Successful implementation of Medical Education Faculty Development Project at Saint George University of Beirut in the immediate post triple blow to Beirut

Background The aim of this study is to explore the efficacy of the Faculty Development Program (FDP) implemented at the Saint George University of Beirut-Faculty of Medicine (SGUB FM) under exceptional circumstances as the triple blow to Beirut. Methods The Faculty Development, directed towards a cohort of 35 faculty members, is composed of two major components: methodology of teaching and techniques of assessment. The Kirkpatrick’s assessment model, in combination with a specifically designed psychological questionnaire, were chosen to assess the effectiveness of the faculty development initiative. Results Results of the different questionnaires were interpreted individually, then through the lens of the psychological questionnaire. A majority of faculty (55%) were significantly affected psychologically by Beirut’s triple blow and 77% of all participants found the workshops to be of excellent quality (Kirkpatrick’s Level I). Moreover, Kirkpatrick’s level II results yielded a 76% mean percentage of correct answers to post-workshops MCQs and a significant improvement in the mean results of the self-assessment questionnaires, administered before and after each workshop. Results also show that the more a trainee is psychologically affected, the less he/she performs as evidenced by a decrease in the satisfaction rate as well as in the score of the cognitive MCQs and of the self-assessment questionnaires. Conclusions This study was able to highlight that significant learning can occur amidst exceptional circumstances like the Beirut triple blow and administration should invest in professional growth to retain its faculty.


Methods
The Faculty Development, directed towards a cohort of 35 faculty members, is composed of two major components: methodology of teaching and techniques of assessment.The Kirkpatrick's assessment model, in combination with a specifically designed psychological questionnaire, were chosen to assess the effectiveness of the faculty development initiative.

Results
Results of the different questionnaires were interpreted individually, then through the lens of the psychological questionnaire.A majority of faculty (55%) were significantly affected psychologically by Beirut's triple blow and 77% of all participants found the workshops to be of excellent quality (Kirkpatrick's Level I).Moreover, Kirkpatrick's level II Ardi Findyartini, Universitas Indonesia, Depok, Indonesia 2.

Open Peer Review
Any reports and responses or comments on the article can be found at the end of the article.

Introduction
In the dynamic tapestry of global medical education, one constant remains: the necessity to evolve and adapt.Faculty development programs (FDPs) have stood as testaments to this evolution, with robust evidence from both the U.S. and the international community affirming their impact on amplifying teaching effectiveness [1][2][3][4][5][6][7] .The exigencies of the COVID-19 era further catalyzed this evolution, making the shift from traditional classrooms to innovative online platforms not just a trend, but an imperative, especially when in-person pedagogical interactions became untenable.Studies like Zuo et al., 2021 8 offer insights into this paradigm shift, while other research underscores the pivotal role of educators' psychological well-being in pedagogical success 9,10 .
Yet, how do these initiatives fare amidst unparalleled adversities?Most academic contexts have not been tested against a confluence of challenges as seen in Beirut.Here, the city grappled with a triad of crises -the destabilization of its banking system since 2019, the ravages of the COVID-19 pandemic, and the profound trauma of the Beirut Explosion on August 4, 2020.The repercussions were particularly acute for the venerable Saint George Hospital University Medical Center (SGHUMC), a beacon of medical excellence since 1878.
On the edge of these tumultuous events, SGHUMC was in the midst of transformative strides.The inauguration of the Saint George University of Beirut (SGUB) in 2018 marked the dawn of an avant-garde medical school (SGUB FM) with visions set on global accreditation and pioneering educational approaches.However, challenges were manifold, with the institution confronting the inertia of a two-decade-old didactic curriculum and a prolonged hiatus in faculty development.
Confronted by these layered challenges, the leadership of the university demonstrated an unwavering resolve towards modernization, envisioning a rejuvenated curriculum and bolstered faculty capabilities.Demonstrating an inspiring resilience against the myriad challenges Beirut presented, the faculty stood resolute in their pedagogical mission.This study explores the inception and challenges of the Curriculum Development Program at SGUB FM, emphasizing the relentless pursuit to empower educators amidst such monumental challenges.

Study population
In preparation for the inaugural MED I class in September 2022, SGUB FM's Dean's Office targeted a faculty development initiative at a group of 35 faculty members, none of whom had prior formal training in faculty development in medical education.This cohort encompassed members of the Curriculum Committee and educators responsible for the MED I and MED II curriculum segments, all of whom concurrently serve as practicing physicians at SGHUMC.

Settings and study design
To support this initiative, an interventional study was launched, piloting a Faculty Development Program (FDP) with an emphasis on student/learner-centered pedagogy.This FDP was meticulously crafted to be interactive, positioning participants at the heart of all discussions.Beyond the core sessions, the workshops were enriched with self-paced readings and follow-up tasks.Upon completing the program, participants were awarded certificates.

Program Modules:
The FDP encompassed the following ten workshops:

Implementation:
For each module, a facilitator from the American University of Beirut Center for Teaching and Learning was invited to the SGUB FM premises to lead an interactive workshop.These sessions spanned over a six-month period, with ten sessions in total, each lasting two hours.

Program Components:
The FDP was designed around two primary components: teaching methodologies and assessment techniques.Given the importance of reflections in enhancing learning experiences, the program culminated with a dedicated session for participants to share and discuss any transformations in their teaching methodologies.

Rationale for Workshop Selection:
Despite the COVID-19 pandemic, there were key reasons for choosing in-person workshops: • Vaccination: All participants had two doses of the Pfizer vaccine, lowering transmission risk.

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Safety: On-site sessions followed strict safety rules, like mask-wearing, good ventilation, and distancing.

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Better Engagement: Face-to-face meetings enable richer discussions and real-time feedback compared to virtual settings.

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Avoiding Screen Burnout: Too much virtual meeting time can lead to fatigue.In-person sessions offered a screen break.

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Practical Learning: Some topics, like group tasks, thrive in a hands-on, in-person environment.
The Kirkpatrick's (1976) 11 assessment model consisting of four levels (appendix 1), was adopted to evaluate the effectiveness of the faculty development initiative due to its simplicity, its assessment of a limited number of variables, the ease of its evaluation criteria, the lack of requirement to collect participants' basic data or past performances as well as the independence of individual and environmental variables 12 .Two levels were developed: Reaction -Level 1 detailed in appendix 2, and Learning -Level 2 detailed in sessions 1 to 9 'Post workshop Multiple Choice Questions' and 'Retrospective Pre and Post' questionnaires.
The retrospective pre-post method (RPP) offers an alternative method to the traditional 'pre-post design' that usually relies on the stability of the participants standard of measurement for the dimension being assessed from one data point to the next 13.As the learners' perception of the dimension(s) being measured evolves, they readjust the criteria for their self-rating: the response shift bias 14,15.When using the RPP method, the ratings of understanding before (referred to as the 'retrospective pre') and after (referred to as the 'retrospective post') the intervention employ the same metric because data are taken at the same point in time, i.e., at the conclusion of training, thus reducing such bias 15.The behavior level (level III) and the results level (level IV) are evaluated by qualitative and quantitative data (open-and closed-ended questions) with trainee faculty after three months and nine months of workshops completion respectively.Results of both Levels III and IV will be interpreted, discussed and diffused in a subsequent paper to be submitted later.
Finally, a specific questionnaire has been developed in collaboration with the Psychiatry Department to study the psychological impact of Beirut's triple blow on the intended faculty development initiative (appendix 3).This 4-point Likert scale questionnaire is composed of three parts: the first part includes direct questions assessing the impacts of COVID-19, of the financial crisis and of the Beirut blast on the daily life of our trainees and of their loved ones; the second and third parts contain indirect questions assessing daily stress and detecting early features of depression.The psychological questionnaire was administered before starting the first session and at the end of the tenth training session to interpret the results of the assessment framework through the lens of Beirut's triple blow's psychological impact.

Pilot study (validity evidence) of the different questionnaires:
Two content experts were involved in developing and reviewing the questionnaires that were pilot tested prior to their implementation on a sample of five faculty members not enrolled in the FDP, making sure they are in line with outcomes being assessed.Physician Examiners that were in charge of course delivery and assessment and Enrolled Trainees were adequately trained prior to FDP administration and given specific guidelines about the questionnaires and rubrics in order to ensure the accuracy and the integrity of the data collected during the response process.The internal structure validity evidence was evaluated by two independent raters whose inter-rater reliability was evaluated by the kappa correlation coefficient that accounts for the random-chance occurrence of rater agreement (Kappa = 0.84).Reliability was evaluated using Cronbach's alpha for internal consistency 16 with a value of 0.89.
Overall, 77% of all participants found the workshops to be of excellent quality with a mean value of overall satisfaction of the quality of the program of 4.1 ± 0.5 (Table 3).

Pre-workshop psychological questionnaire
Participants demonstrated significant psychological adverse effects from the Beirut triple catastrophe, as indicated by statistically significant findings (p < 0.05) in 7 out of 10 survey items.Responses for the following three items, however, did not reach significance: 1. 'In the past 30 days, how much were you affected by the Aug 4, 2020, explosion: nightmares, fear, trouble concentrating, mood changes?' (Mean score = 1.5) (Table 2).
Kirkpatrick's level 1 (Satisfaction questionnaire) results: • According to the results of the first stage of Kirkpatrick evaluation, the number of participants that said the workshops were of excellent quality was 27 (77%).Out of the 35 participants, 31 (90%) expressed complete satisfaction with the workshop format.In every other section of the questionnaire, more than 50 % of the respondents said the quality was very good.

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We computed the mean and SD for every item of the level I questionnaire for all workshops combined (Table 3).On a scale of 1 to 5, instructor assessment averaged 4.1, course content assessment averaged 4.2, course support assessment averaged 3.9, while the overall assessment of the quality of the workshops averaged 4.1.

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Spearman correlation testing yielded a highly significant correlation (p=0.00<0.05)as evidenced by the  high value of the R coefficient between the rank of each workshop in item "Satisfaction with the quality of workshop" and the rank of each workshop in the rest of the items (Table 2).

Kirkpatrick's level 2 (Learning questionnaires) results:
At the end of each module, participants were administered three questionnaires.

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The mean percentage of correct answers to the first questionnaire (that includes 10 to 15 multiple choice questions (MCQs) directly related to each workshop's content (workshops 1 to 9, workshop 10 not included) thus directly testing post-session cognitive learning), was 76% ranging from 65% (workshop 3) to 88% (Workshop 2) (SD=7.7)(Table 4)

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The mean result for the Retrospective Pre questionnaire of all workshops averaged 2.3 SD=0.57(Scale 1 to 5) while the mean result for the Post questionnaire of all workshops increased to 3.6 SD=0.50 (scale 1 to 5) (p=<0.05)(Table 5).Moreover, for every workshop, the increase of the score between the Retrospective Pre and Post questionnaires was significant (p=<0.05)(Table 5).
Post-Workshops Psychological Questionnaire results show there successful learning despite the economical and psycho-social challenges (Table 6).
Comparison between Pre and Post workshops psychological questionnaires show there is no statistically significant difference in the psychological status of the trainees as assessed by our psychological questionnaire prior to and after FDP administration, indicating that the effects of Beirut's triple blow were still affecting most of our participants with the same intensity six months after having started the workshops (Table 7).
A majority of faculty (55%) were markedly affected by Beirut's triple blow with a mean score of 2.1 SD=0.54 at the pre-FDP

Assessment framework results through the lens of Beirut's triple blow's psychological impact:
We computed a variable entitled "Pre-Workshops Mean Psychological questionnaire" corresponding to the mean of the answers to the 10 questions of our psychological questionnaire.

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Kirkpatrick's level I questionnaire: a significant negative relationship (p˂0.05) between the score of the psychological questionnaire and the satisfaction with the quality of the workshops (p=0.00<0.05),and with the way of conducting the workshops (p=0.00<0.05).The more psychologically affected the participants are, the lower is their overall satisfaction with the workshops.• MCQs results:

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Comparing the mean percentage of correct answers to all Level II workshops' MCQs with the Pre-Workshops Mean Psychological questionnaire score yielded also a highly significant negative relationship (p=0.00<0.05).The more psychologically affected the participants are, the lower is their performance in answering the cognitive MCQs in all workshops.(p=0.00<0.05)

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Self-assessment questionnaires (RPP): • (1) The psychological status of the participants does not affect their Retrospective Pre-self-assessment regarding their potential performance in one of the workshops' topics (p=0.35>0.05).

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(2) The more psychologically affected the participants are, the lower is their self-assessment in the Post questionnaires of all workshops regarding their potential performance in one of the workshops' topics (p=0.00<0.05).In other words, trainees that are less affected psychologically are more likely to benefit from the FDP.

Discussion
This study showed a marked boost in trainees' self-awareness, confidence, and their adeptness to new instructional strategies post-intervention.These faculty development programs are known to enhance teaching effectiveness in standard medical education settings [1][2][3][4][5][6][7] .
These programs remain a prominent topic in medical literature, designed to enhance the skills and knowledge of faculty members, subsequently improving the overall quality of medical education [1][2][3][4][5][6][7] .They come in various formats, from brief workshops and seminars to comprehensive long-term degree courses.Their content encompasses a wide range of subjects, including curriculum design, instructional strategies, assessment strategies, leadership, research methods, and the integration of technology.In terms of duration, some are concise, lasting just a few days, while others can extend over several years.The COVID-19 pandemic has seen many of these programs transition to online platforms 8 , although some have adopted a blended approach 17 .Regardless of the format or content, continuous evaluation and feedback are crucial components, ensuring the programs remain effective and up to date.
The initiation of SGUB FM's program occurred amidst a backdrop of significant upheaval in Beirut, marked by socio-political turmoil, economic downturn, and the devastating 2020 port explosion.This unique context not only sets Beirut's medical faculty's challenges apart from their global counterparts but also underscores their resilience.Indeed, these unparalleled events in Beirut lend additional weight and significance to the outcomes of our study.

Limitations of the Study:
While this study offers valuable insights, it's crucial to acknowledge its limitations.Firstly, the sample size was relatively small, limiting the generalizability of the findings.Additionally, the study primarily relied on self-reported data, which may introduce response bias.The external circumstances, including Beirut's triple blow, created a unique context that might not be fully replicable in other settings.Furthermore, the evaluation was limited to Kirkpatrick's Levels I and II, and future studies should explore Levels III and IV to provide a more comprehensive assessment of the program's impact.
Similar studies conducted in the realm of faculty development in medical education have shown satisfaction levels of 63% 18 .The mean value of overall satisfaction for a whole FDP program ranged from 3.6 ± 0.50 (Kim, 2015) 19 to 4.2 ± 0.32 on a 4-point Likert scale.To assess the impact of our FDP, we employed a specifically designed psychological questionnaire in conjunction with Kirkpatrick's evaluation framework, chosen for its simplicity and ease of application 12 .
It's worth noting that the effects of Beirut's triple blow continued to impact most of our trainees with the same intensity even six months after commencing the workshops.This is evident in the absence of a statistically significant difference between the results of the psychological questionnaire administered before and after the 10 workshops.
Level II results (learning) indicate that the mean percentage of correct answers to the nine post-workshop MCQs is 76%.Additionally, the mean results for the RPP questionnaires of all workshops improved significantly from 2.3 (SD=0.57) to 3.6 (SD=0.50) on a 5-point scale (p<0.05).Previous studies, such as Heydari (2019) 18 and Steinert (2016) 7 , have also demonstrated significant improvement in Level II pertaining to knowledge and skills.
When interpreting the results of Kirkpatrick's Levels I and II alongside the psychological questionnaire, a notable pattern emerges.Trainees experiencing higher psychological distress, as indicated by a high mean psychological score, tend to exhibit lower post-workshop satisfaction and reduced performance, as evidenced by decreased scores in cognitive MCQs and the Post questionnaire of the RPP framework.

Implications for Future Faculty Development Initiatives:
These findings hold significant implications for shaping future faculty development initiatives.Firstly, they underscore the importance of considering contextual factors and the psychological well-being of trainees when designing and implementing such programs.Faculty development initiatives should incorporate strategies to address trainees' emotional well-being, particularly in challenging or crisis-prone environments.
Additionally, the study's results will inform the design and assessment of future faculty development initiatives.Understanding the impact of training on Kirkpatrick's Levels I and II provides a foundation for evaluating effectiveness.Future research should delve into Levels III and IV, focusing on behavioral change and organizational impact, to provide a more comprehensive view of program outcomes.
Moreover, given the unique context of Beirut's triple blow and its lasting effects on trainees, future initiatives should include proactive measures to support faculty members' mental and emotional well-being.Proven strategies such as stress coping mechanisms, emotional support, and regular communication from top management should be integrated into program planning [20][21][22] .

Conclusion
In conclusion, while recognizing the study's limitations, these findings will serve as a valuable guide for developing more resilient and effective faculty development programs that can thrive even in challenging circumstances.The study's distinctiveness lies in its ability to illuminate the interplay between trainees' psychological status and their performance, set against the backdrop of Beirut's crises, as assessed by the Kirkpatrick's evaluation framework.Furthermore, it underscores the potential for significant learning amidst stress and uncertainty, particularly in resilient trainees embedded in a country familiar with turmoil.Drawing upon global practices and contextualizing them to Beirut's unique challenges, the lessons learned from this study will contribute significantly to the continuous enhancement of faculty development initiatives worldwide.
This project contains the following extended data: -Faculty Development Appendices

Introduction
The revised introduction both captures and focuses attention on the importance of this issue.The citations of faculty development studies and especially those in disruption provide a stronger context for the study.Additional explanation and citations focused on psychological factors strengthen the context for the focus of this study.The authors might want to include detailed descriptions of the severe external disruptions related to the facilities, persons, processes, and procedures to set the foundation for the importance of this study.This coupled with the effort to seek accreditation and transform faculty development make this study unique in its contribution to knowledge.The authors might want to consider that descriptions such as "venerable", "…a beacon of medical excellence since 1878", and Avante-garde be provided with additional detail to give context (important to this work) to their meaning.

Study population
Demographics such as early, mid, and late career stage would be a useful addition as a lens to review the data.Information on this would help determine if there is a need to differentiate the curriculum based on experience.

Settings and Study Design
This section is much improved as it includes important details that add strength to the study and a clearer picture to guide replication.An example of a typical session would provide further insight into the structure of the intervention.It would illustrate the emphasis on the two primary components, teaching methodologies and assessment techniques.In Program Modules, the breakdown of the methods into the specific sessions with headings provides clear organization.
Given that the reflection workshop is the emphasis of the last module, it would help the readers to have an explanation of how this skill is woven through the various sessions.The use of trained facilitators is commendable and addresses issues related to teaching approaches.
The inclusion of the Psychiatry Department provides an interprofessional collaborative model that can inform future work of similar studies.The use of the retrospective pre-post method is an interesting choice with a literature base to support its use for this type of study.The authors effectively use Kirkpatrick's Evaluation Model and note that future research will address Levels III and IV of this model.It is a challenge to show change at levels III and IV, so the second paper will be a welcome addition to the literature.The inclusion of a pilot study strengthens the impact of this work.Additional information to support the validation of the questionnaires is included.Steps have been taken to check for validity.

Results
The results section is organized and detailed.The tables clearly convey the results.Limiting the use of the term "significant" to indicate p-value would eliminate any confusion.The authors might want to report the results under Kirkpatrick's level I as "27/31 (77%)" to make it clearer to the reader.

Discussion
The Discussion presents clearer details and relates them more effectively to the introduction and the findings with accompanying citations to extend the impact of this work.This revision strengthens the study and will be a guide to future researchers.The authors should be commended for the extensive discussion on limitations and their inclusion of research related to this work.The implications of this study follow from the introduction and the findings.

Conclusion
The conclusion aligns this effort with global faculty development initiatives and research agendas.
Competing Interests: No competing interests were disclosed.
Reviewer Expertise: Qualitative, quantitative, and mixed methods 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.
Reviewer Report 24 November 2023 https://doi.org/10.21956/mep.21345.r35219circumstances and rationale on why this study hence is important for readers.A clearer research question is also warranted.

Methods:
The study setting as elaborated in the current introduction can be considered to be moved in the study setting in the methods section.The authors should elaborate on the medical school curriculum context in which the faculty enact their roles as teachers, as well as the faculty development program available before the present intervention is in place.The use of Kirkpatrick's framework is appropriate.The instruments to measure the satisfaction and knowledge of the workshop participants were fairly explained.
The description of the intervention should be more detailed.It is not adequate to just explain that the intervention is workshop, with selected topics.How was the workshop done?Who lead the workshop?What was the method for the workshop?Were there any activities following the workshops, etc.The authors might consider underlining the rationale of selecting workshops as a strategy in the current faculty development program.In other words, the explanation on validity of the tools being used in this study should be added with the 'validity' or trustworthiness of the workshops, hence the authors may provide both evidence on the effectiveness of the workshop and how and why the workshops were done.

Results:
The results are quite compelling and well described.With further requirement to revise the introduction and methods section, it is sometimes quite challenging to grasp the meaning of the results.

Discussion:
The authors have elaborated the main findings and provided reasoning using relevant literature.The discussion section however still requires further work.I would recommend the authors do not only discuss the level of satisfaction and knowledge, yet how the faculty development programs in the different literature were completed and in what circumstances.Given that the authors aim to highlight the special circumstances of faculty development program they have conducted in Beirut, discussing the contexts of different studies and how they are relevant with this present study is critical.Herewith, it is expected that the authors may elaborate further recommendations or impacts of this study in others settings, as well as specify the limitation of the present study better.

Conclusion:
The conclusion is fair.Yet, clearer research questions/evaluation questions elaborated in the introduction should be able to strengthen the conclusion.

Is the work clearly and accurately presented and does it cite the current literature? Partly
Is the study design appropriate and is the work technically sound?Partly

Are sufficient details of methods and analysis provided to allow replication by others? Partly
This study examines faculty development outcomes under disruptive situations and contributes a unique perspective to this discourse.A few adjustments would strengthen this work.Consider having the manuscript edited to communicate this work more effectively to readers.

Introduction:
The opening sentence needs to capture the attention of the reader.The first two sentences in the third paragraph of the Introduction can be used to create a compelling introduction: "Most faculty development initiatives have been tested in different settings, whether in the United States or abroad, and have proved their efficacy in improving teaching effectiveness in medical education1 - 7; however, such initiatives have still not yet been studied when applied in a combination of exceptional circumstances".This entire second paragraph makes a much stronger opening paragraph for this paper.
Is there an interest in including in the aim the psychological impact on the faculty in keeping with the psychological measures used with the faculty?

Methods: Study Population:
The description is adequate.

Settings and Study Design:
The first sentence is not clear.Explain what is meant by the underlined phrase: "This is an interventional study where the proposed pilot Faculty Development Program (FDP), is designed under the auspices of student/learner-centered classes with the following modules…".

Results:
Tables clearly display results.

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Provide clearer statements of results.It might help to replace the adjective 'significantly' to avoid confusion about the significance of the findings.An example is in the first sentence of the results of the pre-workshop psychological questionnaire.Instead, report that 7 of 10 questions were significant at p <0.05.

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Kirkpatrick's Level I (Satisfaction questionnaire) and Level II (Learning questionnaires) results are clearly presented.

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Provide the rationale for using the Wilcoxon Signed Rank Test rather than a t-test to compare the pre-post workshop psychological questionnaire results.

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Interpretations of the results are more appropriate in the Discussion rather than in the Results section.
○ MCQ results and Self-assessment questionnaires -Report the p-value and omit "highly significant."The comparison of these is a critical component of this study

Discussion:
Explain how the last paragraph of the discussion section relates to the findings as it appears to introduce additional variables.

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Limitations of the study need to be identified.

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How will these results be used to inform future faculty development initiatives?Reviewer Expertise: Qualitative, quantitative, and mixed methods 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.

Comments on this article Version 2
Reader Comment 07 Nov 2023 Balaji Arumugam , Community medicine, TN.Dr. MGR Medical University, AMCH, Tiruvannamalai, India The Kirkpatrick Model is a globally recognized method of evaluating the results of training and learning programs.It assesses both formal and informal training methods and rates them against four levels of criteria: reaction, learning, behavior, and results.The above model is an internationally accepted validated evaluation method for assessment of any training programs.This model was properly scientifically utilized among 35 FDP attendees by the authors especially on level 1 and 2. The Kirkpatrick's assessment model, in combination with a specifically designed psychological questionnaire, were chosen to assess the effectiveness of the faculty development initiative.The study results explored a wonderful subjective as well as the objective results.77% of all participants found the workshops to be of excellent quality (Kirkpatrick's Level I).Moreover, Kirkpatrick's level II results yielded a 76% mean percentage of correct answers to post-workshops MCQs and a significant improvement in the mean results of the self-assessment questionnaires, administered before and after each workshop.This study was able to highlight that significant learning can occur amidst exceptional circumstances.Congratulations to all the authors and stakeholders involved in making this research study on faculty development programme which will be a role model study for our Indian set up where we have started gaining importance for FDP under NMC guidelines.

2 .'
During the past week, have you lost confidence in yourself?' (Mean score = 1.6) 3. 'Over the previous two weeks, have you experienced diminished interest or pleasure in activities, or felt down, depressed, or hopeless?' (Mean score = 1.7).
References are accurate and appropriate.○Isthe work clearly and accurately presented and does it cite the current literature?YesIs the study design appropriate and is the work technically sound?YesAre sufficient details of methods and analysis provided to allow replication by others?PartlyIf applicable, is the statistical analysis and its interpretation appropriate?PartlyHave any limitations of the research been acknowledged?NoAre all the source data underlying the results available to ensure full reproducibility?YesAre the conclusions drawn adequately supported by the results?YesCompeting Interests: I direct the program in which one of the authors (Alexandre Nehme) is enrolled.He took a course I co-taught several years ago.I confirm that this potential conflict of interest did not affect my ability to write an objective and unbiased review of the article.

Psychological Questionnaire: •
The Wilcoxon Signed Rank Test was chosen over the t-test due to the non-normal and potentially ordinal nature of the psychological questionnaire data, which often arises from Likert-type scales.Additionally, the Wilcoxon test is more robust to outliers and aptly designed for paired samples, like our prepost workshop measurements.Significance level was taken at p-value<0.05.This study was approved by the IRB committees of both SGUB (IRB-RES/O/002-22/0122) and Johns Hopkins University IRB (HIRB00014603) where the first author is currently enrolled in the Master of Education in the Health Professions (MEHP).All participants provided written informed consent prior to enrolment in the study.