Dear Dr. Yasir,

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Academic Editor

PLOS ONE

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Additional Editor Comments:

This is an interesting study and both reviewers have highlighted areas that can be expanded or further explained to strengthen the manuscript.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

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

Reviewer #1: Yes

Reviewer #2: No

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

Reviewer #1: Yes

Reviewer #2: Yes

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

The PLOS Data policy

Reviewer #1: No

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: A very interesting research article which thoroughly explores an important topic, presenting results in a clear detailed way. Relates well to and builds on previous research, whilst also identifying key areas for further research. Please see my comments and suggestions below.

No concerns about ethics.

Re data availability - the authors have stated it is not possible to publicly share all data due to its confidential nature. However details of access have been provided.

Abstract and introduction

- good summary of the research though a bit wordy

- identifies gaps in literature which should be filled and how this study relates to previous research

- consider including a brief explanation about how the dentistry course in Pakistan works - How many years is it? How long are the days? How are they assessed/taught?, this could provide a bit more context for international readers who are unaware

Methods

- explanation of participant selection is a bit unclear, were the 12 participants staff selected to lead the focus groups? Or were these 12 participants the remaining students from the original 69 once you had eliminated those who did not attend sessions etc

- were the individuals in the initial focus groups members of staff, or the students themselves - ie: who is helping to develop the LSB curriculum?

- the two above points become more clear in the “pre-assessment phase” section, I think it is the “qualitative segment” section which causes confusion - consider specifying at the beginning of this paragraph that the 12 participants were selected for the focus group rather than for measuring burnout

- why was the CBI-SS tool selected over other tools to measure burnout?

- how much time passed between carrying out the first and second mindfulness sessions? Consider exploring in the discussion whether this may have had an effect on burnout levels

Results

- what was the overall participation rate? It is mentioned that some students were excluded (eg: because they did not attend both mindfulness sessions), overall what % of final year dental students participated in the full study? - if low, mention the limitations of this in the discussion

- some of the themes seemed wordy and overly descriptive, I didn’t feel that describing dental students as “weary sailors” helped to contribute towards the value of this research

- similar to the above point - line 538 in the discussion - “provided a rich texture” feels overly descriptive and not in-keeping with the nature of the paper

Discussion

- an interesting discussion which summarises and explores the findings well

- are there any changes which could be made to the focus group to have a more significant effect on colleague and teacher related burnout? Or can this only be achieved by changes made to the faculty?

- little mention of the limitations of this study, this is a key area to consider, especially as burnout and stress can be so subjective and vary massively between individuals (eg: this was only carried out on students in a specific year group at a specific dental school, did the time of year influence the burnout levels of students, ie were the higher burnout levels recorded close to exam periods?)

- burnout is quite a sensitive topic, consider whether students may have been under- or over- reporting their experiences and how this may pose a limitation

Conclusion

- succinct conclusion which also clearly identifies key areas for future research and action, as well as conveying the importance off this research topic

Statistical analysis

- I do not have sufficient expertise to report on the adequacy of the statistical analysis

Figures and tables

- I felt that the figures helped to map the themes out in an easy to understand way, and summarises well the many factors contributing to burnout in dental students

Reviewer #2: I appreciate the opportunity to review this manuscript. The authors have presented findings from their study on the efficacy of mindfulness practices as essential competencies in mitigating burnout among final-year dental students. Unfortunately, I am unable to recommend this manuscript for publication due to the following reasons:

* Burnout (BO) needs to be framed as a syndrome in the manuscript. According to the World Health Organization and based on the seminal work of Dr. C. Maslach and Dr. S.E. Jackson, burnout syndrome results from prolonged exposure to chronic stress. Providing detailed background information on burnout syndrome is important as it relates to the manuscript’s title and key words the authors chose.

* Based on how the literature defines “efficacy” this study design did not appear to meet standards to measure the efficacy of the mindfulness-based therapies that were examined in this study. For example, the study is lacking randomized control trials and a robust standardization of the intervention protocol to help control for variability in implementation to prevent bias from influencing results. Perhaps the term “effectiveness” might be more appropriate for this study rather than the term efficacy.

* The participants of this study were all from one dental school-- Baqai Dental College in Karachi, Pakistan. A multiple center study to include more schools and final-year dental students would provide a more robust data set because a larger sample size will allow for more statistical power in the data analysis methods. A sample size of 69 final-year dental students from one dental school cohort are too few to publish “efficacy” data on the mindfulness intervention examined in this study. Perhaps it might be more appropriate to frame the study as a pilot study instead.

* There should be discussion and quantitative statistical analysis to examine if (or to what extent) the demographic data collected -- such as gender -- may have influenced the study’s pre-survey and post-survey burnout findings. For example, there is evidence in the literature that female students tend to experience more stress and burnout when compared to their male counterparts.

* While the use of the validated Copenhagen burnout instrument is applauded, more description regarding the Copenhagen instrument in the analysis of quantitative data is needed. For example:

- How many survey items are in each subscale (Personal BO- 6 items?; BO related to studying- 7 items?; BO related to colleagues- 6 items?; teacher-related BO- 6 items)?

- Are survey items scored by frequency?

- What is the scoring scale for each item [“Never (0)” to “Always (4)”]?

- Is there reverse scoring for any of the survey items? If so, which items have reverse scoring?

**While the authors and this reviewer are familiar with the Copenhagen burnout instrument, the audience likely is not as familiar with the instrument. A detailed description of the instrument’s subscales, subscale items, and the scoring of items, are essential to the audiences’ understanding/interpretation the of the quantitative data.

Overall, the study presents a promising concept. However, it requires further refinement and more detailed description within the manuscript.

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Reviewer #1: No

Reviewer #2: No

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Dear Dr. Yasir,

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.

Please submit your revised manuscript by Feb 02 2026 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're 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.

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If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols .

We look forward to receiving your revised manuscript.

Kind regards,

Jenny Wilkinson, PhD

Academic Editor

PLOS One

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Investigating the effectiveness of structured mindfulness sessions in mitigating burnout among final-year dental students: A mixed-methods analysis

PONE-D-25-38768R2

Dear Dr. Yasir,

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Kind regards,

Jenny Wilkinson, PhD

Academic Editor

PLOS One

Additional Editor Comments (optional):

Reviewers' comments: