1. Selection bias and generalizability. Of 55 eligible students, 31 declined (56% non-participation). Students who disliked the course or performed poorly may have self-selected out. How do the authors justify claims of “positive perceptions” when more than half the cohort is unrepresented? What steps were taken to characterize non-responders?
2. No objective outcome measures. The study measures only perceived learning, not actual knowledge acquisition. The authors acknowledge the Dunning-Kruger effect but still conclude the course “provided a strong base” and “reduced cognitive overload.” Without pre/post knowledge assessments or exam performance data, how can these claims be substantiated? Perception ≠ competence.
3. Data saturation is asserted, not demonstrated. The authors state saturation was “assumed” after the fifth focus group yet conducted a sixth. With only four participants per group (below the standard 6–10 for focus groups), saturation is questionable. What evidence (e.g., no new codes across two consecutive groups) supports saturation? Why was a sixth group conducted if saturation was reached?
4. The focus groups were conducted by the principal investigator (FN) and moderated by a faculty member (HG), with senior pharmacy students as observers. Were these individuals involved in teaching or assessing the participants? If so, students may have felt pressured to give socially desirable responses. How was this mitigated?
5. The discussion overreaches. The authors invoke cognitive load theory (refs 23–24) and Vygotsky’s ZPD, but the study design cannot test these frameworks. No measures of cognitive load, working memory, or ZPD were employed. Why are these theories used to interpret findings rather than as testable hypotheses?
6. Ethical approval and consent timing. The study was approved in 2024 (QU-IRB 2135456-1), but the course change occurred earlier. Students were interviewed one year after taking the course. How does the IRB approval timeline align with data collection? Were participants informed that their responses could influence future course design—potentially creating incentive to exaggerate positives?
7. Conflict of interest. The authors are affiliated with the College of Pharmacy where the study was conducted, and some are course instructors. The study evaluates a course they redesigned and teach. How do the authors address this inherent conflict? Was an independent reviewer involved in theme generation?