Virtual Reality and Simulation Videos as Effective Training Tools for Creating Safe and Inclusive Environments for Transgender People

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The paper is well structured but needs more work on the development of the gap in the literature (Intro and Objectives).  Also, preferably the objectives should be merged with the intro.

Better interpretation of the results can be made by further discussing the practical implications of the results in the discussion section.

Comments on the Quality of English Language

Further edits would be needed to improve the English quality.

Author Response

Dear reviewer, thank you for your input and comments.

Two new fonts have been added to the introduction (line 51 and line 110). The introduction has been completed with the mechanism for regulating curricula in Spain and an explanatory paragraph on how constructivist models influence student learning. In addition, the main objective of the study has been restated and incorporated into the introduction as requested.

On the other hand, a paragraph summarising the main practical implications has also been added (line 308).

Reviewer 2 Report

Comments and Suggestions for Authors

Dear editor I would like to thank you for giving me the chance to review such an interesting work. The current study intends to assess undergraduate nursing students' knowledge gained from employing virtual reality and training videos as educational methods. The study's findings suggested that active approaches employing virtual objects can be used as an instructional tool to help nursing students respond correctly to society's changing health demands.

I would like to comment to the author to rewrite the aims of their study in introduction following the way that was used in the abstract. Also, the author would benefit from more concise language and editing to help the readability of the study in introduction and discussion sections.  

Author Response

Dear reviewer, thank you for your input and comments.

As requested, the objectives of the study have been reformulated in line with the text of the abstract, introduction and discussion. I hope you find it suitable.

Reviewer 3 Report

Comments and Suggestions for Authors

The Introduction provides a good foundation for the article, introducing the topic of transgender and gender-diverse individuals in the context of nursing education and the need for trans-competent training. However, the transitions from discussing the term "trans" to the challenges faced by nurses in providing care to trans people could be smoother.

 The "Materials and Methods" section is well-structured, providing a clear overview of the objectives, participants, design, instruments, and ethical considerations. However, authors should provide a brief rationale for choosing a quasi-experimental design.

Why was this design appropriate for assessing the impact of educational interventions? Authors should also consider providing more details about the content of the virtual scenarios. What specific aspects related to trans individuals were covered?

For the ad hoc questionnaire, authors should provide a brief overview of the types of questions included in each category (knowledge, attitudes, and procedures) to give readers a quick understanding. They also should clarify why SPSS Statistics® was chosen for the statistical analysis.

The ethical considerations are well-described. However, the authors should consider adding a sentence or two to explain why this study adheres to the guidelines of the Declaration of Helsinki and European and Spanish laws. This can help contextualize the importance of ethical considerations.

Authors should ensure consistency in numbering and formatting throughout the section. For example, if using subheadings like "2.1," "2.2," etc., maintain this structure consistently.

The "Results" section should provide a brief introduction or context at the beginning of the Results section to guide the reader. The authors should consider providing a brief explanation or interpretation of what is meant by "skill blocs".

The interpretation of McNemar's test results could be more explicit. For example, the authors mention that the result is explained by the similarity in correct and incorrect responses, but a brief interpretation could enhance clarity. The authors should maintain consistency in presenting percentages. For example, sometimes percentages are written out (e.g., "78.18%") while other times as numerals (e.g., "67%").

Authors should choose a consistent format. While the paper discusses the effectiveness of virtual resources, it should provide more justification for why these resources are valuable, especially in comparison to other teaching methods. What specific advantages do they offer? The paper should relate the findings to the broader context of nursing education and healthcare. It should also compare the findings with other studies in a more direct manner. Instead of stating that these results are consistent with similar studies, it should explicitly mention which studies and how your findings align or differ from theirs.

The paper might suggest potential avenues for future research. Are there specific aspects related to nursing education, virtual resources, or gender diversity that warrant further investigation based on your study's findings? This paper should conclude the discussion section by summarizing the main findings and their implications. What contributions does this study make to the field, and how might these findings inform future research or nursing education practices? The paper should ensure consistent formatting for citations. For example, if it uses author names and publication years in some instances, it should maintain this format throughout.

The conclusions section is concise. Nevertheless, it might provide more specificity regarding the legislation that universities should align with. A brief mention of the legislative context will give readers a clearer understanding of the changes or requirements that your study addresses. Emphasize how adjusting curricula in line with legislation impacts the education of nursing students. Highlight the specific ways in which new teaching methodologies enhance academic success and performance. Quantify the impact of SVs and VR on knowledge enhancement and skills acquisition.

If possible, provide specific results or statistics to reinforce the claim that these methodologies are effective and appreciated. Emphasize that the positive impact of SVs and VR is not limited to a specific context but can be generalized.

If there are examples of their success in diverse settings, mention them to highlight the universality of these approaches.  Elaborate on how SVs and VR contribute to developing tolerance, respect, and empathy Specify how your study contributes to future research in obtaining more accurate measurements when pilot-testing virtual resources.

What insights or methodologies from your study can be employed in future research endeavors? Reinforce how the conclusions align with the main objectives set in the introduction.

 

Comments on the Quality of English Language

N/C

Author Response

Dear reviewer, thank you for your input and comments. Please find the author response in the attachment.

 

Author Response File: Author Response.pdf

Reviewer 4 Report

Comments and Suggestions for Authors

To authors, 

This study is significant as a proposal to reflect a universal nursing curriculum that takes into account vulnerable groups that have been excluded from the general nursing curriculum.

However, if you want your paper to be published as an original article rather than a review, you should consider revising the technical aspects of your paper.

1. Introduction: Please highlight the need for research by presenting the current state of existing nursing curricula for trans people or the current state of nursing curricula for vulnerable populations.

2. Participants: In this section, sequentially describe the process by which you were able to obtain the data (54) used in your final analysis from a population of 60 participants.

3. This study is a single experimental group design. Describe any limitations to the generalizing of your findings

4. In the intervention flow in Figure 1, it would be good to include the initial training session and add a step for debriefing. The description of the intervention needs to be more specific. Was the training session done in groups, as a whole, etc.

5. Present Mentimeter results in a graphical representation

6. Description of discussion for question 6.7.8 where there was no significant difference

7. The current discussion description consists of what would be included in the introduction. Please add a discussion that reflects the development of the programme and the effectiveness of the pilot test.

I wish you all the best in your revision work and hope to see this manuscript as a published research article.

Sincerely, your reviewer

 

Author Response

Dear reviewer, thank you for your comments and input.  

1. Introduction: Please highlight the need for research by presenting the current state of existing nursing curricula for trans people or the current state of nursing curricula for vulnerable populations.

The need for research in the field of gender diversity is explained in the introduction, where it is argued that the undergraduate degree in nursing does not contemplate any training in this field. To give it more argument, a new quote has been added about the regulatory body for learning outcomes and curriculum design, saying that they do not fit the needs of the current population and that they must be redesigned (line 51).

2. Participants: In this section, sequentially describe the process by which you were able to obtain the data (54) used in your final analysis from a population of 60 participants.

The process by which we arrive at a final sample of 54 participants is explained in results (line 242), we consider that if we repeat it in participants it would be redundant.

3. This study is a single experimental group design. Describe any limitations to the generalizing of your findings

Following their indications, we have incorporated a paragraph where we explain that despite the statistical power and effect size found, our data should be analyzed with caution (line 334). Since it is a quasi-experimental design, without a control group, purposive sampling and with a relatively small sample. We have also incorporated this analysis into the conclusions.

4. In the intervention flow in Figure 1, it would be good to include the initial training session and add a step for debriefing. The description of the intervention needs to be more specific. Was the training session done in groups, as a whole, etc.

To clarify the design of the intervention, we have incorporated a new figure (Figure 1) as well as the graphical representation of the result of the measurement of responses with Mentimeter (Figure 4).

5. Present Mentimeter results in a graphical representation

Figure 4 has been incorporated for this purpose.

6. Description of discussion for question 6.7.8 where there was no significant difference

The description has been completed in the results section (line 262) and we have described in the discussion what may be the reason for not having found significant differences in questions 6, 7 and 9 (line 353).

7. The current discussion description consists of what would be included in the introduction. Please add a discussion that reflects the development of the programme and the effectiveness of the pilot test.

Two references have been included in the introduction, one of which explains where the learning outcomes of the subjects of the Bachelor's Degree in Nursing are collected and who regulates it. Explaining that the curriculum does not adjust to the needs of the current population and does not include training in gender diversity (line 51). And the other, on how constructivist models of teaching improve learning experiences (line 110). The results of the pilot, the students' perception and satisfaction with the methodologies are described from line 268.   I hope you find all of our corrections adequate.

Round 2

Reviewer 3 Report

Comments and Suggestions for Authors

The paper is well structured and the problem presented is relevant and current.

 

This paper has an adequate organization and the language used in it, makes its content clear, easily readable and understandable. However, the transitions from discussing the term "trans" to the challenges faced by nurses in providing care to trans people could be smoother. Authors should also consider providing more details about the content of the virtual scenarios. What specific aspects related to trans individuals were covered? For the ad hoc questionnaire, authors should provide a brief overview of the types of questions included in each category (knowledge, attitudes, and procedures) to give readers a quick understanding. The conclusions section might provide more specificity regarding the legislation that universities should align with. A brief mention of the legislative context will give readers a clearer understanding of the changes or requirements this study addresses.

Author Response

The paper is well structured and the problem presented is relevant and current.

Dear reviewer, thank you for your input and comments.

Below are our point-by-point answers:

This paper has an adequate organization and the language used in it, makes its content clear, easily readable and understandable. However, the transitions from discussing the term "trans" to the challenges faced by nurses in providing care to trans people could be smoother.

In the introduction, a new paragraph (line 38-45) has been included with a new reference explaining why the term trans is chosen in the scientific community. Based on the standards of care published by the World Professional Association for Transgender Health (WPATH).

It has been indicated that this organization is the international benchmark regarding the care and specific needs of trans people. Thus, we offer a resource for any professional who consults this article and is interested in delving into it.

Authors should also consider providing more details about the content of the virtual scenarios. What specific aspects related to trans individuals were covered?

The specific aspects related to the care of trans people are described in the design and methodology section on line 167-170.

To improve the understanding of the implementation of these aspects, a new paragraph has been introduced (lines 171-178) describing the example of the virtual simulation of the paediatric consultation under an exclusionary and inclusive scenario. It is evident which practices are respectful and which are not, such as the presumption that the trans girl was actually a homosexual boy.

This contribution will make the reader understand perfectly what difference existed between some scenarios and others.

For the ad hoc questionnaire, authors should provide a brief overview of the types of questions included in each category (knowledge, attitudes, and procedures) to give readers a quick understanding.

A description of the contents included in each category has been included by sections (lines 190-198). We believe that readers can now understand the classification in those categories more easily.

The conclusions section might provide more specificity regarding the legislation that universities should align with. A brief mention of the legislative context will give readers a clearer understanding of the changes or requirements this study addresses.

Following their recommendations, we have completed the first paragraph (line 357-363) stating that the NAQAA should revise the curriculum to conform to Law 02/2021, of 7 June of social equality and non-discrimination on grounds of gender identity, gender expression and sexual characteristics.

We hope you will find our contributions adequate.

Author Response File: Author Response.pdf

Reviewer 4 Report

Comments and Suggestions for Authors

I'd like to thank the authors for taking my comments on board and making good revisions to the manuscript. I expect it to be a good paper.

Author Response

Thank you for your response, we feel that your input has greatly improved the paper.