Prevalence and associated risk factors of burnout amongst veterinary students in Ghana.

This study was designed as a cross-sectional study to find out the prevalence and associated risk factors of burnout among veterinary students at Kwame Nkrumah University of Science and Technology (KNUST) in Kumasi-Ghana. A total of 74 veterinary students served as the respondents and were given online questionnaires which comprised questions on emotional exhaustion (EE), depersonalisation (DP) and reduced personal accomplishment (RPA). Data obtained were analysed using descriptive statistics, Chi-square test and regression analysis. Results indicated that on average, the EE and RPA were low with mean score of 12.72 ± 4.46 and 27.96 ± 7.94 whilst DP was high with a mean score of 20.72 ± 6.5 among veterinary students. The year of study had a significant effect (p = 0.000) on burnout with levels of high RPA (80%) and DP (70%) being more in the preclinical students as compared to the clinical students (RPA = 20%, DP = 30%). There was also a significant effect (p = 0.028) of the year of study and type of residence of the students on the high level of DP and RPA. Daily sleep hours of students had Daily sleep hours of the veterinary students were also indicated as a significant associated risk factor of burnout among veterinary students in this study as more less sleep hours (<6hours), causes high levels of DP and RPA. Age, gender and marital status, working status, exercise hours and weekly study hours of students did not count as significant predictive factors (p>0.05) of burnout.

Introduction

Medicine related programmes worldwide are aimed at training and developing world-class students to be well-equipped with the required skills and attitudes necessary to ensure the health needs of the immediate societies and the world at large are not left in jeopardy [1]. In view of this, medical schools across the world have focused on developing a more robust curriculum and nature of studies for their students so that no stone will be left unturned in the bid to delivering good quality medical education [2] of which veterinary medical schools are no exceptions. The robustness of such medical schools can be very stressful for students and can cause burnout syndrome.

Burnout syndrome is characteristically a combination of negative energies that are manifested in emotional and physical exhaustion, depersonalisation, and reduced personal achievements [3]. The burnout syndrome has been reported more in professionals and workers in the human medical schools [4, 5] with less report on veterinary schools. In the academic setting, burnout has been reported by several researchers to be occurring in students of various universities in different countries [6-8] of which veterinary students are no exception [9-11]. Research has indicated strongly that enrolling in a veterinary school comes with a certain level of exposure to stress. This kind of stress exposure is mostly prolonged due to the lengthy years spent in training as a veterinary student [9]. These stresses could arise from many sources which could be either academic related or non-academic related. Academically, the requirement of universities and the demand on students to maintain very good academic standings to keep them in school, coupled with the heavy workload of the veterinary medicine curriculum causes a relatively high level of stress amongst students [12, 13]. In addition to the demanding curriculum, the amount of time dedicated to learning the vast information on the numerous animal species is another source of academic stress [14]. The non- academic sources of stress include the perceived difficulty in fitting in as well as unclear expectations on the part of students, poorer perceived physical health, financial stress and certain stressful activities that students may be involved in during their course of study among others [15-17]. The excessiveness of these stressors leads to burnout syndrome which negatively affects the academic performance of students.

Though several research works have been reporting burnout among students in the medical and veterinary medical schools, the review of literature indicates a void in literature on the occurrence of burnout amongst veterinary students especially in Africa. There is therefore the need to fill this gap in literature concerning burnout amongst veterinary students. This study therefore is focused on examining the level of burnout amongst veterinary students in Ghana as well as the risk factors that expose veterinary students in Ghana to burnout syndrome. The findings of this study will be key in informing the stakeholders in veterinary education to take pragmatic and proactive measures to deal with burnout syndrome amongst veterinary students in order to enhance their academic well-being.

Methods

Research design and study area

This study was designed as a cross-sectional study at the School of Veterinary Medicine (SVM) in Kwame Nkrumah University of Science and Technology (KNUST) in Kumasi—Ghana, one of the two veterinary schools in Ghana. This research was conducted within a month between June and July 2020.

The School of Veterinary Medicine is under the College of Health Sciences in KNUST, Kumasi; the capital city of Ashanti Region of Ghana. The school has its campus at Boadi, a suburb of Kumasi. The veterinary programme run by the School of Veterinary Medicine is a 6-years programme with students in first, second and third years of study classified as pre-clinical students whilst students in clinical years are those in fourth, fifth and sixth years of study. The Veterinary School used in this study, does not have a residence area on campus solely for veterinary students and in view of this, students bear the responsibility to search for accommodation which could be far or near to the campus.

Study population

The study population in this current research comprised all the students of the School of Veterinary Medicine in Kwame Nkrumah University of Science and Technology. The overall population of the students in the School of Veterinary Medicine as at the time of data collection for this current study stood at a total of one hundred and eighty-five (185) students in different years of study. Characteristically, the student population comprises of different individuals with different socio-economic backgrounds and from different ethnicities including some international students from some African countries including Sierra Leone, Congo, Tanzania and Uganda.

Sampling technique and sample size

The sampling technique employed for this study was the simple random sampling technique. This method of sampling technique was used so as to avoid biases on the part of the researcher as well as to ensure that each student was provided with the chance of being selected to be a part of the respondents for this study.

In determining the sample size, the Yamane formula [18] was used. The Yamane formular is stated as n = N/1+N (e)2; where n is sample size. N is population size, e is sampling error constant, power of constant which is 0.05. For sample size calculation; Therefore,

A total of 95 students were needed for the study based on the Yamane Formula. Nevertheless, the issue of COVID-19 caused a shutdown of the University and therefore questionnaires for the study were to be administered to students electronically. With this pandemic insight and due to the inability of all students to have internet connectivity at their various places of residence and localities, the total number of students who were able to have access to internet and were able to completely fill the questionnaire during the period of data collection served as the sample size for this study. This accounted for the differences with 74 students used in the study as compared to the actual ample size of 95 determined by the Yamane Formula above.

Data collection instrument and procedure

In this study, a well-structured questionnaire was designed and designed with Google Forms served as the data collection instrument. The questionnaire comprised questions on the demographic characteristics of the respondents as well as certain practices such as their sleeping hours, exercise hours and study hours. The other section of the questionnaire comprised of questions on emotional exhaustion (EE), Depersonalisation (DP) and Reduced Personal Accomplishment (RPA). Questions on EE focused on the feeling of being emotionally and physically drained as a result of the workload of a veterinary student. Additionally, questions on DP focused on feelings of negativity and indifference towards others whilst questions on RPA focused on the students’ personal unfavourable judgement of themselves in terms of their academic performance.

The questionnaires were successfully administered to the respondents after obtaining their consent. The link to the questionnaires to be completed were delivered to the respondents electronically through electronic platforms (specifically WhatsApp). The responses to the questionnaires were retrieved from Google Forms in a Microsoft Excel format by the researcher after a one-month time frame (from June to July, 2020) has elapsed for students.

Data analysis

Descriptive statistics were used to analyse the demographic characteristics (age, gender, year of study, marital status and residence) and practices of students as well as the responses of the students on emotional exhaustion, depersonalisation and reduced personal accomplishment in the form of frequencies, percentages, mean and standard deviations. The components of burnout were categorised into levels using the mean scores. For EE, low EE was a mean score of ≤17 and moderate EE was a mean score of 18–29. For DP, low DP was a mean score of ≤6, moderate DP was a mean score of 6–11 and high DP was a mean score of ≥12. For RPA, low RPA was a mean score of ≤33, moderate RPA was a mean score of 34–39 and high RPA was a mean score of ≥40. The grading, scoring and categorization for each dimension of burnout ie. emotional exhaustion, depersonalization and reduced personal accomplishment was performed as described by some authors [1].

Pearson Chi-square test was used to determine the association between the demographic characteristics, practices of students and the level of burnout. With respect to the effect of demographic characteristics and practices of students on the burnout of students, multiple logistic regression analyses were used taking into considerations the odd ratios in order to ascertain the risk factors associated with the components of burnout. The outcome variable for the logistic regression model was a combined score on subscales of DP and RPA. The predictor variables included all the demographic characteristics (age, gender, level of study, marital status, residence status and practices of the students). Data analysis performed on all the data collected were performed using Statistical Package for Social Sciences (SPSS Version 20). All statistical analysis and significance were tested at 5% significant level or 95% confidence interval.

Results

Demographic characteristics of students

Results obtained for the demographic characteristics of the respondents from the data analysis are displayed in Table 1 below.

Table 1

Results of demographic characteristics of respondents.

Variable	Category	Frequency (n)	Percentage (%)
Age of Students	<22	41	55.4
	>22	33	44.6
Gender of Students	Female	20	27.0
	Male	54	73.0
Marital Status of Students	Married	5	5.4
	Not Married	69	94.6
Year of Study	Preclinical (Year 1- Year 3)	52	70.3
	Clinical (Year 4-Year 6)	22	29.7
Residence of Students	Dormitory	26	35.1
	Hostel	6	8.1
	Rented apartment	31	41.9
	Traditional Hall	2	2.7
	With parent /family	9	12.2

The findings indicated that out of the 74 respondents, 41 (55.4%) respondents were less than 22 years of age whilst the remaining 33 (44.6%) of the respondents were above 22 years of age. With respect to the sex distribution of the respondents, 54 (73%) of the respondents were males whilst the remaining 20 (27%) of the respondents were females. In terms of marital status of the respondents, 69 (94.6%) of the respondents were unmarried whilst the remaining 5 (5.4%) of the respondents were married. The level of study of the respondents was also considered in this study as shown in Table 1 below. The findings showed that 31 (41.9%) of the respondents were first year students, 7 (9.5%) of the respondents were second year students, 14 (18.9%) of the respondents were third year students, 10 (13.5%) were fourth year students, 9 (12.2%) of the respondents were fifth year students whilst the remaining 3 (4.1%) of the respondents were sixth year students. Results on the place of residence of veterinary students showed that 41.9% were living in rented apartments, 35.1% were living in dormitories, 12.2% were living with their parents / families, 8.1% were living in hostels whilst 2.7% were living in traditional halls.

Practices of students

Findings on the practices of veterinary students were considered in this study as shown in Table 2 below. Results on the weekly study hours showed that 50% studied between 25–40 hours, 31.1% studied less than 25 hours a week whilst 18.9% studied more than 40 hours in a week. It was observed that with respect to exercise hours amongst veterinary students, 64.9% spent less than 2 hours exercising, 28.4% spent between 2–5 hours exercising whilst 6.8% exercised above 5 hours. With sleep hours of students, majority of the students (62.2%) slept less than 6 hours whilst 37.8% slept between 6–10 hours. It was also indicated that 87.8% of the students were not working as they study whilst the remaining 12.2% were engaged in diverse forms of work alongside studying.

Table 2

Results of practices of respondents.

Variable	Category	Frequency (n)	Percentage (%)
Weekly Study Hours	Less than 25 hours	23	31.1
	Between 25–40 hours	37	50.0
	Above 40 hours	14	18.9
Exercise Hours (weekly)	Less than 2 hours	48	64.9
	Between 2–5 hours	21	28.4
	Above 5 hours	5	6.7
Sleep Hours (daily)	Less than 6 hours	46	62.2
	Between 6–10 hours	28	37.8
Works whiles studying	Not Working	65	87.8
	Working	9	12.2

Prevalence of burnout amongst students

Table 3 below summarizes the prevalence of burnout amongst veterinary students. It was observed that majority of the students (86.5%) students reported low levels of emotional exhaustion whilst 13.5% reported moderate levels of emotional exhaustion. The majority of the students (94.6%) reported a high level of depersonalization whilst 5.4% of the students reported a moderate level of depersonalization. Moreover, the majority of the students (77.0%) showed low levels of reduced personal accomplishment with 16.2% and 6.8% of the students showed moderate to high levels of reduced personal accomplishment respectively as shown in Table 3 below.

Table 3

Results on the prevalence of burnout amongst respondents.

Variable	Categories / Levels	Distribution (n (%))	Mean subscales score
Emotional Exhaustion (EE)	Low (≤17)	64 (86.5%)	12.72 ± 4.46
	Moderate (18–29)	10 (13.5%)
Depersonalization (DP)	Moderate (6–11)	4 (5.4%)	20.72 ± 6.51
	High (≥12)	70 (94.6)
Reduced Personal Accomplishment (PA)	Low (≤33)	57 (77.0%)	27.96 ± 7.94
	Moderate (34–39)	12 (16.2%)
	High (≥40)	5 (6.8%)

The mean scores for the various components of burnout indicated that on the average, the emotional exhaustion of the students was low with a mean score of 12.72 ± 4.46. Depersonalisation levels of the students in this study were high with a mean score of 20.72 ± 6.51. With reduced personal accomplishment, the mean score of 27.96 ± 7.94 indicated that the students were satisfied with their personal accomplishments as shown in Table 3 below.

Risk factors of burnout

Demographic characteristics and burnout

The prevalence of burnout amongst veterinary students in this study with respect to the demographic characteristics of the respondents were compared as summarised in Table 4 below. With respect to emotional exhaustion (EE), no student indicated high EE. For age, the majority of the students indicated low EE were less than 22 years old (38, 59.4%) as compared to 26 (40.6%) of the students who were older than 22 years. In addition, 7 (70%) of the students who indicated moderate EE were above 22 years of age. More females 6(60%) indicated moderate levels of EE than males 14 (40%). More students in the preclinical year (7, 70%) reported moderate levels of EE as compared to the clinical year students (3, 30%). More students in rented apartments (50%) reported moderate levels of EE as compared those living in dormitories (10%), traditional halls (0%), hostels (10%) and staying with their parents/ family (20%) Table 4.

Table 4

Results on demographic characteristics and burnout levels.

		Emotional Exhaustion (EE)		Depersonalisation (DP)		Reduced Personal Accomplishment (RPA)
Characteristic	Category	Low	Moderate	Moderate	High	Low	Moderate	High
Age (years)	<22	38 (59.4%)	3 (30%)	1 (25%)	40 (57.1%)	33(54.4%)	4 (33.3%)	4 (80%)
	>22	26 (40.6%)	7 (70%)	3 (75%)	30 (42.9%)	24(45.6%)	8 (66.7%)	1 (20%)
Sex	Male	50 (78.1%)	4 (40%)	2 (50%)	52 (74.3%)	50(87.7%)	3 (25%)	2(41.6%)
	Female	14 (21.9%)	6 (60%)	2 (50%)	18 (25.7%)	8(59.4%)	9 (75%)	3(59.4%)
Marital Status	Married	4 (6.3%)	1 (10%)	3 (75%)	2 (2.9%)	4 (7%)	0 (0%)	0 (0%)
	Single	60 (93.7%)	9 (90%)	1 (25%)	68 (97.1%)	53 (93%)	12 (100%)	5(100%)
Year of study	Preclinical	45 (70.3%)	7 (70%)	3 (75%)	49 (70%)	38(66.7%)	10 (83.3%)	4 (80%)
	Clinical	19 (29.7%)	3 (30%)	1 (25%)	21 (30%)	19(33.3%)	2 (16.7%)	1 (20%)
Residence	Dormitory	25 (39.1%)	1 (10%)	2 (50%)	24 (34.3%)	23(40.3%)	3 (25%)	0 (0%)
	Parents /family	7 (10.9%)	2 (20%)	0 (0%)	9 (12.9%)	3 (5.3%)	2 (16.7%)	4 (80%)
	Rented apartment	26 (40.6%)	5 (50%)	0 (0%)	31 (44.3%)	25 (43.8%)	5 (41.7%)	1 (20%)
	Traditional Hall	2 (3.1%)	0 (0%)	1 (25%)	1 (1.4%)	1 (1.8%)	1 (8.3%)	0 (0%)
	Hostel	4 (6.3%)	2 (20%)	1 (25%)	5 (7.1%)	5 (8.8%)	1 (8.3%)	0 (0%)

Considering depersonalisation, more students who were less than 22 years (40, 57.1%) reported high levels of DP. It was observed that more male students (52, 74.3%) reported high DP as compared to 18 (25.7%) of the females. More students (49, 70%) in the preclinical year reported high levels of DP as compared to the clinical year students (21, 30%). It was further observed that more students in rented apartments (44.3%) reported high levels of EE as compared those living in dormitories (34.3%), traditional halls (1.4%), hostels (7.1%) and staying with their parents/ family (12.9%) (Table 4 above).

Results on reduced personal accomplishment showed that with respect to high RPA more students who were less than 22 years (80%) reported high levels of RPA as compared to the 20% of the students above 22 years of age. It was observed that female students (59.4%) reported high RPA as compared to the males (41.6%). More students (80%) in the preclinical year reported high levels of RPA as compared to the clinical year students (20%). It was also observed that more students living with their families or parents (80%) reported high levels of RPA as compared those living in dormitories (20%). However, with respect to moderate levels of RPA, more students living in rented apartments (41.7%) indicated moderate levels of RPA as compared to students in other types of residence (Table 4 above). The significance between the difference in the demographic characteristics on the components of burnout are presented in Table 5 below.

Table 5

Tabulation of students’ demographic characteristics and high levels of DP and RPA.

Characteristic	Category	DP	Chi-square value	P-value	RPA	Chi-square value	P-value
Age (years)	<22	40 (57.1%)	1.542	0.190	4 (80%)	1.558	0.204
	>22	30 (42.9%)			1 (20%)
Sex	Male	52 (74.3%)	2.519	0.321	2 (41.6%)	1.329	0.240
	Female	18 (25.7%)			3 (59.4%)
Marital Status	Married	2 (2.9%)	0.360	0.059	0 (0%)	0.773	0.860
	Single	68 (97.1%)			5(100%)
Year of study	Preclinical	49 (70%)	0.448	0.034*	4 (80%)	0.390	0.000*
	Clinical	21 (30%)			1 (20%)
Residence	Dormitory	24 (34.3%)	0.173	0.015*	0 (0%)	0.180	0.028*
	Parents /family	9 (12.9%)			4 (80%)
	Rented apartment	31 (44.3%)			1 (20%)
	Traditional Hall	1 (1.4%)			0 (0%)
	Hostel	5 (7.1%)			0 (0%)

* = p-value is significant at 5% significance level (95% Confidence interval).

Effects of demographic characteristics on burnout

Findings on the statistical significance of students’ demographic characteristics on the high levels of DP, and RPA is displayed in Table 5 below. The findings revealed that there was no significant effect (p>0.05) of age, sex, marital status on the high levels of depersonalisation and reduced personal accomplishments of the veterinary students in this study.

The results also showed that there was found a significant effect (p<0.05) of the year of study of the veterinary students as well as the residence of the students on the high level of DP and RPA represented by significance values of p = 0.000 and p = 0.028 respectively. The findings show that the type of residence and year of study are significant risk factors of high levels of depersonalisation and reduced personal accomplishment among veterinary students.

Prevalence of burnout with respect to practices of students

Results on prevalence of burnout amongst the veterinary students with respect to their practices have been presented in Table 6 below. No student indicated high level of emotional exhaustion.

Table 6

Results on student practices and burnout levels.

		Emotional Exhaustion		Depersonalisation		Reduced Personal Accomplishment
Characteristic	Category	Low	Moderate	Moderate	High	Low	Moderate	High
Work status	Working	7 (10.9%)	2 (20%)	1 (25%)	8 (11.4%)	7(9.7%)	1(8.3%)	1 (20%)
	Not working	57 (89.1%)	8 (80%)	3 (75%)	62 (88.6%)	50 (69.4%)	11(91.7%)	4 (80%)
Weekly Study hours	< 25 hrs	18 (28.1%)	5 (50%)	0 (0%)	23(32.9%)	16 (28.1%)	4 (33.3%)	3 (60%)
	25–40 hrs	33 (51.6%)	4 (40%)	2 (50%)	32(45.7%)	33 (57.9%)	2 (16.7%)	2 (40%)
	> 40 hrs	13 (20.3%)	1 (10%)	2 (50%)	12 (17.1%)	8 (14%)	6 (50%)	0 (0%)
Exercise Hours (Weekly)	< 2 hrs	42 (65.6%)	6 (60%)	1 (25%)	47(67.2%)	37 (64.9%)	9 (75%)	2 (40%)
	2–5 hrs	20 (31.3%)	1 (10%)	2 (50%)	19 (27.1%)	16 (28.1%)	3 (25%)	2 (40%)
	> 5 hrs	2 (3.1%)	3 (30%)	1 (25%)	4 (5.7%)	4 (7%)	0 (0%)	1 (20%)
Sleep Hours (Daily)	< 6 hrs	39 (60.9%)	7 (70%)	3 (75%)	43 (61.4%)	36 (63.2%)	7 (58.3%)	3 (60%)
	6–10 hrs	25 (39.1%)	3 (30%)	1 (25%)	27(38.6%)	21 (36.8%)	5 (41.7%)	2 (40%)

For depersonalisation, the majority of the students (88.6%) who indicated high levels of DP were students who were not working while studying. More students (45.7%) who indicated high levels of DP studied between 25–40 hrs a week as compared to those who studied more than 40 hours a week (17.1%) and less than 25 hours a week (32.9%). Furthermore, more students who exercised less than 2 hours weekly (67.2%) indicated high levels of DP as compared to the other students who exercised more than 2 hours weekly (31.3%). In addition, more students who indicated high levels of DP slept less than 6 hours in a day (63.2%) as compared to those who slept between 6–10 hours in a day (32.8%) as shown in Table 5 above.

With reduced personal accomplishment (RPA), the majority of the students (88.6%) who indicated high levels of RPA were students who were not working whiles studying. More students (45.7%) who indicated high levels of RPA studied less than 25 hours a week as compared to those who studied more than 40 hours a week (0%) and between 25–40 hours a week (40%). Furthermore, more students who exercised less than 2 hours weekly (40%) and between 2–5 hours (40%) indicated high levels of RPA as compared to the other students who exercised more than 5 hours weekly (20%). In addition, more students who indicated high levels of RPA slept less than 6 hours in a day (60%) as compared to those who slept between 6–10 hours in a day (40%) as shown in Table 5 above.

Effects of students’ practices on burnout

The result on the effect of practices of students on high levels of DP and RPA is displayed in Table 7 below. The results revealed that there were no significant effects (p>0.05) of the working status, weekly study hours and exercise hours of the veterinary students on the high levels of depersonalisation and reduced personal accomplishments of the veterinary students in this study. Though there were noticeable differences between the categories under each student practice risk factors for high DP and PA, these differences were not significant.

Table 7

Results on practices and burnout levels.

Characteristic	Category	DP	Chi-square value	P-value	RPA	Chi-square value	P-value
Work status	Working	8 (11.4%)	0.142	0.077	1 (20%)	0.132	0.086
	Not working	62 (88.6%)			4 (80%)
Weekly Study hours	< 25 hrs	23(32.9%)	3.341	0.104	3 (60%)	0.456	0.234
	25–40 hrs	32(45.7%)			2 (40%)
	> 40 hrs	12 (17.1%)			0 (0%)
Exercise Hours (Weekly)	< 2 hrs	47(67.2%)	1.447	0.054	2 (40%)	1.296	0.098
	2–5 hrs	19 (27.1%)			2 (40%)
	> 5 hrs	4 (5.7%)			1 (20%)
Sleep Hours	< 6 hrs	43 (61.4%)	1.863	0.035*	3 (60%)	0.176	0.049*
	6–10 hrs	27(38.6%)			2 (40%)

* = p-value is significant at 5% significance level (95% Confidence interval).

However, there was a statistically significant effect (p<0.05) of the sleep hours of students on the high levels of DP and RPA. This finding shows that the sleeping hours of students are significant risk factors of high levels of depersonalisation and reduced personal accomplishment among veterinary students.

Table 8 summarizes the regression analysis of burnout subscales (RPA and DP), demographics and practices of students. The year of study was a significant predictor of reduced personal achievement [OR = 4.28; 95% CI = 1.053–7.180; P-value 0.04*] as per multivariate analysis for demographic characteristics and reduced personal achievement. Similarly, year of study was a significant predictor of depersonalization [OR = 2.75.; 95% Cl 2.016–4.750; P-value 0.010*] as per multiple regression analysis for demographic characteristics and depersonalization.

Table 8

Logistic regression analysis for burnout subscales, students’ demographics and student practices.

Parameter	RPA			DP
	OR	P-value	CI (95%)	OR	P-value	CI (95%)
Demographic Characteristics
Age	1.34	0.65	[0.753–5.423]	0.13	0.58	[0.439–2.742]
Sex	2.52	0.12	[0.519–2.003]	1.09	0.25	[0.216–2.043]
Marital Status	0.65	0.89	[0.433–1.696]	0.18	0.62	[1.643–3.218]
Year of study	4.28	0.04*	[1.053–7.180]	2.75	0.01*	[2.016–4.750]
Residence	0.29	0.02*	[2.602–5.316]	1.30	0.03*	[0.503–2.671]
Practices of students
Work Status	1.69	0.56	[1.117–3.430]	6.43	0.06	[0.605–4.078]
Study Hours	1.73	0.07	[0.950–2.406]	2.09	0.66	[0.785–5.320]
Exercise Hours	0.89	0.09	[1.352–4.007]	2.2	0.41	[2.653–10.541]
Sleep Hours	4.32	0.014*	[4.306–9.001]	1.24	0.000*	[1.349–6.301]

OR- Odd Ratio, CI- Confidence interval,

* = p-value is significant at 5% significance level

The type of residence of students was a significant predictor of reduced personal achievement [OR = 0.29; 95% CI = 2.602–5.316; P-value 0.02*] as per multivariate analysis for demographic characteristics and reduced personal achievement. Similarly, residence of students was a significant predictor of depersonalization [OR = 1.30.; 95% Cl 0.503–2.671; P-value 0.03*] as per multiple regression analysis for demographic characteristics and depersonalization (Table 8).

Findings indicated that daily sleep hours of students were identified a significant predictor of reduced personal achievement [OR = 4.32; 95% CI = 4.306–9.001; P-value 0.014*] as per multivariate analysis for student practices and reduced personal achievement. Similarly, daily sleep hours of students was identified as a significant predictor of depersonalization [OR = 1.24.; 95% Cl 1.349–6.301; P-value 0.000*] as per multiple regression analysis for student practices and depersonalization (Table 8).

Discussion

This current study investigated the prevalence and associated risk factors of burnout among veterinary students in Ghana. The outcome of the findings of this study indicated that on the average, EE of veterinary students was low as indicated by 64 (86.5%) of the students with mean score of 12.72 ± 4.46. RPA was also low as indicated by 57 (77.0%) of the students with a mean score of 27.96 ± 7.94 whilst DP levels of the veterinary students in this study were high as indicated by 70 (94.6%) of the students with a mean score of 20.72 ± 6.5. This finding shows that the level of burnout among veterinary students is not relatively high; however, the depersonalisation component of burnout is the most area experienced by the students. This finding is in sharp contrast to the findings of a study conducted by [10] who in his findings showed that there exists a high level of burnout among veterinary students in Australia. The differences in the prevalence of burnout could be as a result of differences in geographical location as well as the differences in the nature of how the veterinary medicine programme is executed in these two different countries. In Australian veterinary students, it is known that students spend a significant proportion of their time on extramural study (EMS) placements within veterinary clinics, working alongside veterinarians and their clients. Many students also have paid employment in veterinary practices, often as veterinary nurses and therefore more prone to burnout [10] as compared to veterinary students in Ghana who are not engaged in such rigorous activities or paid jobs.

This study also revealed that levels of emotional exhaustion experienced by the veterinary students were low to moderate with majority of the students experiencing low levels of emotional exhaustion. The relatively high depersonalisation among students in this study could be as a result of accumulated stress from relatively unsatisfied academic performances over time. This inadvertently could lead to the development of mostly negative consequences such as having panic disorders and facing severe anxiety or depression. Additionally, these students tend to develop feelings of negativity and indifference towards other students and even their lecturers. This finding in this study corroborates the findings of [16]. According to studies conducted by [16], veterinary medical students experience a lot of psychological and physiological changes during training especially those in their formative years. Academic stressors which include heavy workload, competitiveness with peers, unclear instructor expectations, and excessive worry about being less intelligent than peers are some of the triggers of depersonalization. In addition, many veterinary medical students experience stressful life events such as relational concerns, inadequate self-care regimens, long learning hours as well as physical health concerns which contribute to the unhealthy psychological changes which can result easily in depersonalization [19].

Findings on the effects of demographic characteristics of veterinary students on the high levels of DP and RPA showed that age did not have any significant effect on the high levels of DP and RPA; though the students who were less the 22 years of age recorded high levels of DP (57.1%) and RPA (80%) as compared to the students who were older than 22 years of age (high DP = 42.9%; high RPA = 20%). This shows that burnout amongst veterinary students was not significantly affected by the age of the student though those in the lower age limits suffer the stress of depersonalisation and reduced accomplishments more.

The findings of this current study furthermore showed that there is no significant impact of gender on the prevalence of burnout among veterinary students although females more frequently reported a high level of RPA (59.4%) as compared to male students (41.6%) whilst the male students (74.3%) reported more frequently a high level of DP as compared to the females (25.7%). This finding corroborates the findings of Ilić Živojinović et al., [9] who reported that though female students reported higher levels of burnout especially with emotional exhaustion, the effect of gender on burnout levels were not statistically significant. Notwithstanding, the findings of this study is in sharp contrast with the findings of Gelberg and Gelberg [20], who in their study on stress in veterinary students established that gender has a significant effect on stress and burnout levels with females being the most susceptible as compared to their male counterparts.

The findings of this study showed that the year of study of veterinary students had a significant impact on the level of burnout experienced by the students. This study revealed that the levels of high RPA (80%) and DP (70%) was more in the preclinical students as compared to the clinical students (RPA = 20%, DP = 30% respectively). This finding is consistent with the findings of Feras et al. [21], who in their report concerning burnout in medical students in Lebanon indicated that there is a high level of 75% burnout among preclinical medical students. This could be attributed to the fact that students in preclinical years are new to the various academic and non-academic stressors involved in being a student of veterinary school and hence are now adjusting to the pressures of balancing the rigorous academic course with extracurricular activities. Whereas students in the clinical years have been preconditioned and have adjusted to the academic stress involved in being a veterinary medical student.

The residence of students was found to have a significant effect on the prevalence of burnout in this study. Students who were residing in rented apartments (80%) as well as those living with their families (44.3%) recorded higher levels of DPA and RPA respectively as compared to those who lived in halls (1.4%) on the main KNUST campus. This finding could be explained by the mode of transportation of students from their places of residence to the Veterinary school campus which is located farther away from the main KNUST campus. Also, the financial constraint posed to most students in renting apartments, and hostels could explain this effect of place of residence on burnout levels. The findings of this study support the findings of Chigerwe et al [11] who indicated the type of living arrangements of students in California was associated with burnout.

In this study, the marital status of veterinary students did not have any significant effect (p>0.05) on the high levels of depersonalisation and reduced personal accomplishments of veterinary students. However, there were noticeable differences with high levels of DP and RPA recorded more in the unmarried students of 97.1% and 100% respectively. This difference could be as a result of the lack of emotional partners who can support them to cope in times where they feel unhappy about their academic performances as well as have negative thoughts about their programme of study.

Furthermore, this study revealed that some practices of students could serve as risk factors of burnout in their academic pursuit. The findings showed that daily sleep hours of students had significant effect on the prevalence of burnout. Veterinary students who slept less than 6 hours in a day in this study indicated high levels of DP (61.4%) and RPA (60%) as compared to those who slept between 6–10 hours in a day (high RPA = 40%; high DP = 38.6%). This phenomenon could be attributed to the fact that sleep is significant to reenergising the body and the mind to deal with academic activities. Therefore, less amount of sleep will result in excessive tiredness of both the body and the mind which will affect academic performance as well as lead to low physical energy to carry-out daily activities effectively and efficiently.

There was also found no significant effects (p>0.05) of the working status, weekly study hours and exercise hours of the veterinary students on depersonalisation and reduced personal accomplishments.

Conclusion

Low levels of burnout were observed among veterinary students in Ghana in this study in terms of low levels of emotional exhaustion and reduced personal achievement recorded in the study. Nevertheless, high levels of depersonalisation were observed among the students in this study. The year of study and the place of residence of veterinary students were found to be the associated demographic risk factors for burnout. Daily sleep hours of the veterinary students were also indicated as an associated risk factor of burnout among veterinary students in this study. It is recommended that veterinary students be given the necessary facilities and attention to deal with the increase in depersonalisation. In addition, based on the limitations of the study which involved lesser sample size and use of one of the two veterinary schools in Ghana, further studies should include all the veterinary schools in Ghana using larger sample size in order to provide a more detailed view on burnout in veterinary students.

18 Jun 2021

PONE-D-20-27094

PREVALENCE AND ASSOCIATED RISK FACTORS OF BURNOUT AMONGST VETERINARY STUDENTS IN GHANA

PLOS ONE

Dear Dr. EMIKPE,

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.

The manuscript has been evaluated by two reviewers, and their comments are available below.

The reviewers have raised a number of major concerns. They feel the manuscript requires significant improvements to the English language and editing of this manuscript. They also suggest greater clarity in the methodological reporting of this study, and note that necessity for further detail on the methods and analyses, in addition to greater elaboration in the discussion section regarding the strengths, weaknesses and recommendations deduced from this study.

Could you please carefully revise the manuscript to address all comments raised?

Please submit your revised manuscript by Aug 01 2021 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.

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). You should upload this letter as a separate file labeled 'Response to Reviewers'.

A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.

An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

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:  http://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,

Avanti Dey, PhD

Staff 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 and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

2. In your Data Availability statement, you have not specified where the minimal data set underlying the results described in your manuscript can be found. PLOS defines a study's minimal data set as the underlying data used to reach the conclusions drawn in the manuscript and any additional data required to replicate the reported study findings in their entirety. All PLOS journals require that the minimal data set be made fully available. For more information about our data policy, please see http://journals.plos.org/plosone/s/data-availability.

Upon re-submitting your revised manuscript, please upload your study’s minimal underlying data set as either Supporting Information files or to a stable, public repository and include the relevant URLs, DOIs, or accession numbers within your revised cover letter. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. Any potentially identifying patient information must be fully anonymized.

Important: If there are ethical or legal restrictions to sharing your data publicly, please explain these restrictions in detail. Please see our guidelines for more information on what we consider unacceptable restrictions to publicly sharing data: http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. Note that it is not acceptable for the authors to be the sole named individuals responsible for ensuring data access.

We will update your Data Availability statement to reflect the information you provide in your cover letter.

Additional Editor Comments (if provided):

[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: Partly

Reviewer #2: No

**********

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

Reviewer #1: Yes

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: No

**********

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: No

**********

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: English editing

Table 2 indicate exercise hours if per day or week as well as sleeping hours

Works “while” and not whiles

Demographic characteristics and burnout 7 (70%) as well as the rest of the percentages in the same paragraph.

Discussion and not discussion

use abbreviations after being defined

In the conclusion, burnout was noted due to high depersonalization so remove low levels of exhaustion and personal achievement.

I highly recommend rewriting the conclusion as it doesn’t reflect the strengths, weaknesses and recommendations deduced from this study.

Reviewer #2: The manuscript under review explored the prevalence and associated risk factors among veterinary students in Ghana. Although the researchers tackle an important area of study (burnout in veterinary students), there are some gaps in logic, omissions, and underdeveloped sections in the paper that I believe warrant consideration by the authors and editor. These more substantial edits/suggestions are provided in the list below and in the attached hard copy version. At a more basic level, there are typographical and grammatical errors throughout the document which detract from the clarity of content. I have attached my hard copy edits, which include suggestions for fixing these more minor errors.

1. In the Method section (p. 5), I am wondering how the researchers resolved the issue of the discrepancy between what was needed for Yamane formula and what was actually obtained? This limitation might be worth discussing in more detail in the discussion section (along with any other limitations of the study).

2. On pages 12 – 18, there are very limited descriptions of the statistics tests that were conducted, and the results of these tests are not well described. To remedy, I would suggest describing which tests were conducted at the outset of a paragraph or section (e.g., chi-square or logistic regression) and then include more statistical details for each of the tests (e.g., for a logistic regression you would report the overall model statistics and then individual coefficients, p values, and odds ratios).

3. In the discussion and/or the introduction section, can you provide specific percentages of the average rates of EE, RFA, and DP for the reader to make comparisons between the sample in this study and the larger population.

4. The authors state on p. 18 that “burnout is expressed the most due to depersonalization.” This doesn’t seem entirely accurate given that two of the Burnout components were actually lower than.

5. On p. 19, the discussion about why depersonalization is higher in this sample seems underdeveloped. I would like to see the authors explore the possible reasons for this manifestation of Burnout (and not the others) in the context of this population and the stressors and life experiences they have.

6. The finding that sleep may result in tiredness and a lack of productivity doesn’t seems quite simple and not particularly novel. I’m wondering if the authors can expand on the implications for this connection as it relates to students and practicing vets.

7. The statement that “burnout was observed” at the outset of the conclusion section seems somewhat misleading because you only found that one component of Burnout was observed and in fact the other two components were actually higher than average. I would suggest that this is rephrased here to capture the nuances of the results and, again, would suggest expanding on how and why depersonalization appears to the form that burnout takes with this group.

**********

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: No

[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.]

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 PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Submitted filename: reviewer comments.docx

Click here for additional data file.

Submitted filename: Burnout Mansucript with Edits.pdf

Click here for additional data file.

10 Aug 2021

31st July, 2021

Manuscript PONE-D-20-27094

Staff Editor

PLOS ONE

Dear Avanti Dey (PhD),

Thank you for giving us the opportunity to submit a revised draft of the manuscript “PREVALENCE AND ASSOCIATED RISK FACTORS OF BURNOUT AMONGST VETERINARY STUDENTS IN GHANA” for publication in PLOS ONE. We appreciate the time and effort that you and the reviewers dedicated to providing feedback on our manuscript and are grateful for the insightful comments on and valuable improvements to our paper. We have incorporated most of the suggestions made by the reviewers. Those changes are highlighted within the manuscript. Please see below, in blue, for a point-by-point response to the editor’s and reviewers’ comments and concerns.

Reviewers' Comments to the Authors:

Reviewer 1

1. Table 2 indicate exercise hours if per day or week as well as sleeping hours

Works “while” and not whiles

Demographic characteristics and burnout 7 (70%) as well as the rest of the percentages in the same paragraph.

Discussion and not discussion

use abbreviations after being defined

Authors’ response: The reviewer is correct, and we have made the necessary grammatical error corrections as indicated. The frequency of exercise and sleeping hours have been specified in our revised manuscript.

2. In the conclusion, burnout was noted due to high depersonalization so remove low levels of exhaustion and personal achievement.

I highly recommend rewriting the conclusion as it doesn’t reflect the strengths, weaknesses and recommendations deduced from this study.

Authors’ response: The recommendation given has been considered and the authors have made changes to the conclusion to reflect the strengths, weaknesses and recommendations as indicated by the reviewer.

Reviewer 2

1. In the Method section (p. 5), I am wondering how the researchers resolved the issue of the discrepancy between what was needed for Yamane formula and what was actually obtained? This limitation might be worth discussing in more detail in the discussion section (along with any other limitations of the study).

Authors’ response: The cause for the discrepancy observed in the actual sample size used and that obtained from the Yamane Formula have been explained in detail in the Method section under the heading “Sample size”.

2. On pages 12 – 18, there are very limited descriptions of the statistics tests that were conducted, and the results of these tests are not well described. To remedy, I would suggest describing which tests were conducted at the outset of a paragraph or section (e.g., chi-square or logistic regression) and then include more statistical details for each of the tests (e.g., for a logistic regression you would report the overall model statistics and then individual coefficients, p values, and odds ratios).

Authors’ response: The detailed descriptions of the statistics tests have been previously been spelt out in the Method section under the subsection “Data Analysis” where all tests have been spelt out and what they were used for. In addition, the results on the logistic regression and chi-square tests have been incorporated in the results section as recommended by the reviewer.

3. In the discussion and/or the introduction section, can you provide specific percentages of the average rates of EE, RFA, and DP for the reader to make comparisons between the sample in this study and the larger population.

Authors’ response: The specific percentages of the average rates of EE, RFA and DP have been included in the revised manuscript.

4. The authors state on p. 18 that “burnout is expressed the most due to depersonalization.” This doesn’t seem entirely accurate given that two of the Burnout components were actually lower than.

Authors’ response: The authors have revised this expression and have rectified and rephrased the statement to reflect the true findings of this study.

5. On p. 19, the discussion about why depersonalization is higher in this sample seems underdeveloped. I would like to see the authors explore the possible reasons for this manifestation of Burnout (and not the others) in the context of this population and the stressors and life experiences they have.

Authors’ response: The recommendation given has been considered and the authors have developed the said deficit in writing that you have stated. More reasons have been adduced to why depersonalization was higher in this study.

6. The finding that sleep may result in tiredness and a lack of productivity doesn’t seems quite simple and not particularly novel. I’m wondering if the authors can expand on the implications for this connection as it relates to students and practicing vets

Authors’ response: The connection between sleep and tiredness might not be novel but in our study, however, it adds on to the substantive argument of some the source of stresses that could have easily contribute to burnout in veterinary students. This study sought to explore the risk factors associated with burnout and so on a broader view the authors thought of taking a look at how long students are able to get enough rest as a suggestive predictor of burnout.

7. The statement that “burnout was observed” at the outset of the conclusion section seems somewhat misleading because you only found that one component of Burnout was observed and in fact the other two components were actually higher than average. I would suggest that this is rephrased here to capture the nuances of the results and, again, would suggest expanding on how and why depersonalization appears to the form that burnout takes with this group.

Authors’ response: The recommendation given has been considered and the authors have rephrased the conclusion to reflect the findings of this study and not to mislead.

Submitted filename: RESPONSE TO REVIEWERS(1)-1.docx

Click here for additional data file.

24 Jun 2022

28 Jun 2022

RESPONSE TO REVIEWER’S COMMENTS ON PREVALENCE AND ASSOCIATED RISK FACTORS OF BURNOUT AMONGST VETERINARY STUDENTS IN GHANA

Comment 1: In the Method section (p. 5), I am wondering how the researchers resolved the issue of the discrepancy between what was needed for Yamane formula and what was actually obtained? This limitation might be worth discussing in more detail in the discussion section (along with any other limitations of the study).

Response: The discrepancy between the sample size used and the actual sample size obtained from the Yamane formula has been explained in the methodology aspect under the sample size section in the reviewed manuscript.

Comment 2: On pages 12 – 18, there are very limited descriptions of the statistics tests that were conducted, and the results of these tests are not well described. To remedy, I would suggest describing which tests were conducted at the outset of a paragraph or section (e.g., chi-square or logistic regression) and then include more statistical details for each of the tests (e.g., for a logistic regression you would report the overall model statistics and then individual coefficients, p values, and odds ratios).

Response: This suggestion by the reviewer has been considered by the authors. The statistical tests conducted have been described in details in the data analysis section in the reviewed manuscript.

Comment 3: In the discussion and/or the introduction section, can you provide specific percentages of the average rates of EE, RFA, and DP for the reader to make comparisons between the sample in this study and the larger population.

Response: The specific percentages of the average rates of EE, RFA, and DP have been provided appropriately to enhance comparison between the sample in this study. This has been added in the new manuscript under the discussion section.

Comment 4: The authors state on p. 18 that “burnout is expressed the most due to depersonalization.” This doesn’t seem entirely accurate given that two of the Burnout components were actually lower than.

Response: The statement “burnout is expressed the most due to depersonalization” has been looked at. The write-up in that section has been re-written to reflect the findings on the burnout components in this study. This has been highlighted in the revised manuscript with tracked changes.

Comment 5: On p. 19, the discussion about why depersonalization is higher in this sample seems underdeveloped. I would like to see the authors explore the possible reasons for this manifestation of Burnout (and not the others) in the context of this population and the stressors and life experiences they have.

Response: The authors have acknowledged the concern of the reviewer. In view of this, authors have provided possible reasons for depersonalization being the manifestation of burnout amongst the students in this study. This adjustment is found in the discussion section in the revised manuscript with tracked changes.

Comment 6: The finding that sleep may result in tiredness and a lack of productivity doesn’t seems quite simple and not particularly novel. I’m wondering if the authors can expand on the implications for this connection as it relates to students and practicing vets.

Response: The authors have provided further explanations on sleep affecting productivity and the academic performance of students and practicing veterinarians but rather focusing more on veterinary students.

Comment 7: The statement that “burnout was observed” at the outset of the conclusion section seems somewhat misleading because you only found that one component of Burnout was observed and in fact the other two components were actually higher than average. I would suggest that this is rephrased here to capture the nuances of the results and, again, would suggest expanding on how and why depersonalization appears to the form that burnout takes with this group.

Response: The conclusion has been recaptured and in the revised manuscript to capture the nuances of the results and have slightly expanded on how and why depersonalization appears to the form that burnout takes in this study.

Submitted filename: RESPONSE TO REVIEWER burn out.docx

Click here for additional data file.

1 Jul 2022

PREVALENCE AND ASSOCIATED RISK FACTORS OF BURNOUT AMONGST VETERINARY STUDENTS IN GHANA

PONE-D-20-27094R2

Dear Dr. EMIKPE,

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

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. 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 help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- 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.

Kind regards,

Mohammad Hossein Ebrahimi

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

7 Jul 2022

PONE-D-20-27094R2

Prevalence and associated risk factors of burnout amongst veterinary students in Ghana

Dear Dr. Emikpe:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. 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.

If we can help with anything else, please email us at plosone@plos.org.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Mohammad Hossein Ebrahimi

Academic Editor

PLOS ONE