Students’ Experiences with Interprofessional Service-Learning Global Health Education Pilot Program in Ghana

Round 1

Reviewer 1 Report

Comment on Selection Criteria for Students:

The paper suggests that the selection of students for the program is largely based on their expressed interest in global health, their engagement level, and their willingness to participate in the program's preparatory phases. While these are important factors, a more comprehensive understanding of the selection process would be beneficial. Details regarding specific qualifications, academic standing requirements, or other formal criteria used in the selection process would provide a clearer picture of the student cohort and the program's inclusivity and accessibility.

Comment on Comparative Analysis with Other Regions:

The discussion on the challenges and logistical nuances of the ISL program in Ghana is insightful and adds depth to our understanding of ISL implementations in unique settings. To further enhance the paper's contribution to the field, including a comparative analysis with ISL programs in other regions, such as South America, would be advantageous. This comparison could help highlight the distinct challenges and opportunities the Ghanaian context presents. It could offer valuable insights into the adaptability and scalability of ISL programs in varying geographical and cultural landscapes.

Author Response

Reviewer 1

1. Comment on Selection Criteria for Students:

The paper suggests that the selection of students for the program is largely based on their expressed interest in global health, their engagement level, and their willingness to participate in the program's preparatory phases. While these are important factors, a more comprehensive understanding of the selection process would be beneficial. Details regarding specific qualifications, academic standing requirements, or other formal criteria used in the selection process would provide a clearer picture of the student cohort and the program's inclusivity and accessibility.

Response 1: Thank you very much for your comment on the selection of the students. This manuscript was not developed from a research study. It is not a research study, so we did not use any rigorous selection method. In fact, students were not selected to participate in the program.  As described in pages 5-7, it was international/integrated service-learning pilot program/course/training offered to students from two academic programs: public health and physician assistant programs. The public health students who participated in the program enrolled in it as a practicum course to fulfill their 200 contact hours of practicum. The physician assistant students were only interested in the experience/training. We have described this in sections 2.3.; 2.4.; and 2.5. of the paper.

2. Comment on Comparative Analysis with Other Regions:

The discussion on the challenges and logistical nuances of the ISL program in Ghana is insightful and adds depth to our understanding of ISL implementations in unique settings. To further enhance the paper's contribution to the field, including a comparative analysis with ISL programs in other regions, such as South America, would be advantageous. This comparison could help highlight the distinct challenges and opportunities the Ghanaian context presents. It could offer valuable insights into the adaptability and scalability of ISL programs in varying geographical and cultural landscapes.

Response  2: Thank you for this suggestion. Please refer to the discussion. It has been addressed.

Author Response File: Author Response.docx

Reviewer 2 Report

I was drawn to the way the authors combined different elements into one article, such as interprofessional education, community practice, global health and education, and service learning. However, I was a bit disappointed when the results heavily emphasized learner satisfaction of the program. It is fine to include learner satisfaction but it would have made for a stronger study to include program results, influences, or details. For example, one of the conclusions was that the "gap between public health and health care delivery can be closed using IPE" but I did not see how the satisfaction survey got to that conclusion. I would like to see a stronger connection. If the emphasis of the article is to be on learner satisfaction, I would like to have seen details on how interprofessional interactions were perceived by the learner and how the learners and their Ghanaian educators interacted for the benefit of the community. 

Also, I noticed that in the text it said that "The average age of the students was 36" but the table notes that the Mean Age is 46 years.

The article has a number of grammatical errors that should be cleaned up.

Author Response

Reviewer 2

1. I was drawn to the way the authors combined different elements into one article, such as interprofessional education, community practice, global health and education, and service learning. However, I was a bit disappointed when the results heavily emphasized learner satisfaction of the program. It is fine to include learner satisfaction but it would have made for a stronger study to include program results, influences, or details. For example, one of the conclusions was that the "gap between public health and health care delivery can be closed using IPE" but I did not see how the satisfaction survey got to that conclusion. I would like to see a stronger connection. If the emphasis of the article is to be on learner satisfaction, I would like to have seen details on how interprofessional interactions were perceived by the learner and how the learners and their Ghanaian educators interacted for the benefit of the community. 

   Response 1: Thanks very much for your comments. We have better addressed this in the results and discussion sections. Please refer to pages 11, 12, 13.

Question 2: Also, I noticed that in the text it said that "The average age of the students was 36" but the table notes that the Mean Age is 46 years.

Response 2: Thank you for this observation as well. The average age of 36 was referring to the average age of all the graduate students in the University of Massachusetts (UMass)-Amherst Online Master of Public Health in the Public Health Practice degree program. The mean age of 46 was referring to those students who participated in the ILS pilot program implemented in 2017 and 2018. Please refer to the page 5 of our manuscript and the table 2.

Author Response File: Author Response.docx

Reviewer 3 Report

Overall:

This is a very interesting article and raised an important concept of the development and implementation of Interprofessional Integrated Service-Learning program between the public health students and physician assistant students.  This study was conducted for 2 years as a pilot program and focused on mixed methods of survey using questionnaire.  Quantitate and qualitative data were collected and analyzed. The article is well written and structured. However, in my opinion, the paper has some notable changes regarding questionnaire and text overlap. Below I have provided numerous remarks and comments on the text as it is often vague and long-winded. To some extent, also suggested citing more literature. Please find the comments below.

Abstract:

Results : what are main challenges expressed by the public health and physician assistant students? Mention in separate.

Keywords: Suggested to mention the MeSH terms.

Introduction

1.       Line 66-68 : Recommended to add the supportive references for effects of combining experiential learning with international service and interprofessional collaborations……

2.       Line 40-42 :  Recommended to add relevant references in the sentence starts with ….In 2001, the Institutes of Medicine (IOM) called….”

Methods

3.       Research design is a first step of research methodology: The authors suggest adding the Research design or methods\in the first couple of d\sentence in methods part.

4.       Please describe the 78items of survey questionnaire. Whether its prepared by the authors if this study developed by other researcher.

5.        Data analysis must be revised and all the performed statistical analysis must be explained in brief (E.g: Frequency distribution of demographic characteristics) and Authors are suggested to add the details of quantitative analysis program.

6.       All the qualitative answers must be highlighted in italic font.

9.       Conclusion: recommended to add the study implications in conclusion part.

Author Response

Reviewer 4

Comments and Suggestions for Authors

Overall:

This is a very interesting article and raised an important concept of the development and implementation of Interprofessional Integrated Service-Learning program between the public health students and physician assistant students. This study was conducted for 2 years as a pilot program and focused on mixed methods of survey using questionnaire. Quantitate and qualitative data were collected and analyzed. The article is well written and structured. However, in my opinion, the paper has some notable changes regarding questionnaire and text overlap. Below I have provided numerous remarks and comments on the text as it is often vague and long-winded. To some extent, also suggested citing more literature. Please find the comments below.

Response: Thank you for your comments. We really appreciate them.

Abstract:

1.Results : what are main challenges expressed by the public health and physician assistant students? Mention in separate.

Response: Thank you for this observation. This has been addressed. Please refer to the abstract in the revised manuscript.

Keywords: Suggested to mention the MeSH terms.

Response: This is unclear.  Please what are you referring to?

Introduction

1. Line 66-68 : Recommended to add the supportive references for effects of combining experiential learning with international service and interprofessional collaborations……
2. Line 40-42 :  Recommended to add relevant references in the sentence starts with ….In 2001, the Institutes of Medicine (IOM) called….”

Response: Addressed. Please refer to the introduction.

Methods

3. Research design is a first step of research methodology: The authors suggest adding the Research design or methods\in the first couple of d\sentence in methods part.
4. Please describe the 78items of survey questionnaire. Whether its prepared by the authors if this study developed by other researcher.
5. Data analysis must be revised and all the performed statistical analysis must be explained in brief (E.g: Frequency distribution of demographic characteristics) and Authors are suggested to add the details of quantitative analysis program.
6. All the qualitative answers must be highlighted initalic font.
7. Conclusion: recommended to add the study implications in conclusion part.

Response: Thanks for your comments. Our manuscript was not developed from a research study. It was an ILS program/course. We have revised the methods a little bit. We have also revised the results and discussions. Please refer to the methods, results, and discussion sections of the paper.

Author Response File: Author Response.docx

Reviewer 4 Report

Many thanks for the manuscript. I enjoyed reading it. Below are my comments and suggestions:

(1) Paper title: Information regarading the research location and participants should be provided.

(2) Abstract: More information regarding the research method should be provided.

(3) Keywords: : "Interprofessional" and "Integrated Service Learning" should not be used as they repeat exactly the word/phrase of the paper title.

(4) Introduction:

- The subtitle should begin at "1", not "0". 

- More associated literature should be analysed to identify the research gap(s).

- The research specific objectives and/or research questions should be presented.

(5) Materials and Methods:

- The sampling technique should be described.

- The processes to develop the survey and the methods to ensure the validity and reliability of the survey should be presented.

- The sample size of  6 participants for quantitative data is too small. I think the qualitative data for this study are enough.

- How did you collect the qualitative data?

(6) Discussion: Paragraph 2 and paragraph 3 of the discussion section are not in the form of discussion as you did not connect/compare your research results with those of other studies.

(7) Conclusion: Limitatations and suggestions for further research should be presented.

(8) References: More up-to-date references should be provided.

Minor editing of English language required.

Author Response

Reviewer 5

Many thanks for the manuscript. I enjoyed reading it. Below are my comments and suggestions:

Response:  Thank you for your comments. We are happy that you “enjoyed reading” our paper.

Question 1. Paper title: Information regarding the research location and participants should be provided.

Response:  Thank you for your comment. This has been addressed. Refer to the revised title.

(2) Abstract: More information regarding the research method should be provided.

Response: Thank you again for this suggestion. This was not a research study. This paper is a program report. We have described how the program was developed and implemented in the abstract.

We used online short survey to assess/evaluate students’ experiences with the program. The students were also asked to write a reflection statement on the experience, challenges, and lessons that they learned from participating in the ISL global health education program. It has been described under the methods and materials section of the manuscript.

(3) Keywords: : "Interprofessional" and "Integrated Service Learning" should not be used as they repeat exactly the word/phrase of the paper title.

Response: Thanks so much this observation. We think this is not out of the ordinary. Keywords have included phrases and words in the title in many peer-reviewed published papers/articles.

(4) Introduction:

- The subtitle should begin at "1", not "0". 

 Response:  Thank you. This is corrected. Please see introduction.

- More associated literature should be analysed to identify the research gap(s).

Response:   Thank you again. As noted earlier, this manuscript was not developed from a research study. It is a program report and therefore we did focus on research gap.

- The research specific objectives and/or research questions should be presented.

Response: Thank you for your comments. This paper is not a research paper. It is a project/program report.

(5) Materials and Methods:

- The sampling technique should be described.

Response: Thanks for your comment, but our paper is not a research paper. This was a pilot ISL global health education program. We have described how students were recruited to participate in this program under the materials and methods sections. Please refer again to 2.3, 2.4. 2.5 & 2.6.

- The processes to develop the survey and the methods to ensure the validity and reliability of the survey should be presented.

-This is not clear, but thank you, again for your comments. Our paper is not a research paper.

- The sample size of  6 participants for quantitative data is too small. I think the qualitative data for this study are enough.

Response: Thanks again for your comment.  Our paper was not developed from a research study. It was a program and 6 out of the 9 students who participated in ILS pilot program/course responded to the evaluation/survey questions.

- How did you collect the qualitative data?

Response: Thank you for your question. This has already been addressed in page 7. Please refer the description under 2.6

(6) Discussion: Paragraph 2 and paragraph 3 of the discussion section are not in the form of discussion as you did not connect/compare your research results with those of other studies.

Response: Thanks again. The discussion has been revised. Please refer to the discussion on pages 12 and 13.

(7) Conclusion: Limitations and suggestions for further research should be presented.

Response 7: Thank you. Please this is not a research paper. Our manuscript/paper is project report from a small ISL pilot program. So, we do not need to make any further suggestion for future research.

(8) References: More up-to-date references should be provided.

Response: 8: Thank you for this observation.  We have added more recent references. Please refer to the reference list, page 15.

Author Response File: Author Response.docx

Round 2

Reviewer 4 Report

Many thanks for your effort to revise the paper. I do not have any further comment at this moment.

Minor editing of English language required.