1. The study was conducted at a single institution, and 22 of the 36 participants were from the Medicine, Nursing and Health Sciences (MNHS) faculty. The sample from other faculties (e.g., Business, Education, Science) is very small (n=2-6). Can the authors justify how their cross-disciplinary findings, particularly the claimed “synergy in methods” and the matrix analysis in Figure 1, are not overwhelmingly biased by and representative of the healthcare educator perspective, rather than a genuine synthesis of diverse fields? How can the findings be generalizable to health professions education globally, given the single-site, Anglophone context?
2. The data relies entirely on educators’ self-reported practices via interview. There is no observation of actual teaching or collection of student perspectives to verify if the described “uncertainty stimuli” are implemented as stated or are effective in stimulating student uncertainty. How do the authors address the significant risk of social desirability bias, where participants report pedagogically “ideal” strategies rather than their routine practice? Without triangulation, how can we trust that the mapped “stimuli” exist beyond the interview context?
3. The discussion forcefully aligns the three themes with Mezirow’s Transformative Learning Theory, presenting a prescriptive, three-phase model (Fig. 2). This theoretical integration appears post hoc. What empirical evidence from this study’s data demonstrates that educators consciously structure experiences as “pre-during-post” transformative phases, or that learners actually undergo the described “disorienting dilemma”? Does this theoretical framing risk forcing the data into a pre-existing model rather than letting a grounded theory emerge?
4. Figure 1 uses a matrix with circles to show the “dominancy” of themes across disciplines. This visual representation implies a comparative analysis, but the method is not quantified or statistically tested. Given the vastly different subgroup sizes (e.g., MNHS n=22, Education n=2), on what basis can the authors legitimately assign and compare “dominance”? Does this figure mislead readers by implying equitable comparative analysis where none exists?
5. The study promotes strategies like “placing learners in unfamiliar environments” and “destabilising” them without a commensurate discussion of duty of care, psychological safety, or ethical guidelines. What evidence do the authors have that their interviewed educators implement necessary supports? Given the established link between uncertainty intolerance and learner distress/burnout cited in the introduction, how does this research ensure it is not advocating for pedagogies that could be harmful without robust safeguards?
