The Challenges Teachers in Interprofessional Teaching Face When Developing a Shared Assumption of Responsibility: A Mixed-Methods Study

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for submitting the paper. Interprofessional education is something important to all educators of student healthcare professionals and understanding teacher perspectives would be useful to optimise student learning. Overall, the methodology used is appropriate to collect the data required, however there are a number of issues that make this paper difficult to interpret. These include:

- please revisit the title of the paper as i'm not sure it reflects the data presented.

- interchangeable use of competencies and competences. Please be clear what you mean by each of these. I appreciate they are similar in meaning, depending on the context, however it would be good to standardise use of these terms as much as possible.

- lack of clarity over what teachers from different professions would share responsibility in - would this be in delivery of the session? This needs to be made more explicit.

- lack of clarity in the difference between professional boundaries and competency boundaries (mentioned in the introduction). This made it difficult to understand the aim of the research and thus the research questions. These need better defining in the introduction with some examples of what is meant by professional and competence boundaries. 

- it's challenging to see and understand how the research questions are answered by the results. A lot of data has been collected, but not all of it relates to the questions. It would be good if the questions could be revisited or better context given around how the methods, results and discussion relate to the questions.

- the description of the qualitative results was very confusing. Unfortunately, i couldn't see how this related to the research questions. There could have been clearer links between the narrative of the theme and the associated quotes. I was also unsure about the relevance of moral and legal levels in relation to sharing responsibility for teaching/leading interprofessional sessions. There was also some discussion within this section of the results.

- Various categories and subcategories were identified with no narrative associated with much of the findings. A lot of data seems to have been collected but most of it not presented. The exclusion of other data needs better justification.

- Unfortunately, the discussion did not link with the findings of the study. It was unclear how the research questions were answered by your findings. I think this section needs re-writing to better critique the findings of the study and relate back to the research questions (i.e were the research questions answered?).

- There is no conclusion, which this paper would benefit from.

Some specific questions are:

- was the questionnaire validated in any other way, other than piloting it with test subjects?

- the questionnaire data was analysed descriptively. Was any statistics performed to compare data between the different health professions? 

- in table 2, what would fit in the 'other' criteria

- do you think you had obtained data saturation for each of the health professions?

 

Comments on the Quality of English Language

Overall, the quality of English language was of a good standard. There is some interchangeable use of tense. For examples, saying 'has' instead of 'was'. Past tense should be used. Specific language issues are:

lines 81-82: ...'online questionnaire was used as a basis'...

line 82: ...'understanding the meaning' of what? (unclear)

line 88: ...'Written consent was obtained..' 

line 96: please re-phrase this sentence as it's unclear

line 146: 'Results'

lines 166-190: please check the use of tense

Table 4: physiotherapy and recognising professional boundaries - the % sign needs removing

line 255: sometimes 'care sector' is mentioned. Is this the nurses?

Author Response

Dear reviewer,

thank you very much for your very detailed and helpful comments.

I have revised the article extensively and incorporated your suggestions and ideas to improve the quality of the article.

I have uploaded the completely revised article and look forward to your feedback.

Yours sincerely

Andrea Schlicker

 

- please revisit the title of the paper as i'm not sure it reflects the data presented. - Thank you for your feedback. This aspect has been revised.

- interchangeable use of competencies and competences. - Thank you for your feedback. This aspect has been revised.

- lack of clarity over what teachers from different professions would share responsibility in - Thank you for your feedback. This aspect has been completely revised and modified.

- lack of clarity in the difference between professional boundaries and competency boundaries - Thank you for your feedback. This aspect has been completely revised and modified.

- it's challenging to see and understand how the research questions are answered by the results. A lot of data has been collected, but not all of it relates to the questions. It would be good if the questions could be revisited or better context given around how the methods, results and discussion relate to the questions. - Thank you for your feedback. This aspect has been completely revised and modified.

- the description of the qualitative results was very confusing. - Thank you for your feedback. This aspect has been completely revised and modified.

- Various categories and subcategories were identified with no narrative associated with much of the findings - Thank you for your feedback. This aspect has been revised.

- Unfortunately, the discussion did not link with the findings of the study. - Thank you for your feedback. This aspect has been revised.

- There is no conclusion, which this paper would benefit from. - Thank you for your feedback. A conclusion was included

Author Response File: Author Response.docx

Reviewer 2 Report

Comments and Suggestions for Authors

The study is relevant and engaging. However, I have a few suggestions:

 

The terms "survey" and "questionnaire" are used inconsistently. I recommend choosing one term for clarity and including a copy of the questionnaire in the supplementary materials for transparency.

In line 43, the claim that "almost all medical faculties" have initiated interprofessional education projects is too broad. Consider revising for accuracy or providing a reference to support it.

The paper lacks a conclusion. I recommend adding a section summarizing key findings and discussing potential directions for future research.

Author Response

Dear reviewer,

thank you very much for your very detailed and helpful comments.

I have revised the article extensively and incorporated your suggestions and ideas to improve the quality of the article.

I have uploaded the completely revised article and look forward to your feedback.

Yours sincerely

Andrea Schlicker

 

- In line 43, the claim that "almost all medical faculties" have initiated interprofessional education projects is too broad. Consider revising for accuracy or providing a reference to support it. - Thanks for the feedback. This aspect has been added

- The paper lacks a conclusion. - Thank you for your feedback. A conclusion was included

Author Response File: Author Response.docx

Reviewer 3 Report

Comments and Suggestions for Authors

Dear Authors,

This paper addresses an interesting and relevant topic regarding the perception of competence boundaries and assumption of responsibility among teachers in interprofessional education (IPE). The mixed-methods approach, combining qualitative and quantitative data, is also valuable.

However, several aspects need improvement, including clarification of the research objectives, providing background on IPE, linking results to discussion, offering concrete recommendations on shared responsibility, adding a conclusion, and strengthening references.

Addressing these points will make the paper clearer, more persuasive, and more impactful in contributing to the practice of IPE.

Many thanks.

Best regards,

Comments for author File: Comments.pdf

Author Response

Dear reviewer,

thank you very much for your very detailed and helpful comments.

I have revised the article extensively and incorporated your suggestions and ideas to improve the quality of the article.

I have uploaded the completely revised article and look forward to your feedback.

Yours sincerely

Andrea Schlicker

- Insufficient background on IPE - Thanks for the feedback. This aspect has been added

- Weak connection between results and discussion - Thank you for your feedback. This aspect has been completely revised and modified.

- Absence of a conclusion - Thank you for your feedback. A conclusion was included

- This study focuses on teachers involved in IPE; however, there is a lack of detailed explanation of how IPE is typically practiced in Germany. - Thanks for the feedback. This aspect has been added

- To enhance the background section, I recommend adding information in the Introduction or Methods regarding. - Thanks for the feedback. These aspects have been added

- Weak Connection Between Results and Discussion - Thank you for your feedback. This aspect has been completely revised and modified.

- Responsibility and Taking Responsibility - Thank you for your feedback. This aspect has also been completely revised and adapted.

- Absence of a Conclusion - Thank you for your feedback. A conclusion was included

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for considering the comments and making revisions, accordingly. The manuscript is clearer in focus and much improved. There are still some revisions needed before this is accepted. Most are fairly minor, however some further revision of the discussion is required.

Abstract: please add n-values when you report percentages in the results section. The first sentence of the conclusions needs re-phrasing to make it clearer. 

General comment, please be consistent in terminology for teachers (trainers, teachers and lecturers are sometimes used interchangeably).

Introduction:

• line 47 '..collaboration in the context of training' is this training of the trainers?
• lines 57-58 are unclear in meaning. Please be clear what problems in the practical setting relate to and how this related to the competences.

Methods: line 125 'extracted..' from the data?

Results (title needs a capital R). 

• there weren't many teachers from the medical school. Do you think this would have any impact on your findings? It would be useful to discuss the demographic data and any relevance of it to your findings.
• Table 5 seems superfluous and so could be removed and the information incorporated in the text. Please also provided percentages in the narrative below table 5.
• The qualitative data section would benefit from sub-headings that relate to table 7. In addition, it would be important to understand if there were any varying opinions to those provided. If there are, these should be provided in the manuscript.
• lines 301-304 - is this your opinion or does it come from your findings? It comes across as a discussion of the results.

Discussion: you have the sub-headings of taking responsibility, joint assumption in responsibility and need for content knowledge. It's not clear whether you have addressed the research question about what skills should teachers have. Also, whilst the discussion has improved, i was still struggling with knowing the evidence you provide fits with your aim. Many of the examples are about student learners and how best to train them, rather than how teachers would help facilitate this process, based on your data.

• first paragraph in section 4.1 - it's unclear how the content described in lines 317-327 relate to your findings about teachers, or how the differences in nurses and physicians responsibility differences relate to what your data shows.
• section 4.2 - is the information about ZIPAS necessary for what your study has found? If so, please ensure it's clear how this relates to your findings.
• it might help to include phrases such as 'our study found' or 'this relates to our findings which showed...' How section 4.3 is written is a good example.

Something i forgot to mention before is that there should be an acknowledgement of the limitations of the study.

Conclusions: thank you for adding this. It would be helpful to make more clear what the implications and outcome of your findings would be. For example, what would be the next step and what changes could be recommended based on your findings.

Author Response

Dear reviewer,

thank you for your valuable feedback.I have attached the point-by-point revision.

I hope you are satisfied. If there are any aspects that still need to be worked on, please let me know. I am happy to receive any information that will help to make the topic visible and present it.

Kind regards,

Andrea Schlicker

 

Abstract: please add n-values when you report percentages in the results section. - Numbers added

The first sentence of the conclusions needs re-phrasing to make it clearer. - changed

General comment, please be consistent in terminology for teachers (trainers, teachers and lecturers are sometimes used interchangeably). - revised

Introduction:

• line 47 '..collaboration in the context of training' is this training of the trainers? - Sentence added additionally
• lines 57-58 are unclear in meaning. Please be clear what problems in the practical setting relate to and how this related to the competences. - Sentence added additionally

Methods: line 125 'extracted..' from the data? - - wording changed: Seven topic areas were identified

Results (title needs a capital R). - changed

There weren't many teachers from the medical school. Do you think this would have any impact on your findings? It would be useful to discuss the demographic data and any relevance of it to your findings. - In the limitation added

Table 5 seems superfluous and so could be removed and the information incorporated in the text. - Information has been included in the text

Please also provided percentages in the narrative below table 5.- - Table supplemented with percentages

 

The qualitative data section would benefit from sub-headings that relate to table 7. - Headings have been added

 

Lines 301-304 - is this your opinion or does it come from your findings? It comes across as a discussion of the results. - changed

Discussion: you have the sub-headings of taking responsibility, joint assumption in responsibility and need for content knowledge. It's not clear whether you have addressed the research question about what skills should teachers have. Also, whilst the discussion has improved, i was still struggling with knowing the evidence you provide fits with your aim. Many of the examples are about student learners and how best to train them, rather than how teachers would help facilitate this process, based on your data.  - changed

First paragraph in section 4.1 - it's unclear how the content described in lines 317-327 relate to your findings about teachers, or how the differences in nurses and physicians responsibility differences relate to what your data shows. - changed

Section 4.2 - is the information about ZIPAS necessary for what your study has found? If so, please ensure it's clear how this relates to your findings. - removed

I might help to include phrases such as 'our study found' or 'this relates to our findings which showed...' How section 4.3 is written is a good example. - Thanks for the helpful suggestion

Something i forgot to mention before is that there should be an acknowledgement of the limitations of the study. - supplemented

Conclusions: thank you for adding this. It would be helpful to make more clear what the implications and outcome of your findings would be. For example, what would be the next step and what changes could be recommended based on your findings. - added

Author Response File: Author Response.docx

Reviewer 3 Report

Comments and Suggestions for Authors

Dear Authors,

Overall, the manuscript has been revised based on the feedback provided, and significant improvements are evident. However, I still find the discussion in Section 4.1. Taking Responsibility unconvincing. While the topic of this section is highly relevant and contributes valuable insights into the role of educators in interprofessional education (IPE), the argumentation requires further refinement in the following aspects.

4.1. Taking Responsibility

1. Consistency of Logic and Causal Relationships
This section reports that IPE educators (particularly those in nursing education) tend to adopt a cautious stance toward assuming responsibility. However, the claim that this tendency is caused by a lack of self-reflection opportunities in the IPE curriculum is not sufficiently substantiated.

Currently, the argument requires readers to infer the logical connection between "a lack of self-reflection in IPE" → "its influence on educators’ approach to responsibility." This dependence on reader interpretation weakens the clarity of the discussion.

Suggested Revisions:
Provide a more explicit explanation of how a lack of self-reflection influences the approach to responsibility.
If this causal relationship is not directly supported by the study’s data, it should be clearly stated as a hypothesis and framed as a subject for further research.
Example: “This study observed a tendency among IPE educators to be cautious in assuming responsibility. However, whether this tendency is influenced by the lack of self-reflection opportunities in the IPE curriculum requires further investigation.”

2. Appropriateness of the Citation of Harendza (2022) [21]
Harendza (2022) [21] discusses how nurses tend to bear a significant burden of responsibility early in their careers, while medical students are expected to develop an understanding of responsibility during their studies. While this distinction is insightful, this study does not directly examine the attitudes or behaviors of IPE educators.

Thus, the necessity of citing Harendza (2022) in this context is unclear within the current discussion.

Suggested Revisions:
Clearly explain how Harendza (2022) relates to the approach of IPE educators toward responsibility.
Consider adding more relevant literature that directly addresses how educators assume responsibility in an interprofessional context.
If this study is retained as a citation, add a clarifying statement such as:
“The differences in responsibility perceptions across professions, as highlighted by Harendza (2022), may influence the attitudes of IPE educators toward assuming responsibility.”

3. Alignment Between Data and Arguments
The quantitative data in this study indicates that IPE educators exhibit a cautious stance toward assuming responsibility. However, the claim that this cautious stance results from a lack of self-reflection opportunities is not directly supported by the study’s data. Therefore, additional evidence is required to strengthen this assertion.

Suggested Revisions:
If qualitative data (e.g., interview statements) suggest that the lack of self-reflection impacts responsibility-taking, these should be explicitly referenced.
Incorporate existing literature that explores the influence of self-reflection on responsibility assumption to reinforce this claim.
If the claim remains speculative, present it as a hypothesis rather than a conclusion and highlight it as a topic for future research.
Example: “Providing more opportunities for self-reflection in IPE may enhance educators’ balance in assuming responsibility. However, further empirical research is needed to establish this relationship.”

4. Need for Clarity in Scientific Writing
In scientific writing, statements should not require significant effort on the part of the reader to infer their meaning. The current discussion has the following issues:

The relationship between "lack of self-reflection" and "approach to responsibility" requires reader inference.
The connection between data and argumentation is unclear, potentially leading to multiple interpretations.
Suggested Revisions:
Clearly define the relationship between claims and supporting evidence to avoid logical leaps.
If the study lacks data to substantiate certain claims, explicitly frame them as hypotheses rather than conclusions to prevent misinterpretation.
Overall Evaluation and Revision Suggestions
This section provides an important discussion on the cautious approach of IPE educators in assuming responsibility, which is a valuable contribution to the field. However, the following improvements are necessary:

Clarify whether the lack of self-reflection in IPE directly influences educators’ approach to responsibility or if this remains a hypothesis.
Reevaluate the appropriateness of citing Harendza (2022) [21] and either strengthen its justification or replace it with more relevant literature.
Ensure that claims about responsibility-taking are fully supported by the study’s data or framed as hypotheses for future investigation.
Revise the text to minimize ambiguity and ensure that readers do not need to infer logical connections.
By addressing these issues, this section will become more coherent, logically sound, and scientifically rigorous.

→ Implementing these revisions will strengthen the logical framework of the manuscript and enhance its clarity and impact.

Best regards,

Author Response

Dear reviewer,

thank you for your valuable feedback.I have attached the point-by-point revision.

I hope you are satisfied. If there are any aspects that still need to be worked on, please let me know. I am happy to receive any information that will help to make the topic visible and present it.

Kind regards,

Andrea Schlicker

 

4.1. Taking Responsibility

1. Consistency of Logic and Causal Relationships
   This section reports that IPE educators (particularly those in nursing education) tend to adopt a cautious stance toward assuming responsibility. However, the claim that this tendency is caused by a lack of self-reflection opportunities in the IPE curriculum is not sufficiently substantiated. - revised

Currently, the argument requires readers to infer the logical connection between "a lack of self-reflection in IPE" → "its influence on educators’ approach to responsibility." This dependence on reader interpretation weakens the clarity of the discussion. - revised

Suggested Revisions:
Provide a more explicit explanation of how a lack of self-reflection influences the approach to responsibility.
If this causal relationship is not directly supported by the study’s data, it should be clearly stated as a hypothesis and framed as a subject for further research.
Example: “This study observed a tendency among IPE educators to be cautious in assuming responsibility. However, whether this tendency is influenced by the lack of self-reflection opportunities in the IPE curriculum requires further investigation.” - Thanks for the helpful suggestion

2. 
   Appropriateness of the Citation of Harendza (2022) [21]
   Harendza (2022) [21] discusses how nurses tend to bear a significant burden of responsibility early in their careers, while medical students are expected to develop an understanding of responsibility during their studies. While this distinction is insightful, this study does not directly examine the attitudes or behaviors of IPE educators.Thus, the necessity of citing Harendza (2022) in this context is unclear within the current discussion.Suggested Revisions:
   Clearly explain how Harendza (2022) relates to the approach of IPE educators toward responsibility.
   Consider adding more relevant literature that directly addresses how educators assume responsibility in an interprofessional context.
   If this study is retained as a citation, add a clarifying statement such as:
   “The differences in responsibility perceptions across professions, as highlighted by Harendza (2022), may influence the attitudes of IPE educators toward assuming responsibility.” - This very helpful hint prompted me to revise this part again.
3. 
   Alignment Between Data and Arguments
   The quantitative data in this study indicates that IPE educators exhibit a cautious stance toward assuming responsibility. However, the claim that this cautious stance results from a lack of self-reflection opportunities is not directly supported by the study’s data. Therefore, additional evidence is required to strengthen this assertion.Suggested Revisions:
   If qualitative data (e.g., interview statements) suggest that the lack of self-reflection impacts responsibility-taking, these should be explicitly referenced.
   Incorporate existing literature that explores the influence of self-reflection on responsibility assumption to reinforce this claim. If the claim remains speculative, present it as a hypothesis rather than a conclusion and highlight it as a topic for future research. Example: “Providing more opportunities for self-reflection in IPE may enhance educators’ balance in assuming responsibility. However, further empirical research is needed to establish this relationship.” - revised
4. 
   Need for Clarity in Scientific Writing
   In scientific writing, statements should not require significant effort on the part of the reader to infer their meaning. The current discussion has the following issues: The relationship between "lack of self-reflection" and "approach to responsibility" requires reader inference.
   The connection between data and argumentation is unclear, potentially leading to multiple interpretations.
   Suggested Revisions:
   Clearly define the relationship between claims and supporting evidence to avoid logical leaps.
   If the study lacks data to substantiate certain claims, explicitly frame them as hypotheses rather than conclusions to prevent misinterpretation.
   Overall Evaluation and Revision Suggestions
   This section provides an important discussion on the cautious approach of IPE educators in assuming responsibility, which is a valuable contribution to the field. However, the following improvements are necessary: Clarify whether the lack of self-reflection in IPE directly influences educators’ approach to responsibility or if this remains a hypothesis.
   Reevaluate the appropriateness of citing Harendza (2022) [21] and either strengthen its justification or replace it with more relevant literature.
   Ensure that claims about responsibility-taking are fully supported by the study’s data or framed as hypotheses for future investigation.
   Revise the text to minimize ambiguity and ensure that readers do not need to infer logical connections.
   By addressing these issues, this section will become more coherent, logically sound, and scientifically rigorous. - revised

 

Author Response File: Author Response.docx