Using Gagne’s instructional design to teach communication skills in phlebotomy education through role-play

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Owaidah" } ], "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: Phlebotomy is a medical procedure that is performed frequently in the blood collection activities of medical institutions. The procedure involves close interaction with different types of patients—some of whom are cooperative and others, who, for many reasons, are not (for example, patients who have a fear of needles). Blood extraction is an essential skill in several medical specialties, such as in laboratory sciences. Lesson planning in phlebotomy education is mainly focused on procedural skills, and very little attention is given towards teaching communication skills despite the close patient interaction in phlebotomy. In this paper, I propose a lesson plan for teaching communication skills to medical laboratory sciences and nursing students based on Gagne’s instructional design. Methods: The training session included two main parts: training session using Gange’s instructional design and at the end of the session, the participants were surveyed for the effectiveness of the training session. Results: 17 participants were included in the study. Overall, the majority of the participants were highly satisfied with the effectiveness of the training session in teaching communication skills with all seven survey questions receiving a mean score of 4.58 on a Likert scale of 1-5. Conclusion: We demonstrated the effectiveness of Gange’s instructional beyond theoretical lesson planning to teach communication skills through role-play in phlebotomy education." } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/11-46", "name": "Using Gagne’s instructional design to teach communication skills in..." } } ] } Home Browse Using Gagne’s instructional design to teach communication skills in... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Owaidah AY. Using Gagne’s instructional design to teach communication skills in phlebotomy education through role-play [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2024, 11 :46 ( https://doi.org/10.12688/f1000research.75335.2 ) 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 ▬ ✚ Method Article Revised Using Gagne’s instructional design to teach communication skills in phlebotomy education through role-play [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved] Amani Y. Owaidah https://orcid.org/0000-0002-5224-175X Amani Y. Owaidah https://orcid.org/0000-0002-5224-175X PUBLISHED 05 Aug 2024 Author details Author details Department of Clinical Laboratory Sciences, Imam Abdulrahman bin Faisal University, Dammam, College of Applied Medical Sciences,, Saudi Arabia Amani Y. Owaidah Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Background: Phlebotomy is a medical procedure that is performed frequently in the blood collection activities of medical institutions. The procedure involves close interaction with different types of patients—some of whom are cooperative and others, who, for many reasons, are not (for example, patients who have a fear of needles). Blood extraction is an essential skill in several medical specialties, such as in laboratory sciences. Lesson planning in phlebotomy education is mainly focused on procedural skills, and very little attention is given towards teaching communication skills despite the close patient interaction in phlebotomy. In this paper, I propose a lesson plan for teaching communication skills to medical laboratory sciences and nursing students based on Gagne’s instructional design. Methods: The training session included two main parts: training session using Gange’s instructional design and at the end of the session, the participants were surveyed for the effectiveness of the training session. Results: 17 participants were included in the study. Overall, the majority of the participants were highly satisfied with the effectiveness of the training session in teaching communication skills with all seven survey questions receiving a mean score of 4.58 on a Likert scale of 1-5. Conclusion: We demonstrated the effectiveness of Gange’s instructional beyond theoretical lesson planning to teach communication skills through role-play in phlebotomy education. READ ALL READ LESS Keywords communication skills, phlebotomy, medical education, trypanophobia Corresponding Author(s) Amani Y. Owaidah ( [email protected] ) Close Corresponding author: Amani Y. Owaidah Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2024 Owaidah AY. 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: Owaidah AY. Using Gagne’s instructional design to teach communication skills in phlebotomy education through role-play [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2024, 11 :46 ( https://doi.org/10.12688/f1000research.75335.2 ) First published: 14 Jan 2022, 11 :46 ( https://doi.org/10.12688/f1000research.75335.1 ) Latest published: 05 Aug 2024, 11 :46 ( https://doi.org/10.12688/f1000research.75335.2 ) Revised Amendments from Version 1 1-Changed figure 2 from boxplot to bar chart based on comment of reviewer 1 2- Replaced the term "blood extraction" with "blood collection" based on comment of reviewer 2. 1-Changed figure 2 from boxplot to bar chart based on comment of reviewer 1 2- Replaced the term "blood extraction" with "blood collection" based on comment of reviewer 2. See the author's detailed response to the review by Conor Gilligan See the author's detailed response to the review by Modibo Coulibaly READ REVIEWER RESPONSES Introduction Phlebotomy, also known as venipuncture, denotes the process of drawing blood, and it is considered one of the most common medical procedures in healthcare. 1 Often performed by doctors, nurses, laboratory staff, or specialized phlebotomists, it plays a pivotal role in all laboratory analyses, patient diagnoses, treatments, research, and transfusions. As many countries do not have specialized phlebotomy programs, the procedure is often embedded in the curriculum of most medical specialties. 2 In the field of medical education, phlebotomy has always been taught according to the apprenticeship model, which typically uses the “see one, do one, teach one” approach. 3 In particular, simulators such as mannequins, which offer a physical model of a patient’s arm, have been used to provide students the opportunity to practice a procedure before performing it on a real patient. 4 By using simulations the potential patient risk is reduced in clinical training, which ultimately improves the quality of patient care. Role-play is another teaching strategy that has been used. Students are generally divided into small groups and take turns practicing the steps related to the phlebotomy procedure. 4 These main teaching methods focus on the technical and procedural skills of phlebotomy, and neglect the vital skills of communication. To perform the procedure in real-life (working) situations, healthcare professionals must interact with patients, some of whom may present anxiety or a fear of needles. 5 – 7 Other patients may be difficult to communicate with, especially when the first attempt to draw blood was unsuccessful. This may cause delays in extracting the sample or distress in the phlebotomy process. Therefore, teaching communication skills in phlebotomy is as vital as teaching technical skills. Comprising nine steps, Gagne’s instructional design has been widely used in medical education as a framework for achieving five main learning outcomes (see Table 1 ), including intellectual skills, verbal information, cognitive strategies, attitudes, and motor skills. 8 In this study, the researcher applied Gagne’s steps to phlebotomy education and outlined a detailed lesson plan that incorporates the teaching of communication skills for the process of phlebotomy. Table 1. Gagne’s nine steps of instructional design. Step No. Instructional step 1 Gain attention 2 Inform the learner of the lesson’s objectives 3 Recall prior knowledge 4 Present stimulus 5 Provide learning guidance 6 Elicit performance 7 Provide feedback 8 Assess performance 9 Enhance retention and transfer of acquired knowledge Methods Setting In October 2021, a two-hour training session on communication skills based on Gange’s instructional design using role-play was conducted for the fourth year Clinical Laboratory Sciences (CLS) students and interns of CLS and Nursing programs in Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. An email invitation was sent to the students and interns via email. 17 volunteer participants responded to the invitation. The training session was directed by the author, who acted as the trainer for the entire session. A teaching assistant participated to play the role of the patient in the session. Ethical approval and consent for participation The program and the study were approved by the ethics committee of Imam Abdulrahman bin Faisal University. All participants provided a signed written informed consent to participate in the training session and study, and the study protocol was approved by the institutional review board of Imam Abdulrahman Bin Faisal University (IRB-2021-03-359). The study was conducted in compliance with the Declaration of Helsinki. Eligibility criteria Students who had essential prior knowledge of the pre-analytical variables that are associated with blood collection. These variables include patient variables (fasting), technique variables (patient identification), and specimen variables (anticoagulant specimen processing). Lesson delivery method: Gagne’s nine items of instructional design Gaining attention To engage students at the start of the session, the presenter (also called trainer) played a video demonstrating how a phlebotomist interacts with a child who comes for blood collection but is afraid of needles. This video will not only capture the attention of visual and auditory learners, but also triggers the learners’ personal experiences with blood collection. Audio-visual presentation also stimulates auditory learners through audio narration while, the visual learners found themselves engaged by the interactions in the video. Meanwhile, the kinesthetic learners were drawn towards the activities in the video. Meanwhile, through watching the video and based on the situated learning theory, the interaction between the child and the phlebotomist stimulates past memories and facilitates the students to reflect on their past experience and promotes professional growth. 9 In addition, the video potentially helped keeping the students focused on the objectives throughout the session through reducing the cognitive load. Informing the learner of the objectives To keep students engaged, the presenter asked the students what they thought about the video before stating the session’s objectives. This was intended to help students appreciate the learning objectives in real work situations. The objective of the session was for students to successfully acquire certain capabilities and skills, including how to approach and greet patients in a positive and friendly manner; communicate effectively with patients who exhibit fear and anxiety; and communicate effectively with cooperative patients. Recall of prior learning For students to benefit from the session, the trainer used the constructivism learning theory approach. It is based on allowing students to rely on their previous knowledge and personal experiences, which is then aligned with new information so that the students can construct their own visual interpretations of real work situations. 10 To achieve this purpose, the students were asked about their recent visits to an outpatient clinic or laboratory to perform blood collection. In particular, they will be presented with questions such as a) “ Have you experienced fear from a blood collection procedure ”?; “ Do you know someone, such as a family member or friend, with trypanophobia (phobia of medical procedures)?; and “If yes, how do phlebotomists deal with such a situation?” ; “ What would you do differently if you were a phlebotomist? ” This way, the students were prompted to recall their previous learning experiences and were given approximately five minutes to reflect. This exercise engaged the students’ interpersonal intelligence. Presenting stimulus In this segment of the session, the trainer used role-play to deliver the intended content. Role-play is one of the most widely used teaching methods for the acquisition of communication skills in medical education. 11 Tables 2 and 3 outline the role-play scenarios that were presented in the session. The first scenario demonstrates how students should communicate with a cooperative patient, while the second scenario demonstrates how they should communicate with a patient displaying trypanophobia (fear of needles). To ensure that the students remain engaged in the session, the facilitator encouraged them again to recall their personal experiences of visiting a clinic for a blood test. Table 2. Role-play scenario for a cooperative patient. Scenario Element Description Venue Phlebotomy area in a blood bank laboratory. Role 1. Phlebotomist. 2. Adult patient. Equipment • Two chairs. • Phlebotomy table holding syringes, vacutainers, unlabeled blood collection tubes, and blood test request forms. Background The phlebotomy area in the blood bank is responsible for collecting blood samples from patients for laboratory testing in response to request forms from treating physicians. The patients come to the phlebotomy area with the request forms. The phlebotomist’s role is to identify the patients correctly and greet them in a friendly and polite manner. Scenario Patient: Enters the phlebotomy area with a request form for a blood test. Phlebotomist: Approaches the patient in a friendly manner, saying, “ Good morning. My name is X. How are you today? ” Patient: Responds by saying, “I am good, thanks. ” Phlebotomist: Asks, “ What is your name? ” Phlebotomist then cross-checks the medical record card and request form, along with the medical record number on both forms. Phlebotomist: Smiles encouragingly while labeling the tubes, saying, “Alright, I will take a few milliliters of blood for the blood test your physician requested. ” Patient: Agrees and lifts his or her sleeve for the procedure. Objectives • To demonstrate positive behavior. • To identify the patient correctly. Procedure requirements for the student • Greet the patient with a smile and friendly attitude. • Maintain eye contact. • Identify the patient correctly. • Explain the procedure to the patient. • Maintain a positive attitude throughout the procedure. Table 3. Role-play scenario for a trypanophobic patient. Scenario Element Description Venue Phlebotomy area in a blood bank laboratory. Role 1. Phlebotomist. 2. Adult patient. Equipment • Two chairs. • Phlebotomy table holding syringes, vacutainers, unlabeled blood collection tubes, and blood test request forms. Background The phlebotomy area in the blood bank is responsible for collecting blood samples from patients for laboratory testing in response to request forms from treating physicians. The patients come to the phlebotomy area with the request forms. The phlebotomist’s role is to identify the patients correctly and greet them in a friendly and polite manner. Scenario Patient: Enters the phlebotomy area with a request form for a blood test, displaying some hesitation. Phlebotomist: Approaches the patient in a friendly manner, saying, “ Good morning. My name is X. How are you today ?” Phlebotomist: Notices the patient’s hesitation, asking, “ Are you alright? Are you afraid of needles? ” Patient: Responds, saying, “ Yes. ” Phlebotomist: Reassures the patient and maintains a comforting behavior, saying, “ It is alright. I will use this tiny needle instead. How do you feel about that? ” The phlebotomist continues, asking, “ Have you ever tasted a lemon before? Do you remember how uncomfortable it felt? ” Patient: Responds with a hesitant tone, saying, “ Yes. ” Phlebotomist: Reassures the patient, saying, “ It will feel just like that, and it will take less than a second. ” Patient: Responds, saying, “ Alright. ” Phlebotomist: Continues procedure, saying, “ My name is X. What’s yours? ” The phlebotomist then cross-checks the medical record card and request form, along with the medical record number on both forms. Phlebotomist: Smiles while labeling the tubes, saying, “ Alright, I will take a few milliliters of blood for the blood test your physician requested, and I’ll use this tiny needle. ” Patient: Responds hesitantly, saying, “ Alright. ” Phlebotomist: Instructs in a warm tone, saying, “ Please pinch yourself in the arm for me. What did that feel like? ” Patient: Responds, saying, “ It feels a bit uncomfortable. ” Phlebotomist: Responds, asking, “ Did it hurt much?” Patient: Responds, saying, “ No. ” Phlebotomist: Responds, saying, “ That is how this needle will feel. ” Patient: Responds with a sigh, saying, “ Alright. ” Objectives • To demonstrate positive behavior. • To demonstrate compassion and reassurance. • To identify the patient correctly. Procedure requirements for the student • Greet the patient with smile and friendly attitude. • Identify the patient correctly. • Maintain comfortable eye contact. • Notice the patient’s fear. • Attempt to comfort the patient before explaining the procedure. • Be attentive to the patient’s needs. • Do not undermine the patient’s fear. • Explain the procedure to the patient. • Maintain a positive attitude throughout the procedure. Providing learning guidance For each role-play scenario, the trainer used Peyton’s approach to teaching, which comprises four steps: demonstration, deconstruction, comprehension, and performance. 12 For the first scenario (a normal, cooperative patient), the trainer began the instruction by demonstrating how students should approach the patient friendly and politely; identify the patient correctly; clearly explain the procedure; label the tubes accurately; and approach the patient for the phlebotomy procedure. Thereafter, the trainer deconstructed each step by explaining the rationale behind it. During deconstruction, students were encouraged to ask questions and comment on the process. By encouraging them to ask questions, the trainer facilitated their understanding, further stimulating them to reflect on previous experiences. The second scenario (a trypanophobia patient) required a more explicit demonstration and deconstruction process. The same approach as in the first scenario was used, but the trainer demonstrated more compassion and persuasive skills when the patient (played by a teaching assistant) displayed signs of hesitation, fear, or discomfort. These signs of discomfort could be presented in different ways, such as patients with trypanophobia being hesitant to extend their arm for the procedure, or patients who start crying. The trainer, when taking the role of the phlebotomist, deliberately reacted to the patient’s anxiety by reassuring the patient and calmly asking, “ Are you afraid of needles? ” Questions like these will show the patient that the phlebotomist is paying attention to his or her anxiety. Then, the trainer further reassured the patient by saying, “ I understand that it might be scary, but I’m using this tiny needle, which looks just like a butterfly. ” Descriptive and calming statements like these will encourage the patient to recall associated childhood experiences (e.g., the quick and light brushes of butterfly wings). Subsequently, recalling these experiences can make the patients feel reassured that the short time of discomfort they feel is similar to what they remember, and that the procedure will be over quickly. Eliciting performance After the demonstration step was completed, the trainer conducted the performance step of Peyton’s approach. Students then were be divided into groups of three to role-play and practice their communication skills with different types of patients and were instructed to take turns performing as the phlebotomist, patient, and observer. This activity mimicked real work situations and helped students develop effective communication skills. The observers in the scenarios were responsible for witnessing the interactions between the phlebotomist and patient, as well as discussing the phlebotomist’s performance; they prompted discussions to explain what could be improved or done differently. Studies show that this step reveals the importance of role-play as a teaching method as it not only helps mimic real work situations, but also helps students work in teams and develop their communication skills. 11 Providing feedback In addition to the observer’s feedback in the scenarios, the teaching assistant and trainer observed the students and provided immediate verbal feedback. Feedback, whether positive or negative, is an essential tool in education to help students achieve their maximum potential at any stage of their studies. 13 It should be constructive so that students are encouraged to improve their academic development. 14 The trainer used the tell, explain, listen, and let’ (TELL model) to provide feedback to students during the role-play performances, which comprises of four main features: tell (tell the students the specific behavior that requires improvement, or compliment them on their good behaviors); explain (offer explanations to show students the outcomes that might occur due to the behaviors demonstrated, whether positive or negative); listen (listen to and allow the students to reflect on the feedback that they have received); and ‘let’ (let the students know about the consequences of their actions if the behaviors are not corrected). 14 A common understanding among educators is that feedback is necessary only for the behaviors that require correction. However, feedback that focuses on areas of strength will help build students’ self-confidence and improve their communication with their superiors. 15 Overall, this step aimed to help students achieve the learning objective of the session—that is, to develop an effective communication skill set. Assessing performance After all groups took turns to perform each role and receive feedback, the students were regrouped into pairs. All students took turns to role-play as the phlebotomist and patient, while the teaching assistant and trainer observed how they interact in both roles. A formative assessment was used to evaluate the students’ performances and offered them the opportunity to reflect on and make the necessary adjustments to improve their future learning. 16 A graded checklist was used for the assessment and given to the students, so they would be better informed in future when performing the actions related to phlebotomy (see Figure 1 ). Figure 1. Assessment form. Enhancing retention and transfer The trainer used two methods to help students retain the knowledge that they gained and transfer it to others. First, 15 minutes before the end of the session, the trainer asked students to share their thoughts about the session, what they had learned, and to reflect on their performances. This approach allowed the students to not only retain their knowledge but also learn from the experiences of others. Second, the trainer provided the students their graded assessments to give them the chance to reflect on their performances privately. Finally, at the end of the session, the facilitator provided a summary of the main learning objectives covered. Survey, data collection and analysis At the end of the session, an online survey was sent to all participants to collect their views on the session. Answers to each question was given on a Likert scale of 1-5, where 5 meant strongly agree and 1 strongly disagree. The questions of the survey were modified from Taniguchi et al to fit the outcomes of the lesson plan. 4 The survey also included an open-ended question section to allow the participants to freely express their thoughts about the session. The open-ended section included three questions: 1. What did you learn from the session? 2. What did you like about the session? 3. What can you suggest to us to improve in the future? The survey questions can be found in the Extended data. The participants responses to the seven questions on the Likert scale 1-5 were analyzed using Microsoft excel to calculate the mean, median and interquartile ranges. The themes for the open-ended questions were identified in advance and the participants responses were categorized according to the pre-determined themes as follows: learning outcome, effectiveness of teaching strategy and areas for improvement. Results 15 out of 17 participants responded to the survey with a 88.2% response rate. All participants were females as the CLS and Nursing programs in Imam Abdulrahman bin Faisal University are offered only to females. Most of the participants were of the CLS specialty 93.75%, while only 6.25% were from the nursing specialty. The survey questions are displayed in boxplots as seen in Figure 2 . Generally, participant showed a high satisfaction to the training session. For example, a detailed question on the effectiveness of the session in teaching communication skills showed a mean score of 4.7 on the scale of 5, where 5 being the highest level of satisfaction. Figure 2. Bar chart representing mean of participants response to survey questions (n = 15). 5: strongly agree, 1: strongly disagree. Q1: Effectiveness of training session in teaching communication skills Q2: The video shown was suitable for demonstrating proper communication skills Q3: The case scenarios sufficiently addressed the communication problems with patients Q4: Provided an understanding of potential problems arising from blood collection Q5: Training session taught me patient management skills Q6: Training session helped me improve my communication skills Q7: Role-Play helped me improve my communication skills. 10 out of 15 participants shared their thought about the session through answering the open-ended questions. The participants indicated that they learned how to listen and communicate with patients during phlebotomy, how to deal with different type of patients and most importantly to pay attention to detail. One participant said: “ I learned possible situations I might be go into. Also how to pay attention to detail, and be transparent with the patient as much as possible.” For the second question on what they liked about the session, the participants commended the creative teaching strategy using role-play as well as the interaction with their fellow participants and trainer demonstrating that they learned from listening to other participants sharing their experiences in phlebotomy “ giving the opportunity to hear from everyone, listening to each story everyone had. ” To improve the session in the future the participants suggested to add more videos and case scenarios for role-play and have a blind selection of role-play scenarios and dedicate more time for the session. Discussion In this study, a lesson plan to teach communication skills in phlebotomy was developed and its effectiveness was assessed by the participants of the study. This session allowed the participants to practice their communication skills specifically during phlebotomy, where the focus of the curriculum in on the procedural skill despite that communicating with the patient is one of the crucial steps in ensuring a successful procedure. Overall, the participants were highly satisfied with the training session. The result of this study supports other studies recognizing that incorporating role-play in educational programs is a valuable tool for medical students enabling them to practice multiple skill sets without patient risk. 11 Furthermore, the results shows that this type of teaching strategy has a great value to the trainees, it provided them with the opportunity to interact with other participants and learning from their previous experiences. This is important for professional growth as explained by the situated learning theory. 9 The participants responses to the open-ended questions addresses three main categories: learning outcome, effectiveness of teaching strategy and areas for improvement. 10 out of the 15 participants responding to the first question indicated that they have learned how to communicate with patients under different situations. This supports that the learning outcome of the session plan has been achieved. The responses on the participants on the effectiveness of teaching strategies supports the use of videos and role-play as an -educational teaching strategy to teach communication skills, which allowed them to be creative in visualizing the different scenarios they may face in the future. Under the category of areas of improvement, the participants suggested to include more role-play scenarios representing not only those with trypanophobia but different types of patients. In addition, to have a blind selection from a collection of scenarios not to limit it to two scenarios and to allow the participants to have a blind pick of multiple scenarios instead of taking turns to play a normal patient and a patient with trypanophobia. These responses could be utilized and invested improving educational curriculums. Various studies have demonstrated the benefits of co-creation of the curriculum, where students are seen as partners in education. 17 , 18 Despite the small number of participants in the study, it highlights the importance of communication skills in medical education as well as the importance of utilizing student’s responses in co-creation of the curriculum. Conclusion In conclusion, in this study we have showed that Gagne’s instructional design does not only provide a platform for lecture-based lessons but can also be expanded to accommodate lesson planning for a wide range of skills, such as practical, communication, and interpersonal skills. The results also highlight the importance of students in the process of co-creation of the curriculum. Data availability Underlying data Harvard Dataverse: Using Gagne’s Instructional Design to Teach Communication Skills in Phlebotomy Education through Role-Play. https://doi.org/10.7910/DVN/GTGMGE . 19 This project contains the following underlying data: - Gange phelebotomy session data.tab Extended data Harvard Dataverse: Using Gagne’s Instructional Design to Teach Communication Skills in Phlebotomy Education through Role-Play. https://doi.org/10.7910/DVN/GTGMGE . 19 This project contains the following extended data. - Questionnaire phlebotomy education.rtf Data are available under the terms of the Creative Commons Zero “No rights reserved” data waiver (CC0 1.0 Public domain dedication). Due to the ethical and copyright limitations around social media data, the data from YouTube used in this study cannot be disclosed. Briefly, the video demonstrated the interaction between child and a phlebotomist. The child demonstrated her fear from needles by asking the phlebotomist multiple questions about the blood collection process and was pulling her arm away when the phlebotomist attempted to collect blood from her. The video showed how the phlebotomist communicated positively with the child explaining how the process is performed and trying to ease here worries and explaining to the child the consequences of moving her arm during blood extraction. The Methods section contains detailed information to allow replication of the study. Any queries about the methodology should be directed to the corresponding author. Acknowledgments The author would like to thank Ms. Ashwaq Al-Amri, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia for her help in running the session. Special thanks goes to Dr. Mohammed Al-Eraky, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia for his valuable review of the manuscript. References 1. Stedman TL: Stedman’s medical dictionary for the health professions and nursing. A medical dictionary for the health professions and nursing. 6th ed.Philadelphia, USA: Wolters Kluwer Health; 2008. 2. Mbah HA: Phlebotomy and quality in the African laboratory. Afr J Lab Med. 2014; 3 (1): 4–7. PubMed Abstract | Publisher Full Text 3. Rodriguez-Paz JM, Kennedy M, Salas E, et al. : Beyond “see one, do one, teach one:” toward a different training paradigm. Postgrad. Med. J. 2009; 85 (1003): 244–249. PubMed Abstract | Publisher Full Text 4. Taniguchi JI, Matsui K, Araki T, et al. : Clinical training: a simulation program for phlebotomy. BMC Med. Educ. 2008; 8 : 7. Publisher Full Text 5. Cunha MLDR, Brandi S, Bonfim GFT, et al. : Application program to prepare child/family for venipuncture: experience report. Rev. Bras. Enferm. 2018; 71 (suppl 3): 1474–1478. PubMed Abstract | Publisher Full Text 6. Filbet M, Larkin P, Chabloz C, et al. : Barriers to venipuncture-induced pain prevention in cancer patients: a qualitative study. BMC Palliat. Care. 2017; 16 (1): 5–7. PubMed Abstract | Publisher Full Text 7. Woo WH: Using Gagne’s instructional model in phlebotomy education. Adv. Med. Educ. Pract. 2016; Volume 7 : 511–516. PubMed Abstract | Publisher Full Text 8. Gagné RM, Briggs LJ, Wager WW: Principles of instructional design. Perform. Improv. 2005; 44 : 44–46. Publisher Full Text 9. Knowles M: The adult learner: a neglected species. Houston, Texas: Gulf Publishing Company; 1973 [cited 2021 April 19]; 211. Reference Source 10. Dagar V, Yadav A: Constructivism: a paradigm for teaching and learning. Arts Soc Sci J. 2016; 7 (4): 66–70. Publisher Full Text 11. Nestel D, Tierney T: Role-play for medical students learning about communication: guidelines for maximising benefits. BMC Med. Educ. 2007; 7 : 3. PubMed Abstract | Publisher Full Text 12. Nikendei C, Huber J, Stiepak J, et al. : Modification of Peyton’s four-step approach for small group teaching—a descriptive study. BMC Med. Educ. 2014; 14 (1): 68. PubMed Abstract | Publisher Full Text 13. Hesketh EA, Laidlaw JM: Developing the teaching instinct, 1: feedback. Med. Teach. 2002; 24 (3): 245–248. PubMed Abstract | Publisher Full Text 14. Hamid Y, Mahmood S: Understanding constructive feedback: a commitment between teachers and students for academic and professional development. J. Pak. Med. Assoc. 2010; 60 (3): 224–227. PubMed Abstract 15. Brown N, Cooke L: Giving effective feedback to psychiatric trainees. Adv. Psychiatr. Treat. 2009; 15 (2): 123–128. Publisher Full Text 16. Menéndez IYC, Napa MAC, Moreira MLM, et al. : The importance of formative assessment in the learning teaching process. Int J Soc Sci Humanit. 2019; 3 (2): 238–249. Publisher Full Text 17. Lubicz-Nawrocka TM: Students as partners in learning and teaching: The benefits of co-creation of the curriculum. International Journal for Students As Partners. 2018; 2 (1): 47–63. Publisher Full Text 18. Bovill C, Woolmer C: How conceptualisations of curriculum in higher education influence student-staff co-creation in and of the curriculum. High. Educ. 2019; 78 : 407–422. Publisher Full Text 19. Owaidah A: Using Gagne’s Instructional Design to Teach Communication Skills in Phlebotomy Education through Role-Play, Harvard Dataverse, V1, UNF:6:H0YiVGrIe1LxEYs1fFgEFA== [fileUNF].2021. Publisher Full Text Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 14 Jan 2022 ADD YOUR COMMENT Comment Author details Author details Department of Clinical Laboratory Sciences, Imam Abdulrahman bin Faisal University, Dammam, College of Applied Medical Sciences,, Saudi Arabia Amani Y. Owaidah Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (2) version 2 Revised Published: 05 Aug 2024, 11:46 https://doi.org/10.12688/f1000research.75335.2 version 1 Published: 14 Jan 2022, 11:46 https://doi.org/10.12688/f1000research.75335.1 Copyright © 2024 Owaidah AY. 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 Owaidah AY. Using Gagne’s instructional design to teach communication skills in phlebotomy education through role-play [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2024, 11 :46 ( https://doi.org/10.12688/f1000research.75335.2 ) 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 Aug 2024 Revised Views 0 Cite How to cite this report: Gilligan C. Reviewer Report For: Using Gagne’s instructional design to teach communication skills in phlebotomy education through role-play [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2024, 11 :46 ( https://doi.org/10.5256/f1000research.169898.r310989 ) The direct URL for this report is: https://f1000research.com/articles/11-46/v2#referee-response-310989 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 08 Oct 2024 Conor Gilligan , School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia Approved VIEWS 0 https://doi.org/10.5256/f1000research.169898.r310989 I am happy with the responses and ... Continue reading READ ALL I am happy with the responses and thank the authors for addressing my points. Competing Interests: No competing interests were disclosed. 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 Gilligan C. Reviewer Report For: Using Gagne’s instructional design to teach communication skills in phlebotomy education through role-play [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2024, 11 :46 ( https://doi.org/10.5256/f1000research.169898.r310989 ) The direct URL for this report is: https://f1000research.com/articles/11-46/v2#referee-response-310989 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: Palo S. Reviewer Report For: Using Gagne’s instructional design to teach communication skills in phlebotomy education through role-play [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2024, 11 :46 ( https://doi.org/10.5256/f1000research.169898.r321792 ) The direct URL for this report is: https://f1000research.com/articles/11-46/v2#referee-response-321792 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 10 Sep 2024 Seetu Palo , All India Institute of Medical Sciences, Hyderabad, India Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.169898.r321792 The introduction provides a clear overview of the importance of phlebotomy and its teaching methodologies. The explanation of the apprenticeship model, simulation methods, and role-play is well-done. However, a brief explanation of why communication is so essential in phlebotomy, beyond ... Continue reading READ ALL The introduction provides a clear overview of the importance of phlebotomy and its teaching methodologies. The explanation of the apprenticeship model, simulation methods, and role-play is well-done. However, a brief explanation of why communication is so essential in phlebotomy, beyond just calming patient anxiety, would uplift the manuscript. While the article outlines Gagne’s nine steps and their application to phlebotomy education clearly, the justification for choosing Gagne’s framework is somewhat lacking. Providing more detail on why Gagne’s steps were chosen over other educational models would strengthen the article's theoretical foundation. In the methodology and results section, the use of videos and role-play is appropriate and well-explained, especially with respect to engaging different types of learners. The method of stimulating reflection through personal experiences adds depth to the learning experience. The methods section is comprehensive, but some details are missing. For instance, it would be beneficial to include a more precise explanation of the student’s pre-existing knowledge levels that might influence outcomes. The survey data presented is useful, but the analysis could be more robust. The article mainly reports the mean scores, but does not delve into any statistical tests that could indicate the significance of the findings. While the small sample size may limit this, even basic inferential statistics (e.g., confidence intervals) would provide more weight to the conclusions. The open-ended feedback from participants is valuable and provides qualitative insights, but, categorizing this data into themes is not explored in depth. Expanding on the key themes that emerged from the open-ended questions (e.g., learning outcomes, teaching effectiveness, areas for improvement) would enrich this section. The small sample size (n=17) is a major limitation of the study that should be acknowledged more explicitly. Overall, the article presents a valuable exploration of communication skills training in phlebotomy education, but it could be strengthened by further detailing the analysis of the findings and exploring the broader implications for medical education. Furthermore, the inclusion of practical suggestions for curriculum development and co-creation with students would enhance the impact of the study. The concept of students as partners in education is significant, but this article touches on it only briefly. If co-creation is an important take away from this study, it should be emphasized further with more explanation or examples from other medical education studies that support this approach. For instance, the suggestions made by participants (e.g., more videos, varied role-play scenarios) could be used as a basis for outlining future research directions or practical improvements to curriculum design. Is the rationale for developing the new method (or application) clearly explained? Partly Is the description of the method technically sound? Yes Are sufficient details provided to allow replication of the method development and its use by others? Yes If any results are presented, are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions about the method and its performance adequately supported by the findings presented in the article? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: Pathology, 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 Palo S. Reviewer Report For: Using Gagne’s instructional design to teach communication skills in phlebotomy education through role-play [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2024, 11 :46 ( https://doi.org/10.5256/f1000research.169898.r321792 ) The direct URL for this report is: https://f1000research.com/articles/11-46/v2#referee-response-321792 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 14 Jan 2022 Views 0 Cite How to cite this report: Heldal I. Reviewer Report For: Using Gagne’s instructional design to teach communication skills in phlebotomy education through role-play [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2024, 11 :46 ( https://doi.org/10.5256/f1000research.79193.r201321 ) The direct URL for this report is: https://f1000research.com/articles/11-46/v1#referee-response-201321 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 Oct 2023 Ilona Heldal , Western Norway University of Applied Sciences, Bergen, Norway Not Approved VIEWS 0 https://doi.org/10.5256/f1000research.79193.r201321 The paper explains the importance of explicitly utilizing a structured method (Gagne’s instructional design) for practicing communication and, within this, role-playing for learning phlebotomy. While the issue is important in many educational situations, unfortunately, I cannot suggest the paper for ... Continue reading READ ALL The paper explains the importance of explicitly utilizing a structured method (Gagne’s instructional design) for practicing communication and, within this, role-playing for learning phlebotomy. While the issue is important in many educational situations, unfortunately, I cannot suggest the paper for indexing. The aim is important, but it is difficult to understand the added value of the paper. As the authors stated, it is vital to understand and learn how to practice communication skills in education, preparing students to deal with patients. Much of the obligatory moments are usually included in the procedural learning parts. Accordingly, I do not agree with “Lesson planning in phlebotomy education is mainly focused on procedural skills, and very little attention is given towards teaching communication skills despite the close patient interaction in phlebotomy.” Stated in the abstract. Additionally, the paper shows many similarities with the cited paper from Woo (Woo, W.H., 2016. Using Gagne’s instructional model in phlebotomy education. Advances in medical education and practice, pp.511-516.) without explaining fundamental differences from it. If the authors would like to index the paper, I suggest improving it by explicitly describing procedural learning, what within this learning can be achieved by Gagne’s method, and within this, again, how role-playing is important and planned. Here is a must to differentiate this study from Woo’s. Also, focusing on role-playing particularities, if the role-playing effect can be explicitly described and specificities of this case resulting in changes in student behavior would be a necessity. Is the rationale for developing the new method (or application) clearly explained? No Is the description of the method technically sound? No Are sufficient details provided to allow replication of the method development and its use by others? Yes If any results are presented, are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions about the method and its performance adequately supported by the findings presented in the article? No References 1. Woo WH: Using Gagne's instructional model in phlebotomy education. Adv Med Educ Pract . 2016; 7 : 511-6 PubMed Abstract | Publisher Full Text Competing Interests: No competing interests were disclosed. Reviewer Expertise: Information systems. We have several projects on digital support of learning phlebotomy in various 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 Heldal I. Reviewer Report For: Using Gagne’s instructional design to teach communication skills in phlebotomy education through role-play [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2024, 11 :46 ( https://doi.org/10.5256/f1000research.79193.r201321 ) The direct URL for this report is: https://f1000research.com/articles/11-46/v1#referee-response-201321 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: Coulibaly M. Reviewer Report For: Using Gagne’s instructional design to teach communication skills in phlebotomy education through role-play [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2024, 11 :46 ( https://doi.org/10.5256/f1000research.79193.r201322 ) The direct URL for this report is: https://f1000research.com/articles/11-46/v1#referee-response-201322 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 12 Sep 2023 Modibo Coulibaly , Sominé DOLO hospital of Mopti, Mopti, Mali Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.79193.r201322 Congratulations to the author of this paper. The manuscript is reasonably well written according to the scientific writing and meets the journal's requirements. In this paper, the author tried to emphasize the communication aspect in teaching phlebotomy through Gagne's pedagogical ... Continue reading READ ALL Congratulations to the author of this paper. The manuscript is reasonably well written according to the scientific writing and meets the journal's requirements. In this paper, the author tried to emphasize the communication aspect in teaching phlebotomy through Gagne's pedagogical design and using role-playing games. This method adds a new skill to the routine of practitioners who had benefited from training focused on technical and procedural aspects. The implementation of this practice could contribute to improving the quality of patient care while focusing on their needs. The topic of this paper is in line with the scope of F1000research and would add value to scientific production. However, it contains some weaknesses that should be fixed. The term "blood extraction" is not too suitable. It should, therefore, be replaced by “blood draw” or “blood collection.” The author should give more detail on the study population by explaining why clinical laboratory sciences are offered only to women in his country. Regarding selecting participants, the author only announced that e-mails were sent to students and residents without specifying the number to which the e-mails were sent. So, it's difficult to determine the response rate and discuss other invitation methods, such as physically meeting to find participants. As worded in the paper, the response rate needs to be clarified. Did the ratio of 15 to 17 obtain it? In this case, the response rate is 88.2% instead of 94%. Thank you for specifying. The study concerns only trypanophobia, while there may be other phobias during phlebotomy, such as hematophobia 1 , hypochondriacal patients 2 , and nosocomephobia 3 . To better understand the fundamental concern of patients when they appear anxious, the question to ask these patients must be an open question in the style of "What are you afraid of", instead of "Are you afraid of the needle"? Moreover, the role-play does not allow us to appreciate the real cognitive behavioral perceptions of the actual patients who could have particular intrinsic characteristics whose reflection on the solutions could improve the educational program. As indicated by the participants to include other types of patients, it would be relevant at this level to have patients of pediatric age. These evoke the double challenge and stress condition for the patient and the phlebotomist, given the difficulty of sampling in this category of patients. These conditions can only be assessed by associating a practical phase with real adult and child patients, inpatients, and outpatients. Finally, I suggest the author discuss integrating communication skills with the new approach to phlebotomy automation. Today, miniaturized sampling systems are based on combining ultrasound images, robotics, and artificial intelligence. Incorporating communication skills into these automated systems that perform safe and precise venous sampling would be a disruptive innovation in the sciences of phlebotomy 4 . Is the rationale for developing the new method (or application) clearly explained? Yes Is the description of the method technically sound? Yes Are sufficient details provided to allow replication of the method development and its use by others? Yes If any results are presented, are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions about the method and its performance adequately supported by the findings presented in the article? Yes References 1. Schröder D, Müller F, Heesen G, Hummers E, et al.: Feasibility of self-organized blood sample collection in adults for study purposes in a primary care setting. PLoS One . 2023; 18 (5): e0286014 PubMed Abstract | Publisher Full Text 2. Mobley D, Baum N, Beattie A, Nemeroff C: When Imagination Becomes a Disease: Dealing With Hypochondriacal Patients in Clinical Practice. Ochsner Journal . 2019; 19 (2): 70-73 Publisher Full Text 3. Ashraf Z, Raza S, Khalid F, Sabzwari Z, et al.: Prevalence of Nosocomephobia – Hospital Related Depression. Annals of Psychophysiology . 2016; 3 (1): 27-32 Publisher Full Text 4. Leipheimer J, Balter M, Chen A, Yarmush M: Design and Evaluation of a Handheld Robotic Device for Peripheral Catheterization. J Med Device . 2022; 16 (2): 021015 PubMed Abstract | Publisher Full Text Competing Interests: No competing interests were disclosed. Reviewer Expertise: Clinical Biochemistry 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 Coulibaly M. Reviewer Report For: Using Gagne’s instructional design to teach communication skills in phlebotomy education through role-play [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2024, 11 :46 ( https://doi.org/10.5256/f1000research.79193.r201322 ) The direct URL for this report is: https://f1000research.com/articles/11-46/v1#referee-response-201322 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 Aug 2024 Amani Y. Owaidah , Department of Clinical Laboratory Sciences, Imam Abdulrahman bin Faisal University, Dammam, College of Applied Medical Sciences,, Saudi Arabia 05 Aug 2024 Author Response Dear Respected reviewer, Thank you very much for your valuable comments and feedback on our paper. Below is the response to each point you have raised. Looking forward to ... Continue reading Dear Respected reviewer, Thank you very much for your valuable comments and feedback on our paper. Below is the response to each point you have raised. Looking forward to hearing from you in order to change version 2 accordingly. The term "blood extraction" is not too suitable. It should, therefore, be replaced by “blood draw” or “blood collection.” The terms blood extraction are used interchangeably in laboratory sciences with blood collection. However, the term is a matter of preference rather than an incorrect scientific term. It will be changed in version 2 to Blood collection based on your comments The author should give more detail on the study population by explaining why clinical laboratory sciences are offered only to women in his country. In the university where the study was conducted the program is offered to only female as low enrollment rate were found in males so due to financial reasons the male section was closed. Regarding selecting participants, the author only announced that e-mails were sent to students and residents without specifying the number to which the e-mails were sent. So, it's difficult to determine the response rate and discuss other invitation methods, such as physically meeting to find participants. As worded in the paper, the response rate needs to be clarified. Did the ratio of 15 to 17 obtain it? In this case, the response rate is 88.2% instead of 94%. Thank you for specifying. Thank you for pointing out the typo in the response rate. Indeed it is 88.2%. This will be changed accordingly. Yes, emails were the only method used to communicate with the participants. As mentioned in the paper that only level 4 students were invited to participate in the study therefore the emails of level 4 students was not difficult to track as the number of registered students are in the university’s data base. The study concerns only trypanophobia, while there may be other phobias during phlebotomy, such as hematophobia 1 , hypochondriacal patients 2 , and nosocomephobia 3 . To better understand the fundamental concern of patients when they appear anxious, the question to ask these patients must be an open question in the style of "What are you afraid of", instead of "Are you afraid of the needle"? Thank you for suggesting other phobias. In the paper the author mentions trypanophobia as just an example which is the most commonly encountered. And the phrase “ Are you afraid of the needle"? Is used as a conversation opener rather than specifying a type of phobia. But this comment will be taken for future lessons. Moreover, the role-play does not allow us to appreciate the real cognitive behavioral perceptions of the actual patients who could have particular intrinsic characteristics whose reflection on the solutions could improve the educational program. Role play does not assess the behaviour of actual patients. It is used only as a preliminary teaching methods for students practice. Simulation with real patients is definitely the next step in teaching to assess the real behavioral perceptions. But for the level of the students and administrative limitations simulations could not be used but could be a future study, As indicated by the participants to include other types of patients, it would be relevant at this level to have patients of pediatric age. These evoke the double challenge and stress condition for the patient and the phlebotomist, given the difficulty of sampling in this category of patients. These conditions can only be assessed by associating a practical phase with real adult and child patients, inpatients, and outpatients. Agreed. As in the previous comment simulation with real patients could be a future study to conduct. Also, the reviewer could appreciate pediatric patients require a wide range of administrative process such as parental consent and IRB for involvement in a study. In addition the focus of the paper was for to use a different teaching strategy to just a procedural skill of blood collection. To help students improve their communication skills and teach them how to deal with different situations rather than just a procedure. Finally, I suggest the author discuss integrating communication skills with the new approach to phlebotomy automation. Today, miniaturized sampling systems are based on combining ultrasound images, robotics, and artificial intelligence. Incorporating communication skills into these automated systems that perform safe and precise venous sampling would be a disruptive innovation in the sciences of phlebotomy 4 . This is an excellent point to consider for the future. However , these methods help in teaching procedural skills and the focus of our paper was communication skills. This point could be a focus of another paper using advanced methodologies to teach phlebotomy. Dear Respected reviewer, Thank you very much for your valuable comments and feedback on our paper. Below is the response to each point you have raised. Looking forward to hearing from you in order to change version 2 accordingly. The term "blood extraction" is not too suitable. It should, therefore, be replaced by “blood draw” or “blood collection.” The terms blood extraction are used interchangeably in laboratory sciences with blood collection. However, the term is a matter of preference rather than an incorrect scientific term. It will be changed in version 2 to Blood collection based on your comments The author should give more detail on the study population by explaining why clinical laboratory sciences are offered only to women in his country. In the university where the study was conducted the program is offered to only female as low enrollment rate were found in males so due to financial reasons the male section was closed. Regarding selecting participants, the author only announced that e-mails were sent to students and residents without specifying the number to which the e-mails were sent. So, it's difficult to determine the response rate and discuss other invitation methods, such as physically meeting to find participants. As worded in the paper, the response rate needs to be clarified. Did the ratio of 15 to 17 obtain it? In this case, the response rate is 88.2% instead of 94%. Thank you for specifying. Thank you for pointing out the typo in the response rate. Indeed it is 88.2%. This will be changed accordingly. Yes, emails were the only method used to communicate with the participants. As mentioned in the paper that only level 4 students were invited to participate in the study therefore the emails of level 4 students was not difficult to track as the number of registered students are in the university’s data base. The study concerns only trypanophobia, while there may be other phobias during phlebotomy, such as hematophobia 1 , hypochondriacal patients 2 , and nosocomephobia 3 . To better understand the fundamental concern of patients when they appear anxious, the question to ask these patients must be an open question in the style of "What are you afraid of", instead of "Are you afraid of the needle"? Thank you for suggesting other phobias. In the paper the author mentions trypanophobia as just an example which is the most commonly encountered. And the phrase “ Are you afraid of the needle"? Is used as a conversation opener rather than specifying a type of phobia. But this comment will be taken for future lessons. Moreover, the role-play does not allow us to appreciate the real cognitive behavioral perceptions of the actual patients who could have particular intrinsic characteristics whose reflection on the solutions could improve the educational program. Role play does not assess the behaviour of actual patients. It is used only as a preliminary teaching methods for students practice. Simulation with real patients is definitely the next step in teaching to assess the real behavioral perceptions. But for the level of the students and administrative limitations simulations could not be used but could be a future study, As indicated by the participants to include other types of patients, it would be relevant at this level to have patients of pediatric age. These evoke the double challenge and stress condition for the patient and the phlebotomist, given the difficulty of sampling in this category of patients. These conditions can only be assessed by associating a practical phase with real adult and child patients, inpatients, and outpatients. Agreed. As in the previous comment simulation with real patients could be a future study to conduct. Also, the reviewer could appreciate pediatric patients require a wide range of administrative process such as parental consent and IRB for involvement in a study. In addition the focus of the paper was for to use a different teaching strategy to just a procedural skill of blood collection. To help students improve their communication skills and teach them how to deal with different situations rather than just a procedure. Finally, I suggest the author discuss integrating communication skills with the new approach to phlebotomy automation. Today, miniaturized sampling systems are based on combining ultrasound images, robotics, and artificial intelligence. Incorporating communication skills into these automated systems that perform safe and precise venous sampling would be a disruptive innovation in the sciences of phlebotomy 4 . This is an excellent point to consider for the future. However , these methods help in teaching procedural skills and the focus of our paper was communication skills. This point could be a focus of another paper using advanced methodologies to teach phlebotomy. Competing Interests: There is no competing interest. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 05 Aug 2024 Amani Y. Owaidah , Department of Clinical Laboratory Sciences, Imam Abdulrahman bin Faisal University, Dammam, College of Applied Medical Sciences,, Saudi Arabia 05 Aug 2024 Author Response Dear Respected reviewer, Thank you very much for your valuable comments and feedback on our paper. Below is the response to each point you have raised. Looking forward to ... Continue reading Dear Respected reviewer, Thank you very much for your valuable comments and feedback on our paper. Below is the response to each point you have raised. Looking forward to hearing from you in order to change version 2 accordingly. The term "blood extraction" is not too suitable. It should, therefore, be replaced by “blood draw” or “blood collection.” The terms blood extraction are used interchangeably in laboratory sciences with blood collection. However, the term is a matter of preference rather than an incorrect scientific term. It will be changed in version 2 to Blood collection based on your comments The author should give more detail on the study population by explaining why clinical laboratory sciences are offered only to women in his country. In the university where the study was conducted the program is offered to only female as low enrollment rate were found in males so due to financial reasons the male section was closed. Regarding selecting participants, the author only announced that e-mails were sent to students and residents without specifying the number to which the e-mails were sent. So, it's difficult to determine the response rate and discuss other invitation methods, such as physically meeting to find participants. As worded in the paper, the response rate needs to be clarified. Did the ratio of 15 to 17 obtain it? In this case, the response rate is 88.2% instead of 94%. Thank you for specifying. Thank you for pointing out the typo in the response rate. Indeed it is 88.2%. This will be changed accordingly. Yes, emails were the only method used to communicate with the participants. As mentioned in the paper that only level 4 students were invited to participate in the study therefore the emails of level 4 students was not difficult to track as the number of registered students are in the university’s data base. The study concerns only trypanophobia, while there may be other phobias during phlebotomy, such as hematophobia 1 , hypochondriacal patients 2 , and nosocomephobia 3 . To better understand the fundamental concern of patients when they appear anxious, the question to ask these patients must be an open question in the style of "What are you afraid of", instead of "Are you afraid of the needle"? Thank you for suggesting other phobias. In the paper the author mentions trypanophobia as just an example which is the most commonly encountered. And the phrase “ Are you afraid of the needle"? Is used as a conversation opener rather than specifying a type of phobia. But this comment will be taken for future lessons. Moreover, the role-play does not allow us to appreciate the real cognitive behavioral perceptions of the actual patients who could have particular intrinsic characteristics whose reflection on the solutions could improve the educational program. Role play does not assess the behaviour of actual patients. It is used only as a preliminary teaching methods for students practice. Simulation with real patients is definitely the next step in teaching to assess the real behavioral perceptions. But for the level of the students and administrative limitations simulations could not be used but could be a future study, As indicated by the participants to include other types of patients, it would be relevant at this level to have patients of pediatric age. These evoke the double challenge and stress condition for the patient and the phlebotomist, given the difficulty of sampling in this category of patients. These conditions can only be assessed by associating a practical phase with real adult and child patients, inpatients, and outpatients. Agreed. As in the previous comment simulation with real patients could be a future study to conduct. Also, the reviewer could appreciate pediatric patients require a wide range of administrative process such as parental consent and IRB for involvement in a study. In addition the focus of the paper was for to use a different teaching strategy to just a procedural skill of blood collection. To help students improve their communication skills and teach them how to deal with different situations rather than just a procedure. Finally, I suggest the author discuss integrating communication skills with the new approach to phlebotomy automation. Today, miniaturized sampling systems are based on combining ultrasound images, robotics, and artificial intelligence. Incorporating communication skills into these automated systems that perform safe and precise venous sampling would be a disruptive innovation in the sciences of phlebotomy 4 . This is an excellent point to consider for the future. However , these methods help in teaching procedural skills and the focus of our paper was communication skills. This point could be a focus of another paper using advanced methodologies to teach phlebotomy. Dear Respected reviewer, Thank you very much for your valuable comments and feedback on our paper. Below is the response to each point you have raised. Looking forward to hearing from you in order to change version 2 accordingly. The term "blood extraction" is not too suitable. It should, therefore, be replaced by “blood draw” or “blood collection.” The terms blood extraction are used interchangeably in laboratory sciences with blood collection. However, the term is a matter of preference rather than an incorrect scientific term. It will be changed in version 2 to Blood collection based on your comments The author should give more detail on the study population by explaining why clinical laboratory sciences are offered only to women in his country. In the university where the study was conducted the program is offered to only female as low enrollment rate were found in males so due to financial reasons the male section was closed. Regarding selecting participants, the author only announced that e-mails were sent to students and residents without specifying the number to which the e-mails were sent. So, it's difficult to determine the response rate and discuss other invitation methods, such as physically meeting to find participants. As worded in the paper, the response rate needs to be clarified. Did the ratio of 15 to 17 obtain it? In this case, the response rate is 88.2% instead of 94%. Thank you for specifying. Thank you for pointing out the typo in the response rate. Indeed it is 88.2%. This will be changed accordingly. Yes, emails were the only method used to communicate with the participants. As mentioned in the paper that only level 4 students were invited to participate in the study therefore the emails of level 4 students was not difficult to track as the number of registered students are in the university’s data base. The study concerns only trypanophobia, while there may be other phobias during phlebotomy, such as hematophobia 1 , hypochondriacal patients 2 , and nosocomephobia 3 . To better understand the fundamental concern of patients when they appear anxious, the question to ask these patients must be an open question in the style of "What are you afraid of", instead of "Are you afraid of the needle"? Thank you for suggesting other phobias. In the paper the author mentions trypanophobia as just an example which is the most commonly encountered. And the phrase “ Are you afraid of the needle"? Is used as a conversation opener rather than specifying a type of phobia. But this comment will be taken for future lessons. Moreover, the role-play does not allow us to appreciate the real cognitive behavioral perceptions of the actual patients who could have particular intrinsic characteristics whose reflection on the solutions could improve the educational program. Role play does not assess the behaviour of actual patients. It is used only as a preliminary teaching methods for students practice. Simulation with real patients is definitely the next step in teaching to assess the real behavioral perceptions. But for the level of the students and administrative limitations simulations could not be used but could be a future study, As indicated by the participants to include other types of patients, it would be relevant at this level to have patients of pediatric age. These evoke the double challenge and stress condition for the patient and the phlebotomist, given the difficulty of sampling in this category of patients. These conditions can only be assessed by associating a practical phase with real adult and child patients, inpatients, and outpatients. Agreed. As in the previous comment simulation with real patients could be a future study to conduct. Also, the reviewer could appreciate pediatric patients require a wide range of administrative process such as parental consent and IRB for involvement in a study. In addition the focus of the paper was for to use a different teaching strategy to just a procedural skill of blood collection. To help students improve their communication skills and teach them how to deal with different situations rather than just a procedure. Finally, I suggest the author discuss integrating communication skills with the new approach to phlebotomy automation. Today, miniaturized sampling systems are based on combining ultrasound images, robotics, and artificial intelligence. Incorporating communication skills into these automated systems that perform safe and precise venous sampling would be a disruptive innovation in the sciences of phlebotomy 4 . This is an excellent point to consider for the future. However , these methods help in teaching procedural skills and the focus of our paper was communication skills. This point could be a focus of another paper using advanced methodologies to teach phlebotomy. Competing Interests: There is no competing interest. Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Gilligan C. Reviewer Report For: Using Gagne’s instructional design to teach communication skills in phlebotomy education through role-play [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2024, 11 :46 ( https://doi.org/10.5256/f1000research.79193.r146424 ) The direct URL for this report is: https://f1000research.com/articles/11-46/v1#referee-response-146424 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 24 Aug 2022 Conor Gilligan , School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.79193.r146424 The authors present a detailed description of their lesson plan for teaching communication skills associated with phlebotomy. The description of the lesson is clear and each step is well justified. The value of the focus on communication ... Continue reading READ ALL The authors present a detailed description of their lesson plan for teaching communication skills associated with phlebotomy. The description of the lesson is clear and each step is well justified. The value of the focus on communication skills associated with phlebotomy is made clear, but the need for this work in terms of the application of Gagne's instructional design to this process is less clearly justified. There is a plethora of literature describing educational interventions for improving medical students' communication skills across diverse medical consultations. The authors could more clearly explain why the communication required during/associated with phlebotomy is unique and why a different teaching approach is required. The authors describe the lesson plan using language that presents the approach as very certainly achieve the desired outcomes. In many cases, these are in fact the intentions of the selected approaches, rather than absolutes. The authors refer learning styles in their 'gaining attention' section - presenting these as though they exist as entirely mutually exclusive ways of learning. Recent literature support the blurring of boundaries between learning styles. The approach used appropriately provides stimuli which will appeal to a range of learning styles and I think it would be useful to emphasize the blurred 'boundaries' between styles. I would like to better understand the logistics of the facilitator and teaching assisting observing and providing feedback on student role-plays - how was this managed with multiple groups and pairs conducting role-play at once? I'm not sure that a boxplot is the most appropriate format in which to present the data in figure 2 - perhaps a bar graph displaying means would be more clearly illustrative of the point? The limitations of this work need to be acknowledged. There is no measure of behavioural outcome. While it is recognised that such measures are difficult to achieve, it should be acknowledged that in the absence of such measures, the true effectiveness of this session remains unknown. Is the rationale for developing the new method (or application) clearly explained? Partly Is the description of the method technically sound? Yes Are sufficient details provided to allow replication of the method development and its use by others? Yes If any results are presented, are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions about the method and its performance adequately supported by the findings presented in the article? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Medical education, interactional skills teaching, healthcare communication 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 Gilligan C. Reviewer Report For: Using Gagne’s instructional design to teach communication skills in phlebotomy education through role-play [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2024, 11 :46 ( https://doi.org/10.5256/f1000research.79193.r146424 ) The direct URL for this report is: https://f1000research.com/articles/11-46/v1#referee-response-146424 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 Aug 2024 Amani Y. Owaidah , Department of Clinical Laboratory Sciences, Imam Abdulrahman bin Faisal University, Dammam, College of Applied Medical Sciences,, Saudi Arabia 05 Aug 2024 Author Response Dear respected reviewer, Thank you for your valuable comments that is highly appreciated. Following are my responses to your comments, to the best of my knowledge, I have addressed ... Continue reading Dear respected reviewer, Thank you for your valuable comments that is highly appreciated. Following are my responses to your comments, to the best of my knowledge, I have addressed all the comments/ clarifications requested. The value of the focus on communication skills associated with phlebotomy is made clear, but the need for this work in terms of the application of Gagne's instructional design to this process is less clearly justified. There is a plethora of literature describing educational interventions for improving medical students' communication skills across diverse medical consultations. The authors could more clearly explain why the communication required during/associated with phlebotomy is unique and why a different teaching approach is required. With phlebotomy, the teaching approach is focused on the procedural skill of withdrawal of blood successfully, which is covered in m any laboratory sessions throughout the educational curriculum, however, with phlebotomy, there is a level of communication with patients/ donors with the phlebotomist. In real-life cases some patients present phobia of needles or anxiety, therefore, the phlebotomist with addition to excellent procedural skills has to have good communication skills to accommodate different types of patients in order to draw blood from them. In the absence of such skills the phlebotomist will not be able to ease patients and fulfill doctors request for testing. The authors describe the lesson plan using language that presents the approach as very certainly achieve the desired outcomes. In many cases, these are in fact the intentions of the selected approaches, rather than absolutes. The authors refer learning styles in their 'gaining attention' section - presenting these as though they exist as entirely mutually exclusive ways of learning. Recent literature support the blurring of boundaries between learning styles. The approach used appropriately provides stimuli which will appeal to a range of learning styles and I think it would be useful to emphasize the blurred 'boundaries' between styles. This is an excellent point to emphasize the different learning styles. However, the focus teaching strategy was not to go into detail on the various learning styles rather than presenting a well-known instructional design for a lesson plan to follow to ensure proper implementation of a new teaching approach. Follow up work could include the behavioral outcome on different cohorts. I would like to better understand the logistics of the facilitator and teaching assisting observing and providing feedback on student role-plays - how was this managed with multiple groups and pairs conducting role-play at once? As the number of students were small. The instructor and teaching assistant moved around the groups while they were practicing their role-play to provide them feedback. In addition, as described in the paper the in the group one student took the role of the observer to observe the other two students. Which one played the patient and the other played the role of the phlebotomist. The observer also provided feedback to their colleagues on their performance. By this methods student gain the skill of peer assessment and raise their sense of self-awareness. I'm not sure that a boxplot is the most appropriate format in which to present the data in figure 2 - perhaps a bar graph displaying means would be more clearly illustrative of the point? The use of boxplots was selected by to present the different quartiles of the analysis. However, if necessary format could be presented in bar graphs. The limitations of this work need to be acknowledged. There is no measure of behavioural outcome. While it is recognised that such measures are difficult to achieve, it should be acknowledged that in the absence of such measures, the true effectiveness of this session remains unknown. I agree, the behavioral outcome should be assessed to measure the true effectiveness of the session. However, However, the focus teaching strategy presenting a well-known instructional design for a lesson plan to follow to ensure proper implementation of a new teaching approach. Follow up work could include the behavioral outcome on different cohorts. Also could include feedback from clinical instructors to provide feedback on the effectiveness of this teaching method. The outcome of the current paper could be used to improve the design of the current curriculum by providing the students with the opportunity to co-create the curriculum. Looking forward to hearing from you Dear respected reviewer, Thank you for your valuable comments that is highly appreciated. Following are my responses to your comments, to the best of my knowledge, I have addressed all the comments/ clarifications requested. The value of the focus on communication skills associated with phlebotomy is made clear, but the need for this work in terms of the application of Gagne's instructional design to this process is less clearly justified. There is a plethora of literature describing educational interventions for improving medical students' communication skills across diverse medical consultations. The authors could more clearly explain why the communication required during/associated with phlebotomy is unique and why a different teaching approach is required. With phlebotomy, the teaching approach is focused on the procedural skill of withdrawal of blood successfully, which is covered in m any laboratory sessions throughout the educational curriculum, however, with phlebotomy, there is a level of communication with patients/ donors with the phlebotomist. In real-life cases some patients present phobia of needles or anxiety, therefore, the phlebotomist with addition to excellent procedural skills has to have good communication skills to accommodate different types of patients in order to draw blood from them. In the absence of such skills the phlebotomist will not be able to ease patients and fulfill doctors request for testing. The authors describe the lesson plan using language that presents the approach as very certainly achieve the desired outcomes. In many cases, these are in fact the intentions of the selected approaches, rather than absolutes. The authors refer learning styles in their 'gaining attention' section - presenting these as though they exist as entirely mutually exclusive ways of learning. Recent literature support the blurring of boundaries between learning styles. The approach used appropriately provides stimuli which will appeal to a range of learning styles and I think it would be useful to emphasize the blurred 'boundaries' between styles. This is an excellent point to emphasize the different learning styles. However, the focus teaching strategy was not to go into detail on the various learning styles rather than presenting a well-known instructional design for a lesson plan to follow to ensure proper implementation of a new teaching approach. Follow up work could include the behavioral outcome on different cohorts. I would like to better understand the logistics of the facilitator and teaching assisting observing and providing feedback on student role-plays - how was this managed with multiple groups and pairs conducting role-play at once? As the number of students were small. The instructor and teaching assistant moved around the groups while they were practicing their role-play to provide them feedback. In addition, as described in the paper the in the group one student took the role of the observer to observe the other two students. Which one played the patient and the other played the role of the phlebotomist. The observer also provided feedback to their colleagues on their performance. By this methods student gain the skill of peer assessment and raise their sense of self-awareness. I'm not sure that a boxplot is the most appropriate format in which to present the data in figure 2 - perhaps a bar graph displaying means would be more clearly illustrative of the point? The use of boxplots was selected by to present the different quartiles of the analysis. However, if necessary format could be presented in bar graphs. The limitations of this work need to be acknowledged. There is no measure of behavioural outcome. While it is recognised that such measures are difficult to achieve, it should be acknowledged that in the absence of such measures, the true effectiveness of this session remains unknown. I agree, the behavioral outcome should be assessed to measure the true effectiveness of the session. However, However, the focus teaching strategy presenting a well-known instructional design for a lesson plan to follow to ensure proper implementation of a new teaching approach. Follow up work could include the behavioral outcome on different cohorts. Also could include feedback from clinical instructors to provide feedback on the effectiveness of this teaching method. The outcome of the current paper could be used to improve the design of the current curriculum by providing the students with the opportunity to co-create the curriculum. Looking forward to hearing from you Competing Interests: I declare no competing interests Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 05 Aug 2024 Amani Y. Owaidah , Department of Clinical Laboratory Sciences, Imam Abdulrahman bin Faisal University, Dammam, College of Applied Medical Sciences,, Saudi Arabia 05 Aug 2024 Author Response Dear respected reviewer, Thank you for your valuable comments that is highly appreciated. Following are my responses to your comments, to the best of my knowledge, I have addressed ... Continue reading Dear respected reviewer, Thank you for your valuable comments that is highly appreciated. Following are my responses to your comments, to the best of my knowledge, I have addressed all the comments/ clarifications requested. The value of the focus on communication skills associated with phlebotomy is made clear, but the need for this work in terms of the application of Gagne's instructional design to this process is less clearly justified. There is a plethora of literature describing educational interventions for improving medical students' communication skills across diverse medical consultations. The authors could more clearly explain why the communication required during/associated with phlebotomy is unique and why a different teaching approach is required. With phlebotomy, the teaching approach is focused on the procedural skill of withdrawal of blood successfully, which is covered in m any laboratory sessions throughout the educational curriculum, however, with phlebotomy, there is a level of communication with patients/ donors with the phlebotomist. In real-life cases some patients present phobia of needles or anxiety, therefore, the phlebotomist with addition to excellent procedural skills has to have good communication skills to accommodate different types of patients in order to draw blood from them. In the absence of such skills the phlebotomist will not be able to ease patients and fulfill doctors request for testing. The authors describe the lesson plan using language that presents the approach as very certainly achieve the desired outcomes. In many cases, these are in fact the intentions of the selected approaches, rather than absolutes. The authors refer learning styles in their 'gaining attention' section - presenting these as though they exist as entirely mutually exclusive ways of learning. Recent literature support the blurring of boundaries between learning styles. The approach used appropriately provides stimuli which will appeal to a range of learning styles and I think it would be useful to emphasize the blurred 'boundaries' between styles. This is an excellent point to emphasize the different learning styles. However, the focus teaching strategy was not to go into detail on the various learning styles rather than presenting a well-known instructional design for a lesson plan to follow to ensure proper implementation of a new teaching approach. Follow up work could include the behavioral outcome on different cohorts. I would like to better understand the logistics of the facilitator and teaching assisting observing and providing feedback on student role-plays - how was this managed with multiple groups and pairs conducting role-play at once? As the number of students were small. The instructor and teaching assistant moved around the groups while they were practicing their role-play to provide them feedback. In addition, as described in the paper the in the group one student took the role of the observer to observe the other two students. Which one played the patient and the other played the role of the phlebotomist. The observer also provided feedback to their colleagues on their performance. By this methods student gain the skill of peer assessment and raise their sense of self-awareness. I'm not sure that a boxplot is the most appropriate format in which to present the data in figure 2 - perhaps a bar graph displaying means would be more clearly illustrative of the point? The use of boxplots was selected by to present the different quartiles of the analysis. However, if necessary format could be presented in bar graphs. The limitations of this work need to be acknowledged. There is no measure of behavioural outcome. While it is recognised that such measures are difficult to achieve, it should be acknowledged that in the absence of such measures, the true effectiveness of this session remains unknown. I agree, the behavioral outcome should be assessed to measure the true effectiveness of the session. However, However, the focus teaching strategy presenting a well-known instructional design for a lesson plan to follow to ensure proper implementation of a new teaching approach. Follow up work could include the behavioral outcome on different cohorts. Also could include feedback from clinical instructors to provide feedback on the effectiveness of this teaching method. The outcome of the current paper could be used to improve the design of the current curriculum by providing the students with the opportunity to co-create the curriculum. Looking forward to hearing from you Dear respected reviewer, Thank you for your valuable comments that is highly appreciated. Following are my responses to your comments, to the best of my knowledge, I have addressed all the comments/ clarifications requested. The value of the focus on communication skills associated with phlebotomy is made clear, but the need for this work in terms of the application of Gagne's instructional design to this process is less clearly justified. There is a plethora of literature describing educational interventions for improving medical students' communication skills across diverse medical consultations. The authors could more clearly explain why the communication required during/associated with phlebotomy is unique and why a different teaching approach is required. With phlebotomy, the teaching approach is focused on the procedural skill of withdrawal of blood successfully, which is covered in m any laboratory sessions throughout the educational curriculum, however, with phlebotomy, there is a level of communication with patients/ donors with the phlebotomist. In real-life cases some patients present phobia of needles or anxiety, therefore, the phlebotomist with addition to excellent procedural skills has to have good communication skills to accommodate different types of patients in order to draw blood from them. In the absence of such skills the phlebotomist will not be able to ease patients and fulfill doctors request for testing. The authors describe the lesson plan using language that presents the approach as very certainly achieve the desired outcomes. In many cases, these are in fact the intentions of the selected approaches, rather than absolutes. The authors refer learning styles in their 'gaining attention' section - presenting these as though they exist as entirely mutually exclusive ways of learning. Recent literature support the blurring of boundaries between learning styles. The approach used appropriately provides stimuli which will appeal to a range of learning styles and I think it would be useful to emphasize the blurred 'boundaries' between styles. This is an excellent point to emphasize the different learning styles. However, the focus teaching strategy was not to go into detail on the various learning styles rather than presenting a well-known instructional design for a lesson plan to follow to ensure proper implementation of a new teaching approach. Follow up work could include the behavioral outcome on different cohorts. I would like to better understand the logistics of the facilitator and teaching assisting observing and providing feedback on student role-plays - how was this managed with multiple groups and pairs conducting role-play at once? As the number of students were small. The instructor and teaching assistant moved around the groups while they were practicing their role-play to provide them feedback. In addition, as described in the paper the in the group one student took the role of the observer to observe the other two students. Which one played the patient and the other played the role of the phlebotomist. The observer also provided feedback to their colleagues on their performance. By this methods student gain the skill of peer assessment and raise their sense of self-awareness. I'm not sure that a boxplot is the most appropriate format in which to present the data in figure 2 - perhaps a bar graph displaying means would be more clearly illustrative of the point? The use of boxplots was selected by to present the different quartiles of the analysis. However, if necessary format could be presented in bar graphs. The limitations of this work need to be acknowledged. There is no measure of behavioural outcome. While it is recognised that such measures are difficult to achieve, it should be acknowledged that in the absence of such measures, the true effectiveness of this session remains unknown. I agree, the behavioral outcome should be assessed to measure the true effectiveness of the session. However, However, the focus teaching strategy presenting a well-known instructional design for a lesson plan to follow to ensure proper implementation of a new teaching approach. Follow up work could include the behavioral outcome on different cohorts. Also could include feedback from clinical instructors to provide feedback on the effectiveness of this teaching method. The outcome of the current paper could be used to improve the design of the current curriculum by providing the students with the opportunity to co-create the curriculum. Looking forward to hearing from you Competing Interests: I declare no competing interests Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 14 Jan 2022 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 4 Version 2 (revision) 05 Aug 24 read read Version 1 14 Jan 22 read read read Conor Gilligan , The University of Newcastle, Newcastle, Australia Modibo Coulibaly , Sominé DOLO hospital of Mopti, Mopti, Mali Ilona Heldal , Western Norway University of Applied Sciences, Bergen, Norway Seetu Palo , All India Institute of Medical Sciences, Hyderabad, India 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 © 2024 Gilligan C. 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. 08 Oct 2024 | for Version 2 Conor Gilligan , School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia 0 Views copyright © 2024 Gilligan C. 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 I am happy with the responses and thank the authors for addressing my points. Competing Interests No competing interests were disclosed. 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) Gilligan C. Peer Review Report For: Using Gagne’s instructional design to teach communication skills in phlebotomy education through role-play [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2024, 11 :46 ( https://doi.org/10.5256/f1000research.169898.r310989) 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/11-46/v2#referee-response-310989 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Palo S. 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. 10 Sep 2024 | for Version 2 Seetu Palo , All India Institute of Medical Sciences, Hyderabad, India 0 Views copyright © 2024 Palo S. 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 The introduction provides a clear overview of the importance of phlebotomy and its teaching methodologies. The explanation of the apprenticeship model, simulation methods, and role-play is well-done. However, a brief explanation of why communication is so essential in phlebotomy, beyond just calming patient anxiety, would uplift the manuscript. While the article outlines Gagne’s nine steps and their application to phlebotomy education clearly, the justification for choosing Gagne’s framework is somewhat lacking. Providing more detail on why Gagne’s steps were chosen over other educational models would strengthen the article's theoretical foundation. In the methodology and results section, the use of videos and role-play is appropriate and well-explained, especially with respect to engaging different types of learners. The method of stimulating reflection through personal experiences adds depth to the learning experience. The methods section is comprehensive, but some details are missing. For instance, it would be beneficial to include a more precise explanation of the student’s pre-existing knowledge levels that might influence outcomes. The survey data presented is useful, but the analysis could be more robust. The article mainly reports the mean scores, but does not delve into any statistical tests that could indicate the significance of the findings. While the small sample size may limit this, even basic inferential statistics (e.g., confidence intervals) would provide more weight to the conclusions. The open-ended feedback from participants is valuable and provides qualitative insights, but, categorizing this data into themes is not explored in depth. Expanding on the key themes that emerged from the open-ended questions (e.g., learning outcomes, teaching effectiveness, areas for improvement) would enrich this section. The small sample size (n=17) is a major limitation of the study that should be acknowledged more explicitly. Overall, the article presents a valuable exploration of communication skills training in phlebotomy education, but it could be strengthened by further detailing the analysis of the findings and exploring the broader implications for medical education. Furthermore, the inclusion of practical suggestions for curriculum development and co-creation with students would enhance the impact of the study. The concept of students as partners in education is significant, but this article touches on it only briefly. If co-creation is an important take away from this study, it should be emphasized further with more explanation or examples from other medical education studies that support this approach. For instance, the suggestions made by participants (e.g., more videos, varied role-play scenarios) could be used as a basis for outlining future research directions or practical improvements to curriculum design. Is the rationale for developing the new method (or application) clearly explained? Partly Is the description of the method technically sound? Yes Are sufficient details provided to allow replication of the method development and its use by others? Yes If any results are presented, are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions about the method and its performance adequately supported by the findings presented in the article? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Pathology, 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) Palo S. Peer Review Report For: Using Gagne’s instructional design to teach communication skills in phlebotomy education through role-play [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2024, 11 :46 ( https://doi.org/10.5256/f1000research.169898.r321792) 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/11-46/v2#referee-response-321792 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2023 Heldal I. 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 Oct 2023 | for Version 1 Ilona Heldal , Western Norway University of Applied Sciences, Bergen, Norway 0 Views copyright © 2023 Heldal I. 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) 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 paper explains the importance of explicitly utilizing a structured method (Gagne’s instructional design) for practicing communication and, within this, role-playing for learning phlebotomy. While the issue is important in many educational situations, unfortunately, I cannot suggest the paper for indexing. The aim is important, but it is difficult to understand the added value of the paper. As the authors stated, it is vital to understand and learn how to practice communication skills in education, preparing students to deal with patients. Much of the obligatory moments are usually included in the procedural learning parts. Accordingly, I do not agree with “Lesson planning in phlebotomy education is mainly focused on procedural skills, and very little attention is given towards teaching communication skills despite the close patient interaction in phlebotomy.” Stated in the abstract. Additionally, the paper shows many similarities with the cited paper from Woo (Woo, W.H., 2016. Using Gagne’s instructional model in phlebotomy education. Advances in medical education and practice, pp.511-516.) without explaining fundamental differences from it. If the authors would like to index the paper, I suggest improving it by explicitly describing procedural learning, what within this learning can be achieved by Gagne’s method, and within this, again, how role-playing is important and planned. Here is a must to differentiate this study from Woo’s. Also, focusing on role-playing particularities, if the role-playing effect can be explicitly described and specificities of this case resulting in changes in student behavior would be a necessity. Is the rationale for developing the new method (or application) clearly explained? No Is the description of the method technically sound? No Are sufficient details provided to allow replication of the method development and its use by others? Yes If any results are presented, are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions about the method and its performance adequately supported by the findings presented in the article? No References 1. Woo WH: Using Gagne's instructional model in phlebotomy education. Adv Med Educ Pract . 2016; 7 : 511-6 PubMed Abstract | Publisher Full Text Competing Interests No competing interests were disclosed. Reviewer Expertise Information systems. We have several projects on digital support of learning phlebotomy in various 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 (0) Heldal I. Peer Review Report For: Using Gagne’s instructional design to teach communication skills in phlebotomy education through role-play [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2024, 11 :46 ( https://doi.org/10.5256/f1000research.79193.r201321) 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/11-46/v1#referee-response-201321 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2023 Coulibaly M. 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. 12 Sep 2023 | for Version 1 Modibo Coulibaly , Sominé DOLO hospital of Mopti, Mopti, Mali 0 Views copyright © 2023 Coulibaly M. 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) 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 Congratulations to the author of this paper. The manuscript is reasonably well written according to the scientific writing and meets the journal's requirements. In this paper, the author tried to emphasize the communication aspect in teaching phlebotomy through Gagne's pedagogical design and using role-playing games. This method adds a new skill to the routine of practitioners who had benefited from training focused on technical and procedural aspects. The implementation of this practice could contribute to improving the quality of patient care while focusing on their needs. The topic of this paper is in line with the scope of F1000research and would add value to scientific production. However, it contains some weaknesses that should be fixed. The term "blood extraction" is not too suitable. It should, therefore, be replaced by “blood draw” or “blood collection.” The author should give more detail on the study population by explaining why clinical laboratory sciences are offered only to women in his country. Regarding selecting participants, the author only announced that e-mails were sent to students and residents without specifying the number to which the e-mails were sent. So, it's difficult to determine the response rate and discuss other invitation methods, such as physically meeting to find participants. As worded in the paper, the response rate needs to be clarified. Did the ratio of 15 to 17 obtain it? In this case, the response rate is 88.2% instead of 94%. Thank you for specifying. The study concerns only trypanophobia, while there may be other phobias during phlebotomy, such as hematophobia 1 , hypochondriacal patients 2 , and nosocomephobia 3 . To better understand the fundamental concern of patients when they appear anxious, the question to ask these patients must be an open question in the style of "What are you afraid of", instead of "Are you afraid of the needle"? Moreover, the role-play does not allow us to appreciate the real cognitive behavioral perceptions of the actual patients who could have particular intrinsic characteristics whose reflection on the solutions could improve the educational program. As indicated by the participants to include other types of patients, it would be relevant at this level to have patients of pediatric age. These evoke the double challenge and stress condition for the patient and the phlebotomist, given the difficulty of sampling in this category of patients. These conditions can only be assessed by associating a practical phase with real adult and child patients, inpatients, and outpatients. Finally, I suggest the author discuss integrating communication skills with the new approach to phlebotomy automation. Today, miniaturized sampling systems are based on combining ultrasound images, robotics, and artificial intelligence. Incorporating communication skills into these automated systems that perform safe and precise venous sampling would be a disruptive innovation in the sciences of phlebotomy 4 . Is the rationale for developing the new method (or application) clearly explained? Yes Is the description of the method technically sound? Yes Are sufficient details provided to allow replication of the method development and its use by others? Yes If any results are presented, are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions about the method and its performance adequately supported by the findings presented in the article? Yes References 1. Schröder D, Müller F, Heesen G, Hummers E, et al.: Feasibility of self-organized blood sample collection in adults for study purposes in a primary care setting. PLoS One . 2023; 18 (5): e0286014 PubMed Abstract | Publisher Full Text 2. Mobley D, Baum N, Beattie A, Nemeroff C: When Imagination Becomes a Disease: Dealing With Hypochondriacal Patients in Clinical Practice. Ochsner Journal . 2019; 19 (2): 70-73 Publisher Full Text 3. Ashraf Z, Raza S, Khalid F, Sabzwari Z, et al.: Prevalence of Nosocomephobia – Hospital Related Depression. Annals of Psychophysiology . 2016; 3 (1): 27-32 Publisher Full Text 4. Leipheimer J, Balter M, Chen A, Yarmush M: Design and Evaluation of a Handheld Robotic Device for Peripheral Catheterization. J Med Device . 2022; 16 (2): 021015 PubMed Abstract | Publisher Full Text Competing Interests No competing interests were disclosed. Reviewer Expertise Clinical Biochemistry 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 (1) Author Response 05 Aug 2024 Amani Y. Owaidah, Department of Clinical Laboratory Sciences, Imam Abdulrahman bin Faisal University, Dammam, College of Applied Medical Sciences,, Saudi Arabia Dear Respected reviewer, Thank you very much for your valuable comments and feedback on our paper. Below is the response to each point you have raised. Looking forward to hearing from you in order to change version 2 accordingly. The term "blood extraction" is not too suitable. It should, therefore, be replaced by “blood draw” or “blood collection.” The terms blood extraction are used interchangeably in laboratory sciences with blood collection. However, the term is a matter of preference rather than an incorrect scientific term. It will be changed in version 2 to Blood collection based on your comments The author should give more detail on the study population by explaining why clinical laboratory sciences are offered only to women in his country. In the university where the study was conducted the program is offered to only female as low enrollment rate were found in males so due to financial reasons the male section was closed. Regarding selecting participants, the author only announced that e-mails were sent to students and residents without specifying the number to which the e-mails were sent. So, it's difficult to determine the response rate and discuss other invitation methods, such as physically meeting to find participants. As worded in the paper, the response rate needs to be clarified. Did the ratio of 15 to 17 obtain it? In this case, the response rate is 88.2% instead of 94%. Thank you for specifying. Thank you for pointing out the typo in the response rate. Indeed it is 88.2%. This will be changed accordingly. Yes, emails were the only method used to communicate with the participants. As mentioned in the paper that only level 4 students were invited to participate in the study therefore the emails of level 4 students was not difficult to track as the number of registered students are in the university’s data base. The study concerns only trypanophobia, while there may be other phobias during phlebotomy, such as hematophobia 1 , hypochondriacal patients 2 , and nosocomephobia 3 . To better understand the fundamental concern of patients when they appear anxious, the question to ask these patients must be an open question in the style of "What are you afraid of", instead of "Are you afraid of the needle"? Thank you for suggesting other phobias. In the paper the author mentions trypanophobia as just an example which is the most commonly encountered. And the phrase “ Are you afraid of the needle"? Is used as a conversation opener rather than specifying a type of phobia. But this comment will be taken for future lessons. Moreover, the role-play does not allow us to appreciate the real cognitive behavioral perceptions of the actual patients who could have particular intrinsic characteristics whose reflection on the solutions could improve the educational program. Role play does not assess the behaviour of actual patients. It is used only as a preliminary teaching methods for students practice. Simulation with real patients is definitely the next step in teaching to assess the real behavioral perceptions. But for the level of the students and administrative limitations simulations could not be used but could be a future study, As indicated by the participants to include other types of patients, it would be relevant at this level to have patients of pediatric age. These evoke the double challenge and stress condition for the patient and the phlebotomist, given the difficulty of sampling in this category of patients. These conditions can only be assessed by associating a practical phase with real adult and child patients, inpatients, and outpatients. Agreed. As in the previous comment simulation with real patients could be a future study to conduct. Also, the reviewer could appreciate pediatric patients require a wide range of administrative process such as parental consent and IRB for involvement in a study. In addition the focus of the paper was for to use a different teaching strategy to just a procedural skill of blood collection. To help students improve their communication skills and teach them how to deal with different situations rather than just a procedure. Finally, I suggest the author discuss integrating communication skills with the new approach to phlebotomy automation. Today, miniaturized sampling systems are based on combining ultrasound images, robotics, and artificial intelligence. Incorporating communication skills into these automated systems that perform safe and precise venous sampling would be a disruptive innovation in the sciences of phlebotomy 4 . This is an excellent point to consider for the future. However , these methods help in teaching procedural skills and the focus of our paper was communication skills. This point could be a focus of another paper using advanced methodologies to teach phlebotomy. View more View less Competing Interests There is no competing interest. reply Respond Report a concern Coulibaly M. Peer Review Report For: Using Gagne’s instructional design to teach communication skills in phlebotomy education through role-play [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2024, 11 :46 ( https://doi.org/10.5256/f1000research.79193.r201322) 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/11-46/v1#referee-response-201322 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2022 Gilligan C. 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. 24 Aug 2022 | for Version 1 Conor Gilligan , School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia 0 Views copyright © 2022 Gilligan C. 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) 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 The authors present a detailed description of their lesson plan for teaching communication skills associated with phlebotomy. The description of the lesson is clear and each step is well justified. The value of the focus on communication skills associated with phlebotomy is made clear, but the need for this work in terms of the application of Gagne's instructional design to this process is less clearly justified. There is a plethora of literature describing educational interventions for improving medical students' communication skills across diverse medical consultations. The authors could more clearly explain why the communication required during/associated with phlebotomy is unique and why a different teaching approach is required. The authors describe the lesson plan using language that presents the approach as very certainly achieve the desired outcomes. In many cases, these are in fact the intentions of the selected approaches, rather than absolutes. The authors refer learning styles in their 'gaining attention' section - presenting these as though they exist as entirely mutually exclusive ways of learning. Recent literature support the blurring of boundaries between learning styles. The approach used appropriately provides stimuli which will appeal to a range of learning styles and I think it would be useful to emphasize the blurred 'boundaries' between styles. I would like to better understand the logistics of the facilitator and teaching assisting observing and providing feedback on student role-plays - how was this managed with multiple groups and pairs conducting role-play at once? I'm not sure that a boxplot is the most appropriate format in which to present the data in figure 2 - perhaps a bar graph displaying means would be more clearly illustrative of the point? The limitations of this work need to be acknowledged. There is no measure of behavioural outcome. While it is recognised that such measures are difficult to achieve, it should be acknowledged that in the absence of such measures, the true effectiveness of this session remains unknown. Is the rationale for developing the new method (or application) clearly explained? Partly Is the description of the method technically sound? Yes Are sufficient details provided to allow replication of the method development and its use by others? Yes If any results are presented, are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions about the method and its performance adequately supported by the findings presented in the article? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Medical education, interactional skills teaching, healthcare communication 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 (1) Author Response 05 Aug 2024 Amani Y. Owaidah, Department of Clinical Laboratory Sciences, Imam Abdulrahman bin Faisal University, Dammam, College of Applied Medical Sciences,, Saudi Arabia Dear respected reviewer, Thank you for your valuable comments that is highly appreciated. Following are my responses to your comments, to the best of my knowledge, I have addressed all the comments/ clarifications requested. The value of the focus on communication skills associated with phlebotomy is made clear, but the need for this work in terms of the application of Gagne's instructional design to this process is less clearly justified. There is a plethora of literature describing educational interventions for improving medical students' communication skills across diverse medical consultations. The authors could more clearly explain why the communication required during/associated with phlebotomy is unique and why a different teaching approach is required. With phlebotomy, the teaching approach is focused on the procedural skill of withdrawal of blood successfully, which is covered in m any laboratory sessions throughout the educational curriculum, however, with phlebotomy, there is a level of communication with patients/ donors with the phlebotomist. In real-life cases some patients present phobia of needles or anxiety, therefore, the phlebotomist with addition to excellent procedural skills has to have good communication skills to accommodate different types of patients in order to draw blood from them. In the absence of such skills the phlebotomist will not be able to ease patients and fulfill doctors request for testing. The authors describe the lesson plan using language that presents the approach as very certainly achieve the desired outcomes. In many cases, these are in fact the intentions of the selected approaches, rather than absolutes. The authors refer learning styles in their 'gaining attention' section - presenting these as though they exist as entirely mutually exclusive ways of learning. Recent literature support the blurring of boundaries between learning styles. The approach used appropriately provides stimuli which will appeal to a range of learning styles and I think it would be useful to emphasize the blurred 'boundaries' between styles. This is an excellent point to emphasize the different learning styles. However, the focus teaching strategy was not to go into detail on the various learning styles rather than presenting a well-known instructional design for a lesson plan to follow to ensure proper implementation of a new teaching approach. Follow up work could include the behavioral outcome on different cohorts. I would like to better understand the logistics of the facilitator and teaching assisting observing and providing feedback on student role-plays - how was this managed with multiple groups and pairs conducting role-play at once? As the number of students were small. The instructor and teaching assistant moved around the groups while they were practicing their role-play to provide them feedback. In addition, as described in the paper the in the group one student took the role of the observer to observe the other two students. Which one played the patient and the other played the role of the phlebotomist. The observer also provided feedback to their colleagues on their performance. By this methods student gain the skill of peer assessment and raise their sense of self-awareness. I'm not sure that a boxplot is the most appropriate format in which to present the data in figure 2 - perhaps a bar graph displaying means would be more clearly illustrative of the point? The use of boxplots was selected by to present the different quartiles of the analysis. However, if necessary format could be presented in bar graphs. The limitations of this work need to be acknowledged. There is no measure of behavioural outcome. While it is recognised that such measures are difficult to achieve, it should be acknowledged that in the absence of such measures, the true effectiveness of this session remains unknown. I agree, the behavioral outcome should be assessed to measure the true effectiveness of the session. However, However, the focus teaching strategy presenting a well-known instructional design for a lesson plan to follow to ensure proper implementation of a new teaching approach. Follow up work could include the behavioral outcome on different cohorts. Also could include feedback from clinical instructors to provide feedback on the effectiveness of this teaching method. The outcome of the current paper could be used to improve the design of the current curriculum by providing the students with the opportunity to co-create the curriculum. Looking forward to hearing from you View more View less Competing Interests I declare no competing interests reply Respond Report a concern Gilligan C. Peer Review Report For: Using Gagne’s instructional design to teach communication skills in phlebotomy education through role-play [version 2; peer review: 1 approved, 2 approved with reservations, 1 not approved] . F1000Research 2024, 11 :46 ( https://doi.org/10.5256/f1000research.79193.r146424) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. 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