Thank you for submitting this article, and apologies for the delay in completing the review process. I think that your study addresses a relevant issue in contemporary physiotherapy education, however, there are a number of areas in which I think the article would benefit from significant revision and clarification.
The fundamental issue to address from my perspective relates to the aims and methodology of the study as currently reported. Your concluding statement in the introduction gives the objective of the study as being to “…assess the reach of pre-recorded learning material on the current understanding of pain…”. However, the methods and results reported relate predominantly to the development of the resources, with reference also to a survey evaluating the effectiveness and acceptability of the resources. The discussion and conclusion then focus back on the reach or potential reach and therefore do not relate to the methods and results. My feeling is that overall the article would benefit from being rewritten with a clearer aim of articulating the process of development of the learning materials in line with your methods, with less emphasis on reach, which has not been established at this point.
In relation to the methodology, my feeling is that the process described in your methods section suggests that the study might be better conceived of as a piece of action research. Your methods appear to describe a process of problem identification, action planning, data collection, analysis and planning of future action through at least two cycles, which is in keeping with an action research methodology. Rewriting the article as a report of an action research project would provide clearer alignment between your aims, methods and results. I also feel this would give more scope to add detail regarding the curriculum review phase of the project, which would increase the usefulness of the article for other physiotherapy educators.
Bearing in mind this overall recommendation, please find below further comments relating to each section.
This provides a clear background to the project, although would benefit from being split up into paragraphs. There is a sound argument for the need to update the pain curricula of pre-registration physiotherapy programmes in India and some of the contextual barriers to this. Considering to what extent pain curricula in other countries share the issues identified may add relevance to a broader readership, for example, there are studies of pain curricula in the UK and Finland. I also wondered whether considering studies evaluating the relationship between pain education and students’ beliefs and practice (such as Springer et al 2018 and Domenench et al 2011 and would strengthen the rationale.
The methods provide some clear detail around the process of developing the teaching materials. As per my previous comments, I feel that reconceiving of this paper as a report of an action research paper would provide a clearer structure. This could incorporate the phases that you have identified as well as including more detail on the reflective process that led you from the initial intensive training programme that you developed to the current project. As a reader, I would have been interested to know more about the curriculum review and how the plan for the recorded materials was informed by this process and the input of the external expert review committee. It would also be good to have more information on the evaluation survey aims and content.
Examples of published action research projects of teaching material development in healthcare education that might be helpful for restructuring your paper include; “A model teaching session for the hypothesis-driven physical examination” (Nishigori et al 2011) and “Learning to listen: Improving students’ communication with disabled people” (Anderson et al 2011).
In keeping with the restructure towards action research, your results would focus more on how each stage and each group of participants (initial project group and experience with the previous intense teaching model, external expert review committee, students and educators at participating institutions) informed the development of the teaching resources and the future direction. I would suggest that more detail around the content of the teaching package and how topics were structured and linked rather than on their duration would be of most interest to other healthcare educators. Greater clarity is needed around who was involved in the initial rollout of the materials and the evaluation survey, possibly in the form of a flow diagram, as I found this difficult to track through.
Discussion and future perspectives
The discussion should provide a more detailed explanation and analysis of the results presented. Expanding the scope of the discussion away from the current and potential reach of the resources to focus more on the development process and the content of the project output in the form of the teaching materials would fit with the proposed methodological change. It would also be good to see a critique of your methods in the form of strengths and limitations of the study, as this adds reflexivity and would potentially be useful for other educators undertaking a similar project.
Thank you again for submitting this article. I would be interested to see a future iteration of it and happy to continue the discourse.