Efficacy of an Integrated Simulation-Based Education Approach to Train Non-Technical Skills in Medical Undergraduate Students

Round 1

Reviewer 1 Report

Very interesting and innovative topic, as it associates NTS with simulated training in the basic training of future health professionals.

Well-structured article, with good support and rationale. The abstract should be concise to capture the reader's interest by objectively illustrating the gains of the study carried out.  It is considered that some of the studies presented, despite giving the notion that current pedagogical practices and curricula, of health degrees, need emerging updating, are very old (1978; 1987...). The need for their use in the discussion is questioned. 

In the methodology, the authors should better justify the study being prospective and better describe some aspects of data collection to illustrate how to replicate this same study in other realities. Ethical issues should be reviewed. For, despite the justification by the Law of Healing Professions, Hamburg, in the case of a study for international publication with university students, the permission of an ethics committee is considered essential and not just the individual informed consent of the participants, in writing. 

The presentation of the data and the discussion are clear, objectively illustrate the findings and meet the objectives of the work. The discussion presents a good comparison of authors, and it is considered that older studies (prior to 2010) can be dispensed with as they do not add value to the discussion. The conclusions are very synthetic and do not provide an effective response to the objective of the study. In view of the findings of this study, other conclusions should be synthetically highlighted.

Comments for author File: Comments.pdf

Author Response

See document

Author Response File: Author Response.pdf

Reviewer 2 Report

• The main question was addressed by the research. It is not clear the relevance and interest for the restructuring of pegagogic methods. What innovation does repetition learning bring? What place does training in rapid response skills and clinical reasoning have in order to act in emergency situations, in situations liable to out of control? Will repetition learning respond to exceptional situations?
• How innovative is this research? What does it add to the subject area compared with other published material?
• The paper is well written, text clear and easy to read.
• The conclusions is inconsistent with the evidence and arguments presented. Need to address the main question posed.
• The data collection instrument is not presented, making it difficult to assess the results. Furthermore, data were collected from 2017 to 2019; why did it take so long to release it?
• Several concepts related to the phenomenon are presented, but the defined theoretical framework is not clear. What theory(ies) supports this research?

• The main question was addressed by the research. It is not clear the relevance and interest for the restructuring of pegagogic methods. What innovation does repetition learning bring? What place does training in rapid response skills and clinical reasoning have in order to act in emergency situations, in situations liable to out of control? Will repetition learning respond to exceptional situations?
• How innovative is this research? What does it add to the subject area compared with other published material?
• The paper is well written, text clear and easy to read.
• The conclusions is inconsistent with the evidence and arguments presented. Need to address the main question posed.
• The data collection instrument is not presented, making it difficult to assess the results. Furthermore, data were collected from 2017 to 2019; why did it take so long to release it?
• Several concepts related to the phenomenon are presented, but the defined theoretical framework is not clear. What theory(ies) supports this research?

Author Response

See document

Author Response File: Author Response.pdf

Reviewer 3 Report

It was not clear how they reduced the sample from 945 to 939 as shown in Table 1.

Poor conclusion without description of the implications of this study on the training of medical students and suggestion for future studies.

Author Response

See document

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

.

Comments for author File: Comments.pdf

Author Response

Please see document

Author Response File: Author Response.pdf