The study reports improved IPC knowledge and PPE skills after using D-B_EPCD, but in my opinion, to strengthen the study, you should apply more rigorous analytical methods to support a causal interpretation of these improvements. The current analysis does not sufficiently address potential confounding factors such as parallel training efforts, general institutional learning, or pandemic-related behavioral changes over time. Additionally, the reported average system usage frequency (1.74 times/week) raises questions about the relationship between system engagement and outcomes; was there a measurable dose-response effect? To better substantiate your conclusions, you should consider using approaches such as mixed-effects modeling or interrupted time series analysis to control for temporal trends and confounders, and to model the relationship between system use intensity and skill acquisition.
