key arguments.

The limitations section is too general. Please address methodological concerns such as small sample size, potential selection bias, and the influence of moderators who were involved in the program.

The reference to the COVID-19 pandemic is vague. Instead of speculation, support claims about its long-term impact with citations or label them clearly as assumptions.

The suggestion to use a Delphi method is promising but underdeveloped. Clarify what specific questions it would address.

Conclusions

Conclusions are too general and repeat earlier points. Try to present clear and actionable implications for curriculum design.

Acknowledge that student perspectives do not necessarily reflect actual learning outcomes—this is a key limitation.

References:

Comments on the Quality of English Language

There are minor grammatical errors (e.g., “student’s point of view” should be “sttudents' point of view”; “extend” should be “extent”)...

Author Response

See attachment

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

Dear authors,

ng, Erika Zelko

Author Response

see attachment

Author Response File: Author Response.docx

Reviewer 4 Report

Comments and Suggestions for Authors

Title:

Line 2-3 "Building Bridges Between Conveying Knowledge and Competencies: The Role of Lectures in a Family Medicine Curriculum"

Comment: The title is descriptive but overly long. Consider simplifying to "The Role of Lectures in Competency-Based Family Medicine Education" for clarity and conciseness.

Abstract:

Line 10-12: "Medical education is moving from a cognition-based to a competency-based model in Germany. Traditional learning activities are questioned."

Comment: This opening is strong but lacks depth. Why are traditional methods being questioned? Adding a brief mention of their limitations (e.g., lack of practical engagement) would provide better context.

Introduction:

Line 33-34: "Medicine is learned by the bedside and not in the classroom."

Comment: The quote is impactful, but could be followed by a brief explanation of how modern competency-based education builds on this principle. The historical context is valuable; however, it should be tied more explicitly to the study's focus.

Line 36-41: "The national competency catalogue for undergraduate medical education (NKLM)... aims to foster the transfer of theoretical knowledge into a practical context."

Comment: This is a strong contextualization of the shift in medical education. Consider elaborating on how NKLM specifically impacts lecture design and the integration of competency-based learning.

Line 49-51: "Changing the concept of medical education and building the right framework for competency-based learning often must be approached from different angles."

Comment: This statement is broad. Adding specific examples of challenges faced by institutions (e.g., resistance to change, lack of resources, or faculty training) would make it more concrete.

Methods:

Line 97-98: "This study follows an explorative qualitative approach, using semi-structured interviews as the source of data for qualitative content analysis."

Comment: The methodology is clearly stated, but the rationale for choosing qualitative methods could be elaborated. Why were interviews chosen over surveys or observational studies? Were they the best fit for exploring student perspectives?

Results:

Line 135-137: "We clustered the possible functions of lectures into three main categories (main roles): The entertaining role, providing a social and physical learning environment, and the theory-complementing role of lectures."

Comment: Clear categorisation, but the reasoning behind these specific clusters could be explained further. Were these categories derived from literature, or were they purely emergent from student feedback?

Line 241: Figure 1: Different forms of lectures and their characteristics are mentioned by interview participants.
- Comment: Clear description, but is this a data presentation figure or table? I suggest being labelled as a table on top of the columns.

Discussion:

Line 256-258: "Intrinsic motivation can emerge when experiencing pleasure that arises only from gaining knowledge or competencies during learning activities."

Comment: This is a strong theoretical connection. Consider linking it more explicitly to the study's findings on interactive lectures and their role in fostering intrinsic motivation.

Line 267-269: "The transfer of knowledge from theory to a real-life situation can also take place in the classroom, e.g. when explanations and competencies are contextualized."

Comment: This is a valuable insight. Adding examples from the study (e.g., real-life videos used in lectures) would make it more concrete and relatable.

References:

Line 351-383:

Comment:
The references are comprehensive and relevant. However, some citations (e.g., [1], [3]) are web links. Consider including more peer-reviewed sources to strengthen the academic rigor…….. Accessed Day Month Year.
Some references are old; they need to be updated with recently published studies.

Comments for author File: Comments.pdf

Author Response

See attachment

Author Response File: Author Response.docx