We would like to thank the Editors and the Reviewers for their valuable comments.

We have
amended our manuscript accordingly. The detailed responses to all issues raised by the
Reviewers are provided below.

1. Title: “The impact of education on the decision of medical students in Poland to get
vaccinated against SARS-CoV-2- Cross-sectional survey” is not appropriate. “Impact
of Education” may lead to misleading, which is interpreted as education intervention.
In fact, the study is an observational study. Please change.

Thank you for this valuable comment. We agree that our title was not precise enough. We
propose a different title:

“The impact of knowledge about the pandemic on the decision of medical students in Poland
to get vaccinated against SARS-CoV-2- Cross-sectional survey”.

2. There are inconsistencies among the aims, the hypothesis, the questioner and the
results.  
a. In the introduction section stated: “The survey was aimed at investigating students'
apprehensions toward vaccinations, concerns regarding the new SARS-CoV-2
variants, preferred educational tools for acquiring information about the pandemic, the
presence of constantly updated COVID- 19 curricula and a clear system for
monitoring infections at their universities, personal protective equipment providence
and compliance “. In the last sentence of the introduction state: “This is the first study
to evaluate the vaccination rate and the state of knowledge among medical students in
Poland, comparing English and Polish divisions”.  

b. While in the hypothesis: We hypothesize that (1) new variants of the virus might
cause unwillingness of getting being vaccinated or receiving booster shots, (2)
students' awareness of the pandemic and willingness to be educated on this field is a
strong positive predictor of being getting vaccinated, (3) students from universities
which provide suitable educational tools are better informed about the pandemic 

c. In the results section stated: “good knowledge about ways of transmission is not
statistically significant in determining if a student is vaccinated”. How about results to
answer the first and second hypotheses?

We apologize for the lack of accuracy. We believe that the difficulties with understanding this
part of manuscript might be caused by the wrong order of our results section. We have
amended the order accordingly. First hypothesis (new variants of the virus might cause
unwillingness of being vaccinated or receiving getting booster shots) is now explained in the
first results part “Students’ apprehensions toward vaccinations” where we explain this issue.
The second hypothesis (students' awareness of the pandemic and willingness to be educated
on this field is a strong positive predictor of getting vaccinated) has its explanation in parts 3.3
(Students’ knowledge). The last hypothesis is explained now in the paragraph 3.4 (The role
of University). We really hope that by correcting the order of the results part accordingly to
the hypothesis order we made all our explanations clearer.

d. Looking at your data, I would suggest you assess the determinant of being
vaccinated among medical students in Poland, with the determinants: demography
 characteristics, knowledge/awareness, attitude, perception, being vaccinated with the
influenza vaccine, and information received from the university. 

Thank you for this comment. Taking into consideration all your suggestion we would like to
explain why we haven’t provided all of that.

a) The demography characteristics: many students leave their family sites to study in big
cities as it is in our case. At Wrocław Medical University the vast majority of students
are students not from Wrocław. So, the point is that students who are in first or second
year of studies might base their believes on the theories that they brought from home
but as the education is progressing students base their believes on opinions shared in
their academic societies. We perceive it as a bias. If we would like to know if the
demography characteristics influences students’ attitude toward vaccinations and
medicine at all we would have to divide them into groups depending on how long they
are studying in different city or even how often they go back home where they can
create their way of thinking as well as at their studies.
b) Knowledge/awareness: we have provided that in point 3.3 (Students’ knowledge).
c) Attitude, perception: We’re afraid we are not sure what is the exact meaning of this
characteristics. We have assessed students attitude toward their future occupation by
rating the sentence “Keeping up to date with the upcoming vaccines is important for
my role as a future health care worker” which brought some interesting results. Not all
asked question were finally included in the manuscript but if it would be helpful, we
can share our entire survey.
d) Being vaccinated with the influenza vaccine: we have provided that in point 3.4 (PD
95.7% of students were vaccinated against COVID-19 and in ED 93.8% of students.
Additionally, students were asked about vaccination against seasonal influenza with
the following results 42.1% vaccinated in PD and 49.1% in ED. Being vaccinated
against seasonal influenza is statistically significant in determining if a student is
vaccinated against COVID-19 (chisquare-score = 40.06 and p<0.001).
e) Information received from the university: we have provided that in point 3.4 (The
participating students were asked to answer the following question: Do you feel well-
informed by your University about COVID-19 symptoms/consequences/prevention?
At PD 968 students (77.6%) felt well-informed by their University about COVID-19
symptoms, 799 (64.0%) about COVID-19 consequences and 1033 (82.8%) about
COVID-19 prophylaxis. In ED 206 students (75.5%) felt well-informed by their
University about COVID-19 symptoms, 176 (64.5%) about COVID-19 consequences
and 215 (78.8%) about COVID-19 prevention. A year of studies is not statistically
significant in determining if a student knows all ways of COVID-19 transmission
(chisquare-score = 7.997 and p value is = 0.16).

3. The Questionnaire: Explanation regarding questioners is difficult to understand. Some

explanations were mentioned in the study design, and some in the results section. It
would be better if it is written in one section, and put the questioner in the
supplementation file. The questionnaire is developed by the authors. How is the
validity and reliability of the questionnaire? What is the definition of good
knowledge?

Thank you for this valuable remark. We agree that the questionnaire should be
attached to the supplementation file.
 Our research was aimed at exploring and understanding students’ opinions, believes
and declarations in target groups in specified environment and specified field. With
this aim in mind, we prepared a simple set of questions. We do not propose this
questionnaire as a complete tool for future researches. Moreover, both future
development of the pandemic (last weeks and months) as well as our observations
based on gathered data are features which will require at least slight modification of
the questionnaire. Indeed, it is important to underline the original and pioneer
character of the survey, we provided this clarification in methods section. Therefore,
in the manuscript the following sentence has been added: “Moreover, the method
applied in this research was created by the authors with the aim of obtaining specific
statistical results reflecting features of investigated phenomenon, therefore it wasn’t
validated psychometrically. This kind of validation, as well as an update of the
questions asked would be performed in case the research continues in the future.”
We considered that students had good knowledge when they were able to point the
correct ways of transmission of the virus.

4. Statistical analysis: it is stated: “Our sample was not representative of all students at
Polish Medical Universities but presents preliminary results of investigated group”,
Please elaborate more regarding this statement.

We would like to deeply apologize for the lack of accuracy in this sentence. Instead of
sentence “Our sample was not representative of all students at Polish Medical Universities”
we should have written “Our sample did not include all students at Polish Medical
Universities, however our group was representative and enabled us to run all the statical
analysis.” because we have investigated very large group and our sample group was sufficient
to run all the statistical analysis. We provide an explanation below. We plan to extend our
research and investigate this issue also at non-medical universities.

5. The results: 
a. each table and figure must have a title and also information on the legend. Some
table and figures have no title and information.
i. Figures 1 and 3: the Y-axis is the absolute number? is it the respondent's answer
correct? It would be better to put statistical results between Poland and the English
division. 
ii. Figure 5? It has been included in figure 2?
iii. Figure 6 and 7:__put in one figure or put in one table.
b. I would suggest presenting the result according to the demographic characteristic,
number (%) of students receiving the COVID-19 vaccines, knowledge/ awareness,
perceptions, practice (receiving the influenza vaccine, using a mask, social distancing,
hand hygiene), and table on bivariate analysis and multivariate analysis of those
determinants on receiving COVID-19 vaccination.

We would like to deeply apologize for the lack of accuracy regarding the figures.
a. each table and figure must have a title and also information on the legend. Some
table and figures have no title and information.
 We made sure that each table and figure have a title and information on the legend
in the version newly submitted.

i. iFigures 1 and 3: the Y-axis is the absolute number? is it the respondent's answer
correct? It would be better to put statistical results between Poland and the English
division. 

The Y-axis represent the absolute number of students that replied to this question by a
given answer. For example, in figure 1, 1220 students from Polish division answered
that droplet is one of the possible ways of transmission of the virus. The two wrong
answers to the questions were foodborne and through parasites. We attached new
figures 1 and 3 and hope it reaches the reviewer’s expectations

ii. Figure 5? It has been included in figure 2?

In the figure 2, we wanted to highlight the most important features in vaccination

prediction by using a DecisionTreeClassifier, showing that answering positively to the
sentence “Keeping up to date with the upcoming vaccine is important for my role as a
future health care worker” is the most important predictive factor of being vaccinated,
in our study. In the figure 5, we put emphasis on the graded question and to present the
results as such. If it is a reviewer’s wish we can delete or modify on of the figures.

iii. Figure 6 and 7:__put in one figure or put in one table

We believe that keeping the pie chart model would be overloaded with the results of
both questions in one graph. We present both results in one table and hope it reaches
the reviewer’s expectations.

b. I would suggest presenting the result according to the demographic characteristic,

number (%) of students receiving the COVID-19 vaccines, knowledge/ awareness,
perceptions, practice (receiving the influenza vaccine, using a mask, social distancing,
hand hygiene), and table on bivariate analysis and multivariate analysis of those
determinants on receiving COVID-19 vaccination.

Thank you for this comment. Some of the demographic characteristics are presented in table 1
(such as gender, age, University and year of studies). We explained in previous comment why
we have decided not to focus on city of origin. We have added sentence about vaccination
ratio at both Polish and English division in 3.1 (study group) section.
“96% of Polish divisions students and 94% of English divisions students were vaccinated
against COVID-19.”

Other mentioned (knowledge/ awareness, perceptions, practice (receiving the influenza

vaccine, using a mask, social distancing, hand hygiene)) are already included in results
section or in figures. We have found that the most important positive predictor of being
vaccinated was rating 5 out of 5 to the statement "Keeping up to date with the upcoming
vaccines is important for my role as a future health care worker". The most important features
in vaccination prediction are shown in figure 4.