Competency-Based Workforce Development and Education in Global Oncology
Round 1
Reviewer 1 Report
Thank you for allowing me to review this interesting article. I have divided my comments into major suggestions and minor suggestions, I hope that is helpful for you.
Major suggestions:
While your paper is organized into a review of the importance of CBME in oncology education, your review also includes the role of EPAs and essential professional duties; yet EPAs and essential professional duties are not included in your analysis of importance or your literature review. I suggest re-writing lines 50 - 58 on page 2 to frame CBME as one aspect of outcomes-based education, or alternatively, to eliminate Box A from the manuscript.
You exclude the issues with assessment of competencies in individuals and teams, compared to the assessment of time-based education objectives, and the obstacles to and limitations of individual- and team-based assessment in CBME. These issues are an important limitation of CBME.
Your comparison of LMI and HI countries is one of the most promising parts of the paper, but is very incomplete - there is no comparison, for example, of limitations to implementation of CBME in HI vs LMI countries. I think this comparison, using the articles you found, is vital to the paper. There are other opportunities to compare the two mentioned in the paper as well - for example p. 12 line 143, p. 12 line 147, and p. 13 line 153. While you state that there is a paucity of data, the articles cited are not well explicated in these categories, and only your use of PubMed is listed in the scoping review - which would be very difficult to get published in my many researchers. You cite use of the gray literature but that is not documented in your PRISMA diagram.
Your discussion of the relevance of your analysis for LMICs lacks specificity - for example, you state, "some successful innovative programs have been successful" without giving the reader any idea what types of programs are successful vs unsuccessful. (p 16 lines 277-278)
Finally, your article does not link CBME to patient outcomes, nor to addressing disparities in care. Dealing with structural racism is the subject of several published competency sets (see for example the AAMC's DEI competencies (https://www.aamc.org/data-reports/report/diversity-equity-and-inclusion-competencies-across-learning-continuum); how important is it to patient outcomes in cancer care that these are included in the curriculum?
Minor issues:
Readers may not be familiar with the use of "LMI" and "HI" to describe countries; please at least write out the acronym on the first use. Same for UHC and SDG (p 18 line 301).
I suggest putting the table of articles by country in a sentence format; and putting the articles by year in a different format - your first grouping of years is 1992 - 1999 (8 years), your second is 2000 - 2010 (11 years), your third is 2011 - 2020 (10 years) and your fourth is 2021-2022 (2 years). You might consider a figure where the x-axis is years(each year 1992 - 2022) and the y-axis is the number of articles.
In the summary of articles (the third part of the table, I suggest keeping this as a table and completing the "size" column for the Ndlovu article (or indicating none given).
Your concluding call for collaboration is important. Thank you for your work.
Author Response
Please see attachment.
Author Response File: 
Author Response.docx
Reviewer 2 Report
Dear Authors, thank you for sharing this interesting review on the concept of competency-based medical education (CBME) in the context of oncology to provide insights and guidance for those interested in adopting or adapting competency-based education in training programs. As you showed, research on health professional education is lagging significantly behind other areas and this article will help strengthening works on health professional education.
My only suggestion would be to synthesize the Tables, maybe just graphically, as sometimes it was difficult to go through them while reading the paper.
Author Response
Please see the attachment.
Author Response File: Author Response.docx
Reviewer 3 Report
They need to do a proper literature review and explain why they chose this methodology.
How did they solve the disadvantages of the model?
Author Response
Please see the attachment.
Author Response File: Author Response.docx
Round 2
Reviewer 1 Report
Thank you for making the changes as described in your cover letter. I believe that the manuscript was made stronger by these changes and is suitable for publication.
Reviewer 3 Report
proof reading is needed
