Pharmacist-led prescription writing educational intervention to final-year medical students: A pre-post non-randomised longitudinal study

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Mallett" } ], "publisher": { "@type": "Organization", "name": "F1000Research", "logo": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 480, "width": 60 } }, "image": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 1200, "width": 150 }, "description": " Background Writing a medication prescription is a multifaceted skill expected of all junior doctors. However, many medical students feel a lack of preparedness and confidence after graduation. Separating the teaching of practical and clinical components may enhance understanding of the practical skills to complete a prescription. This study aimed to: (1) assess whether additional pharmacist-led multimodal education interventions change the prescribing skills of Australian final-year medical students, (2) evaluate knowledge retention a year later in the same participants as junior doctors, and (3) determine whether there is an association between self-perceived confidence to prescribe and their practical ability to write safe and legal prescriptions. This manuscript details the methods used in this novel longitudinal study. Methods This non-randomised pre-post longitudinal study was conducted in two phases. The intervention was additional pharmacist-led multimodal education on prescription writing skills for final-year medical students. The intervention group completed the pre-post and follow-up tests. This study was approved by the James Cook University Human Research Ethics Committee (approval number H9114). Discussion This paper presents the methods and protocol of an approved and funded non-randomised longitudinal study investigating the potential of additional education led by pharmacist educators to improve prescribing knowledge and skills among final-year medical students in Australia. Prescribing skills education for medical students may reduce the probability of potentially incorrect or unsafe prescribing habits as junior doctors. Education standards do not acknowledge adherence to local legal regulations when prescribing and do not recommend mandatory teaching or assessment criteria. This study reviews the effectiveness of and need for additional education on the practical skill of writing a medication prescription. If positive, the findings of this study will have practical and policy impacts that may result in long-term improvements in safe medicine practice and ultimately benefit patient care. 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F1000Research 2026, 14 :581 ( https://doi.org/10.12688/f1000research.163920.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Study Protocol Revised Pharmacist-led prescription writing educational intervention to final-year medical students: A pre-post non-randomised longitudinal study [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] Sophie Mokrzecki https://orcid.org/0000-0003-3181-6523 1,2 , Tarun Sen Gupta 1 , Tilley Pain 3,4 , Stephen Perks 2 , Andrew J. Mallett https://orcid.org/0000-0002-8752-2551 1,5,6 Sophie Mokrzecki https://orcid.org/0000-0003-3181-6523 1,2 , Tarun Sen Gupta 1 , [...] Tilley Pain 3,4 , Stephen Perks 2 , Andrew J. Mallett https://orcid.org/0000-0002-8752-2551 1,5,6 PUBLISHED 05 Feb 2026 Author details Author details 1 College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia 2 Pharmacy Department, Townsville University Hospital, Townsville, Queensland, 4814, Australia 3 Allied Health Governance Office, Townsville University Hospital, Townsville, QLD, Australia 4 College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia 5 Department of Renal Medicine, Townsville University Hospital, Townsville, QLD, Australia 6 Institute for Molecular Bioscience and Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia Sophie Mokrzecki Roles: Conceptualization, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Software, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Tarun Sen Gupta Roles: Supervision, Validation, Visualization, Writing – Review & Editing Tilley Pain Roles: Supervision, Writing – Review & Editing Stephen Perks Roles: Investigation, Methodology, Resources, Software, Supervision, Validation, Visualization, Writing – Review & Editing Andrew J. Mallett Roles: Methodology, Supervision, Validation, Visualization, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Background Writing a medication prescription is a multifaceted skill expected of all junior doctors. However, many medical students feel a lack of preparedness and confidence after graduation. Separating the teaching of practical and clinical components may enhance understanding of the practical skills to complete a prescription. This study aimed to: (1) assess whether additional pharmacist-led multimodal education interventions change the prescribing skills of Australian final-year medical students, (2) evaluate knowledge retention a year later in the same participants as junior doctors, and (3) determine whether there is an association between self-perceived confidence to prescribe and their practical ability to write safe and legal prescriptions. This manuscript details the methods used in this novel longitudinal study. Methods This non-randomised pre-post longitudinal study was conducted in two phases. The intervention was additional pharmacist-led multimodal education on prescription writing skills for final-year medical students. The intervention group completed the pre-post and follow-up tests. This study was approved by the James Cook University Human Research Ethics Committee (approval number H9114). Discussion This paper presents the methods and protocol of an approved and funded non-randomised longitudinal study investigating the potential of additional education led by pharmacist educators to improve prescribing knowledge and skills among final-year medical students in Australia. Prescribing skills education for medical students may reduce the probability of potentially incorrect or unsafe prescribing habits as junior doctors. Education standards do not acknowledge adherence to local legal regulations when prescribing and do not recommend mandatory teaching or assessment criteria. This study reviews the effectiveness of and need for additional education on the practical skill of writing a medication prescription. If positive, the findings of this study will have practical and policy impacts that may result in long-term improvements in safe medicine practice and ultimately benefit patient care. READ ALL READ LESS Keywords Medical students, Prescriptions, Pharmacists, Medical education Corresponding Author(s) Sophie Mokrzecki ( [email protected] ) Close Corresponding author: Sophie Mokrzecki Competing interests: No competing interests were disclosed. Grant information: This study was funded by an approved and competitively awarded grant: 2023 and 2024 Townsville Hospital and Health Service (THHS) Study Education and Research Trust Account (SERTA) Grants. AJM was supported by a Queensland Health Advancing Clinical Research Fellowship. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2026 Mokrzecki S et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Mokrzecki S, Sen Gupta T, Pain T et al. Pharmacist-led prescription writing educational intervention to final-year medical students: A pre-post non-randomised longitudinal study [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2026, 14 :581 ( https://doi.org/10.12688/f1000research.163920.2 ) First published: 12 Jun 2025, 14 :581 ( https://doi.org/10.12688/f1000research.163920.1 ) Latest published: 05 Feb 2026, 14 :581 ( https://doi.org/10.12688/f1000research.163920.2 ) Revised Amendments from Version 1 This version has undergone major reviews to the entirety of the paper. We believe this paper now presents a clearer protocol in the possibility that this study is replicated at other sites. Further explanation into how the study was conducted and justifications as to why allows the reader to have a transparent view of the methods used to both educate and assess the participants. The tense used in this paper was a major correction, and hope this provides clarity to the reviewers and future readers. This version has undergone major reviews to the entirety of the paper. We believe this paper now presents a clearer protocol in the possibility that this study is replicated at other sites. Further explanation into how the study was conducted and justifications as to why allows the reader to have a transparent view of the methods used to both educate and assess the participants. The tense used in this paper was a major correction, and hope this provides clarity to the reviewers and future readers. See the authors' detailed response to the review by Pathiyil Ravi Shankar See the authors' detailed response to the review by Paul Chin See the authors' detailed response to the review by David Newby READ REVIEWER RESPONSES Introduction A medication prescription is a legal document that only approved prescribers may authorise, ensuring the safe use of medicines. Writing a medication prescription is a multifaceted skill incorporating multiple layers and dimensions ( Figure 1 ). While it is a competency expected of all junior doctors, many medical students feel a lack of preparedness and confidence in completing a medication prescription after graduation. 1 , 2 Unpreparedness may occur because of an unclear definition of the term ‘prescribe’ resulting in medical education governing bodies and providers not developing clear strategic learning and assessment resources 3 to teach the different aspects of prescribing. Figure 1. Infographic describing the characteristics of what makes prescribing medication for the consumer multilayered and multidimensional (reproduced with permission) 2 . The definition of ‘to prescribe’ varies internationally based on local legislative or professional requirements. 4 , 5 Here, we describe a research study and intervention conducted in Australia where the Health Workforce Australia definition of prescribe will be used: ‘ the process involving information gathering, clinical decision making, communication and evaluation, resulting in the initiation, continuation or cessation of a medicine’. 4 This definition aligns with the steps within the medication management pathway 6 as recommended by the Australian Commission on Safety and Quality in Health Care, ensuring the safe and quality use of medications. The medication management pathway describes prescribing as multilayered ( Figure 1 ), 6 grouping clinical and practical knowledge and calling the combined process “prescribing.” We previously proposed that education may be designed to teach the technical and practical skills of prescribing independently from clinical decision-making by separating the two components. 2 Separating the multilayered prescribing pathway allows education systems to restructure and develop specific learning objectives for the practical skill of writing medication prescriptions. Teaching the practical and clinical components separately may enhance the understanding of the practical skill of prescribing, prior to integrating the clinical knowledge of prescribing into the completed prescription. Prescribing is also multidimensional ( Figure 1 ), with differences between inpatient ordering and writing outpatient or discharge prescriptions. Targeted education on the practical skill of writing a discharge or outpatient prescription is less than that on inpatient medication ordering. 2 , 7 Education on one type of medication authorisation fails to prepare future prescribers across other contexts or scenarios of medication authorisation and prescription. It is critical for medical students to gain knowledge and skills in prescription writing throughout their medical training so that they understand, and can apply, the fundamentals of prescription and medication supply authorisation by the time of graduation. 8 It is assumed that this knowledge and understanding will produce efficient, safe, and legal prescribers using all prescribing domains (electronic and handwritten). Sound awareness of the fundamentals of a prescription may reduce prescribing errors when using unfamiliar systems to prescribe. Influencing early awareness of safe and legal prescribing can be challenging. Many educational interventions target junior doctors, with less emphasis on educating medical students. Differences in medical education curricula (e.g., postgraduate versus undergraduate courses and varying length of university degrees), and assessable criteria may contribute to inconsistent prescribing skills of graduates and thus, possible inadvertent medication errors or harm. These education shortfalls may increase medication misadventure, harm to patients and costs on health systems. 9 , 10 The World Health Organisation (WHO) Guide to Good Prescribing (GGP) is a well-known and well-utilised resource in medical education curricula worldwide. The GGP is a 6-step therapeutic problem-solving guide for teaching prescribing to medical students internationally but is not mandatory. It proposes that clinical training focuses on diagnostic rather than therapeutic skills and acknowledges that prescribing skills do not improve much after graduation. 9 We recommend mandatory training on the practical skill of prescribing while acknowledging the importance of therapeutic knowledge. The identified gap in medical education is in teaching the skill of writing a discharge or outpatient medication prescription. We have previously identified that Australian and New Zealand (NZ) final-year medical students prefer pharmacists to provide multimodal education on prescription writing. 2 Students in their final year of medical school training are likely motivated to actively engage in prescription education and training, given the proximate need to independently apply the knowledge in their subsequent first postgraduate or internship year. To our knowledge, no studies have investigated the incorporation of a pharmacist educator with additional multimodal learning resources for final-year medical students to improve multilayered and multidimensional prescribing skills across potential outpatient and discharge prescription settings. In this study, we built upon previous pilot findings 2 , 11 to conduct a pre-post non-randomised longitudinal study of a pharmacist educator who developed additional prescription education interventions for final-year medical students in Australia. Our primary objective is to assess whether pharmacist-led multimodal education interventions change the discharge/outpatient technical prescribing skills of final-year medical students, at James Cook University (JCU), Australia. Our secondary aim was to review knowledge retention of prescribing skills in the same participants a year later as junior doctors. Thirdly, we aimed to determine if there is an association between participants’ self-perceived confidence in prescribing and their practical ability to write safe and legal discharge/outpatient prescriptions. This manuscript describes in detail the methods used in this novel longitudinal study. Protocol Study design This non-randomised pre-post longitudinal study was conducted in two phases ( Figure 2 ). The intervention was pharmacist-led multimodal education on prescription writing skills for final-year medical students. This is a non-randomised study with no control group based on ethics, fairness, and logistics of conducting the intervention over vast geographical locations to ensure that information sharing did not contaminate the collected data. Figure 2. Design structure of two-phase non-randomised pre-post longitudinal review study. Phase 2A Baseline data collected in 2023 assisted in the content validity of this two-phase study, informing phase 2B. This phase acted as the comparator to phase 2B pre-test, ensuring that students’ prescribing skills are comparable at similar time points, both between calendar years and prior to additional educational interventions. Due to study logistics with the participating university, ethical approvals, and accounting for assessment burden on participants, this cohort did not act as a control group and were not assessed 5 weeks post standard placement (with no additional education interventions). A pilot study had previously published the effects with a control group. 11 Phase 2B This interventional phase formed the pre-post design of this study in 2024. The principal investigator is a pharmacist who developed and led the multimodal educational intervention conducted after the pre-test. Participants attended their standard 5-week placement block prior to completing the post-test. Phase 3 Participants who acknowledged their participation in phase 3 voluntarily provided a contact email after completing phase 2B. The follow-up test in 2025 resulted in the longitudinal design of this study. Study setting This study is developed and conducted in Queensland (QLD), Australia, through the Medical School Program of the JCU College of Medicine and Dentistry. Bachelor of Medicine, Bachelor of Surgery at JCU is a 6-year undergraduate course. Like other Australian medical schools, it undergoes periodic review and accreditation by the Australian Medical Council. The course includes face-to-face and case-based learning modalities with mandatory clinical placements. Placement blocks vary in duration and expose students to a variety of specialties. Not all students complete identical placement rotations at the same time. The JCU curriculum, like many other curricula, focuses more on therapeutic choice (for example, choice of drug, dose and route) rather than the technical skill to writing a medication prescription, which is the focus of this study. In 5 th year, students receive an introduction to prescribing as per the Pharmaceutical Benefits Scheme (PBS). Students are not assessed on this information and have limited opportunity to practice writing a prescription. Any other learnings on prescription writing are opportunistic or self-directed. Anecdotally, medical students have written medication prescriptions and had an authorised prescriber countersign, but this process is not legal. This study provided a protected environment for participants to practice writing a medication prescription, which is an essential skill that does not have mandated assessment in Australia. Participants As the recruited medical school, convenience sampling was used to invite all JCU final-year medical students based in Townsville, Cairns, Mackay, rural and remote locations, and on their elective rotation. JCU medical students not in their final year of medical education or from other universities were excluded from this study. This study also excluded junior doctors from 2025 who were not actively involved in phase 2B during 2024. All participants were required to provide written informed consent in each phase by completing a mandatory field when commencing the test and accepting to participate. Phase 2A of this study was conducted in 2023 with JCU final-year medical students. This was the comparator to phase 2B pre-test. Participation was voluntary and anonymous. This cohort was not included in the interventional study. There were 169 year-6 (final-year) medical students enrolled at JCU in each year of 2023 and 2024 and invited to participate. Our randomised controlled trial pilot study produced a difference in the total mean score of eight points between groups. 11 However, the pilot study involved a very small sample size, so the lower bound of the 95% confidence interval for the mean difference was substantially less (approximately 3); therefore, a conservative approach requires a sample size large enough to allow a difference as small as 3 to be detected. This was based on a two-tailed test with an alpha of 5% and power of 80%. This difference in prescribing scores is clinically meaningful and relevant to practice based on the literature. 11 , 12 A 25% dropout rate was factored into the sample size calculation. Using G*Power version 3.1.9.4, this study required 76 participants and therefore a total of 95 students was determined to be an ideal sample size. We previously identified final-year medical student’s preference for prescription writing education is during the final year of medical education. 2 Phase 2B included the JCU final-year medical student cohort of 2024 from July to August. The consenting Phase 2B cohort formed the participant group for phase 3 in 2025 as junior doctors (interns). In the Australian context, the intern year is the first postgraduate year (PGY1) after completion of medical school and is completed in accredited hospitals and health services in accredited programs with provisional registration from the national clinician registration body (Australian Health Practitioner Regulation Agency - AHPRA). Progression to general registration as a medical officer is conditional upon the successful completion of all the required rotations in an accredited intern program. Voluntary participation in phase 2B and phase 3 was not anonymous to ensure that data could be paired to assist with the analysis. Data from phase 2B and phase 3 was coded, analysed, and presented in de-identified formats. Intervention Intervention and assessment criteria are specific to local state legal regulation of the Medicines and Poisons (Medicines) Regulation (MPR) 2021. Some participants may have been on placement in other locations external to QLD at the time. However, as their medical degree is based through JCU QLD, all educational materials used in the additional education modalities and assessable criteria adhered to QLD regulations. Additional education modalities Mokrzecki et al. phase-1 study identified that final-year medical students’ preference is a multimodal education package on the skill of prescription writing delivered by a pharmacist during standard placement blocks with hands-on experiences (workshops) and tutorials. 2 These preferences assisted in developing the intervention methods presented. Final-year medical students from 2023 (Phase 2A) completed only the online prescription writing test to ensure content validity during the intervention phase (phase 2B). Phase 2A testing was conducted in a whole cohort session, where participants were then offered the face-to-face education package to meet ethics criteria. This study aimed to cover all additional education modalities by providing face-to-face education with case-based learning and hands-on experiences (roughly 1.5 h), supported by an online learning module (roughly 30 min), implemented during a standard five-week placement block ( Figure 2 ). Education was provided by a pharmacist regarding the skill of writing a prescription, separate from the clinical decision-making process within the medication management pathway. Education materials were supported by resources such as the MPR, PBS, and the Australian Medicines Handbook (AMH). To assess the content and remove bias from having one pharmacist educator, this intervention recruited two other pharmacists to deliver the face-to-face intervention to the participants in Cairns and Online. All trainers underwent training by SM to ensure consistency in education delivery. The effects of this multimodal education package on prescribing skills were determined by assessing participants pre-post the intervention, and again as junior doctors (intern year). Online learning module The online education is an interactive learning module developed through Articulate ® by SM and launched online on LearnJCU ® (digital learning environment utilised by JCU) after students completed the pre-test. It is an overview of the face-to-face education that participants were encouraged to complete. Participants could engage with the content as many times as they wished during the five-week placement period. Access to the content closed immediately before completing the post-test. Face-to-face education Face-to-face education consisted of an interactive hands-on teaching model (workshop format), first reviewing the legal requirements of a prescription from the Queensland MPR (tutorial format). This guided case-based learning into training functionalities of the PBS and AMH, and how using these resources assist in writing medication prescriptions. Hands-on opportunities During face-to-face education, cases were used to assist participants in learning and practicing how to write various medication prescriptions. In Australia, the government and the scheduling of medicines restrict the use of medications and poisons. These restrictions determine the way a prescription needs to be written and extra legal and safety criteria that the prescriber must document. Medicines and poisons are classified under schedules (S2-10) as per the Standard for the Uniform Scheduling of Medicines and Poisons (SUSMP). For the purposes of this intervention, participants were mainly taught about S4 (Prescription Only), and S8 (Controlled Drugs) scheduling as this encompassed the general factors required when writing a prescription. Education was further extrapolated by teaching differences in PBS and non-PBS medications. Participants also engaged with the interactive features of the online learning module to complete S4 and Monitored medicine/S8 medication prescriptions. All prescription writing cases used during the educational interventions and the pre-post and follow-up tests differed to reduce the potential of information sharing. Assessment and data collection methods To our knowledge, no assessment tool has been developed that has the functionality to assess the skill of writing a complete discharge or outpatient medication prescription separate from making a clinical decision or inpatient medication ordering. The assessment tool developed for this study was conceptualised by the principal investigator (SM), based on the MPR requirements, and approved by all authors ( Figure 3 and Table 1 ). A pilot study by Mokrzecki et al. 11 and some of the preliminary questions of Mokrzecki et al. 2 assisted in the development of all test questions in each phase. Online prescription writing assessment consisted of varied preliminary questions (demographic and multiple-choice knowledge-based questions) and five cases yielding six prescriptions ( Figure 3 ). Figure 3. Copy of phase 2A written case information showing an example of similar Schedule four prescription cases in each phase. Four other cases (complex S4, S4 streamline, S8 and mixed), are not displayed. Table 1. DPSP components. Drug factors Prescriber factors Safety factors Patient factors 1. Name 2. Strength 3. Dose/Form 4. Directions 5. Quantity 6. Repeats 1. Name (with unique identifier – prescriber number) 2. Signature 3. Place of practice address 4. Contact number 5. Qualifications 1. Prescription date 2. Legible and approved abbreviations 3. PBS/non-PBS eligible 4. Extra S8 prescription requirements (quantity in words and figures) 1. Name 2. Home address 3. Date of birth (if monitored medicine/S8 prescription) Qualtrics ® is a web-based software used by SM to roll out the online test, allowing participants to type and submit a complete medication prescription online for the case questions without prompting through an online formulary ( Figure 4 ). Anecdotal information from phase 2A provided insight into the ability of participants to use the ‘copy and paste’ functionality of the case information into the answer boxes. As we were assessing participants knowledge on what the required components are of a prescription, to mitigate this, the case information was added as a picture into the test for phases 2B onwards. Figure 4. Copy of Qualtrics formatting allowing students to free-type the answer to the prescribing case. All tests had different cases used; however, each test consisted of Schedule 4 (S4), complex S4, S4 streamline, Schedule 8 (S8), and mixed (S4+S8) cases. Each prescription was critiqued according to set criteria as per the legal MPR and PBS, which must be adhered to when prescribing in QLD. Within the 6-5-4-3 criterion, four overarching components were established (DPSP – six Drug factors, five Prescriber factors, four Safety factors, and three Patient factors), which are listed in Table 1 . To our knowledge, this was the first study to develop an assessment rubric or framework to teach and critique discharge/outpatient prescriptions. This novel assessment framework did not require validation, as data collection was based on local legal regulations and guidelines of assessment rather than the establishment of a research tool. The model was also presented in this unique format in an aim to simplify teaching and learning for the participants. After writing each prescription, participants were asked if they were confident that their prescription was legal and safe by stating ‘confident’ or ‘not confident’ ( Figure 4 ). This self-perceived confidence rating was then re-termed “appropriately confident (or not)” based on the dispensability of the prescription(s). The dispensability of a prescription became a categorical variable and was added as another layer of assessment. This is because, numerically a prescription could have been considered a “pass”, however, if it did not contain the legal and safety requirements as per DPSP (and MPR), then a pharmacist would not be able to dispense the prescription(s) or supply the medication(s). Qualtrics data was imported into Microsoft Excel and an appropriate statistical software system for analysis. Formatting of data coding and dispensability criteria as per the MPR were established by SM and SP. De-identified data was coded by SM, and SP independently completed random verification by cross-checking the coded data with the original de-identified data. This method was to ensure accuracy and consistency in marking. If discrepancies were identified, SM and SP together verified coded data with the original data and corrected based on the pre-agreed criteria. Where an agreement could not be reached, the remaining authors were consulted and an outcome agreed upon. SM and SP were not blinded to the data timepoint as data was collected at specific times and coding began immediately due to time constraints. Measuring effectiveness - comparisons Three comparator points were used for data collection. The first was the year 2023 phase 2A cohort to the 2024 phase 2B cohort pre-test data. This comparison determined if participants are comparable from 2023 to 2024 with similar baseline knowledge between years. This established the level of current education practices and the impact it is having on technical prescribing skills. The second comparator group was the 2024 phase 2B cohort pre-test to phase 2B participants’ post-test data. This tested the outcome of possible changes in prescribing knowledge and skills after the intervention. The analysis of knowledge retention involved a comparison of phase 2B data to phase 3 data. The three time points (pre-post-longitudinal, see Figure 2 ) assisted in the analysis and possible justification of additional education modalities delivered during the medical degree. Proposed data analysis Identifiable data for phase 2B and phase 3 were collected to perform paired data analysis after reidentification. All data analyses will be presented and published in a de-identified manner. The following datasets will be compared and analysed, where if chosen to present as a P value, <0.05 is considered statistically significant in all cases: - phase 2A to phase 2B pre-data, phase 2B pre- to post-data, and phase 2B pre-post-data to phase 3. A new numerical variable may be created in calculating the difference in scores (between and within pre-post phase 2B and phase 3). Therefore, this may also be tested to determine whether the results are normally distributed. Further analysis will be undertaken to seek specific insights into the relative confidence in prescribing abilities in relation to dispensability. Ethics approval This study was approved by the JCU Human Research Ethics Committee on June 15 th , 2023 (approval number H9114). JCU Medical School provided written support for the principal investigator to conduct this study. Medical Deans Australia and New Zealand were aware of this study and provided written support in conducting phase-1 (information not provided in this paper). No further site-specific approvals were required as each study location used JCU clinical medical school facilities and resources. Research carried out for this study adhered to the Declaration of Helsinki. Dissemination As the principal investigator, SM completed this study for the purposes of her Doctor of Philosophy (PhD). SM is undertaking this as a PhD by publication; therefore, all results will be disseminated by publication and presentations in addition to the final thesis. The Townsville Hospital and Health Service (THHS) Study, Education, Research Trust Account (SERTA) grants assisted in providing SM funded time to complete this study and her thesis. Data sharing is not yet applicable, as confidential datasets have been generated and analysis is still being completed during the publication of this current paper (excluding phase-1, not presented). 2 Datasets that are generated and/or analysed will not be publicly available because of confidentiality but may be available from the corresponding author upon reasonable request. Study status Data collection and coding for all phases has been completed and this study has concluded. Complex data analysis is currently ongoing, and the relative results will be presented in future papers and submitted for publication when appropriate. Discussion Early prescribing skills education for medical students may reduce the probability of potentially incorrect or unsafe prescribing habits. 8 , 9 Australian medical education clinical practice standards explain prescribing as graduates’ ability to appropriately, effectively, and sustainably prescribe in line with quality and safety frameworks and clinical guidelines. 13 This standard does not acknowledge adherence to local legal regulations when prescribing and does not recommend mandatory teaching or assessment criteria. In Australia, it is not yet mandatory for medical graduates to successfully complete a prescribing competency exam to gain conditional or general registration with the AHPRA. Unclear resources to guide the teaching and assessment of prescription writing can result in inconsistent and possibly unsafe prescribing practices among medical graduates. A similar pilot study presented the risks and benefits of a randomised controlled trial. 11 The main limitation of this study was its small sample size. Owing to this and other identified risks, we have designed and conducted a longitudinal non-randomised study underpinned by high calibre methods to generate robust and generalisable data that answers the study aims. This study is the first to have investigated whether pharmacist-led multimodal education interventions changed the prescribing skills of JCU final-year medical students. In addition, the results will determine the participants’ knowledge retention by following them up a year later as junior doctors in their intern year. Therefore, this study reviewed the effectiveness of and need for additional education on the practical skill of writing a discharge/outpatient medication prescription. Furthermore, this study assessed participants’ self-perceived confidence in relation to the dispensability of their prescription(s). The Dunning-Kruger effect is explored whereby participants pre-prescribing skill compared to their post-prescribing skill, and a self-assessment of confidence determines the estimation of their abilities in relation to their competence. The potential limitations of this study include the lack of control group and non-randomisation of participants, recruitment from one university within one state of Australia (QLD), and data collection at only one time point within the intervention year. Other limitations are associated with the other two factors that may influence the outcome: a lack of varying professional background of the educator and not providing education to students in any other year level of medical education and following them through the timeline. The limitations of this study have been assessed, and justifications were made to assist in removing bias. Therefore, the strengths of this study include recruiting one university that has students enrolled and conducting placement over several locations (local, rural, remote, and elective rotations) across multiple hospitals and health services, and diverse geography. The tutorial/workshop educational intervention was offered face-to-face and via a virtual setting, again removing bias by not excluding participants based on location and allowing for collection of this data through a questioning technique within the preliminary questions of the test. High-standard data collection methods adhering to QLD legal regulations ensured integrity. No control group, non-randomisation and one time-point data collection after participants had undertaken a minimum of three standard final year medical school clinical placements of varying rotation types was carefully considered and proposed as appropriate methodological factors given the participant cohort which ensured that information sharing could not contaminate the collected data. To reduce information sharing, participants were asked to delete any photos taken of the study material and all had copy materials were discarded at completion of the education session. Having no control group was considered in relation to clinical placement experience not being a measure of impact factor within this study as it is standard practice in the medical education curriculum. Therefore, completing a pre-post study in phase 2A was unjustifiable given it would be assessing changes in prescribing, post exposure to clinical placement rotation of varying specialties as not each student attended the identical specialty at the same time. This study was assessing the change in prescribing skills with the addition of the educational interventions mentioned and not a comparison to standard curricular. The educator was removed as a factor that could influence the change in prescribing skills as we used three educators with the same professional background (pharmacist) who provided standardised education. Review and approval by the JCU Human Research Ethics Committee and grant review panel of the funder (THHS SERTA) further supported this proposal. Engagement with stakeholders has been key to the design of this study. The research team consulted experts where appropriate to conduct and report on the topic. Support was provided by Medical Deans Australia and New Zealand, and JCU Medical Deans. The methodology of this study was strongly considered and evaluated by the investigator team, medical education experts, and statisticians to ensure rigor. Results from each phase of the study will be disseminated through appropriate presentations and publications and will inform any methodological modifications that might become unexpectedly indicated. In summary, we presented the methods and protocol of an approved and funded non-randomised longitudinal study that investigated the potential of pharmacist educators to improve technical prescribing knowledge and skills among Australian final-year medical students. If positive, the findings of this study will have practical and policy impacts that may result in long-term improvement in safe medicine practice and ultimately benefit patient care. Declarations Consent Participants partaking in this voluntary study provided informed consent. Additionally, before beginning each test, participants were required to provide consent to participate by completing a mandatory acknowledgment field. This process served as a form of written consent. Participants were advised that de-identified data would be used in research publications and reports as outlined to them prior to consenting to start the voluntary test and interventions. Clinical trial number Not applicable. Pre-print This paper has been accepted as a pre-print: 14 Sophie Mokrzecki, Tarun Sen Gupta, Tilley Pain et al. Pharmacist-led prescription writing educational intervention to final-year medical students: A pre-post nonrandomised longitudinal study, 18 February 2025, PREPRINT (Version 1) available at Research Square [ https://doi.org/10.21203/rs.3.rs-5823347/v1 ]. Data availability statement No data is associated with this article. Acknowledgements The authors would like to acknowledge the contributions and assistance of Dr. Sarah Chalmers, Leanne Southgate, Associate Professor Zaf Smith, Ms. Bronwyn Howes, JCU Medical and Clinical School, TUH Pharmacy Department, participating JCU medical students, Haley Plaza, and Vaughan Schipplock. All those listed are aware and have granted permission to have their names and affiliations listed. References 1. Australian Medical Council, Medical Board of Australia: Australian Medical Council and Medical Board of Australia’s Preparedness for Internship Survey.2019. Reference Source 2. Mokrzecki S, Perks S, Pain T, et al. : Australian and New Zealand medical students’ confidence and preparedness to prescribe. BMC Med. Educ. 2025; 25 : 536. Publisher Full Text 3. Newble D, Dawson B, Dauphinee D, et al. : Guidelines for assessing clinical competence. Teach. Learn. Med. 1994; 6 (3): 213–220. Publisher Full Text 4. Health Workforce Australia: Health Professionals Prescribing Pathway (HPPP) Project - Final Report.2013. 5. NPS MedicineWise: Prescribing Competencies Framework: Embedding quality use of medicines into practice. Sydney: 2nd ed. 2021. 6. Australian Commission on Safety and Quality in Health Care: Safety and Quality Improvement Guide Standard 4: Medication Safety (October 2012). Sydney: ACSQHC; 2012. 7. Mokrzecki S, Mallett AJ, Sen Gupta T, et al. : Do educational interventions improve prescribing skills of medical students compared to no additional learning? A systematic review. Med. Educ. Online. 2023; 28 (1). PubMed Abstract | Publisher Full Text | Free Full Text 8. Malca CM, Siccha SC, Cardenas FE, et al. : Improvement in drug prescription skills in medical students through in-person and remote simulated interviews. Preprint. medRxiv. 2023. Publisher Full Text 9. De Vries TPGM, Henning RH, Hogerzeil HV, et al. : Guide to good prescribing: a practical manual.1994. Reference Source 10. Haque M: Good prescribing to maximize patient benefit. Int. J. Nutr. Pharmacol. Neurol. Dis. 2018; 8 (3): 67–69. Publisher Full Text 11. Mokrzecki S, Pain T, Mallett AJ, et al. : Pharmacist-Led Education for Final Year Medical Students: A Pilot Study. Front. Med. 2021; 8 (732054). PubMed Abstract | Publisher Full Text | Free Full Text 12. Garbutt JM, DeFer TM, Highstein G, et al. : Safe Prescribing: An Educational Intervention For Medical Students. Teach. Learn. Med. 2006; 18 (3): 244–250. Publisher Full Text 13. Australian Medical Council: Standards for Assessment and Accreditation of Primary Medical Programs 2023.July 2023. Accessed September 2023. Reference Source 14. Mokrzecki S, Gupta TS, Pain T, et al. : Pharmacist-led prescription writing educational intervention to final-year medical students: A pre-post nonrandomised longitudinal study, 18 February 2025, PREPRINT (Version 1). Research Square. Publisher Full Text Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 12 Jun 2025 ADD YOUR COMMENT Comment Author details Author details 1 College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia 2 Pharmacy Department, Townsville University Hospital, Townsville, Queensland, 4814, Australia 3 Allied Health Governance Office, Townsville University Hospital, Townsville, QLD, Australia 4 College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia 5 Department of Renal Medicine, Townsville University Hospital, Townsville, QLD, Australia 6 Institute for Molecular Bioscience and Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia Sophie Mokrzecki Roles: Conceptualization, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Software, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Tarun Sen Gupta Roles: Supervision, Validation, Visualization, Writing – Review & Editing Tilley Pain Roles: Supervision, Writing – Review & Editing Stephen Perks Roles: Investigation, Methodology, Resources, Software, Supervision, Validation, Visualization, Writing – Review & Editing Andrew J. Mallett Roles: Methodology, Supervision, Validation, Visualization, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information This study was funded by an approved and competitively awarded grant: 2023 and 2024 Townsville Hospital and Health Service (THHS) Study Education and Research Trust Account (SERTA) Grants. AJM was supported by a Queensland Health Advancing Clinical Research Fellowship. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Article Versions (2) version 2 Revised Published: 05 Feb 2026, 14:581 https://doi.org/10.12688/f1000research.163920.2 version 1 Published: 12 Jun 2025, 14:581 https://doi.org/10.12688/f1000research.163920.1 Copyright © 2026 Mokrzecki S et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Mokrzecki S, Sen Gupta T, Pain T et al. Pharmacist-led prescription writing educational intervention to final-year medical students: A pre-post non-randomised longitudinal study [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2026, 14 :581 ( https://doi.org/10.12688/f1000research.163920.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 2 VERSION 2 PUBLISHED 05 Feb 2026 Revised Views 0 Cite How to cite this report: Shankar PR. Reviewer Report For: Pharmacist-led prescription writing educational intervention to final-year medical students: A pre-post non-randomised longitudinal study [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2026, 14 :581 ( https://doi.org/10.5256/f1000research.195514.r455864 ) The direct URL for this report is: https://f1000research.com/articles/14-581/v2#referee-response-455864 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 19 Feb 2026 Pathiyil Ravi Shankar , IMU Centre for Education, IMU University, Federal Territory of Kuala Lumpur, Kuala Lumpur, Malaysia Approved VIEWS 0 https://doi.org/10.5256/f1000research.195514.r455864 Thanks for the clarifications by the authors. I am ... Continue reading READ ALL Thanks for the clarifications by the authors. I am happy to approve the revised version of the study protocol. Competing Interests: No competing interests were disclosed. Reviewer Expertise: Small group learning, rational use of medicines, pharmacology education, presecribing skills education I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Shankar PR. Reviewer Report For: Pharmacist-led prescription writing educational intervention to final-year medical students: A pre-post non-randomised longitudinal study [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2026, 14 :581 ( https://doi.org/10.5256/f1000research.195514.r455864 ) The direct URL for this report is: https://f1000research.com/articles/14-581/v2#referee-response-455864 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Chin P. Reviewer Report For: Pharmacist-led prescription writing educational intervention to final-year medical students: A pre-post non-randomised longitudinal study [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2026, 14 :581 ( https://doi.org/10.5256/f1000research.195514.r455865 ) The direct URL for this report is: https://f1000research.com/articles/14-581/v2#referee-response-455865 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 19 Feb 2026 Paul Chin , university of otago, Dunedin, New Zealand Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.195514.r455865 Thanks to the authors for significant efforts in editing the manuscript and responding to my comments. I'm still unclear regarding exactly how the DPSP is used to generate a quantitative metric of prescribing skill. The authors note that "a ... Continue reading READ ALL Thanks to the authors for significant efforts in editing the manuscript and responding to my comments. I'm still unclear regarding exactly how the DPSP is used to generate a quantitative metric of prescribing skill. The authors note that "a prescription may score for example 20 out of 30 points correct" - but how does the DPSP translate into these points? As it stands, there are 18 distinct criteria in Table 1 - is each given 1 point? Or if the aforementioned 30 points maps to the 18 criteria, how is this done? Competing Interests: No competing interests were disclosed. Reviewer Expertise: medical education I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Chin P. Reviewer Report For: Pharmacist-led prescription writing educational intervention to final-year medical students: A pre-post non-randomised longitudinal study [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2026, 14 :581 ( https://doi.org/10.5256/f1000research.195514.r455865 ) The direct URL for this report is: https://f1000research.com/articles/14-581/v2#referee-response-455865 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 12 Jun 2025 Views 0 Cite How to cite this report: Chin P. Reviewer Report For: Pharmacist-led prescription writing educational intervention to final-year medical students: A pre-post non-randomised longitudinal study [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2026, 14 :581 ( https://doi.org/10.5256/f1000research.180341.r438125 ) The direct URL for this report is: https://f1000research.com/articles/14-581/v1#referee-response-438125 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 02 Jan 2026 Paul Chin , university of otago, Dunedin, New Zealand Not Approved VIEWS 0 https://doi.org/10.5256/f1000research.180341.r438125 Overall This manuscript describes a two-phase, non-randomised pre–post longitudinal educational intervention evaluating pharmacist-led prescription-writing education for final-year medical students, with follow-up as junior doctors one year later. The topic is clinically important (prescribing legality/safety ... Continue reading READ ALL Overall This manuscript describes a two-phase, non-randomised pre–post longitudinal educational intervention evaluating pharmacist-led prescription-writing education for final-year medical students, with follow-up as junior doctors one year later. The topic is clinically important (prescribing legality/safety and transition-to-practice), but the current protocol has design and reporting ambiguities that make attribution of effect difficult and would limit reproducibility unless addressed with major revisions. Abstract nil Main text Introduction nil Protocol The investigators clearly describe the prescription aspects reviewed in the study (DPSP Table 1). However, exactly how this is used to determine the safety and legality of the prescription. For example, mention is made of ‘Dispensability’ in the ‘Proposed data analysis’, with P < 0.05 considered statistically significant, but a numerical metric of dispensability is not specified other than “A new numerical variable may be created…”. The word ‘may’ indicates this is not a requirement of the study, which is puzzling. Earlier under ‘Participants’ there is mention of “a difference in the total mean score of eight points between groups”; it would be useful for this numerical rubric to explicitly be in this manuscript. Assessor procedures are insufficiently described: it is unclear whether one or multiple raters will score prescriptions, whether raters are blinded to timepoint (pre vs post vs follow-up), and how disagreements will be resolved—this is essential given the potential subjectivity of judging abbreviations/legibility/dispensability. Tense and study status are inconsistent: parts read as already conducted (Phases 2A/2B) while other sections read as planned, which creates uncertainty about what is prospective versus completed and what aspects are still modifiable (particularly Phase 3). Based on the dates in Figure 2, the entire study has presumably been completed already. Confounding and contamination: the design explicitly includes a 5-week placement period between pre- and post-test, which is a strong alternative explanation for improvement; the analysis plan should state how placement exposure will be measured/adjusted for (rotation type, prescribing exposure, supervisor input) and how contamination (sharing materials among students) will be assessed. Discussion nil Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Partly Are sufficient details of the methods provided to allow replication by others? No Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests: No competing interests were disclosed. Reviewer Expertise: medical education I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Chin P. Reviewer Report For: Pharmacist-led prescription writing educational intervention to final-year medical students: A pre-post non-randomised longitudinal study [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2026, 14 :581 ( https://doi.org/10.5256/f1000research.180341.r438125 ) The direct URL for this report is: https://f1000research.com/articles/14-581/v1#referee-response-438125 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 05 Feb 2026 Sophie Mokrzecki , College of Medicine and Dentistry, James Cook University, Townsville, Australia 05 Feb 2026 Author Response …the current protocol has design and reporting ambiguities that make attribution of effect difficult and would limit reproducibility unless addressed with major revisions. The ... Continue reading …the current protocol has design and reporting ambiguities that make attribution of effect difficult and would limit reproducibility unless addressed with major revisions. The authors thank the reviewer for this comment and believe that the edits provided address this concern. The investigators clearly describe the prescription aspects reviewed in the study (DPSP Table 1). However, exactly how this is used to determine the safety and legality of the prescription. For example, mention is made of ‘Dispensability’ in the ‘Proposed data analysis’, with P < 0.05 considered statistically significant, but a numerical metric of dispensability is not specified other than “A new numerical variable may be created…”. The word ‘may’ indicates this is not a requirement of the study, which is puzzling. Earlier under ‘Participants’ there is mention of “a difference in the total mean score of eight points between groups”; it would be useful for this numerical rubric to explicitly be in this manuscript. The DPSP criteria is based on the legal document used in QLD (state government) that must be followed when writing a medication prescription (the Medicines and Poisons Regulation - MPR). The safety component is based on the MPR and the pharmaceutical benefits scheme (PBS) that is decided by the national government. Therefore, the DPSP provides the numerical rubric that is being used for this study. Therefore, numeric evaluation of these components will be published. The dispensability is not a numeric value, but rather, if the prescription meets all the legal and safety criteria because otherwise a pharmacist is unable to dispense the prescription. However, the authors hope they have now made it more clear to the reviewer under ‘Assessment and data collection methods’ why dispensability and numeric values will be presented. This is because whilst a prescription may score for example 20 out of 30 points correct and considered a “pass”, if it does not have all the components as per the DPSP, then the prescription is not dispensable. The word ‘may’ has been used as this study involves complex data analysis that has not yet been undertaken in other studies. We are now in the process of completing this data analysis and still determining the best statistical tests to complete to obtain a presentable result that provides an answer to the aims. Assessor procedures are insufficiently described: it is unclear whether one or multiple raters will score prescriptions, whether raters are blinded to timepoint (pre vs post vs follow-up), and how disagreements will be resolved—this is essential given the potential subjectivity of judging abbreviations/legibility/dispensability. The authors thank the reviewer for noting this oversite. Please see addition of information on how assessment was conducted within the section ‘Assessment and data collection methods’. Tense and study status are inconsistent: parts read as already conducted (Phases 2A/2B) while other sections read as planned, which creates uncertainty about what is prospective versus completed and what aspects are still modifiable (particularly Phase 3). Based on the dates in Figure 2, the entire study has presumably been completed already. Thank you to the reviewer for bringing this to the authors attention. This has now been corrected throughout the paper. Since writing the paper and attempting to have this approved (peer-reviewed) for publication, time had passed. This study was planned based on a tight schedule and formed part of a larger PhD study. The intervention had to move forward irrespective of this paper not being formally published first. Confounding and contamination: the design explicitly includes a 5-week placement period between pre- and post-test, which is a strong alternative explanation for improvement; the analysis plan should state how placement exposure will be measured/adjusted for (rotation type, prescribing exposure, supervisor input) and how contamination (sharing materials among students) will be assessed. The authors thank the reviewer for this comment. Please see addition to limitations paragraph within the discussion as to why placement has not been considered in the analysis plan of this study. …the current protocol has design and reporting ambiguities that make attribution of effect difficult and would limit reproducibility unless addressed with major revisions. The authors thank the reviewer for this comment and believe that the edits provided address this concern. The investigators clearly describe the prescription aspects reviewed in the study (DPSP Table 1). However, exactly how this is used to determine the safety and legality of the prescription. For example, mention is made of ‘Dispensability’ in the ‘Proposed data analysis’, with P < 0.05 considered statistically significant, but a numerical metric of dispensability is not specified other than “A new numerical variable may be created…”. The word ‘may’ indicates this is not a requirement of the study, which is puzzling. Earlier under ‘Participants’ there is mention of “a difference in the total mean score of eight points between groups”; it would be useful for this numerical rubric to explicitly be in this manuscript. The DPSP criteria is based on the legal document used in QLD (state government) that must be followed when writing a medication prescription (the Medicines and Poisons Regulation - MPR). The safety component is based on the MPR and the pharmaceutical benefits scheme (PBS) that is decided by the national government. Therefore, the DPSP provides the numerical rubric that is being used for this study. Therefore, numeric evaluation of these components will be published. The dispensability is not a numeric value, but rather, if the prescription meets all the legal and safety criteria because otherwise a pharmacist is unable to dispense the prescription. However, the authors hope they have now made it more clear to the reviewer under ‘Assessment and data collection methods’ why dispensability and numeric values will be presented. This is because whilst a prescription may score for example 20 out of 30 points correct and considered a “pass”, if it does not have all the components as per the DPSP, then the prescription is not dispensable. The word ‘may’ has been used as this study involves complex data analysis that has not yet been undertaken in other studies. We are now in the process of completing this data analysis and still determining the best statistical tests to complete to obtain a presentable result that provides an answer to the aims. Assessor procedures are insufficiently described: it is unclear whether one or multiple raters will score prescriptions, whether raters are blinded to timepoint (pre vs post vs follow-up), and how disagreements will be resolved—this is essential given the potential subjectivity of judging abbreviations/legibility/dispensability. The authors thank the reviewer for noting this oversite. Please see addition of information on how assessment was conducted within the section ‘Assessment and data collection methods’. Tense and study status are inconsistent: parts read as already conducted (Phases 2A/2B) while other sections read as planned, which creates uncertainty about what is prospective versus completed and what aspects are still modifiable (particularly Phase 3). Based on the dates in Figure 2, the entire study has presumably been completed already. Thank you to the reviewer for bringing this to the authors attention. This has now been corrected throughout the paper. Since writing the paper and attempting to have this approved (peer-reviewed) for publication, time had passed. This study was planned based on a tight schedule and formed part of a larger PhD study. The intervention had to move forward irrespective of this paper not being formally published first. Confounding and contamination: the design explicitly includes a 5-week placement period between pre- and post-test, which is a strong alternative explanation for improvement; the analysis plan should state how placement exposure will be measured/adjusted for (rotation type, prescribing exposure, supervisor input) and how contamination (sharing materials among students) will be assessed. The authors thank the reviewer for this comment. Please see addition to limitations paragraph within the discussion as to why placement has not been considered in the analysis plan of this study. Competing Interests: Not applicable Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 05 Feb 2026 Sophie Mokrzecki , College of Medicine and Dentistry, James Cook University, Townsville, Australia 05 Feb 2026 Author Response …the current protocol has design and reporting ambiguities that make attribution of effect difficult and would limit reproducibility unless addressed with major revisions. The ... Continue reading …the current protocol has design and reporting ambiguities that make attribution of effect difficult and would limit reproducibility unless addressed with major revisions. The authors thank the reviewer for this comment and believe that the edits provided address this concern. The investigators clearly describe the prescription aspects reviewed in the study (DPSP Table 1). However, exactly how this is used to determine the safety and legality of the prescription. For example, mention is made of ‘Dispensability’ in the ‘Proposed data analysis’, with P < 0.05 considered statistically significant, but a numerical metric of dispensability is not specified other than “A new numerical variable may be created…”. The word ‘may’ indicates this is not a requirement of the study, which is puzzling. Earlier under ‘Participants’ there is mention of “a difference in the total mean score of eight points between groups”; it would be useful for this numerical rubric to explicitly be in this manuscript. The DPSP criteria is based on the legal document used in QLD (state government) that must be followed when writing a medication prescription (the Medicines and Poisons Regulation - MPR). The safety component is based on the MPR and the pharmaceutical benefits scheme (PBS) that is decided by the national government. Therefore, the DPSP provides the numerical rubric that is being used for this study. Therefore, numeric evaluation of these components will be published. The dispensability is not a numeric value, but rather, if the prescription meets all the legal and safety criteria because otherwise a pharmacist is unable to dispense the prescription. However, the authors hope they have now made it more clear to the reviewer under ‘Assessment and data collection methods’ why dispensability and numeric values will be presented. This is because whilst a prescription may score for example 20 out of 30 points correct and considered a “pass”, if it does not have all the components as per the DPSP, then the prescription is not dispensable. The word ‘may’ has been used as this study involves complex data analysis that has not yet been undertaken in other studies. We are now in the process of completing this data analysis and still determining the best statistical tests to complete to obtain a presentable result that provides an answer to the aims. Assessor procedures are insufficiently described: it is unclear whether one or multiple raters will score prescriptions, whether raters are blinded to timepoint (pre vs post vs follow-up), and how disagreements will be resolved—this is essential given the potential subjectivity of judging abbreviations/legibility/dispensability. The authors thank the reviewer for noting this oversite. Please see addition of information on how assessment was conducted within the section ‘Assessment and data collection methods’. Tense and study status are inconsistent: parts read as already conducted (Phases 2A/2B) while other sections read as planned, which creates uncertainty about what is prospective versus completed and what aspects are still modifiable (particularly Phase 3). Based on the dates in Figure 2, the entire study has presumably been completed already. Thank you to the reviewer for bringing this to the authors attention. This has now been corrected throughout the paper. Since writing the paper and attempting to have this approved (peer-reviewed) for publication, time had passed. This study was planned based on a tight schedule and formed part of a larger PhD study. The intervention had to move forward irrespective of this paper not being formally published first. Confounding and contamination: the design explicitly includes a 5-week placement period between pre- and post-test, which is a strong alternative explanation for improvement; the analysis plan should state how placement exposure will be measured/adjusted for (rotation type, prescribing exposure, supervisor input) and how contamination (sharing materials among students) will be assessed. The authors thank the reviewer for this comment. Please see addition to limitations paragraph within the discussion as to why placement has not been considered in the analysis plan of this study. …the current protocol has design and reporting ambiguities that make attribution of effect difficult and would limit reproducibility unless addressed with major revisions. The authors thank the reviewer for this comment and believe that the edits provided address this concern. The investigators clearly describe the prescription aspects reviewed in the study (DPSP Table 1). However, exactly how this is used to determine the safety and legality of the prescription. For example, mention is made of ‘Dispensability’ in the ‘Proposed data analysis’, with P < 0.05 considered statistically significant, but a numerical metric of dispensability is not specified other than “A new numerical variable may be created…”. The word ‘may’ indicates this is not a requirement of the study, which is puzzling. Earlier under ‘Participants’ there is mention of “a difference in the total mean score of eight points between groups”; it would be useful for this numerical rubric to explicitly be in this manuscript. The DPSP criteria is based on the legal document used in QLD (state government) that must be followed when writing a medication prescription (the Medicines and Poisons Regulation - MPR). The safety component is based on the MPR and the pharmaceutical benefits scheme (PBS) that is decided by the national government. Therefore, the DPSP provides the numerical rubric that is being used for this study. Therefore, numeric evaluation of these components will be published. The dispensability is not a numeric value, but rather, if the prescription meets all the legal and safety criteria because otherwise a pharmacist is unable to dispense the prescription. However, the authors hope they have now made it more clear to the reviewer under ‘Assessment and data collection methods’ why dispensability and numeric values will be presented. This is because whilst a prescription may score for example 20 out of 30 points correct and considered a “pass”, if it does not have all the components as per the DPSP, then the prescription is not dispensable. The word ‘may’ has been used as this study involves complex data analysis that has not yet been undertaken in other studies. We are now in the process of completing this data analysis and still determining the best statistical tests to complete to obtain a presentable result that provides an answer to the aims. Assessor procedures are insufficiently described: it is unclear whether one or multiple raters will score prescriptions, whether raters are blinded to timepoint (pre vs post vs follow-up), and how disagreements will be resolved—this is essential given the potential subjectivity of judging abbreviations/legibility/dispensability. The authors thank the reviewer for noting this oversite. Please see addition of information on how assessment was conducted within the section ‘Assessment and data collection methods’. Tense and study status are inconsistent: parts read as already conducted (Phases 2A/2B) while other sections read as planned, which creates uncertainty about what is prospective versus completed and what aspects are still modifiable (particularly Phase 3). Based on the dates in Figure 2, the entire study has presumably been completed already. Thank you to the reviewer for bringing this to the authors attention. This has now been corrected throughout the paper. Since writing the paper and attempting to have this approved (peer-reviewed) for publication, time had passed. This study was planned based on a tight schedule and formed part of a larger PhD study. The intervention had to move forward irrespective of this paper not being formally published first. Confounding and contamination: the design explicitly includes a 5-week placement period between pre- and post-test, which is a strong alternative explanation for improvement; the analysis plan should state how placement exposure will be measured/adjusted for (rotation type, prescribing exposure, supervisor input) and how contamination (sharing materials among students) will be assessed. The authors thank the reviewer for this comment. Please see addition to limitations paragraph within the discussion as to why placement has not been considered in the analysis plan of this study. Competing Interests: Not applicable Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Shankar PR. Reviewer Report For: Pharmacist-led prescription writing educational intervention to final-year medical students: A pre-post non-randomised longitudinal study [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2026, 14 :581 ( https://doi.org/10.5256/f1000research.180341.r438128 ) The direct URL for this report is: https://f1000research.com/articles/14-581/v1#referee-response-438128 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 02 Jan 2026 Pathiyil Ravi Shankar , IMU Centre for Education, IMU University, Federal Territory of Kuala Lumpur, Kuala Lumpur, Malaysia Not Approved VIEWS 0 https://doi.org/10.5256/f1000research.180341.r438128 The manuscript uses both past and future tense to refer to the study and this is confusing. I was confused on reading through the manuscript regarding if this is a study protocol or a report on a study that ... Continue reading READ ALL The manuscript uses both past and future tense to refer to the study and this is confusing. I was confused on reading through the manuscript regarding if this is a study protocol or a report on a study that has already been done. The authors mention that phase 3 would be done in 2025. As 2025 is nearly over can some information on phase 3 be provided. I would be interested in knowing what prescribing education was being offered at JCU before this intervention? More details about the intervention are also useful. Why is the intervention termed multimodal? Who is funding the study? Can details of the online prescription writing test be provided? The authors mention, “All tests will have different cases used; however, each test will consist of Schedule 4 (S4), complex S4, S4 streamline, Schedule 8 (S8), and mixed (S4+S8) cases.” Can this be explained for non-Australian readers? The authors mention, “Data collection for phase 3 of this study is currently ongoing and is expected to be completed by August 2025, at which point the study will conclude.” Has this phase been concluded? Are the results being published separately? ‘Participants will also engage with the interactive features of the online learning module to complete Schedule 4 (prescription-only medication) and Schedule 8 (controlled drug) medication prescriptions’. Can some information about the different drug schedules in Australia be provided? Is prescribing regulated at the national or the provincial level? One of the challenges is that by the time this protocol is being reviewed, most of the results may be available. Are there any reasons for the delay in submitting this proposal for publication? Which parts of this study have already been published? Is the rationale for, and objectives of, the study clearly described? Partly Is the study design appropriate for the research question? Partly Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? No Competing Interests: No competing interests were disclosed. Reviewer Expertise: Small group learning, rational use of medicines, pharmacology education, presecribing skills education I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Shankar PR. Reviewer Report For: Pharmacist-led prescription writing educational intervention to final-year medical students: A pre-post non-randomised longitudinal study [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2026, 14 :581 ( https://doi.org/10.5256/f1000research.180341.r438128 ) The direct URL for this report is: https://f1000research.com/articles/14-581/v1#referee-response-438128 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 05 Feb 2026 Sophie Mokrzecki , College of Medicine and Dentistry, James Cook University, Townsville, Australia 05 Feb 2026 Author Response The manuscript uses both past and future tense to refer to the study and this is confusing. Thank you to the reviewer for bringing ... Continue reading The manuscript uses both past and future tense to refer to the study and this is confusing. Thank you to the reviewer for bringing this to the authors attention. This has now been corrected throughout the paper. Since writing the paper and attempting to have this approved (peer-reviewed) for publication, time had passed. This study was planned based on a tight schedule and formed part of a larger PhD study. The intervention had to move forward irrespective of this paper not being formally published first. I was confused on reading through the manuscript regarding if this is a study protocol or a report on a study that has already been done. The authors still position this as a protocol paper as it was submitted and initially published in the original form prior to the completion of the study and prior to study results publication. The authors mention that phase 3 would be done in 2025. As 2025 is nearly over can some information on phase 3 be provided. As this is a methods paper, the results from phase 3 will be published in a separate paper to follow. However, we hope that further clarification on the study design has been provided with the edits made. I would be interested in knowing what prescribing education was being offered at JCU before this intervention? More details about the intervention are also useful. Why is the intervention termed multimodal? Who is funding the study? Can details of the online prescription writing test be provided? Thank you for this comment. Please see addition of requested information under ‘Study setting’. Without context on more details on the intervention wanted, the authors are unable to provide this specifically. We do hope that the updated version provides further details on the intervention provided to participants. This was a multimodal intervention due to it being delivered in various ways: face-to-face (using tutorial/workshop-based format), and an online learning module developed by the PI specifically for this study. The addition of explaining that SM’s time was funded by a SERTA grant has been added to the paper. The authors have now provided edits under ‘Assessment and data collection methods’ and believe that there is sufficient explanation of the online test that was developed in Qualtrics®. Figure 3 also shows an example of one of the cases where the participant was required to generate a prescription. The authors mention, “All tests will have different cases used; however, each test will consist of Schedule 4 (S4), complex S4, S4 streamline, Schedule 8 (S8), and mixed (S4+S8) cases.” Can this be explained for non-Australian readers? The authors thank the reviewer for this suggestion. Please see further information provided under ‘Additional education modalities – hands-on opportunities ’. The authors mention, “Data collection for phase 3 of this study is currently ongoing and is expected to be completed by August 2025, at which point the study will conclude.” Has this phase been concluded? Are the results being published separately? This paper was originally accepted for pre-print at a time when phase 3 had not yet commenced. We thank you for noting this, and we have now edited this section. Please see statement regarding results pertaining to each phase being presented separately as this is also being conducted as a PhD by publication. ‘Participants will also engage with the interactive features of the online learning module to complete Schedule 4 (prescription-only medication) and Schedule 8 (controlled drug) medication prescriptions’. Can some information about the different drug schedules in Australia be provided? Is prescribing regulated at the national or the provincial level? We thank the reviewer for bringing these suggestions. Please see addition of explanation. We hope it is now clear that prescribing is regulated at a state and national level. S4 and S8 have also been added to the ‘List of abbreviations’. One of the challenges is that by the time this protocol is being reviewed, most of the results may be available. Are there any reasons for the delay in submitting this proposal for publication? Which parts of this study have already been published? This paper was submitted in June 2025 to F1000R. Prior to this it was under review with another journal that took almost a year to then reject it with no feedback. We appreciate that it would have been ideal to have this published prior to the completion of the study, however it isn’t without lack of trying. As we hope the reviewer can understand, in what is at times considered a sensitive topic, it is sometimes hard to have papers published within an effective period. The only phase that has been published to date is phase 1, which is not presented in this methodology. Currently, complex statistical analysis is still being completed due to a novel way of assessment, as presented in this paper. Are the datasets clearly presented in a useable and accessible format? No The authors note that this response is different to other reviewers. This is a methods paper presenting the methodology to a larger study and no data is publishable here. As stipulated, all relatable data to the individual phases will be presented in separate papers. Therefore, the authors believe this response should be “Not applicable”. The manuscript uses both past and future tense to refer to the study and this is confusing. Thank you to the reviewer for bringing this to the authors attention. This has now been corrected throughout the paper. Since writing the paper and attempting to have this approved (peer-reviewed) for publication, time had passed. This study was planned based on a tight schedule and formed part of a larger PhD study. The intervention had to move forward irrespective of this paper not being formally published first. I was confused on reading through the manuscript regarding if this is a study protocol or a report on a study that has already been done. The authors still position this as a protocol paper as it was submitted and initially published in the original form prior to the completion of the study and prior to study results publication. The authors mention that phase 3 would be done in 2025. As 2025 is nearly over can some information on phase 3 be provided. As this is a methods paper, the results from phase 3 will be published in a separate paper to follow. However, we hope that further clarification on the study design has been provided with the edits made. I would be interested in knowing what prescribing education was being offered at JCU before this intervention? More details about the intervention are also useful. Why is the intervention termed multimodal? Who is funding the study? Can details of the online prescription writing test be provided? Thank you for this comment. Please see addition of requested information under ‘Study setting’. Without context on more details on the intervention wanted, the authors are unable to provide this specifically. We do hope that the updated version provides further details on the intervention provided to participants. This was a multimodal intervention due to it being delivered in various ways: face-to-face (using tutorial/workshop-based format), and an online learning module developed by the PI specifically for this study. The addition of explaining that SM’s time was funded by a SERTA grant has been added to the paper. The authors have now provided edits under ‘Assessment and data collection methods’ and believe that there is sufficient explanation of the online test that was developed in Qualtrics®. Figure 3 also shows an example of one of the cases where the participant was required to generate a prescription. The authors mention, “All tests will have different cases used; however, each test will consist of Schedule 4 (S4), complex S4, S4 streamline, Schedule 8 (S8), and mixed (S4+S8) cases.” Can this be explained for non-Australian readers? The authors thank the reviewer for this suggestion. Please see further information provided under ‘Additional education modalities – hands-on opportunities ’. The authors mention, “Data collection for phase 3 of this study is currently ongoing and is expected to be completed by August 2025, at which point the study will conclude.” Has this phase been concluded? Are the results being published separately? This paper was originally accepted for pre-print at a time when phase 3 had not yet commenced. We thank you for noting this, and we have now edited this section. Please see statement regarding results pertaining to each phase being presented separately as this is also being conducted as a PhD by publication. ‘Participants will also engage with the interactive features of the online learning module to complete Schedule 4 (prescription-only medication) and Schedule 8 (controlled drug) medication prescriptions’. Can some information about the different drug schedules in Australia be provided? Is prescribing regulated at the national or the provincial level? We thank the reviewer for bringing these suggestions. Please see addition of explanation. We hope it is now clear that prescribing is regulated at a state and national level. S4 and S8 have also been added to the ‘List of abbreviations’. One of the challenges is that by the time this protocol is being reviewed, most of the results may be available. Are there any reasons for the delay in submitting this proposal for publication? Which parts of this study have already been published? This paper was submitted in June 2025 to F1000R. Prior to this it was under review with another journal that took almost a year to then reject it with no feedback. We appreciate that it would have been ideal to have this published prior to the completion of the study, however it isn’t without lack of trying. As we hope the reviewer can understand, in what is at times considered a sensitive topic, it is sometimes hard to have papers published within an effective period. The only phase that has been published to date is phase 1, which is not presented in this methodology. Currently, complex statistical analysis is still being completed due to a novel way of assessment, as presented in this paper. Are the datasets clearly presented in a useable and accessible format? No The authors note that this response is different to other reviewers. This is a methods paper presenting the methodology to a larger study and no data is publishable here. As stipulated, all relatable data to the individual phases will be presented in separate papers. Therefore, the authors believe this response should be “Not applicable”. Competing Interests: Not applicable Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 05 Feb 2026 Sophie Mokrzecki , College of Medicine and Dentistry, James Cook University, Townsville, Australia 05 Feb 2026 Author Response The manuscript uses both past and future tense to refer to the study and this is confusing. Thank you to the reviewer for bringing ... Continue reading The manuscript uses both past and future tense to refer to the study and this is confusing. Thank you to the reviewer for bringing this to the authors attention. This has now been corrected throughout the paper. Since writing the paper and attempting to have this approved (peer-reviewed) for publication, time had passed. This study was planned based on a tight schedule and formed part of a larger PhD study. The intervention had to move forward irrespective of this paper not being formally published first. I was confused on reading through the manuscript regarding if this is a study protocol or a report on a study that has already been done. The authors still position this as a protocol paper as it was submitted and initially published in the original form prior to the completion of the study and prior to study results publication. The authors mention that phase 3 would be done in 2025. As 2025 is nearly over can some information on phase 3 be provided. As this is a methods paper, the results from phase 3 will be published in a separate paper to follow. However, we hope that further clarification on the study design has been provided with the edits made. I would be interested in knowing what prescribing education was being offered at JCU before this intervention? More details about the intervention are also useful. Why is the intervention termed multimodal? Who is funding the study? Can details of the online prescription writing test be provided? Thank you for this comment. Please see addition of requested information under ‘Study setting’. Without context on more details on the intervention wanted, the authors are unable to provide this specifically. We do hope that the updated version provides further details on the intervention provided to participants. This was a multimodal intervention due to it being delivered in various ways: face-to-face (using tutorial/workshop-based format), and an online learning module developed by the PI specifically for this study. The addition of explaining that SM’s time was funded by a SERTA grant has been added to the paper. The authors have now provided edits under ‘Assessment and data collection methods’ and believe that there is sufficient explanation of the online test that was developed in Qualtrics®. Figure 3 also shows an example of one of the cases where the participant was required to generate a prescription. The authors mention, “All tests will have different cases used; however, each test will consist of Schedule 4 (S4), complex S4, S4 streamline, Schedule 8 (S8), and mixed (S4+S8) cases.” Can this be explained for non-Australian readers? The authors thank the reviewer for this suggestion. Please see further information provided under ‘Additional education modalities – hands-on opportunities ’. The authors mention, “Data collection for phase 3 of this study is currently ongoing and is expected to be completed by August 2025, at which point the study will conclude.” Has this phase been concluded? Are the results being published separately? This paper was originally accepted for pre-print at a time when phase 3 had not yet commenced. We thank you for noting this, and we have now edited this section. Please see statement regarding results pertaining to each phase being presented separately as this is also being conducted as a PhD by publication. ‘Participants will also engage with the interactive features of the online learning module to complete Schedule 4 (prescription-only medication) and Schedule 8 (controlled drug) medication prescriptions’. Can some information about the different drug schedules in Australia be provided? Is prescribing regulated at the national or the provincial level? We thank the reviewer for bringing these suggestions. Please see addition of explanation. We hope it is now clear that prescribing is regulated at a state and national level. S4 and S8 have also been added to the ‘List of abbreviations’. One of the challenges is that by the time this protocol is being reviewed, most of the results may be available. Are there any reasons for the delay in submitting this proposal for publication? Which parts of this study have already been published? This paper was submitted in June 2025 to F1000R. Prior to this it was under review with another journal that took almost a year to then reject it with no feedback. We appreciate that it would have been ideal to have this published prior to the completion of the study, however it isn’t without lack of trying. As we hope the reviewer can understand, in what is at times considered a sensitive topic, it is sometimes hard to have papers published within an effective period. The only phase that has been published to date is phase 1, which is not presented in this methodology. Currently, complex statistical analysis is still being completed due to a novel way of assessment, as presented in this paper. Are the datasets clearly presented in a useable and accessible format? No The authors note that this response is different to other reviewers. This is a methods paper presenting the methodology to a larger study and no data is publishable here. As stipulated, all relatable data to the individual phases will be presented in separate papers. Therefore, the authors believe this response should be “Not applicable”. The manuscript uses both past and future tense to refer to the study and this is confusing. Thank you to the reviewer for bringing this to the authors attention. This has now been corrected throughout the paper. Since writing the paper and attempting to have this approved (peer-reviewed) for publication, time had passed. This study was planned based on a tight schedule and formed part of a larger PhD study. The intervention had to move forward irrespective of this paper not being formally published first. I was confused on reading through the manuscript regarding if this is a study protocol or a report on a study that has already been done. The authors still position this as a protocol paper as it was submitted and initially published in the original form prior to the completion of the study and prior to study results publication. The authors mention that phase 3 would be done in 2025. As 2025 is nearly over can some information on phase 3 be provided. As this is a methods paper, the results from phase 3 will be published in a separate paper to follow. However, we hope that further clarification on the study design has been provided with the edits made. I would be interested in knowing what prescribing education was being offered at JCU before this intervention? More details about the intervention are also useful. Why is the intervention termed multimodal? Who is funding the study? Can details of the online prescription writing test be provided? Thank you for this comment. Please see addition of requested information under ‘Study setting’. Without context on more details on the intervention wanted, the authors are unable to provide this specifically. We do hope that the updated version provides further details on the intervention provided to participants. This was a multimodal intervention due to it being delivered in various ways: face-to-face (using tutorial/workshop-based format), and an online learning module developed by the PI specifically for this study. The addition of explaining that SM’s time was funded by a SERTA grant has been added to the paper. The authors have now provided edits under ‘Assessment and data collection methods’ and believe that there is sufficient explanation of the online test that was developed in Qualtrics®. Figure 3 also shows an example of one of the cases where the participant was required to generate a prescription. The authors mention, “All tests will have different cases used; however, each test will consist of Schedule 4 (S4), complex S4, S4 streamline, Schedule 8 (S8), and mixed (S4+S8) cases.” Can this be explained for non-Australian readers? The authors thank the reviewer for this suggestion. Please see further information provided under ‘Additional education modalities – hands-on opportunities ’. The authors mention, “Data collection for phase 3 of this study is currently ongoing and is expected to be completed by August 2025, at which point the study will conclude.” Has this phase been concluded? Are the results being published separately? This paper was originally accepted for pre-print at a time when phase 3 had not yet commenced. We thank you for noting this, and we have now edited this section. Please see statement regarding results pertaining to each phase being presented separately as this is also being conducted as a PhD by publication. ‘Participants will also engage with the interactive features of the online learning module to complete Schedule 4 (prescription-only medication) and Schedule 8 (controlled drug) medication prescriptions’. Can some information about the different drug schedules in Australia be provided? Is prescribing regulated at the national or the provincial level? We thank the reviewer for bringing these suggestions. Please see addition of explanation. We hope it is now clear that prescribing is regulated at a state and national level. S4 and S8 have also been added to the ‘List of abbreviations’. One of the challenges is that by the time this protocol is being reviewed, most of the results may be available. Are there any reasons for the delay in submitting this proposal for publication? Which parts of this study have already been published? This paper was submitted in June 2025 to F1000R. Prior to this it was under review with another journal that took almost a year to then reject it with no feedback. We appreciate that it would have been ideal to have this published prior to the completion of the study, however it isn’t without lack of trying. As we hope the reviewer can understand, in what is at times considered a sensitive topic, it is sometimes hard to have papers published within an effective period. The only phase that has been published to date is phase 1, which is not presented in this methodology. Currently, complex statistical analysis is still being completed due to a novel way of assessment, as presented in this paper. Are the datasets clearly presented in a useable and accessible format? No The authors note that this response is different to other reviewers. This is a methods paper presenting the methodology to a larger study and no data is publishable here. As stipulated, all relatable data to the individual phases will be presented in separate papers. Therefore, the authors believe this response should be “Not applicable”. Competing Interests: Not applicable Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Newby D. Reviewer Report For: Pharmacist-led prescription writing educational intervention to final-year medical students: A pre-post non-randomised longitudinal study [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2026, 14 :581 ( https://doi.org/10.5256/f1000research.180341.r391881 ) The direct URL for this report is: https://f1000research.com/articles/14-581/v1#referee-response-391881 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 05 Sep 2025 David Newby , University of Newcastle, Newcastle, New South Wales, Australia Not Approved VIEWS 0 https://doi.org/10.5256/f1000research.180341.r391881 This study addresses a meaningful gap in the literature, given the limited evidence on the effectiveness of pharmacy-led prescribing training—or prescribing education more broadly. Considering that prescribing is a routine yet high-stakes task for junior doctors, often performed independently and ... Continue reading READ ALL This study addresses a meaningful gap in the literature, given the limited evidence on the effectiveness of pharmacy-led prescribing training—or prescribing education more broadly. Considering that prescribing is a routine yet high-stakes task for junior doctors, often performed independently and under pressure (e.g., during night shifts with minimal support), the topic is clearly relevant. That said, I’m unsure whether the study design will allow for a clear demonstration of impact, particularly in the absence of a comparator group. Including such a group could strengthen the study’s ability to attribute outcomes directly to the intervention.. Background: The study protocol effectively highlights the importance of prescribing training for undergraduate medical students, noting both the current gaps in formal education and the lack of confidence among new graduates in prescribing tasks. The authors also reference their own work to support the value of pharmacist-led prescribing training, which appears to be well-received by students. Additionally, the background insightfully points out that most prescribing education focuses on inpatient scenarios, with limited attention given to outpatient or discharge prescribing—an area that deserves more emphasis. While the aims of the study are reasonably well-articulated, I have some concerns about whether the proposed methods will adequately address these aims. Study design: The protocol outlines a two-phase study: Phase 2A and 2B focus on the immediate impact of a pharmacist-led prescribing intervention on undergraduate medical students, while Phase 3 aims to assess retention of this impact one year post-graduation. However, the role of Phase 2A remains unclear. The authors describe it as contributing to ‘content validity’ and also refer to it as a ‘comparator’ group. Yet, based on the description and Figure 2, Phase 2A participants only complete a pre-test and are not followed up after their 5-week placement (unlike Phase 2B participants). This limits their utility as a true comparator group. Moreover, the manuscript states that comparisons will be made between post-test data from both Phase 2A and 2B participants. However, Figure 2 shows that Phase 2A participants only complete a single test (equivalent to the pre-test I presume). As described, this appears to be a single-arm pre-post study, which limits the ability to attribute any observed changes in prescribing to the intervention itself. It remains possible that improvements are due to the placement experience rather than the intervention, given the absence of a comparable group that underwent the same placement without the intervention. This represents a significant limitation in the study design. It seems that Phase 2A data are primarily used to establish baseline equivalence with Phase 2B, but without follow-up, their relevance is questionable. A broader concern is the inconsistent use of tense throughout the manuscript. For example, the methods section refers to the study in the past tense (“This non-randomised pre-post longitudinal study was conducted…” p.4), while later sections use the future tense (“Phase 2B will include the JCU final-year medical student cohort…” p.6). It is clear from the manuscript that this is not a proposed ‘protocol’ – rather it is a half-completed study (i.e. Phase 2A and 2B have been completed). This raises questions about the appropriateness of presenting this as a protocol. Typically, protocols are published prior to study commencement to allow transparency and pre-specification of methods. If Phases 2A and 2B are already complete, the rationale for publishing this as a protocol—beyond outlining Phase 3—is unclear. The sample size calculation section would benefit from re-structuring. Currently, it begins with the final sample size and then discusses adjustments for attrition. It would be clearer to first explain the expected effect size and the assumptions underlying the power calculation, followed by how this informed the required sample size and any adjustments for dropout. While the intervention is described in reasonable detail, replication would be difficult based on the current information. Only one example of a prescribing scenario is provided; including a broader sample or an appendix with all scenarios would enhance reproducibility. The assessment of student prescribing is generally well-described. However, it is unclear whether assessments are conducted by a single assessor or multiple independent assessors. Although the criteria (referred to as the ‘DPSP’) appear to be somewhat objective, inter-rater reliability would be improved by having two or more assessors independently score the responses, with discrepancies resolved by consensus or a third reviewer. Additionally, the acronym ‘DPSP’ is not defined in the manuscript and should be clarified. Discussion: The Discussion section appropriately highlights the potential relevance of the study’s findings for informing future medical student training. However, a significant concern that is not addressed in the limitations section is the study’s ability to robustly evaluate the impact of the pharmacist-led prescribing intervention. Based on the protocol as described, the absence of a true comparator arm substantially weakens the study’s capacity to attribute observed changes in prescribing behavior to the intervention itself. This is particularly notable given that Phase 2A, conducted the year prior, could have served as a comparator group. The lack of follow-up for Phase 2A participants limits the ability to distinguish the effects of the intervention from other influences, such as the clinical placement experience. A more explicit discussion of this design limitation would strengthen the manuscript and provide a more balanced interpretation of any findings. Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? No Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests: No competing interests were disclosed. Reviewer Expertise: Undergraduate prescribing education I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Newby D. Reviewer Report For: Pharmacist-led prescription writing educational intervention to final-year medical students: A pre-post non-randomised longitudinal study [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2026, 14 :581 ( https://doi.org/10.5256/f1000research.180341.r391881 ) The direct URL for this report is: https://f1000research.com/articles/14-581/v1#referee-response-391881 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 05 Feb 2026 Sophie Mokrzecki , College of Medicine and Dentistry, James Cook University, Townsville, Australia 05 Feb 2026 Author Response I’m unsure whether the study design will allow for a clear demonstration of impact, particularly in the absence of a comparator group. Including such a group could strengthen ... Continue reading I’m unsure whether the study design will allow for a clear demonstration of impact, particularly in the absence of a comparator group. Including such a group could strengthen the study’s ability to attribute outcomes directly to the intervention.. The authors thank the reviewer for their time in providing feedback. The comparator group are the pre-test responses. Please see line added in study design Phase 2A and limitations in discussion for justification on not having a control group. Ideally a control group is from the same cohort (same educational year) of final-year medical students to show that the outcome(s) are directly related to the intervention, rather than between years. Due to ethics, and logistics discussed with the university year-level coordinator, we were unable to have a control group within the same year, so decided on a comparator group between and within years. We hope the edits of this paper provide further clarity on this point. While the aims of the study are reasonably well-articulated, I have some concerns about whether the proposed methods will adequately address these aims. Aim 1: Change in prescribing skills post additional educational intervention(s) - assessed by a pre-post test Aim 2: Review of knowledge retention - following the same cohort through to the next year Aim 3: Self-perceived confidence - cross assessment of participants acknowledgment of their confidence in their prescription being legal and safe with the assessor’s critiqued dispensability of the prescription We appreciate the comment by the reviewer. The study with the stipulated aims underwent review and approval by an ethics panel. All data received can be used to assist in answering the aims. A statistician has been consulted to assist in data review to produce results based on the outcome measures. However, the role of Phase 2A remains unclear. The authors describe it as contributing to ‘content validity’ and also refer to it as a ‘comparator’ group. Yet, based on the description and Figure 2, Phase 2A participants only complete a pre-test and are not followed up after their 5-week placement (unlike Phase 2B participants). This limits their utility as a true comparator group. Please see point one for further justification. We appreciate the statement made by the reviewer here. However, between years, phase 2A would also not be a true comparator or control group pre-post standard placement as the participants were from different final-years of medical education (2023 and 2024). Phase 2A is therefore to test the use and functionality of the online test, as well as to act as a comparator to phase 2B pre-test results, ensuring that participants baseline level of knowledge is similar from university curricular. This intervention was not to assess standard mandatory educational interventions (placement), but the addition of the education explained. Moreover, the manuscript states that comparisons will be made between post-test data from both Phase 2A and 2B participants. However, Figure 2 shows that Phase 2A participants only complete a single test (equivalent to the pre-test I presume). As described, this appears to be a single-arm pre-post study, which limits the ability to attribute any observed changes in prescribing to the intervention itself. We hope that enough clarity has been provided in the updated manuscript that phase 2A is a comparator to phase 2B pre-test to only determine if baseline knowledge is comparable between years (between group assessment). Figure 2 does show the exact study design. A pilot study was completed (Ref 11) that was an RCT. We believe this already showed the impact of a control group on a smaller scale. However, as we have justified, we were not able to complete an RCT on a larger scale with a longitudinal study. It remains possible that improvements are due to the placement experience rather than the intervention, given the absence of a comparable group that underwent the same placement without the intervention. This represents a significant limitation in the study design. It seems that Phase 2A data are primarily used to establish baseline equivalence with Phase 2B, but without follow-up, their relevance is questionable. We appreciate the point that the reviewer has made. However, the authors hope that we have provided clarity, that the improvement would be based on the additional education modalities provided in this study. Participants attend placement throughout their final year, so the impact of a 5-week placement only pre-post study (phase 2A) would only be showing standard education provided by the university each year. It would also not be accurate as the students attend varied specialty placement blocks at differing times. Therefore, a single arm review of knowledge in phase 2A was appropriate and reduced assessment fatigue of participants. inconsistent use of tense throughout the manuscript. For example, the methods section refers to the study in the past tense (“This non-randomised pre-post longitudinal study was conducted…” p.4), while later sections use the future tense (“Phase 2B will include the JCU final-year medical student cohort…” p.6). It is clear from the manuscript that this is not a proposed ‘protocol’ – rather it is a half-completed study (i.e. Phase 2A and 2B have been completed). This raises questions about the appropriateness of presenting this as a protocol. Typically, protocols are published prior to study commencement to allow transparency and pre-specification of methods. If Phases 2A and 2B are already complete, the rationale for publishing this as a protocol—beyond outlining Phase 3—is unclear. Thank you to the reviewer for bringing this to the authors attention. This has now been corrected throughout the paper. Since writing the paper and attempting to have this approved (peer-reviewed) for publication, time had passed. This study was planned based on a tight schedule and formed part of a larger PhD study. The intervention had to move forward irrespective of this paper not being formally published first. Regarding this being a protocol or methods paper, the authors still position this as a protocol paper. This is because it was submitted and initially published in the original form prior to the completion of the study and prior to study results publication. The sample size calculation section would benefit from re-structuring. Currently, it begins with the final sample size and then discusses adjustments for attrition. It would be clearer to first explain the expected effect size and the assumptions underlying the power calculation, followed by how this informed the required sample size and any adjustments for dropout. We thank the reviewer for this suggestion and have made appropriate changes to the paper. While the intervention is described in reasonable detail, replication would be difficult based on the current information. Only one example of a prescribing scenario is provided; including a broader sample or an appendix with all scenarios would enhance reproducibility. For the assessment component, we appreciate that an example of the entire test would be of benefit. However, each time point used a different batch case questions to reduce information sharing. Therefore, giving a copy of one test is not the same test used in each phase. Different preliminary questions were also used to help answer different questions from each phase. At the time, we were unable to upload the preliminary questions as the study was still open and we didn’t want to risk participants having open availability to the answers. A sample case was provided along with the written explanation on the basis that a similar test constructed from the information provided is reproducible according to local legal regulations and overall, the types of prescriptions that can be generated. It is also worth noting that the domain to upload this paper did not allow for an extra attachment of an appendix. The assessment of student prescribing is generally well-described. However, it is unclear whether assessments are conducted by a single assessor or multiple independent assessors. Although the criteria (referred to as the ‘DPSP’) appear to be somewhat objective, inter-rater reliability would be improved by having two or more assessors independently score the responses, with discrepancies resolved by consensus or a third reviewer. Additionally, the acronym ‘DPSP’ is not defined in the manuscript and should be clarified. The authors thank the reviewer for noting this oversite. Please see addition of information on how assessment was conducted. The DPSP criteria is determined by the legal factors required as per the MPR. This is explained under the ‘Assessment and data collection methods’ section. The criterion was presented in this way (a new model established by the PI) to simplify teaching and learning and therefore standardise it to the assessment categories. The authors appreciate that the definition of DPSP was not as clear as first intended and hope that the edits now highlight the meaning. It has also been added to the start of the paper under ‘List of abbreviations’. However, a significant concern that is not addressed in the limitations section is the study’s ability to robustly evaluate the impact of the pharmacist-led prescribing intervention. Based on the protocol as described, the absence of a true comparator arm substantially weakens the study’s capacity to attribute observed changes in prescribing behavior to the intervention itself. This is particularly notable given that Phase 2A, conducted the year prior, could have served as a comparator group. The lack of follow-up for Phase 2A participants limits the ability to distinguish the effects of the intervention from other influences, such as the clinical placement experience. A more explicit discussion of this design limitation would strengthen the manuscript and provide a more balanced interpretation of any findings. We thank the reviewer for raising this concern. Please see updates in the limitations paragraph of the discussion to reflect the decision to not have a “control” group. But please also note: Phase 2A would not be a true control if done as pre-post, as these students were not from the same cohort Due to ethics, the logistics of the cohort and the potential for information sharing explained in the paper, we could not conduct an RCT with a control for phase 2B The clinical placement experience for each student, whilst standardised, varied in specialty at the time of the intervention. For example, not all students were on a medical placement rotation. So, whilst the placement experience may have impacted learning in general, this was the students’ standard mandatory rotations for their university degree, and the aim of this study is to assess if the addition of the educational modalities from this intervention changed prescribing skills The use of a control group had previously been used in a smaller pilot study. Therefore, a positive change in prescribing skills had previously been seen with a RCT, and the goal was to determine if a similar but larger study design would cultivate another positive change in prescribing skills. I’m unsure whether the study design will allow for a clear demonstration of impact, particularly in the absence of a comparator group. Including such a group could strengthen the study’s ability to attribute outcomes directly to the intervention.. The authors thank the reviewer for their time in providing feedback. The comparator group are the pre-test responses. Please see line added in study design Phase 2A and limitations in discussion for justification on not having a control group. Ideally a control group is from the same cohort (same educational year) of final-year medical students to show that the outcome(s) are directly related to the intervention, rather than between years. Due to ethics, and logistics discussed with the university year-level coordinator, we were unable to have a control group within the same year, so decided on a comparator group between and within years. We hope the edits of this paper provide further clarity on this point. While the aims of the study are reasonably well-articulated, I have some concerns about whether the proposed methods will adequately address these aims. Aim 1: Change in prescribing skills post additional educational intervention(s) - assessed by a pre-post test Aim 2: Review of knowledge retention - following the same cohort through to the next year Aim 3: Self-perceived confidence - cross assessment of participants acknowledgment of their confidence in their prescription being legal and safe with the assessor’s critiqued dispensability of the prescription We appreciate the comment by the reviewer. The study with the stipulated aims underwent review and approval by an ethics panel. All data received can be used to assist in answering the aims. A statistician has been consulted to assist in data review to produce results based on the outcome measures. However, the role of Phase 2A remains unclear. The authors describe it as contributing to ‘content validity’ and also refer to it as a ‘comparator’ group. Yet, based on the description and Figure 2, Phase 2A participants only complete a pre-test and are not followed up after their 5-week placement (unlike Phase 2B participants). This limits their utility as a true comparator group. Please see point one for further justification. We appreciate the statement made by the reviewer here. However, between years, phase 2A would also not be a true comparator or control group pre-post standard placement as the participants were from different final-years of medical education (2023 and 2024). Phase 2A is therefore to test the use and functionality of the online test, as well as to act as a comparator to phase 2B pre-test results, ensuring that participants baseline level of knowledge is similar from university curricular. This intervention was not to assess standard mandatory educational interventions (placement), but the addition of the education explained. Moreover, the manuscript states that comparisons will be made between post-test data from both Phase 2A and 2B participants. However, Figure 2 shows that Phase 2A participants only complete a single test (equivalent to the pre-test I presume). As described, this appears to be a single-arm pre-post study, which limits the ability to attribute any observed changes in prescribing to the intervention itself. We hope that enough clarity has been provided in the updated manuscript that phase 2A is a comparator to phase 2B pre-test to only determine if baseline knowledge is comparable between years (between group assessment). Figure 2 does show the exact study design. A pilot study was completed (Ref 11) that was an RCT. We believe this already showed the impact of a control group on a smaller scale. However, as we have justified, we were not able to complete an RCT on a larger scale with a longitudinal study. It remains possible that improvements are due to the placement experience rather than the intervention, given the absence of a comparable group that underwent the same placement without the intervention. This represents a significant limitation in the study design. It seems that Phase 2A data are primarily used to establish baseline equivalence with Phase 2B, but without follow-up, their relevance is questionable. We appreciate the point that the reviewer has made. However, the authors hope that we have provided clarity, that the improvement would be based on the additional education modalities provided in this study. Participants attend placement throughout their final year, so the impact of a 5-week placement only pre-post study (phase 2A) would only be showing standard education provided by the university each year. It would also not be accurate as the students attend varied specialty placement blocks at differing times. Therefore, a single arm review of knowledge in phase 2A was appropriate and reduced assessment fatigue of participants. inconsistent use of tense throughout the manuscript. For example, the methods section refers to the study in the past tense (“This non-randomised pre-post longitudinal study was conducted…” p.4), while later sections use the future tense (“Phase 2B will include the JCU final-year medical student cohort…” p.6). It is clear from the manuscript that this is not a proposed ‘protocol’ – rather it is a half-completed study (i.e. Phase 2A and 2B have been completed). This raises questions about the appropriateness of presenting this as a protocol. Typically, protocols are published prior to study commencement to allow transparency and pre-specification of methods. If Phases 2A and 2B are already complete, the rationale for publishing this as a protocol—beyond outlining Phase 3—is unclear. Thank you to the reviewer for bringing this to the authors attention. This has now been corrected throughout the paper. Since writing the paper and attempting to have this approved (peer-reviewed) for publication, time had passed. This study was planned based on a tight schedule and formed part of a larger PhD study. The intervention had to move forward irrespective of this paper not being formally published first. Regarding this being a protocol or methods paper, the authors still position this as a protocol paper. This is because it was submitted and initially published in the original form prior to the completion of the study and prior to study results publication. The sample size calculation section would benefit from re-structuring. Currently, it begins with the final sample size and then discusses adjustments for attrition. It would be clearer to first explain the expected effect size and the assumptions underlying the power calculation, followed by how this informed the required sample size and any adjustments for dropout. We thank the reviewer for this suggestion and have made appropriate changes to the paper. While the intervention is described in reasonable detail, replication would be difficult based on the current information. Only one example of a prescribing scenario is provided; including a broader sample or an appendix with all scenarios would enhance reproducibility. For the assessment component, we appreciate that an example of the entire test would be of benefit. However, each time point used a different batch case questions to reduce information sharing. Therefore, giving a copy of one test is not the same test used in each phase. Different preliminary questions were also used to help answer different questions from each phase. At the time, we were unable to upload the preliminary questions as the study was still open and we didn’t want to risk participants having open availability to the answers. A sample case was provided along with the written explanation on the basis that a similar test constructed from the information provided is reproducible according to local legal regulations and overall, the types of prescriptions that can be generated. It is also worth noting that the domain to upload this paper did not allow for an extra attachment of an appendix. The assessment of student prescribing is generally well-described. However, it is unclear whether assessments are conducted by a single assessor or multiple independent assessors. Although the criteria (referred to as the ‘DPSP’) appear to be somewhat objective, inter-rater reliability would be improved by having two or more assessors independently score the responses, with discrepancies resolved by consensus or a third reviewer. Additionally, the acronym ‘DPSP’ is not defined in the manuscript and should be clarified. The authors thank the reviewer for noting this oversite. Please see addition of information on how assessment was conducted. The DPSP criteria is determined by the legal factors required as per the MPR. This is explained under the ‘Assessment and data collection methods’ section. The criterion was presented in this way (a new model established by the PI) to simplify teaching and learning and therefore standardise it to the assessment categories. The authors appreciate that the definition of DPSP was not as clear as first intended and hope that the edits now highlight the meaning. It has also been added to the start of the paper under ‘List of abbreviations’. However, a significant concern that is not addressed in the limitations section is the study’s ability to robustly evaluate the impact of the pharmacist-led prescribing intervention. Based on the protocol as described, the absence of a true comparator arm substantially weakens the study’s capacity to attribute observed changes in prescribing behavior to the intervention itself. This is particularly notable given that Phase 2A, conducted the year prior, could have served as a comparator group. The lack of follow-up for Phase 2A participants limits the ability to distinguish the effects of the intervention from other influences, such as the clinical placement experience. A more explicit discussion of this design limitation would strengthen the manuscript and provide a more balanced interpretation of any findings. We thank the reviewer for raising this concern. Please see updates in the limitations paragraph of the discussion to reflect the decision to not have a “control” group. But please also note: Phase 2A would not be a true control if done as pre-post, as these students were not from the same cohort Due to ethics, the logistics of the cohort and the potential for information sharing explained in the paper, we could not conduct an RCT with a control for phase 2B The clinical placement experience for each student, whilst standardised, varied in specialty at the time of the intervention. For example, not all students were on a medical placement rotation. So, whilst the placement experience may have impacted learning in general, this was the students’ standard mandatory rotations for their university degree, and the aim of this study is to assess if the addition of the educational modalities from this intervention changed prescribing skills The use of a control group had previously been used in a smaller pilot study. Therefore, a positive change in prescribing skills had previously been seen with a RCT, and the goal was to determine if a similar but larger study design would cultivate another positive change in prescribing skills. Competing Interests: Not applicable Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 05 Feb 2026 Sophie Mokrzecki , College of Medicine and Dentistry, James Cook University, Townsville, Australia 05 Feb 2026 Author Response I’m unsure whether the study design will allow for a clear demonstration of impact, particularly in the absence of a comparator group. Including such a group could strengthen ... Continue reading I’m unsure whether the study design will allow for a clear demonstration of impact, particularly in the absence of a comparator group. Including such a group could strengthen the study’s ability to attribute outcomes directly to the intervention.. The authors thank the reviewer for their time in providing feedback. The comparator group are the pre-test responses. Please see line added in study design Phase 2A and limitations in discussion for justification on not having a control group. Ideally a control group is from the same cohort (same educational year) of final-year medical students to show that the outcome(s) are directly related to the intervention, rather than between years. Due to ethics, and logistics discussed with the university year-level coordinator, we were unable to have a control group within the same year, so decided on a comparator group between and within years. We hope the edits of this paper provide further clarity on this point. While the aims of the study are reasonably well-articulated, I have some concerns about whether the proposed methods will adequately address these aims. Aim 1: Change in prescribing skills post additional educational intervention(s) - assessed by a pre-post test Aim 2: Review of knowledge retention - following the same cohort through to the next year Aim 3: Self-perceived confidence - cross assessment of participants acknowledgment of their confidence in their prescription being legal and safe with the assessor’s critiqued dispensability of the prescription We appreciate the comment by the reviewer. The study with the stipulated aims underwent review and approval by an ethics panel. All data received can be used to assist in answering the aims. A statistician has been consulted to assist in data review to produce results based on the outcome measures. However, the role of Phase 2A remains unclear. The authors describe it as contributing to ‘content validity’ and also refer to it as a ‘comparator’ group. Yet, based on the description and Figure 2, Phase 2A participants only complete a pre-test and are not followed up after their 5-week placement (unlike Phase 2B participants). This limits their utility as a true comparator group. Please see point one for further justification. We appreciate the statement made by the reviewer here. However, between years, phase 2A would also not be a true comparator or control group pre-post standard placement as the participants were from different final-years of medical education (2023 and 2024). Phase 2A is therefore to test the use and functionality of the online test, as well as to act as a comparator to phase 2B pre-test results, ensuring that participants baseline level of knowledge is similar from university curricular. This intervention was not to assess standard mandatory educational interventions (placement), but the addition of the education explained. Moreover, the manuscript states that comparisons will be made between post-test data from both Phase 2A and 2B participants. However, Figure 2 shows that Phase 2A participants only complete a single test (equivalent to the pre-test I presume). As described, this appears to be a single-arm pre-post study, which limits the ability to attribute any observed changes in prescribing to the intervention itself. We hope that enough clarity has been provided in the updated manuscript that phase 2A is a comparator to phase 2B pre-test to only determine if baseline knowledge is comparable between years (between group assessment). Figure 2 does show the exact study design. A pilot study was completed (Ref 11) that was an RCT. We believe this already showed the impact of a control group on a smaller scale. However, as we have justified, we were not able to complete an RCT on a larger scale with a longitudinal study. It remains possible that improvements are due to the placement experience rather than the intervention, given the absence of a comparable group that underwent the same placement without the intervention. This represents a significant limitation in the study design. It seems that Phase 2A data are primarily used to establish baseline equivalence with Phase 2B, but without follow-up, their relevance is questionable. We appreciate the point that the reviewer has made. However, the authors hope that we have provided clarity, that the improvement would be based on the additional education modalities provided in this study. Participants attend placement throughout their final year, so the impact of a 5-week placement only pre-post study (phase 2A) would only be showing standard education provided by the university each year. It would also not be accurate as the students attend varied specialty placement blocks at differing times. Therefore, a single arm review of knowledge in phase 2A was appropriate and reduced assessment fatigue of participants. inconsistent use of tense throughout the manuscript. For example, the methods section refers to the study in the past tense (“This non-randomised pre-post longitudinal study was conducted…” p.4), while later sections use the future tense (“Phase 2B will include the JCU final-year medical student cohort…” p.6). It is clear from the manuscript that this is not a proposed ‘protocol’ – rather it is a half-completed study (i.e. Phase 2A and 2B have been completed). This raises questions about the appropriateness of presenting this as a protocol. Typically, protocols are published prior to study commencement to allow transparency and pre-specification of methods. If Phases 2A and 2B are already complete, the rationale for publishing this as a protocol—beyond outlining Phase 3—is unclear. Thank you to the reviewer for bringing this to the authors attention. This has now been corrected throughout the paper. Since writing the paper and attempting to have this approved (peer-reviewed) for publication, time had passed. This study was planned based on a tight schedule and formed part of a larger PhD study. The intervention had to move forward irrespective of this paper not being formally published first. Regarding this being a protocol or methods paper, the authors still position this as a protocol paper. This is because it was submitted and initially published in the original form prior to the completion of the study and prior to study results publication. The sample size calculation section would benefit from re-structuring. Currently, it begins with the final sample size and then discusses adjustments for attrition. It would be clearer to first explain the expected effect size and the assumptions underlying the power calculation, followed by how this informed the required sample size and any adjustments for dropout. We thank the reviewer for this suggestion and have made appropriate changes to the paper. While the intervention is described in reasonable detail, replication would be difficult based on the current information. Only one example of a prescribing scenario is provided; including a broader sample or an appendix with all scenarios would enhance reproducibility. For the assessment component, we appreciate that an example of the entire test would be of benefit. However, each time point used a different batch case questions to reduce information sharing. Therefore, giving a copy of one test is not the same test used in each phase. Different preliminary questions were also used to help answer different questions from each phase. At the time, we were unable to upload the preliminary questions as the study was still open and we didn’t want to risk participants having open availability to the answers. A sample case was provided along with the written explanation on the basis that a similar test constructed from the information provided is reproducible according to local legal regulations and overall, the types of prescriptions that can be generated. It is also worth noting that the domain to upload this paper did not allow for an extra attachment of an appendix. The assessment of student prescribing is generally well-described. However, it is unclear whether assessments are conducted by a single assessor or multiple independent assessors. Although the criteria (referred to as the ‘DPSP’) appear to be somewhat objective, inter-rater reliability would be improved by having two or more assessors independently score the responses, with discrepancies resolved by consensus or a third reviewer. Additionally, the acronym ‘DPSP’ is not defined in the manuscript and should be clarified. The authors thank the reviewer for noting this oversite. Please see addition of information on how assessment was conducted. The DPSP criteria is determined by the legal factors required as per the MPR. This is explained under the ‘Assessment and data collection methods’ section. The criterion was presented in this way (a new model established by the PI) to simplify teaching and learning and therefore standardise it to the assessment categories. The authors appreciate that the definition of DPSP was not as clear as first intended and hope that the edits now highlight the meaning. It has also been added to the start of the paper under ‘List of abbreviations’. However, a significant concern that is not addressed in the limitations section is the study’s ability to robustly evaluate the impact of the pharmacist-led prescribing intervention. Based on the protocol as described, the absence of a true comparator arm substantially weakens the study’s capacity to attribute observed changes in prescribing behavior to the intervention itself. This is particularly notable given that Phase 2A, conducted the year prior, could have served as a comparator group. The lack of follow-up for Phase 2A participants limits the ability to distinguish the effects of the intervention from other influences, such as the clinical placement experience. A more explicit discussion of this design limitation would strengthen the manuscript and provide a more balanced interpretation of any findings. We thank the reviewer for raising this concern. Please see updates in the limitations paragraph of the discussion to reflect the decision to not have a “control” group. But please also note: Phase 2A would not be a true control if done as pre-post, as these students were not from the same cohort Due to ethics, the logistics of the cohort and the potential for information sharing explained in the paper, we could not conduct an RCT with a control for phase 2B The clinical placement experience for each student, whilst standardised, varied in specialty at the time of the intervention. For example, not all students were on a medical placement rotation. So, whilst the placement experience may have impacted learning in general, this was the students’ standard mandatory rotations for their university degree, and the aim of this study is to assess if the addition of the educational modalities from this intervention changed prescribing skills The use of a control group had previously been used in a smaller pilot study. Therefore, a positive change in prescribing skills had previously been seen with a RCT, and the goal was to determine if a similar but larger study design would cultivate another positive change in prescribing skills. I’m unsure whether the study design will allow for a clear demonstration of impact, particularly in the absence of a comparator group. Including such a group could strengthen the study’s ability to attribute outcomes directly to the intervention.. The authors thank the reviewer for their time in providing feedback. The comparator group are the pre-test responses. Please see line added in study design Phase 2A and limitations in discussion for justification on not having a control group. Ideally a control group is from the same cohort (same educational year) of final-year medical students to show that the outcome(s) are directly related to the intervention, rather than between years. Due to ethics, and logistics discussed with the university year-level coordinator, we were unable to have a control group within the same year, so decided on a comparator group between and within years. We hope the edits of this paper provide further clarity on this point. While the aims of the study are reasonably well-articulated, I have some concerns about whether the proposed methods will adequately address these aims. Aim 1: Change in prescribing skills post additional educational intervention(s) - assessed by a pre-post test Aim 2: Review of knowledge retention - following the same cohort through to the next year Aim 3: Self-perceived confidence - cross assessment of participants acknowledgment of their confidence in their prescription being legal and safe with the assessor’s critiqued dispensability of the prescription We appreciate the comment by the reviewer. The study with the stipulated aims underwent review and approval by an ethics panel. All data received can be used to assist in answering the aims. A statistician has been consulted to assist in data review to produce results based on the outcome measures. However, the role of Phase 2A remains unclear. The authors describe it as contributing to ‘content validity’ and also refer to it as a ‘comparator’ group. Yet, based on the description and Figure 2, Phase 2A participants only complete a pre-test and are not followed up after their 5-week placement (unlike Phase 2B participants). This limits their utility as a true comparator group. Please see point one for further justification. We appreciate the statement made by the reviewer here. However, between years, phase 2A would also not be a true comparator or control group pre-post standard placement as the participants were from different final-years of medical education (2023 and 2024). Phase 2A is therefore to test the use and functionality of the online test, as well as to act as a comparator to phase 2B pre-test results, ensuring that participants baseline level of knowledge is similar from university curricular. This intervention was not to assess standard mandatory educational interventions (placement), but the addition of the education explained. Moreover, the manuscript states that comparisons will be made between post-test data from both Phase 2A and 2B participants. However, Figure 2 shows that Phase 2A participants only complete a single test (equivalent to the pre-test I presume). As described, this appears to be a single-arm pre-post study, which limits the ability to attribute any observed changes in prescribing to the intervention itself. We hope that enough clarity has been provided in the updated manuscript that phase 2A is a comparator to phase 2B pre-test to only determine if baseline knowledge is comparable between years (between group assessment). Figure 2 does show the exact study design. A pilot study was completed (Ref 11) that was an RCT. We believe this already showed the impact of a control group on a smaller scale. However, as we have justified, we were not able to complete an RCT on a larger scale with a longitudinal study. It remains possible that improvements are due to the placement experience rather than the intervention, given the absence of a comparable group that underwent the same placement without the intervention. This represents a significant limitation in the study design. It seems that Phase 2A data are primarily used to establish baseline equivalence with Phase 2B, but without follow-up, their relevance is questionable. We appreciate the point that the reviewer has made. However, the authors hope that we have provided clarity, that the improvement would be based on the additional education modalities provided in this study. Participants attend placement throughout their final year, so the impact of a 5-week placement only pre-post study (phase 2A) would only be showing standard education provided by the university each year. It would also not be accurate as the students attend varied specialty placement blocks at differing times. Therefore, a single arm review of knowledge in phase 2A was appropriate and reduced assessment fatigue of participants. inconsistent use of tense throughout the manuscript. For example, the methods section refers to the study in the past tense (“This non-randomised pre-post longitudinal study was conducted…” p.4), while later sections use the future tense (“Phase 2B will include the JCU final-year medical student cohort…” p.6). It is clear from the manuscript that this is not a proposed ‘protocol’ – rather it is a half-completed study (i.e. Phase 2A and 2B have been completed). This raises questions about the appropriateness of presenting this as a protocol. Typically, protocols are published prior to study commencement to allow transparency and pre-specification of methods. If Phases 2A and 2B are already complete, the rationale for publishing this as a protocol—beyond outlining Phase 3—is unclear. Thank you to the reviewer for bringing this to the authors attention. This has now been corrected throughout the paper. Since writing the paper and attempting to have this approved (peer-reviewed) for publication, time had passed. This study was planned based on a tight schedule and formed part of a larger PhD study. The intervention had to move forward irrespective of this paper not being formally published first. Regarding this being a protocol or methods paper, the authors still position this as a protocol paper. This is because it was submitted and initially published in the original form prior to the completion of the study and prior to study results publication. The sample size calculation section would benefit from re-structuring. Currently, it begins with the final sample size and then discusses adjustments for attrition. It would be clearer to first explain the expected effect size and the assumptions underlying the power calculation, followed by how this informed the required sample size and any adjustments for dropout. We thank the reviewer for this suggestion and have made appropriate changes to the paper. While the intervention is described in reasonable detail, replication would be difficult based on the current information. Only one example of a prescribing scenario is provided; including a broader sample or an appendix with all scenarios would enhance reproducibility. For the assessment component, we appreciate that an example of the entire test would be of benefit. However, each time point used a different batch case questions to reduce information sharing. Therefore, giving a copy of one test is not the same test used in each phase. Different preliminary questions were also used to help answer different questions from each phase. At the time, we were unable to upload the preliminary questions as the study was still open and we didn’t want to risk participants having open availability to the answers. A sample case was provided along with the written explanation on the basis that a similar test constructed from the information provided is reproducible according to local legal regulations and overall, the types of prescriptions that can be generated. It is also worth noting that the domain to upload this paper did not allow for an extra attachment of an appendix. The assessment of student prescribing is generally well-described. However, it is unclear whether assessments are conducted by a single assessor or multiple independent assessors. Although the criteria (referred to as the ‘DPSP’) appear to be somewhat objective, inter-rater reliability would be improved by having two or more assessors independently score the responses, with discrepancies resolved by consensus or a third reviewer. Additionally, the acronym ‘DPSP’ is not defined in the manuscript and should be clarified. The authors thank the reviewer for noting this oversite. Please see addition of information on how assessment was conducted. The DPSP criteria is determined by the legal factors required as per the MPR. This is explained under the ‘Assessment and data collection methods’ section. The criterion was presented in this way (a new model established by the PI) to simplify teaching and learning and therefore standardise it to the assessment categories. The authors appreciate that the definition of DPSP was not as clear as first intended and hope that the edits now highlight the meaning. It has also been added to the start of the paper under ‘List of abbreviations’. However, a significant concern that is not addressed in the limitations section is the study’s ability to robustly evaluate the impact of the pharmacist-led prescribing intervention. Based on the protocol as described, the absence of a true comparator arm substantially weakens the study’s capacity to attribute observed changes in prescribing behavior to the intervention itself. This is particularly notable given that Phase 2A, conducted the year prior, could have served as a comparator group. The lack of follow-up for Phase 2A participants limits the ability to distinguish the effects of the intervention from other influences, such as the clinical placement experience. A more explicit discussion of this design limitation would strengthen the manuscript and provide a more balanced interpretation of any findings. We thank the reviewer for raising this concern. Please see updates in the limitations paragraph of the discussion to reflect the decision to not have a “control” group. But please also note: Phase 2A would not be a true control if done as pre-post, as these students were not from the same cohort Due to ethics, the logistics of the cohort and the potential for information sharing explained in the paper, we could not conduct an RCT with a control for phase 2B The clinical placement experience for each student, whilst standardised, varied in specialty at the time of the intervention. For example, not all students were on a medical placement rotation. So, whilst the placement experience may have impacted learning in general, this was the students’ standard mandatory rotations for their university degree, and the aim of this study is to assess if the addition of the educational modalities from this intervention changed prescribing skills The use of a control group had previously been used in a smaller pilot study. Therefore, a positive change in prescribing skills had previously been seen with a RCT, and the goal was to determine if a similar but larger study design would cultivate another positive change in prescribing skills. Competing Interests: Not applicable Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 12 Jun 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 3 Version 2 (revision) 05 Feb 26 read read Version 1 12 Jun 25 read read read David Newby , University of Newcastle, Newcastle, Australia Pathiyil Ravi Shankar , IMU University, Federal Territory of Kuala Lumpur, Malaysia Paul Chin , university of otago, Dunedin, New Zealand Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Shankar P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 19 Feb 2026 | for Version 2 Pathiyil Ravi Shankar , IMU Centre for Education, IMU University, Federal Territory of Kuala Lumpur, Kuala Lumpur, Malaysia 0 Views copyright © 2026 Shankar P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Thanks for the clarifications by the authors. I am happy to approve the revised version of the study protocol. Competing Interests No competing interests were disclosed. Reviewer Expertise Small group learning, rational use of medicines, pharmacology education, presecribing skills education I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Shankar PR. Peer Review Report For: Pharmacist-led prescription writing educational intervention to final-year medical students: A pre-post non-randomised longitudinal study [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2026, 14 :581 ( https://doi.org/10.5256/f1000research.195514.r455864) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-581/v2#referee-response-455864 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Chin P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 19 Feb 2026 | for Version 2 Paul Chin , university of otago, Dunedin, New Zealand 0 Views copyright © 2026 Chin P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Thanks to the authors for significant efforts in editing the manuscript and responding to my comments. I'm still unclear regarding exactly how the DPSP is used to generate a quantitative metric of prescribing skill. The authors note that "a prescription may score for example 20 out of 30 points correct" - but how does the DPSP translate into these points? As it stands, there are 18 distinct criteria in Table 1 - is each given 1 point? Or if the aforementioned 30 points maps to the 18 criteria, how is this done? Competing Interests No competing interests were disclosed. Reviewer Expertise medical education I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Chin P. Peer Review Report For: Pharmacist-led prescription writing educational intervention to final-year medical students: A pre-post non-randomised longitudinal study [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2026, 14 :581 ( https://doi.org/10.5256/f1000research.195514.r455865) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-581/v2#referee-response-455865 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Chin P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 02 Jan 2026 | for Version 1 Paul Chin , university of otago, Dunedin, New Zealand 0 Views copyright © 2026 Chin P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Not Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Overall This manuscript describes a two-phase, non-randomised pre–post longitudinal educational intervention evaluating pharmacist-led prescription-writing education for final-year medical students, with follow-up as junior doctors one year later. The topic is clinically important (prescribing legality/safety and transition-to-practice), but the current protocol has design and reporting ambiguities that make attribution of effect difficult and would limit reproducibility unless addressed with major revisions. Abstract nil Main text Introduction nil Protocol The investigators clearly describe the prescription aspects reviewed in the study (DPSP Table 1). However, exactly how this is used to determine the safety and legality of the prescription. For example, mention is made of ‘Dispensability’ in the ‘Proposed data analysis’, with P < 0.05 considered statistically significant, but a numerical metric of dispensability is not specified other than “A new numerical variable may be created…”. The word ‘may’ indicates this is not a requirement of the study, which is puzzling. Earlier under ‘Participants’ there is mention of “a difference in the total mean score of eight points between groups”; it would be useful for this numerical rubric to explicitly be in this manuscript. Assessor procedures are insufficiently described: it is unclear whether one or multiple raters will score prescriptions, whether raters are blinded to timepoint (pre vs post vs follow-up), and how disagreements will be resolved—this is essential given the potential subjectivity of judging abbreviations/legibility/dispensability. Tense and study status are inconsistent: parts read as already conducted (Phases 2A/2B) while other sections read as planned, which creates uncertainty about what is prospective versus completed and what aspects are still modifiable (particularly Phase 3). Based on the dates in Figure 2, the entire study has presumably been completed already. Confounding and contamination: the design explicitly includes a 5-week placement period between pre- and post-test, which is a strong alternative explanation for improvement; the analysis plan should state how placement exposure will be measured/adjusted for (rotation type, prescribing exposure, supervisor input) and how contamination (sharing materials among students) will be assessed. Discussion nil Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Partly Are sufficient details of the methods provided to allow replication by others? No Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests No competing interests were disclosed. Reviewer Expertise medical education I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. reply Respond to this report Responses (1) Author Response 05 Feb 2026 Sophie Mokrzecki, College of Medicine and Dentistry, James Cook University, Townsville, Australia …the current protocol has design and reporting ambiguities that make attribution of effect difficult and would limit reproducibility unless addressed with major revisions. The authors thank the reviewer for this comment and believe that the edits provided address this concern. The investigators clearly describe the prescription aspects reviewed in the study (DPSP Table 1). However, exactly how this is used to determine the safety and legality of the prescription. For example, mention is made of ‘Dispensability’ in the ‘Proposed data analysis’, with P < 0.05 considered statistically significant, but a numerical metric of dispensability is not specified other than “A new numerical variable may be created…”. The word ‘may’ indicates this is not a requirement of the study, which is puzzling. Earlier under ‘Participants’ there is mention of “a difference in the total mean score of eight points between groups”; it would be useful for this numerical rubric to explicitly be in this manuscript. The DPSP criteria is based on the legal document used in QLD (state government) that must be followed when writing a medication prescription (the Medicines and Poisons Regulation - MPR). The safety component is based on the MPR and the pharmaceutical benefits scheme (PBS) that is decided by the national government. Therefore, the DPSP provides the numerical rubric that is being used for this study. Therefore, numeric evaluation of these components will be published. The dispensability is not a numeric value, but rather, if the prescription meets all the legal and safety criteria because otherwise a pharmacist is unable to dispense the prescription. However, the authors hope they have now made it more clear to the reviewer under ‘Assessment and data collection methods’ why dispensability and numeric values will be presented. This is because whilst a prescription may score for example 20 out of 30 points correct and considered a “pass”, if it does not have all the components as per the DPSP, then the prescription is not dispensable. The word ‘may’ has been used as this study involves complex data analysis that has not yet been undertaken in other studies. We are now in the process of completing this data analysis and still determining the best statistical tests to complete to obtain a presentable result that provides an answer to the aims. Assessor procedures are insufficiently described: it is unclear whether one or multiple raters will score prescriptions, whether raters are blinded to timepoint (pre vs post vs follow-up), and how disagreements will be resolved—this is essential given the potential subjectivity of judging abbreviations/legibility/dispensability. The authors thank the reviewer for noting this oversite. Please see addition of information on how assessment was conducted within the section ‘Assessment and data collection methods’. Tense and study status are inconsistent: parts read as already conducted (Phases 2A/2B) while other sections read as planned, which creates uncertainty about what is prospective versus completed and what aspects are still modifiable (particularly Phase 3). Based on the dates in Figure 2, the entire study has presumably been completed already. Thank you to the reviewer for bringing this to the authors attention. This has now been corrected throughout the paper. Since writing the paper and attempting to have this approved (peer-reviewed) for publication, time had passed. This study was planned based on a tight schedule and formed part of a larger PhD study. The intervention had to move forward irrespective of this paper not being formally published first. Confounding and contamination: the design explicitly includes a 5-week placement period between pre- and post-test, which is a strong alternative explanation for improvement; the analysis plan should state how placement exposure will be measured/adjusted for (rotation type, prescribing exposure, supervisor input) and how contamination (sharing materials among students) will be assessed. The authors thank the reviewer for this comment. Please see addition to limitations paragraph within the discussion as to why placement has not been considered in the analysis plan of this study. View more View less Competing Interests Not applicable reply Respond Report a concern Chin P. Peer Review Report For: Pharmacist-led prescription writing educational intervention to final-year medical students: A pre-post non-randomised longitudinal study [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2026, 14 :581 ( https://doi.org/10.5256/f1000research.180341.r438125) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-581/v1#referee-response-438125 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Shankar P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 02 Jan 2026 | for Version 1 Pathiyil Ravi Shankar , IMU Centre for Education, IMU University, Federal Territory of Kuala Lumpur, Kuala Lumpur, Malaysia 0 Views copyright © 2026 Shankar P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Not Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The manuscript uses both past and future tense to refer to the study and this is confusing. I was confused on reading through the manuscript regarding if this is a study protocol or a report on a study that has already been done. The authors mention that phase 3 would be done in 2025. As 2025 is nearly over can some information on phase 3 be provided. I would be interested in knowing what prescribing education was being offered at JCU before this intervention? More details about the intervention are also useful. Why is the intervention termed multimodal? Who is funding the study? Can details of the online prescription writing test be provided? The authors mention, “All tests will have different cases used; however, each test will consist of Schedule 4 (S4), complex S4, S4 streamline, Schedule 8 (S8), and mixed (S4+S8) cases.” Can this be explained for non-Australian readers? The authors mention, “Data collection for phase 3 of this study is currently ongoing and is expected to be completed by August 2025, at which point the study will conclude.” Has this phase been concluded? Are the results being published separately? ‘Participants will also engage with the interactive features of the online learning module to complete Schedule 4 (prescription-only medication) and Schedule 8 (controlled drug) medication prescriptions’. Can some information about the different drug schedules in Australia be provided? Is prescribing regulated at the national or the provincial level? One of the challenges is that by the time this protocol is being reviewed, most of the results may be available. Are there any reasons for the delay in submitting this proposal for publication? Which parts of this study have already been published? Is the rationale for, and objectives of, the study clearly described? Partly Is the study design appropriate for the research question? Partly Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? No Competing Interests No competing interests were disclosed. Reviewer Expertise Small group learning, rational use of medicines, pharmacology education, presecribing skills education I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. reply Respond to this report Responses (1) Author Response 05 Feb 2026 Sophie Mokrzecki, College of Medicine and Dentistry, James Cook University, Townsville, Australia The manuscript uses both past and future tense to refer to the study and this is confusing. Thank you to the reviewer for bringing this to the authors attention. This has now been corrected throughout the paper. Since writing the paper and attempting to have this approved (peer-reviewed) for publication, time had passed. This study was planned based on a tight schedule and formed part of a larger PhD study. The intervention had to move forward irrespective of this paper not being formally published first. I was confused on reading through the manuscript regarding if this is a study protocol or a report on a study that has already been done. The authors still position this as a protocol paper as it was submitted and initially published in the original form prior to the completion of the study and prior to study results publication. The authors mention that phase 3 would be done in 2025. As 2025 is nearly over can some information on phase 3 be provided. As this is a methods paper, the results from phase 3 will be published in a separate paper to follow. However, we hope that further clarification on the study design has been provided with the edits made. I would be interested in knowing what prescribing education was being offered at JCU before this intervention? More details about the intervention are also useful. Why is the intervention termed multimodal? Who is funding the study? Can details of the online prescription writing test be provided? Thank you for this comment. Please see addition of requested information under ‘Study setting’. Without context on more details on the intervention wanted, the authors are unable to provide this specifically. We do hope that the updated version provides further details on the intervention provided to participants. This was a multimodal intervention due to it being delivered in various ways: face-to-face (using tutorial/workshop-based format), and an online learning module developed by the PI specifically for this study. The addition of explaining that SM’s time was funded by a SERTA grant has been added to the paper. The authors have now provided edits under ‘Assessment and data collection methods’ and believe that there is sufficient explanation of the online test that was developed in Qualtrics®. Figure 3 also shows an example of one of the cases where the participant was required to generate a prescription. The authors mention, “All tests will have different cases used; however, each test will consist of Schedule 4 (S4), complex S4, S4 streamline, Schedule 8 (S8), and mixed (S4+S8) cases.” Can this be explained for non-Australian readers? The authors thank the reviewer for this suggestion. Please see further information provided under ‘Additional education modalities – hands-on opportunities ’. The authors mention, “Data collection for phase 3 of this study is currently ongoing and is expected to be completed by August 2025, at which point the study will conclude.” Has this phase been concluded? Are the results being published separately? This paper was originally accepted for pre-print at a time when phase 3 had not yet commenced. We thank you for noting this, and we have now edited this section. Please see statement regarding results pertaining to each phase being presented separately as this is also being conducted as a PhD by publication. ‘Participants will also engage with the interactive features of the online learning module to complete Schedule 4 (prescription-only medication) and Schedule 8 (controlled drug) medication prescriptions’. Can some information about the different drug schedules in Australia be provided? Is prescribing regulated at the national or the provincial level? We thank the reviewer for bringing these suggestions. Please see addition of explanation. We hope it is now clear that prescribing is regulated at a state and national level. S4 and S8 have also been added to the ‘List of abbreviations’. One of the challenges is that by the time this protocol is being reviewed, most of the results may be available. Are there any reasons for the delay in submitting this proposal for publication? Which parts of this study have already been published? This paper was submitted in June 2025 to F1000R. Prior to this it was under review with another journal that took almost a year to then reject it with no feedback. We appreciate that it would have been ideal to have this published prior to the completion of the study, however it isn’t without lack of trying. As we hope the reviewer can understand, in what is at times considered a sensitive topic, it is sometimes hard to have papers published within an effective period. The only phase that has been published to date is phase 1, which is not presented in this methodology. Currently, complex statistical analysis is still being completed due to a novel way of assessment, as presented in this paper. Are the datasets clearly presented in a useable and accessible format? No The authors note that this response is different to other reviewers. This is a methods paper presenting the methodology to a larger study and no data is publishable here. As stipulated, all relatable data to the individual phases will be presented in separate papers. Therefore, the authors believe this response should be “Not applicable”. View more View less Competing Interests Not applicable reply Respond Report a concern Shankar PR. Peer Review Report For: Pharmacist-led prescription writing educational intervention to final-year medical students: A pre-post non-randomised longitudinal study [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2026, 14 :581 ( https://doi.org/10.5256/f1000research.180341.r438128) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-581/v1#referee-response-438128 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Newby D. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 05 Sep 2025 | for Version 1 David Newby , University of Newcastle, Newcastle, New South Wales, Australia 0 Views copyright © 2025 Newby D. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Not Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This study addresses a meaningful gap in the literature, given the limited evidence on the effectiveness of pharmacy-led prescribing training—or prescribing education more broadly. Considering that prescribing is a routine yet high-stakes task for junior doctors, often performed independently and under pressure (e.g., during night shifts with minimal support), the topic is clearly relevant. That said, I’m unsure whether the study design will allow for a clear demonstration of impact, particularly in the absence of a comparator group. Including such a group could strengthen the study’s ability to attribute outcomes directly to the intervention.. Background: The study protocol effectively highlights the importance of prescribing training for undergraduate medical students, noting both the current gaps in formal education and the lack of confidence among new graduates in prescribing tasks. The authors also reference their own work to support the value of pharmacist-led prescribing training, which appears to be well-received by students. Additionally, the background insightfully points out that most prescribing education focuses on inpatient scenarios, with limited attention given to outpatient or discharge prescribing—an area that deserves more emphasis. While the aims of the study are reasonably well-articulated, I have some concerns about whether the proposed methods will adequately address these aims. Study design: The protocol outlines a two-phase study: Phase 2A and 2B focus on the immediate impact of a pharmacist-led prescribing intervention on undergraduate medical students, while Phase 3 aims to assess retention of this impact one year post-graduation. However, the role of Phase 2A remains unclear. The authors describe it as contributing to ‘content validity’ and also refer to it as a ‘comparator’ group. Yet, based on the description and Figure 2, Phase 2A participants only complete a pre-test and are not followed up after their 5-week placement (unlike Phase 2B participants). This limits their utility as a true comparator group. Moreover, the manuscript states that comparisons will be made between post-test data from both Phase 2A and 2B participants. However, Figure 2 shows that Phase 2A participants only complete a single test (equivalent to the pre-test I presume). As described, this appears to be a single-arm pre-post study, which limits the ability to attribute any observed changes in prescribing to the intervention itself. It remains possible that improvements are due to the placement experience rather than the intervention, given the absence of a comparable group that underwent the same placement without the intervention. This represents a significant limitation in the study design. It seems that Phase 2A data are primarily used to establish baseline equivalence with Phase 2B, but without follow-up, their relevance is questionable. A broader concern is the inconsistent use of tense throughout the manuscript. For example, the methods section refers to the study in the past tense (“This non-randomised pre-post longitudinal study was conducted…” p.4), while later sections use the future tense (“Phase 2B will include the JCU final-year medical student cohort…” p.6). It is clear from the manuscript that this is not a proposed ‘protocol’ – rather it is a half-completed study (i.e. Phase 2A and 2B have been completed). This raises questions about the appropriateness of presenting this as a protocol. Typically, protocols are published prior to study commencement to allow transparency and pre-specification of methods. If Phases 2A and 2B are already complete, the rationale for publishing this as a protocol—beyond outlining Phase 3—is unclear. The sample size calculation section would benefit from re-structuring. Currently, it begins with the final sample size and then discusses adjustments for attrition. It would be clearer to first explain the expected effect size and the assumptions underlying the power calculation, followed by how this informed the required sample size and any adjustments for dropout. While the intervention is described in reasonable detail, replication would be difficult based on the current information. Only one example of a prescribing scenario is provided; including a broader sample or an appendix with all scenarios would enhance reproducibility. The assessment of student prescribing is generally well-described. However, it is unclear whether assessments are conducted by a single assessor or multiple independent assessors. Although the criteria (referred to as the ‘DPSP’) appear to be somewhat objective, inter-rater reliability would be improved by having two or more assessors independently score the responses, with discrepancies resolved by consensus or a third reviewer. Additionally, the acronym ‘DPSP’ is not defined in the manuscript and should be clarified. Discussion: The Discussion section appropriately highlights the potential relevance of the study’s findings for informing future medical student training. However, a significant concern that is not addressed in the limitations section is the study’s ability to robustly evaluate the impact of the pharmacist-led prescribing intervention. Based on the protocol as described, the absence of a true comparator arm substantially weakens the study’s capacity to attribute observed changes in prescribing behavior to the intervention itself. This is particularly notable given that Phase 2A, conducted the year prior, could have served as a comparator group. The lack of follow-up for Phase 2A participants limits the ability to distinguish the effects of the intervention from other influences, such as the clinical placement experience. A more explicit discussion of this design limitation would strengthen the manuscript and provide a more balanced interpretation of any findings. Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? No Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests No competing interests were disclosed. Reviewer Expertise Undergraduate prescribing education I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. reply Respond to this report Responses (1) Author Response 05 Feb 2026 Sophie Mokrzecki, College of Medicine and Dentistry, James Cook University, Townsville, Australia I’m unsure whether the study design will allow for a clear demonstration of impact, particularly in the absence of a comparator group. Including such a group could strengthen the study’s ability to attribute outcomes directly to the intervention.. The authors thank the reviewer for their time in providing feedback. The comparator group are the pre-test responses. Please see line added in study design Phase 2A and limitations in discussion for justification on not having a control group. Ideally a control group is from the same cohort (same educational year) of final-year medical students to show that the outcome(s) are directly related to the intervention, rather than between years. Due to ethics, and logistics discussed with the university year-level coordinator, we were unable to have a control group within the same year, so decided on a comparator group between and within years. We hope the edits of this paper provide further clarity on this point. While the aims of the study are reasonably well-articulated, I have some concerns about whether the proposed methods will adequately address these aims. Aim 1: Change in prescribing skills post additional educational intervention(s) - assessed by a pre-post test Aim 2: Review of knowledge retention - following the same cohort through to the next year Aim 3: Self-perceived confidence - cross assessment of participants acknowledgment of their confidence in their prescription being legal and safe with the assessor’s critiqued dispensability of the prescription We appreciate the comment by the reviewer. The study with the stipulated aims underwent review and approval by an ethics panel. All data received can be used to assist in answering the aims. A statistician has been consulted to assist in data review to produce results based on the outcome measures. However, the role of Phase 2A remains unclear. The authors describe it as contributing to ‘content validity’ and also refer to it as a ‘comparator’ group. Yet, based on the description and Figure 2, Phase 2A participants only complete a pre-test and are not followed up after their 5-week placement (unlike Phase 2B participants). This limits their utility as a true comparator group. Please see point one for further justification. We appreciate the statement made by the reviewer here. However, between years, phase 2A would also not be a true comparator or control group pre-post standard placement as the participants were from different final-years of medical education (2023 and 2024). Phase 2A is therefore to test the use and functionality of the online test, as well as to act as a comparator to phase 2B pre-test results, ensuring that participants baseline level of knowledge is similar from university curricular. This intervention was not to assess standard mandatory educational interventions (placement), but the addition of the education explained. Moreover, the manuscript states that comparisons will be made between post-test data from both Phase 2A and 2B participants. However, Figure 2 shows that Phase 2A participants only complete a single test (equivalent to the pre-test I presume). As described, this appears to be a single-arm pre-post study, which limits the ability to attribute any observed changes in prescribing to the intervention itself. We hope that enough clarity has been provided in the updated manuscript that phase 2A is a comparator to phase 2B pre-test to only determine if baseline knowledge is comparable between years (between group assessment). Figure 2 does show the exact study design. A pilot study was completed (Ref 11) that was an RCT. We believe this already showed the impact of a control group on a smaller scale. However, as we have justified, we were not able to complete an RCT on a larger scale with a longitudinal study. It remains possible that improvements are due to the placement experience rather than the intervention, given the absence of a comparable group that underwent the same placement without the intervention. This represents a significant limitation in the study design. It seems that Phase 2A data are primarily used to establish baseline equivalence with Phase 2B, but without follow-up, their relevance is questionable. We appreciate the point that the reviewer has made. However, the authors hope that we have provided clarity, that the improvement would be based on the additional education modalities provided in this study. Participants attend placement throughout their final year, so the impact of a 5-week placement only pre-post study (phase 2A) would only be showing standard education provided by the university each year. It would also not be accurate as the students attend varied specialty placement blocks at differing times. Therefore, a single arm review of knowledge in phase 2A was appropriate and reduced assessment fatigue of participants. inconsistent use of tense throughout the manuscript. For example, the methods section refers to the study in the past tense (“This non-randomised pre-post longitudinal study was conducted…” p.4), while later sections use the future tense (“Phase 2B will include the JCU final-year medical student cohort…” p.6). It is clear from the manuscript that this is not a proposed ‘protocol’ – rather it is a half-completed study (i.e. Phase 2A and 2B have been completed). This raises questions about the appropriateness of presenting this as a protocol. Typically, protocols are published prior to study commencement to allow transparency and pre-specification of methods. If Phases 2A and 2B are already complete, the rationale for publishing this as a protocol—beyond outlining Phase 3—is unclear. Thank you to the reviewer for bringing this to the authors attention. This has now been corrected throughout the paper. Since writing the paper and attempting to have this approved (peer-reviewed) for publication, time had passed. This study was planned based on a tight schedule and formed part of a larger PhD study. The intervention had to move forward irrespective of this paper not being formally published first. Regarding this being a protocol or methods paper, the authors still position this as a protocol paper. This is because it was submitted and initially published in the original form prior to the completion of the study and prior to study results publication. The sample size calculation section would benefit from re-structuring. Currently, it begins with the final sample size and then discusses adjustments for attrition. It would be clearer to first explain the expected effect size and the assumptions underlying the power calculation, followed by how this informed the required sample size and any adjustments for dropout. We thank the reviewer for this suggestion and have made appropriate changes to the paper. While the intervention is described in reasonable detail, replication would be difficult based on the current information. Only one example of a prescribing scenario is provided; including a broader sample or an appendix with all scenarios would enhance reproducibility. For the assessment component, we appreciate that an example of the entire test would be of benefit. However, each time point used a different batch case questions to reduce information sharing. Therefore, giving a copy of one test is not the same test used in each phase. Different preliminary questions were also used to help answer different questions from each phase. At the time, we were unable to upload the preliminary questions as the study was still open and we didn’t want to risk participants having open availability to the answers. A sample case was provided along with the written explanation on the basis that a similar test constructed from the information provided is reproducible according to local legal regulations and overall, the types of prescriptions that can be generated. It is also worth noting that the domain to upload this paper did not allow for an extra attachment of an appendix. The assessment of student prescribing is generally well-described. However, it is unclear whether assessments are conducted by a single assessor or multiple independent assessors. Although the criteria (referred to as the ‘DPSP’) appear to be somewhat objective, inter-rater reliability would be improved by having two or more assessors independently score the responses, with discrepancies resolved by consensus or a third reviewer. Additionally, the acronym ‘DPSP’ is not defined in the manuscript and should be clarified. The authors thank the reviewer for noting this oversite. Please see addition of information on how assessment was conducted. The DPSP criteria is determined by the legal factors required as per the MPR. This is explained under the ‘Assessment and data collection methods’ section. The criterion was presented in this way (a new model established by the PI) to simplify teaching and learning and therefore standardise it to the assessment categories. The authors appreciate that the definition of DPSP was not as clear as first intended and hope that the edits now highlight the meaning. It has also been added to the start of the paper under ‘List of abbreviations’. However, a significant concern that is not addressed in the limitations section is the study’s ability to robustly evaluate the impact of the pharmacist-led prescribing intervention. Based on the protocol as described, the absence of a true comparator arm substantially weakens the study’s capacity to attribute observed changes in prescribing behavior to the intervention itself. This is particularly notable given that Phase 2A, conducted the year prior, could have served as a comparator group. The lack of follow-up for Phase 2A participants limits the ability to distinguish the effects of the intervention from other influences, such as the clinical placement experience. A more explicit discussion of this design limitation would strengthen the manuscript and provide a more balanced interpretation of any findings. We thank the reviewer for raising this concern. Please see updates in the limitations paragraph of the discussion to reflect the decision to not have a “control” group. But please also note: Phase 2A would not be a true control if done as pre-post, as these students were not from the same cohort Due to ethics, the logistics of the cohort and the potential for information sharing explained in the paper, we could not conduct an RCT with a control for phase 2B The clinical placement experience for each student, whilst standardised, varied in specialty at the time of the intervention. For example, not all students were on a medical placement rotation. So, whilst the placement experience may have impacted learning in general, this was the students’ standard mandatory rotations for their university degree, and the aim of this study is to assess if the addition of the educational modalities from this intervention changed prescribing skills The use of a control group had previously been used in a smaller pilot study. Therefore, a positive change in prescribing skills had previously been seen with a RCT, and the goal was to determine if a similar but larger study design would cultivate another positive change in prescribing skills. View more View less Competing Interests Not applicable reply Respond Report a concern Newby D. Peer Review Report For: Pharmacist-led prescription writing educational intervention to final-year medical students: A pre-post non-randomised longitudinal study [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2026, 14 :581 ( https://doi.org/10.5256/f1000research.180341.r391881) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-581/v1#referee-response-391881 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions Adjust parameters to alter display View on desktop for interactive features Includes Interactive Elements View on desktop for interactive features Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. 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