Self-Regulated Video-Based Learning for Cultivating Surgical Skills: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Round 1
Reviewer 1 Report
I read with great interest the paper entitled "Self-Regulated Video-Based Learning for Cultivating Surgical Skills: A Systematic Review and Meta-Analysis of Randomized Controlled Trials" authored by Niklas Pakkasjärvi et al.
This literature review and meta-analysis emphasize the use of Video-Based Learning in order to improve surgical skills.
I strongly advise the publication of this paper after some minor review:
- Minor editing of English language required especially in the introduction;
- At line 54, the comma should be removed;
- The Jadad Scale should be reported and explained in supplementary materials;
- The author contributions at line 131-133 should be removed and re-written at the end of manuscript in the section “Author contributions”;
- Remove the word “altogheter” from line 148;
- The paragraph 3.1 “Summary of the included study” should be move on supplement materials while the three studies used for meta-analysis should be reported in table;
- OSATS score should be briefly explained in the methods of analysis;
Table 1 and table 2 should be formatted according to the specification of the paper
In my humble opinion, the manuscript represents a very interesting analysis on digital learning and I suggest to insert the paper in the Special Issue of IME entitled “Telemedicine, E-Health and Digital Transitions”.
Small revisions of the English language would be needed especially in the introduction, which should be more fluent
Author Response
I read with great interest the paper entitled "Self-Regulated Video-Based Learning for Cultivating Surgical Skills: A Systematic Review and Meta-Analysis of Randomized Controlled Trials" authored by Niklas Pakkasjärvi et al.
This literature review and meta-analysis emphasize the use of Video-Based Learning in order to improve surgical skills.
RESPONSE: We thank the reviewer for the kind and encouraging words!
I strongly advise the publication of this paper after some minor review:
- Minor editing of English language required especially in the introduction;
RESPONSE: We thank the reviewer for this criticism and have now revised the Introduction. All changes are tracked in the word file and highlighted in yellow.
- At line 54, the comma should be removed;
RESPONSE: corrected.
- The Jadad Scale should be reported and explained in supplementary materials;
RESPONSE: As stated in the Methods-section, the Jadad scale was used for quality assessment of the included RCT’s. “The validated scale assesses the quality of RCTs under three domains—randomization, blinding, and withdrawals and dropouts. Using this scale, a maximum score of 5 and a minimum score of 1 can be assigned for the included studies. Two authors performed the methodological quality assessment (SA and NP). Any dispute was resolved through consensus or by discussion with a third author (HA).” And then in the Results-Section: “Utilizing the Jadad quality assessment scale, it was noted that the randomization process was not optimal in 3/7 studies (table 2). Also, all included studies had performed single-blinding only. However, the information about withdrawals/dropouts (if any) was satisfactorily reported in the included trials.”
While it is good that the reviewer emphasizes the quality assessment, we feel that the current extent suffices and would prefer not to elaborate any further on the quality assessment, especially as the limitations-paragraph in the Discussion also addresses this.
- The author contributions at line 131-133 should be removed and re-written at the end of manuscript in the section “Author contributions”;
RESPONSE: The Author contributions are now after the conclusions, before the references which we believe is the correct position.
- Remove the word “altogheter” from line 148;
RESPONSE: corrected.
- The paragraph 3.1 “Summary of the included study” should be move on supplement materials while the three studies used for meta-analysis should be reported in table;
RESPONSE: We thank the reviewer for the criticism. However, we would prefer to maintain the current format. We think that a verbal summary is mandatory to let the reader clearly understand the individual papers, especially as they are limited in number. Further, figure 1 depicts the results from the meta-analysis and therefore adding a separate table would be redundant. We hope the reviewer understands our intentions here.
- OSATS score should be briefly explained in the methods of analysis;
RESPONSE: corrected. We have amended the OSATS-explanation as follows: The OSATS (Objective Structured Assessment of Technical Skills) is a validated assessment tool specifically designed to quantitatively measure and evaluate the technical proficiency of surgical skills and objective manner.
Table 1 and table 2 should be formatted according to the specification of the paper
RESPONSE: We kindly ask the editorial office for guidance on this matter.
In my humble opinion, the manuscript represents a very interesting analysis on digital learning and I suggest to insert the paper in the Special Issue of IME entitled “Telemedicine, E-Health and Digital Transitions”.
RESPONSE: We thank the esteemed reviewer for the kind words of encouragement and concur with the suggestion of inserting the paper in the special issue.
Comments on the Quality of English Language
Small revisions of the English language would be needed especially in the introduction, which should be more fluent
RESPONSE: The language has now been updated accordingly.
Reviewer 2 Report
Although Covid-19 is fading away, its impact will last, and experiences gained from such a period may be valuable for future disasters/learning disruptions. From that perspective, this is an interesting and timely work (that addressed the VBL for surgical skills training). However, after a careful reading, several minor issues emerged; I describe them briefly below. Hopefully it will help the authors to improve this work.
1. One fundamental issue is the number of articles identified. I’m sure there is no fixed requirement of how many pieces are needed for a systematic literature review and meta-analysis. However, for the current study that features only 7 for review and 3 for mata, it is suggested to provide some references that may explain why those articles are enough. Or/and authors should mention this as an additional limitation of this work. I did not see much for the current version. Please consider improving it.
2. On Page 2, line 84, in the “materials and methods” section, authors searched three databases, namely PubMed, ProQuest, and Cochrane, without stating why, could there be any other potential databases? For example, you can add words such as “those databases were chosen due to....” to solve this.
3. Page 7. I was wondering if "2020 and onwards" is proper in the inclusion criteria table. I suggest you set a fixed date. You have to know the time you searched the database. Otherwise, readers may raise critiques. This is very important issue, be careful.
4. The conclusion is well written.
5. To sum up, this is good work addressing one crucial current learning topic. Authors are suggested to address the above-mentioned issues before this can be accepted. Good luck!
Overall this manuscript is well-writen, but still I suggest authors to have it proofread by some native language users for better flow.
Author Response
Although Covid-19 is fading away, its impact will last, and experiences gained from such a period may be valuable for future disasters/learning disruptions. From that perspective, this is an interesting and timely work (that addressed the VBL for surgical skills training). However, after a careful reading, several minor issues emerged; I describe them briefly below. Hopefully it will help the authors to improve this work.
RESPONSE: We thank the esteemed reviewer for the kind words of encouragement
- One fundamental issue is the number of articles identified. I’m sure there is no fixed requirement of how many pieces are needed for a systematic literature review and meta-analysis. However, for the current study that features only 7 for review and 3 for mata, it is suggested to provide some references that may explain why those articles are enough. Or/and authors should mention this as an additional limitation of this work. I did not see much for the current version. Please consider improving it.
RESPONSE: We thank the reviewer for pointing this out. This is a consequence on the lack of high-quality research on SR-VBL for surgical learning and the incoherent use of appropriate terms for SR-VBL. We were forced to perform the searches with broad terms and then manually filter for the correct articles. We believe further research will improve as SR-VBL is now correctly introduced in our manuscript. With regards to the final number of articles in the review, there is no limit specifically, but naturally the quality of evidence is only as good as the material analyzed. We have added “and limited” (“In addition, the study population was heterogeneous and limited, thereby introducing confounding factors into the analysis”) to the section on limitations, stating this shortcoming.
- 2. On Page 2, line 84, in the “materials and methods” section, authors searched three databases, namely PubMed, ProQuest, and Cochrane, without stating why, could there be any other potential databases? For example, you can add words such as “those databases were chosen due to....” to solve this.
RESPONSE: Pubmed was chosen for its excellent coverage, ProQuest for the pedagogical focus and Cochrane for quality. We have added: “These databases were chosen for optimal coverage, focus on education and learning and high-quality research.” to explain this.
- Page 7. I was wondering if "2020 and onwards" is proper in the inclusion criteria table. I suggest you set a fixed date. You have to know the time you searched the database. Otherwise, readers may raise critiques. This is very important issue, be careful.
RESPONSE: We concur with this notion and agree that the time is important. The time of database searches was 17.04.2022 and is stated in the Materials and Methods: “Two investigators (NP and SA) independently conducted searches on PubMed, ProQuest ERIC, and Cochrane databases on 17.4.2022.” With regards to the inclusion criteria, we stated eligibility in the methods as follows: “The inclusion criteria for the studies were (table 1): all the studies were peer-reviewed, and they applied varied modes of self-regulated video-based learning (SR-VBL) for operative interventions in surgical learning in a randomized controlled study. All studies were to include objective outcome assessments of the intervention. We included studies from 2020 onwards not to overlap with previous studies and to focus on the era during which the Covid-pandemic forced most students into distance learning.” We hope this is sufficient.
- 4. The conclusion is well written.
RESPONSE: We thank the reviewer for the kind words!
- To sum up, this is good work addressing one crucial current learning topic. Authors are suggested to address the above-mentioned issues before this can be accepted. Good luck!
RESPONSE: We thank the reviewer for the encouragement!
Comments on the Quality of English Language
Overall this manuscript is well-writen, but still I suggest authors to have it proofread by some native language users for better flow.
RESPONSE: We thank the reviewer for the positive comments. We have now revised the language for better flow.
Round 2
Reviewer 1 Report
The authors fully answered the questions posed.
I have no further comments. I recommend inclusion of the manuscript in the special issue "Telemedicine, E-health and Digital Transitions."
Reviewer 2 Report
I think authors addressed to my concerned well.
