Design and Assessment of a Multidisciplinary Training Programme on Child Abuse and Child Protection for Medical Students Comprising Coursework and a Seminar

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Introduction: The introduction needs to comprehensively review the literature on the training of child abuse and protection in medical schools globally, focusing on the various approaches, their effectiveness, and the implications of implementing such a program at the University of Ghana.

Methods:

1. The methodology section requires clarification.

2. It's crucial to establish the effectiveness of the training program through pre- and post-test knowledge assessments. This study lacks a pre-test, making it challenging to determine any enhancement in student knowledge.

3. Furthermore, the details of the study instrument and the nature of the multidisciplinary training program, including the qualifications and roles of the trainers, need to be elaborated.

Results:

1. The results section appears disorganized.

2. The results emphasized on the description of the training program.

Discussion:

1. The discussion is overly lengthy and includes some irrelevant information.

2. It would be beneficial to compare this training program with those implemented in medical schools in other countries and identify the strengths and weaknesses of the current program.

3. Furthermore, analyzing both pre- and post-training test scores would provide deeper insights into the program's impact on student learning.

Final comment:  To enhance the study's impact, a longitudinal follow-up would be advantageous. This would allow for the assessment of the long-term effects of the training on students' professional behavior and competence in handling child abuse cases, thus offering a more comprehensive understanding of the program's effectiveness.

Comments on the Quality of English Language

Extensive editing of English language required.

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Reviewer 2 Report

Comments and Suggestions for Authors

The manuscript reports an interesting experience on an often neglected topic. I found particularly relevant the reference to an emergent health and social topic in the country. Actually, one of the study's key takeaways that should be emphasized is the importance of firmly establishing medical education in the context of the needs of the population that will be served.

Overall, the study is based on a follow-up survey and is an "how I did it" account of a local experience. The scientific value is low, so a reader's main interest might be to focus on the topics, the expected learning outcomes, and the teaching and learning methods aligned to them. I suggest some changes in this direction to improve the interest in the article.

1. Aim and Objectives of the training programme (lines160-170)

In this section you mix up some real learning outcomes with teachers' actions (equip or provide students with knowledge ...)

I suggest that you provide a list of expected learning outcomes, expressed in the standard format as "verb + object + context". For example: at the end of the teaching and learning activity, the student will be able to:
- explain the definition of, risk factors for, and results of child abuse and neglect in an oral presentation (an essay, a poster, a dissertation, ...)
- identify indicators of abuse and neglect in a clinical vignette (or simulated case, video, etc.)

In reading your manuscript I had the impression that you focused the topics (the knowledge content) rather that the competecies (the way a student or professional USES knowledge). If you list the expected learning outcomes, you can then justify the way in which you designed both the assessment and the teaching and learning activities.
To be clearer, you wrote that "A majority of the students were able to correctly identify the components of child abuse and the forms of child abuse as shown in Table 3." (lines 302-303) I disagree that by answering a true or false question, you can assess if the student is able to "identify" risk factors or types of abuse. I think this is only "listing" or "pointing in a list.". From a cognitive point of view, this does not necessarily correspond to the ability to recognize a risk condition in a scenario, even in a text or simulation.

Teaching and learning activities

I suggest that you could summarize the activities in a diagram, showing their flow and the number of students engaged in each phase and activity. A diagram would be very useful for the reader. 

In lines 380–381, you wrote "This seminar emphasized history taking, clinical examination and decision-making ability". I agree that the seminar could have emphasized the need for specific training for HT, PE, and DM skills. I don't think that attending a seminar or even designing and preparing a seminar is aligned with the acquisition of practical communication and DM skills.
I have the same problem with lines 427-429 "Thus, we used the lecture, case reports and presentations on the major forms of abuse and clinical management to develop their clinical reasoning ability. What was lacking was clinical experience,". What was lacking is active training ON cinical cases, according to the case-based learning principles. Case reports are not enough! Even clinical experience, if it is not followed by critical self or social reflection does not produce learning.

In the Discussion you should highlight the need students expressed for more active learning methods. Not only role play or simulation, that are resource expensive, but mainly case-based learning.

References
I suggest that you add some more references on educational programs on child abuse. Through a quick search I found
- PLoS One 2022 Nov 9;17(11):e0276985. doi: 10.1371/journal.pone.0276985. Digital games and virtual reality applications in child abuse: A scoping review and conceptual framework
- Knowledge and attitudes toward child abuse and neglect among medical and dental undergraduate students and interns in Riyadh, Saudi Arabia Gopalakrishna, Vidyullatha et al
- PEREZ-RENDON, José Gabriel et al. Child abuse topic in undergraduate and postgraduate medical curriculum in Mexico. Acta pediatr. Méx [online]. 2015, vol.36, n.2, pp.61-71.
- Child Abuse Training and Knowledge: A National Survey of Emergency Medicine, Family Medicine, and Pediatric Residents and Program Directors Pediatrics (2009) 123 (4): e595–e602. https://doi.org/10.1542/peds.2008-2938

These are the results of a 5 minutes browsing through Pubmed and Google Scholar, I'm sure you can do better.

Minor issues
1. Lines 87-88 "Seminars are presentations that enable students to collect, organise and present data on an assigned topic according to conventional outlines within a given time frame [16]." I suggest that you should move this sentence at th eend of the section, just after the first mention of "seminar"

2. line 126 "All 208 final-year medical students": from both the programs? 

3. line 149 "the 6th year of medical school or the third clinical year": again, third year from the graduate program and 6th undergraduate?

4. lines 176-177 "This was shared through balloting for 4 to 6 topics together with other topics that were unrelated to child abuse/protection among the 50 students in each group." Sorry, I could not understand this sentence, please rephrase it.

5. line 184 "Community Diagnosis projects": either you write it always in Capital or in plain letters.

6. lines 253-254 "and Thirty-Three (33) guests and staff. A total of Twenty-Four (24)" Why in Capital?

Comments on the Quality of English Language

Overall, the English language is good. I just pointed to one odd sentence and the use of Capitol.

Author Response

Please see attached file

Author Response File: Author Response.docx

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

The authors responded adequately to my suggestion, and the manuscript is improved and fit for publication