PONE-D-19-32894

Predictors of burnout among Belgrade veterinary students: a cross-sectional study

PLOS ONE

Dear Dr. Janković,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Two reviewers have assessed your work. Although one of them advises against the consideration of your paper, I would like to say that after a careful review of the manuscript, I believe (also based in the comments provided by the second reviewer) that the work has a certain potential and could be revised by the authors. Thus, based in the comments/suggestions provided by this reviewer, please consider performing an extensive revision of the paper. Afterwards, I will submit it for and a second evaluation from two academic reviewers.

We would appreciate receiving your revised manuscript by Mar 15 2020 11:59PM. When you are ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter.

To enhance the reproducibility of your results, we recommend that if applicable you deposit your laboratory protocols in protocols.io, where a protocol can be assigned its own identifier (DOI) such that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). This letter should be uploaded as separate file and labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. This file should be uploaded as separate file and labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. This file should be uploaded as separate file and labeled 'Manuscript'.

Please note while forming your response, if your article is accepted, you may have the opportunity to make the peer review history publicly available. The record will include editor decision letters (with reviews) and your responses to reviewer comments. If eligible, we will contact you to opt in or out.

We look forward to receiving your revised manuscript.

Kind regards,

Sergio A. Useche, Ph.D.

Academic Editor

PLOS ONE

Journal Requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

http://www.journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and http://www.journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

2. Please provide additional details regarding participant consent.

In the Methods section, please ensure that you have specified what type of consent you obtained (for instance, written or verbal) and whether the ethics committee approved this consent procedure.

If verbal consent was obtained please state why it was not possible to obtain written consent and how verbal consent was recorded. If your study included minors, state whether you obtained consent from parents or guardians.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Partly

**********

2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: N/A

Reviewer #2: No

**********

3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: this is not an appropriate journal for this type of study. A veterinary or mainstream education journal would be more appropriate. It seems silly for me to keep writing to ensure that minimum characters are met before I can submit this review!!!! PLoS One needs a better system to avoid discouraging reviewers.

Reviewer #2: Thank you for the opportunity to review your manuscript. It is an important addition to the veterinary and mental health literature. Please consider these comments for improvement and clarity.

Line 47: "walkability" is not a commonly used English word and does not transmit a known stressor.

Line 49: "eustress" is spot-on but uncommonly used. You may consider defining it or selecting a more common word to indicate your intent.

Line 78: This is the Knowledge Gap and can be more accurate if "still lacking" was changed to "infrequent".

Line 80: This is the Hypothesis and is somewhat vague due to the suggestion that "prevalence...is significant". The remainder of that sentence is not needed as you are not testing interventions.

Line 90 and 91: perhaps changing the word "grade" to "year in school" may be more appropriate.

Line 101: The Belgrade study should be referenced. Is this #28?

Line 105: Should ref #28 here be ref #30? If so, some rearrangement of reference order is needed.

Line 108: Should ref #13 here be ref #18?

Line 121L Statistical analysis: The deficiencies here should be addressed to better understand and clarify your approach. A power calculation was not completed or reported and tests for normality were not mentioned. You have chosen parametric statistics but never indicated proof that your data was normally distributed.

Line 137: Table 1: There are some inconsistencies which make interpretation very questionable. For instance: the number of male (325) and female (165) participants do not equal the total of all genders (496). Also similarly, the number of male (134) and female (79) participants do not equal the total of all genders (215) with burnout. Many of the N and percentages do not match, therefore, please review and revise all the data in this Table. Without that detail, there is too much inconsistency to believe your data and conclusions.

Line 139:Improvement to remind the reader that >= 27 for EE and >=10 for DP are your cut-offs for burnout. "High" is relative and the level at which you analyzed your data and made your interpretations must be crystal clear.

Line 141: "Cocarame" should be "Cochran"

Line 144: Again, relative relationships must be avoided in Results and are better left to the Conclusions. Please provide specific data instead of "low" PA score. This should be the pattern throughout.

Line 154: Please insert a comma between the parameter and "n (%)" throughout this table. Ensure that the "n" is always present. Also in Table 2 and Table 3, the p value is not always clearly indicating which parameters it is comparing. Do you only provide the statistically significant data for the parameter that meets significance? Sometimes the p value appears to be on a specific line and other times it appears to split the line spacing.

Line 177&178: This seems to be a nonsequitor. Perhaps it is the right sentiment but needs more explanation to clarify to the reader.

Line 187: This study from Tennessee ("College" of Veterinary Medicine, not "Faculty") had 289 students not 389 as written. Also, there are contradictory versions of this study depending on the link followed from pubmed - one abstract is the Tennessee description. Another one follows a report from Oregon State University. Please be sure of your reference and trail of information.

Line 189: "Faculty" should read "Kansas State Univeristy College"

Line 200: Ref 33 may suggest investigation into the causes of stress in a students studies or implementation of programs to reduce the stressors is needed - which is it you seek in this line? Please clarify and allow for completion of your thought in this paragraph.

Line 207: This is not a study of veterinary students, please amend as it implies that this is known in DVMs but it is not.

Line 224: The comment "(borderline significance)" is incorrect. Data is either significant upon your predetermined criteria and level or it is not. Amend this, please.

Line 251: The limitations can be improved overall. There are many limitations that were not nor are not measured in your study that may contribute to burnout. You may mention other burnout scales or references that suggest those with burnout are more apt to complete the survey. The mention of the recent war in Serbia could also be viewed to improve resilience and not to lowered their ability to cope. You do not mention resilience, grit, or other measures of improved mental wellbeing anywhere in your manuscript. The limitations may be a good place to introduce that concept as you were not, at the outset, looking to compare highly and poorly resilient people and their predisposition (or not) to burnout. Also recent publications that discuss burnout in the workplace that may be most related to administrative policy/procedure and not work load could be mentioned.

**********

6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: Yes: Karl E Jandrey

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files to be viewed.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email us at figures@plos.org. Please note that Supporting Information files do not need this step.

Predictors of burnout among Belgrade veterinary students: a cross-sectional study

PONE-D-19-32894R1

Dear Dr. Janković,

We are pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it complies with all outstanding technical requirements.

Within one week, you will receive an e-mail containing information on the amendments required prior to publication. When all required modifications have been addressed, you will receive a formal acceptance letter and your manuscript will proceed to our production department and be scheduled for publication.

Shortly after the formal acceptance letter is sent, an invoice for payment will follow. To ensure an efficient production and billing process, please log into Editorial Manager at https://www.editorialmanager.com/pone/, click the "Update My Information" link at the top of the page, and update your user information. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to enable them to help maximize its impact. If they will be preparing press materials for this manuscript, you must inform our press team as soon as possible and no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

With kind regards,

Sergio A. Useche, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #2: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #2: No

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #2: Thank you for carefully re-evaluating your data and updating the manuscript in a more clear and understandable condition. There are aa few very minor language irregularities in some of the newer text which the editor will likely catch and amend. The concept and information you have presented is in a publishable stage.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #2: Yes: Karl Jandrey, DVM, MAS, DACVECC