Correcting the commentary: a reaffirmation of the purpose and findings of our study

We thank Li and Liu for their thoughtful and constructive commentary [1] on our study [2]. We are pleased that our use of constructed-response items, Rasch modelling and expert-led content validation was recognised as a meaningful contribution to the assessment of sono-anatomy interpretation [1]. We acknowledge the limitations identified and offer clarifications and future directions for our work. Our tool was designed to assess image interpretation specifically; as outlined in our study, this is one component of the clinical triumvirate of acquisition, interpretation and safe needling [3]. We agree that comprehensive competence includes image acquisition and needle handling, and we envisage our instrument as complementary to procedural assessments such as direct observation of procedural skills and global rating scales. The inclusion of non-sonographic items related to dosing, equipment and safety was based on expert consensus and the 2010 curriculum of the Royal College of Anaesthetists, which was in use at the time of study design. We fully concur that applying Rasch modelling to all items in the main study is important to enhance psychometric coherence; we were careful to explain this in the methods. We are aligning future iterations with the 2021 curriculum from the Royal College of Anaesthetists. The exclusion of the transversus abdominis plane (TAP) block reflected the RA-UK Delphi classification at the time of study design [4, 5]. We are committed to including TAP and emerging blocks in future versions, in line with evolving consensus. In this pilot phase, we recognised the fatigue point occurred at item 49 and the question bank was reduced to 44 items accordingly for the main study, as we were careful to explain. However, we acknowledge participant feedback regarding fatigue and are exploring shorter forms and adaptive delivery to preserve precision while improving usability. While internal consistency was high (α 0.92), we agree that further validity studies, including test–retest reliability, cross-site generalisability and workplace outcome correlations are essential before high-stake implementation and testing. We appreciate the recommendations from Li and Liu and share their vision for a multimodal, curriculum-aligned framework that integrates interpretation, acquisition and procedural safety. We look forward to refining and expanding the tool to better support resident doctors, educators and patient care.