What Are the Important Qualities and Abilities of Future Doctors? A Nationwide Attitude Survey in Japan

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This paper describes a nationwide survey of the general public in Japan assessing the attributes they believe are important for becoming a doctor.   

 

Abstract:

-       Lines 6-8: This sentence is slightly confusing.   Please rephrase “original items for the elements…” to be more specific to what the survey captured

-       A survey response rate needs to be added.  Of the 1,200 people offered the survey, how many responded to it?

-       Please briefly mention how the survey was distributed.

-       Please provide percentages of agreement with each statement.  How many respondents agreed with “cares about other’s feelings”, and the other statements listed?

 

Introduction:

-       The introduction needs significant revisions to add references to support the authors’ claims.  The introduction should provide background to the central question or aim of the paper.  For example, what is known about the general public's thoughts about the key attributes of a doctor?  Have other surveys like this been conducted?  Why is the public an important stakeholder in the training of doctors?

-       As you revise this section, I would consider a more global look at medical school admissions beyond Japan. A few examples of areas needing further references are listed below.

-       Paragraph 2 (Lines 26 – 30) outlines objectives for selecting applicants to medical school.  However, no references are listed.  Please expand this section and include relevant references to support these claims.

-        Lines 31 – 32 need additional support and a reference.  Why does a smaller applicant pool mean that fewer applicants will possess the necessary abilities to attend medical school?  For example, a smaller applicant pool might represent the best possible candidates for medical school, and therefore, this statement would be incorrect.

-       Lines 32 – 33: Please provide information about how often medical schools in Japan and perhaps worldwide do not meet their admission quotas.  This is exceedingly rare in certain parts of the world.

-       Lines 43-50: This paragraph proposes an idea about entrance to medical school.  This could fit into the discussion, but should not be part of the introduction.  The introduction should provide background to why you performed your study and what is known about the topic at hand.

-       Line 57-59: Please remove the repetition of “Japanese” and “Japan”; only one of these is needed

-       Please add further information about the study being conducted and its aims at the end of the introduction

 

Materials & Methods:

-       Line 76 states that “six people who agreed were surveyed”.  Does this mean that 6 of 30 households agreed to be surveyed?  Please provide additional information about how these 6 people were determine for study enrollment.

-       Please provide additional information about the “leaving method” used to conduct the study

-       Table 1: List income in both mil yan and USD.  It will help your reader if you do this conversion for them rather than listing it at the end of the table

-       Lines 89-91: This section needs further expiation.  How were these important elements determined?  Were they determined by NOS investigators or the authors? 

-       Table 2: The asterick (*) at the end of the table states “This list was derived from…”. This information should be in the text of the manuscript and expanded upon.

-       Lines 109-112: It’s unclear if survey responses for negative answers were also combined in the analysis. 

-       Lines 137-138: IRB approval should be listed under Survey Procedures.

 

Results:

-       Line 141 (second sentence): This sentence is inverted; please rewrite for clarity.

-       Table 4: Revise to make information more readable.  For example, columns with attribute, n, and percent would make this much easier to read. There is a typo in Table 4 (education)

-       Table 5: “Regarding the elements indicating the qualities and abilities suitable for…” is very wordy.  Please rewrite for clarity.

-       Lines 156-158: Please add percentages for agreement with each statement.

-       Tables 6-1 and 6-2 are difficult to read.  Please reconsider how present this information in a more readable format.  This information would be much easier to digest if presented graphically.

-       Line 223-239: p-values should be added when the word “significant” or “significantly” is stated.

-       Lines 248-251: Further information needs to be given about the factor analysis before Table 7 is presented.  Table 7 doesn’t make sense in its current form.

 

Discussion:

-       The discussion needs to be fundamentally rewritten.  As it currently stands, the discussion provides a brief summary of the study’s key findings and then provides information about previous studies as would be found in an introduction.  However, the discussion should place the current study in the context of published literature.  How does this study expand what is already known on this topic?  Are the findings similar or different from previously published literature?

-       Line 255-256: Please add percentages for “ability to judge situations” and “empathy” to represent “high ratio of positive answers”

-       Lines 259-260: What is meant by the statement: “A similar trend was observed for the average values obtained by scoring the responses?”  Please expand this statement for further clarification

-       Lines 267-268: Please define factor 1 and factor 2 with the assumption that readers may only read the discussion.  For example, what is the “first factor”?  What is the “second factor”?  Why should the reader care about these factors?

-       Line 290: Please define MCAT, which is an abbreviation for a specific test

-       Lines 307-312: References need to be provided for the numbers given

-       Lines 321-328: References need to be added to support the authors’ statements

-       Limitations section: The authors should highlight how future studies could expand this work.

 

Conclusions:

-       Additional conclusions should be offered to highlight the importance of this study and how it may inform medical school admissions

-       Line 386: Please provide percentage of affirmative responses for “Cares about others’ feelings”

 

 

Comments on the Quality of English Language

Quality is generally good.  Please check for typos and oddly phrased statements as noted in the detailed review. 

Author Response

Please see the attached file 

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Review of Education Sciences XXX What are the Important Qualities and Abilities..etc

 

This manuscript reports about a Japanese national survey study under a more or less representative lay population sample to collect opinions about desired qualities of applicants for medical school, based on a predefined set of 16 qualities, and using a service that regularly collects population data (Nippon Research Center).

The researchers find that Academic Ability ranks much lower than several more general qualities and suggest a redirection of selection criteria, also to offer more opportunities for non-urban applicants. 

 

General comments

 

·      While reading, I kept wondering how this study would help to solve a problem, that seems to have been the reason to conduct it: too much stress among applicants because of unreasonable entrance requirements, which seems to deter particularly students from rural areas from applying.

 

·      What can be seen in several countries is that the bigger the gap between the number of places and the number of applicants, the higher the entrance requirements become. The decrease applicants that the authors notice might by itself be expected (on the longer run) to decrease the entrance requirements, or said differently, an increase of applicants (particularly from non-urban regions) that the authors seem to desire may actually lead to more competition and stress, rather than less. I do not believe the statement (p1r31) that “if the pool of applicants is small, only a few will possess the necessary 31 abilities, and an imbalance in those abilities will occur” if you mean to say that fewer will be selected. Japan needs doctors, am I’m sure that entry criteria will be lowered if there are few applicants. And I do not believe that high competition before and during training is necessarily good for the medical workforce. 

 

·      I also mis the justification for many of the data that have been collected. How do all these detailed population characteristics add to hypotheses of the study and subsequently to their conclusions? For instances, why is age, gender, income of the respondents important? 

 

·      I appreciate the wish to nationalize entrance criteria, but again I wonder how this study support that processes. One sensible approach to decrease this stress is to apply a lottery among this who fundamentally qualify. That is not a very popular approach but there are arguments to support that (see ten Cate O. Rationales for a Lottery Among the Qualified to Select Medical Trainees: Decades of Dutch Experience. J Graduate Med Educ 2021;(5):612-615.)

 

·      One major comment with this paper is that I find the nature of the paper not very clear. It presents research data, but it presents many opinions in the introduction and in the discussion that are not directly related to the study results, at it almost reads like an opinion piece or a policy paper than a focused research study.

 

Specific comments

·      P2r89: The 16 qualities for the population survey were based on discussions among the co-researchers and during ‘symposiums’. That seems somewhat unsatisfactory to me. The problem with surveys is that what is put in determines the boundaries of the results, so, much energy should go into designing the survey, to avoid a garbage-in-garbage-out phenomenon. That process is not well described. Is, for instance, it not clear why ethical behavior, abiding by the law and avoiding harm to others (I would say ’benevolence’) were not regarded useful qualities to include. Next, I became confused when I read (P4r96) that “This list was derived from respondents’ answers to the question “What elements do you think 96 indicate the qualities and abilities that are important for becoming a doctor?’” Was that a different study? Or if that question was part of the survey, how could respondents then have answered to these 16 items on a 7 point Likert scale? I also has some issues with some of the suggested selection criteria. How can the ‘experience of illness or disability’ be an entrance criterium for medical school?

 

·      Table 5 list percentages of ‘positive’ answers, but ‘positive’ is not explained. Is that the highest score on the Likert scale?

 

·      Tables 6-1 and 6-2 provides huge numbers of data, that are hardly readable. But most importantly, the story gets lost in the myriad of data point. In addition: I did not see Bonferroni corrections of significance testing; if not done, all p-values larger than 0.001 are futile, and significant testing is only useful of a pre-set hypothesis is being tested. I did not see these hypotheses.

 

·      Table 7 provides factor analyses but the factors are not interpreted and labeled.

 

 

Comments on the Quality of English Language

No comments

Author Response

Please see the attached file 

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors At the beginning, I propose to clearly define what competences a medical student should have, in accordance with the literature on the subject. Please pay attention to both soft skills and social. It seems to me that there is no precisely defined problem in the introduction. Please complete introduction to the above-mentioned competences and a clear definition of the purpose of the study. Section: Main conclusions I suggest removing this section altogether or expanding it. In its current form it does not constitute a form of: Discuss. Delete it or check out other research on this topic. Content from this section could be moved to the Conclusions section as there is too little information here. Reports should not include percentages. You should supplement your applications with your results research and what global impact it will have.

Author Response

Please see the attached file

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Please see the attached file 

Comments for author File: Comments.pdf

Comments on the Quality of English Language

Please see comments above.  Minimal editing needed.

Author Response

May 2, 2024

 

Dear Editors:

 

We wish to re-submit the manuscript titled “What are the Important Qualities and Abilities of Future Doctors? A Nationwide Attitude Survey in Japan” The manuscript ID is 2749402.

 

We thank you and the reviewer for your thoughtful suggestions and insights. The manuscript has benefited from these insightful suggestions. I look forward to working with you and the reviewer to move this manuscript closer to publication in Education Sciences

 

The manuscript has been rechecked and the necessary changes have been made in accordance with the reviewer’s suggestions. The responses to all comments have been prepared and attached herewith.

 

Thank you for your consideration. I look forward to hearing from you.

 

 

 

 

Reviewer 1

Overall:

-               Several paragraphs are only 1 sentence long. Please rearrange paragraphs so that they are at least 2-3 sentences long and the ideas presented connect to each other

RESPONSE: Following your suggestion, we have combined single-sentence paragraphs with surrounding paragraphs depending on their content (lines 22, 38, 63, 311-312, 343, 353, and 375).

 

Introduction:

-              The first 3 paragraphs are confusing as the authors go back and forth between qualities deemed important for medical school and how students are assessed entering medical school. Would recommend rearranging these paragraphs to group ideas into: (1) qualities deemed important for medical school, (2) how students are assessed, and (3) how fewer applicants impacts selection for these qualities

RESPONSE: We have rewritten the description of this part following the suggested framework (lines 20–40).

 

-              Line 63: please correct typo – “compared with the weight attached to other qualities…”

RESPONSE: Thank you for pointing out the typo. The text containing this part has been rewritten to be more concise (lines 48-50).

 

Materials & Methods:

-              Table 2: The asterisk (*) at the end of the table states “In Japan, mock examinations…” This information should be in the text of the manuscript rather than at the bottom of the table

RESPONSE: We have moved the footnote of Table 2 to the text before the table (lines 105–110).

 

-              Lines 134-137: The information about # of respondents and the Likert scale used should be moved up so that the reader understands how respondents were instructed to answer the question reflected in Table 2

RESPONSE: We have moved this paragraph before the table (lines 111–114)

 

-              Methods and results state that 1,200 people responded to the survey; however, the abstract states 1,190 responded. Please ensure that these numbers match where appropriate

RESPONSE: Regarding the attributes of respondents, all 1,200 participants answered, but 10 did not answer any questions about their opinions on the elements indicating the qualities and abilities suitable for becoming a doctor. In “2.3 Analysis,” we have written that when calculating the percentage of positive responses, non-respondents were included in the denominator. To make these circumstances clear, we have changed the number 1,200 in the first sentence of “3.1. Respondents’ attributes” to 1,190. We have added a footnote to explain why “1,200” has been noted in Tables 4 and 5.

 

Discussion:

-              Lines 326-327: Recommend rewording as the following phrase is confusing: “regarding the elements indicating the qualities and abilities that are important”….

RESPONSE: We have rewritten the description of this part to “regarding the important elements of the qualities and abilities of prospective physicians” (lines 231-232).

 

-              Line 367: What does “it” refer to in the following sentence “unlike the MCAT which is a standardized examination…, it does not specialize”. Does “it” refer to the Japanese academic examination? Please clarify this for your reader

RESPONSE: We have rewritten the description of this part to clarify that “it” refers to the Japanese academic examination (lines 266–268).

 

-              Line 391: Please define AAMC as this abbreviation is not used earlier in the text

RESPONSE: We have added the definition of AAMC (line 291-292)

 

Author Response File: Author Response.pdf