Terminal efficiency of Peruvian university students in the second specialty programs of a dental school over seven years

Karen Llajaida Cabanillas-Yllesca; Karla Lucero Avalos-Baltodano; Roberto A. León-Manco; María Claudia Garcés-Elías; Cesar D. Rojas-Senador

doi:10.12688/f1000research.157705.2

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Research Article

Revised

Terminal efficiency of Peruvian university students in the second specialty programs of a dental school over seven years

[version 2; peer review: 2 approved]

Karen Llajaida Cabanillas-Yllesca¹, Karla Lucero Avalos-Baltodano¹, Roberto A. León-Manco¹, María Claudia Garcés-Elías¹, Cesar D. Rojas-Senador ¹

Karen Llajaida Cabanillas-Yllesca¹, Karla Lucero Avalos-Baltodano¹, [...] Roberto A. León-Manco¹, María Claudia Garcés-Elías¹, Cesar D. Rojas-Senador ¹

PUBLISHED 09 May 2025

Author details Author details

¹ Facultad de Estomatología, Universidad Peruana Cayetano Heredia, Lima, Peru

Karen Llajaida Cabanillas-Yllesca
Roles: Conceptualization, Methodology

Karla Lucero Avalos-Baltodano
Roles: Investigation, Resources

Roberto A. León-Manco
Roles: Conceptualization, Methodology, Writing – Review & Editing

María Claudia Garcés-Elías
Roles: Conceptualization, Methodology, Writing – Review & Editing

Cesar D. Rojas-Senador
Roles: Data Curation, Formal Analysis, Investigation, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

Abstract

Background

Terminal efficiency (TE), the proportion of students completing academic programs within the expected timeframe, is a critical metric for assessing postgraduate health education quality, yet it remains underexplored in Latin American dental specialties. Efficient training is vital for producing competent professionals to meet regional healthcare demands. This study aimed to determine the TE of Peruvian university students in second specialty dental programs at a Peruvian university from 2017 to 2023.

Methods

A longitudinal, cross-sectional analysis was conducted using 257 complete records from the university institutional repository. Inclusion criteria encompassed full documentation of admission, academic status, and graduation dates. TE was calculated as the time from document submission to graduation, categorized as ≤1 year or ≥2 years. Statistical analyses included Chi-square tests, non-parametric Mann-Whitney U and Kruskal-Wallis tests, Poisson regression, and hierarchical multiple linear regression on log-transformed TE.

Results:

Mean TE was 0.93 years (SD=1.22), with 72.37% of students (n=186) completing within ≤1 year. Significant variations were observed by submission year (p=0.001) and specialty (p<0.001), with Oral and Maxillofacial Radiology (0.30 years) outperforming Periodontics and Implantology (1.76 years). The submission year was the only significant predictor of mean TE (β=0.144, p<0.001).

Conclusion

Dental programs of a Peruvian university demonstrate robust TE, though specialty-specific and temporal disparities highlight areas for improvement. Targeted interventions, such as streamlined thesis processes and specialty-specific support, could enhance efficiency, informing educational policy in Latin America.

Keywords

Education, Efficiency, Students, Dentistry, Universities

Corresponding author: Cesar D. Rojas-Senador

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2025 Cabanillas-Yllesca KL et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Cabanillas-Yllesca KL, Avalos-Baltodano KL, León-Manco RA et al. Terminal efficiency of Peruvian university students in the second specialty programs of a dental school over seven years [version 2; peer review: 2 approved]. F1000Research 2025, 13:1307 (https://doi.org/10.12688/f1000research.157705.2) First published: 31 Oct 2024, 13:1307 (https://doi.org/10.12688/f1000research.157705.1) Latest published: 09 May 2025, 13:1307 (https://doi.org/10.12688/f1000research.157705.2)

Revised Amendments from Version 1

The revised manuscript "Terminal Efficiency of Peruvian University Students in Second Specialty Programs of a Dental School Over Seven Years" has been enhanced in clarity, scientific rigor, and relevance. The Introduction and Discussion sections have been streamlined by simplifying complex sentences to improve readability while preserving scientific accuracy. The Results section now includes additional graphs and refined tables to present key findings more effectively. We have strengthened the literature review by incorporating recent international studies on terminal efficiency in postgraduate dental education. To address the limitations of the cross-sectional design, we conducted multivariate regression analyses to control for confounders such as specialty, sex, and year of submission, with results integrated into the revised Results and Discussion sections. The Methods section has been expanded to detail data extraction, cleaning, and verification processes, confirm the absence of missing data, and clarify sensitivity analyses, including outlier management and logarithmic transformations. Statistical test rationales (Chi-square, Mann-Whitney U, Kruskal-Wallis) are now justified, with effect sizes and post hoc analyses detailed for practical significance. The Discussion explicitly addresses study limitations, including the single-institution focus and cross-sectional design, and includes a new subsection on practical implications for educational policy. The impact of external factors, such as COVID-19, is thoroughly analyzed with supporting data trends. Finally, the Conclusions have been tempered to reflect the exploratory nature of the study, ensuring alignment with the revised findings and limitations. These changes enhance the manuscript’s clarity, robustness, and applicability to dental education research.

See the authors' detailed response to the review by Avita Rath

Introduction

Higher education in health sciences is essential for training specialized professionals who contribute to national development through scientific, technical, and cultural advancements. Universities serve as key institutions in this process, providing the education and innovation required to equip professionals with the competencies needed to excel in their fields and address societal demands.¹ In Peru, the demand for advanced education in health sciences, particularly dentistry, has risen sharply in recent years, reflecting the growing need for skilled practitioners in a competitive healthcare landscape.² This trend underscores the critical importance of efficient academic programs that enable students to complete their training and obtain professional titles promptly, thereby enhancing their ability to contribute to public health and national progress.

Efficiency in higher education is a multifaceted concept, often evaluated through indicators that assess the quality and timeliness of academic outcomes. Among these, terminal efficiency (TE) stands out as a vital metric, defined as the proportion of students who complete their academic programs and obtain their professional titles within the expected timeframe.³ In postgraduate settings, where specialized training is both intensive and time-sensitive, TE serves as a key measure of program effectiveness, reflecting the ability of institutions to prepare graduates for professional practice.⁴ In dental education, TE is particularly significant, as it indicates how well specialty programs produce competent professionals capable of meeting complex oral health challenges.

Despite its importance, research on TE in postgraduate dental programs remains limited, especially in Peru and the broader Latin American context. While studies have explored TE at the undergraduate level, postgraduate programs—such as second specialty programs in dentistry—have received scant attention.⁵ These programs are critical for developing advanced expertise, yet they face unique challenges, including delays in degree completion due to research requirements, institutional processes, or external factors like the COVID-19 pandemic.⁶ In Peru, where the University Law (Law No. 30220) mandates specific academic requirements for second specialty degrees, including a minimum of two semesters with a minimum content of forty academic credits and a thesis or academic paper, understanding TE is essential for optimizing educational quality and addressing regional gaps in the literature.⁷

This study aims to determine the terminal efficiency of Peruvian university students enrolled in second specialty programs at the dental school of a Peruvian university over a seven-year period (2017–2023). The seven-year timeframe was selected to capture trends and assess the impact of external disruptions, such as the COVID-19 pandemic, which altered educational and administrative processes globally.⁸ By examining TE in this context, the study provides a comprehensive evaluation of program efficiency at a leading Peruvian institution and focus on postgraduate dental education in Peru, an underexplored area despite its relevance to educational policy and public health.

Methods

Study design

For this study, a cross-sectional design was proposed, with the population consisting of all document records submitted for obtaining a title of second professional specialty in each of the programs offered by the Postgraduate and Specialization Unit of the Dental School in the Universidad Peruana Cayetano Heredia (UPCH) in Lima, Peru, published in the institutional repository, a digital archive of academic documents, between 2017 and 2023. The decision was made to work with the entire population; therefore, no sample size was determined.

The study encompassed records of all students enrolled in second professional specialty programs at UPCH from 2017 to 2023, subject to specific selection criteria. Inclusion required complete documentation of program admission date, academic status, and graduation date for those who completed the program. Conversely, records with incomplete or inconsistent information in the above fields were excluded. Furthermore, the study omitted records of exchange students and those who transferred from other universities during the specified period. As all 258 records met the inclusion criteria, the entire population was analyzed, eliminating sampling bias.

Variables

This research considered terminal efficiency (TE) as both a quantitative and qualitative variable. Additionally, some covariates were included, such as the year of formal document submission, the mode of document preparation, the second professional specialty in dentistry, and sex.

TE, as a quantitative variable or mean TE, was calculated from the difference in years between the formal submission of the document to obtain the title of second professional specialty to an expert jury, verified with the publication in the institutional repository of UPCH, and the student’s graduation year. As a qualitative variable or categorized TE, two categories were considered: “Up to 1 year” when TE was less than or equal to 1, and “2 years or more” when TE was greater than or equal to 2.

The mode of document preparation, as a qualitative variable, considered two categories: “Individual” when the document to obtain the title of second professional specialty in dentistry was prepared by a single student, and “Collective” when the document was prepared by two students or more.

The second professional specialty in dentistry, as a qualitative variable, considered twelve categories: “Dental Auditing”, “Oral and Maxillofacial Surgery”, “Endodontics”, “Special Patients Stomatology”, “Integral Oral Implantology”, “Restorative and Esthetic Dentistry”, “Pediatric Dentistry”, “Orthodontics and Maxillary Orthopedics”, “Periodontics and Implantology”, “Oral and Maxillofacial Radiology”, “Oral Rehabilitation”, and “Dental Public Health” which are part of the Peruvian list of recognized dental specialties in Article 26th of the Regulation of the Dentist’s Labor Law, Law No. 27878, amended in 2020 by Supreme Decree No. 023-2020-SA.⁹

Data collection

Data were sourced from the UPCH institutional repository, a public digital archive of documents submitted for second professional specialty titles (2017–2023). All 258 records meeting the inclusion criteria (complete admission, status, and graduation data) were extracted, with no exclusions, ensuring no selection bias.

Two researchers extracted data (sex, year of submission, mode of preparation, specialty) from repository metadata and full-text documents, using a structured protocol. Graduation years were obtained via a formal request to the repository administration. Data were recorded in Microsoft Excel 365 with unique identifiers for anonymity.

During cleaning, data completeness was verified by confirming that all records contained values for each variable (sex, year, mode, specialty, graduation year). No missing or incomplete data were identified, as all records met the inclusion criteria and repository entries were fully documented. To ensure this, the researchers cross-checked each record against metadata and full-text files, resolving any discrepancies through consensus or consultation with a third researcher. Standardized formats were applied (e.g., dates as YYYY, specialty names per Law No. 27878).

A random 10% sample (n=26) was cross-checked against original repository entries, and graduation years were validated with UPCH academic records. No missing data or inconsistencies were found, confirming the dataset's completeness. Data were anonymized per ethical approval (CONSTANCIA-CIEI-428-39-23).

Data analysis

Sensitivity analyses were conducted to ensure the robustness of the findings. Outliers were identified using the interquartile range method as TE values below -3 years or above 5 years (Q1 − 1.5 × IQR or Q3 + 1.5 × IQR).¹⁰ One record with a mean TE of 6 years was excluded, but its removal did not alter the direction or significance of the findings, confirming the robustness of the results. No missing or incomplete data were identified, as all 257 records met the inclusion criteria and were fully documented in the repository.

The descriptive analysis provided absolute and relative. For the bivariate analysis, associations were evaluated using the Chi-square statistical test; additionally, the Kolmogorov-Smirnov test was used to assess the normality of the data distribution (p < 0.001), and the non-parametric Mann-Whitney U and Kruskal-Wallis tests, with the corresponding post hoc test, were employed to determine differences between groups.

The chi-square test was used to determine if there is a significant association between two categorical variables.¹¹ The Mann-Whitney U test was employed to identify differences between the summary measures (medians) of dichotomous covariate categories (mode of document preparation and sex), as these categories divided the sample into two groups with independent measures. The Kruskal-Wallis test was used to detect differences between the summary measures (medians) of polytomous covariate categories (year of formal document submission and second professional specialty in dentistry), which divided the sample into more than two groups with independent measures.¹²

For multivariate analysis, Poisson regression was employed to estimate crude (PR) and adjusted prevalence ratios (aPR). This method is primarily used for modeling count data, where the response variable represents counts of events, and it is useful for binary outcome analysis to estimate adjusted risk and prevalence ratios.^13,14 In cross-sectional studies, it is often preferable to estimate prevalence ratios rather than odds ratios, especially when the outcome is not rare.¹⁴ Two models were generated: a crude model (with year of formal document submission as the independent variable and categorized TE as the dependent variable) and an adjusted model incorporating covariates (mode of document preparation, second professional specialty in dentistry, and sex).

Additionally, a hierarchical multiple linear regression was developed; this statistical method analyzes data with a hierarchical structure, allowing for the inclusion of predictor variables at multiple levels of analysis while considering variance at each level. This method examines a continuous dependent variable to elucidate relationships between predictors and the dependent variable.¹⁵ Given these characteristics, a variance inflation factor (VIF) test was performed to assess multicollinearity among the covariates. The results indicated values of less than 5 (VIF < 5), confirming that it was unnecessary to eliminate any variables. Consequently, the hierarchical multiple linear regression was deemed suitable for this study, facilitating the construction of models relating the independent variables to mean TE, as analyzed across the entire dataset.

Before this analysis, a logarithmic transformation was applied to the dependent variable due to its lack of normal distribution, which constrained the use of multiple linear regression as part of the proposed analytical statistics for this study. It is important to note that the application of logarithmic transformation is supported in various investigations, including those by Feng et al. in 2013, and Habibzadeh in 2024, which indicate that transforming a dataset with a non-normal distribution into one approximating normality is preferable, as statistical tests assuming normality typically yield more efficient inferences.^16,17

The dataset with 257 records, as no missing or incomplete data were identified during extraction and cleaning, ensuring a complete dataset for all variables (sex, year, mode, specialty, graduation year), was imported into STATA v. 18.0 for analysis. Microsoft Excel 365 was used to organize and present the results in tables. The study considered a 95% confidence level and a p-value <0.05 to determine statistical significance.

Results

The terminal efficiency (TE) of 257 Peruvian university students enrolled in second specialty programs at the dental school of Universidad Peruana Cayetano Heredia from 2017 to 2023 was analyzed. All records, sourced from the institutional repository, contained complete data with no exclusions due to missing or inconsistent information. Categorically, TE was achieved within one year by 72.37% of students (n = 186), while 27.63% (n = 71) required two years or more ( Table 1). The mean TE was calculated as 0.93 years (SD = 1.22), with a median of 1.00 year (IQR = 2.00) ( Table 2).

Table 1. Categorized terminal efficiency of Peruvian university students in the second professional specialty programs of a dental school over seven years.

Variables		n	%	Categorized terminal efficiency
				Up to 1 year		2 years and older		p
				n	%	n	%	p
Total		257	100.00	186	72.37	71	27.63
Year of formal document submission
	2017	25	9.73	21	84.00	4	16.00	0.067*
	2018	33	12.84	30	90.91	3	9.09
	2019	42	16.34	25	59.52	17	40.48
	2020	54	21.01	39	72.22	15	27.78
	2021	39	15.18	28	71.79	11	28.21
	2022	29	11.28	19	65.52	10	34.48
	2023	35	13.62	24	68.57	11	31.43
Mode of document preparation
	Individual	155	60.31	111	71.61	44	28.39	0.737*
	Collective	102	39.69	75	73.53	27	26.47	0.737*
Second professional specialty in dentistry
	Dental Auditing	2	0.78	2	100.00	0	0.00	0.562**
	Oral and Maxillofacial Surgery	8	3.11	3	37.50	5	62.50
	Endodontics	28	10.89	22	78.57	6	21.43
	Special Patients Stomatology	7	2.72	5	71.43	2	28.57
	Integral Oral Implantology	2	0.78	1	50.00	1	50.00
	Restorative and Esthetic Dentistry	23	8.95	18	78.26	5	21.74
	Pediatric Dentistry	31	12.06	24	77.42	7	22.58
	Orthodontics and Maxillary Orthopedics	21	8.17	18	85.71	3	14.29
	Periodontics and Implantology	17	6.61	6	35.29	11	64.71
	Oral and Maxillofacial Radiology	53	20.62	48	90.57	5	9.43
	Oral Rehabilitation	36	14.01	21	58.33	15	41.67
	Dental Public Health	29	11.28	18	62.07	11	37.93
Sex
	Female	156	60.70	112	71.79	44	28.21	0.797*
	Male	101	39.30	74	73.27	27	26.73	0.797*

* Chi-square test.

** Chi-square test corrected by Yates.

Table 2. Mean terminal efficiency of Peruvian university students in the second professional specialty programs of a dental school over seven years.

Variables		n	%	Mean terminal efficiency
Variables		n	%	X	SD	M	IQR	p
Total		257	100.00	0.93	1.22	1.00	2.00
Year of formal document submission
	2017	25	9.73	0.48	1.08	0.00abcd	1.00	0.001*
	2018	33	12.84	0.33	0.78	0.00efghi	0.00
	2019	42	16.34	1.14	0.93	1.00aej	2.00
	2020	54	21.01	0.74	1.01	0.00fj	2.00
	2021	39	15.18	1.08	1.24	1.00bg	2.00
	2022	29	11.28	1.34	1.47	1.00ch	2.00
	2023	35	13.62	1.37	1.61	1.00di	3.00
Mode of document preparation
	Individual	155	60.31	0.91	1.32	0.00	2.00	0.141**
	Collective	102	39.69	0.97	1.05	1.00	2.00	0.141**
Second professional specialty in dentistry
	Dental Auditing	2	0.78	1.00	0.00	1.00a	0.00	<0.001*
	Oral and Maxillofacial Surgery	8	3.11	2.00	1.60	2.00bcde	3.00
	Endodontics	28	10.89	0.75	1.00	1.00bfgh	1.00
	Special Patients Stomatology	7	2.72	1.43	1.51	1.00i	3.00
	Integral Oral Implantology	2	0.78	1.50	0.71	1.50j	1.00
	Restorative and Esthetic Dentistry	23	8.95	0.57	1.31	0.00cklmn	1.00
	Pediatric Dentistry	31	12.06	1.03	1.20	1.00kop	1.00
	Orthodontics and Maxillary Orthopedics	21	8.17	0.62	1.20	0.00dqr	1.00
	Periodontics and Implantology	17	6.61	1.76	0.97	2.00floqs	1.00
	Oral and Maxillofacial Radiology	53	20.62	0.30	0.97	0.00aegijpstu	0.00
	Oral Rehabilitation	36	14.01	1.31	0.82	1.00hmrt	1.00
	Dental Public Health	29	11.28	1.28	1.49	1.00nu	2.00
Sex
	Female	156	60.70	0.95	1.19	1.00	2.00	0.571**
	Male	101	39.30	0.91	1.26	0.00	2.00	0.571**

* Kruskal-Wallis test; post hoc Mann Whitney U test, equal letters show a statistically significant difference (p<0.05).

** Mann Whitney U test.

Associations between categorized TE and covariates were assessed using the Chi-square test. A significant association was identified with the year of document submission (χ² = 11.77, p = 0.067, Cramer's V = 0.21), though the p-value approached but did not reach the conventional threshold of 0.05. The proportion of students achieving TE within one year peaked in 2018 (90.91%, n = 30/33) and was lowest in 2019 (59.52%, n = 25/42) ( Figure 1 and Table 1). No significant associations were observed with the mode of document preparation (p = 0.737) or sex (p = 0.797) ( Table 1).

Figure 1. Categorized terminal efficiency of Peruvian university students in the second professional specialty programs of a dental school by year of formal document submission.

Differences in mean TE across groups were evaluated using non-parametric tests due to the non-normal distribution of TE (Kolmogorov-Smirnov test, p < 0.001). The Kruskal-Wallis test revealed significant variation by year of submission (H = 24.08, p = 0.001, η² = 0.07), with post hoc Mann-Whitney U tests indicating that mean TE in 2018 (0.33 years) was significantly lower than in 2019 (1.14 years, p < 0.001), 2020 (0.74 years, p = 0.032), 2021 (1.08 years, p = 0.002), 2022 (1.34 years, p = 0.001), and 2023 (1.37 years, p < 0.002) ( Figure 2 and Table 2). Similarly, significant differences were detected across dental specialties (H = 55.87, p < 0.001, η² = 0.18). Post hoc tests showed that Oral and Maxillofacial Radiology (mean TE = 0.30 years) had a significantly lower TE compared to Dental Auditing (1.00 years, p = 0.029), Oral and Maxillofacial Surgery (2.00 years, p < 0.001), Endodontics (0.75 years, p = 0.002), Special Patients Stomatology (1.43 years, p = 0.004), Integral Oral Implantology (1.50 years, p = 0.016), Pediatric Dentistry (1.03 years, p < 0.001), Periodontics and Implantology (1.76 years, p < 0.001), Oral Rehabilitation (1.31 years, p < 0.001) and Dental Public Health (1.28 years, p < 0.001) ( Figure 3 and Table 2). No significant differences in mean TE were found by mode of document preparation (p = 0.141) or sex (p = 0.571) ( Table 2).

Figure 2. Boxplot of mean terminal efficiency of Peruvian university students in the second professional specialty programs of a dental school by year of formal document submission.

Figure 3. Boxplot of mean terminal efficiency of Peruvian university students over seven years by second professional specialty in dentistry.

Poisson regression was employed to estimate prevalence ratios (PR) for categorized TE, adjusting for potential confounders (year of formal document submission, mode of document preparation, second professional specialty in dentistry, and sex). In the adjusted model, no significant predictors of achieving TE within one year were identified (p > 0.05 for all variables) ( Table 3). Hierarchical multiple linear regression was conducted on log-transformed mean TE to address its skewed distribution. The final model, adjusted for all covariates, explained 6% of the variance (R² = 0.06, p = 0.004), with the year of formal document submission as the only significant predictor (β = 0.144, 95% CI: 0.071–0.218, p < 0.001) ( Table 4).

Table 3. Multivariate analysis of the categorized terminal efficiency among Peruvian university students in the second professional specialty programs of a dental school over seven years.

Variables		Categorized terminal efficiency (Up to 1 year)
		Crude model			Adjusted model
		PR	95% CI	p	aPR	95% CI	p
Year of formal document submission
	2017	Ref.			Ref.
	2018	1.08	0.88-1.33	0.444	1.04	0.84-1.28	0.734
	2019	0.71	0.52-0.96	0.026	0.96	0.74-1.23	0.730
	2020	0.86	0.68-1.09	0.213	0.98	0.65-1.48	0.927
	2021	0.86	0.66-1.11	0.238	0.71	0.49-1.04	0.075
	2022	0.78	0.57-1.07	0.122	0.95	0.63-1.41	0.783
	2023	0.82	0.62-1.08	0.159	0.99	0.72-1.35	0.937
Mode of document preparation
	Individual	Ref.
	Collective	1.03	0.88-1.20	0.735	-	-	-
Second professional specialty in dentistry
	Dental Auditing	Ref.
	Oral and Maxillofacial Surgery	0.38	0.15-0.92	0.032	-	-	-
	Endodontics	0.79	0.65-0.95	0.015	-	-	-
	Special Patients Stomatology	0.71	0.45-1.14	0.159	-	-	-
	Integral Oral Implantology	0.50	0.13-2.00	0.327	-	-	-
	Restorative and Esthetic Dentistry	0.78	0.63-0.97	0.026	-	-	-
	Pediatric Dentistry	0.77	0.64-0.94	0.008	-	-	-
	Orthodontics and Maxillary Orthopedics	0.86	0.72-1.02	0.084	-	-	-
	Periodontics and Implantology	0.35	0.19-0.67	0.002	-	-	-
	Oral and Maxillofacial Radiology	0.91	0.83-0.99	0.025	-	-	-
	Oral Rehabilitation	0.58	0.44-0.77	<0.001	-	-	-
	Dental Public Health	0.62	0.47-0.83	0.001	-	-	-
Sex
	Female	Ref.
	Male	1.02	0.88-1.19	0.795	-	-	-

Table 4. Multivariate analysis of the mean terminal efficiency among Peruvian university students in the second professional specialty programs of a dental school over seven years.

Variables		R²	Change of R²	p-value Change of R²	β₀	β	β*	95% CI	p-value	p-value Model
Model 1		0.06	0.06	<0.001	0.404					<0.001
	Year of formal document submission	0.06	0.06	<0.001	0.404	0.142	0.240	0.071-0.213	<0.001	<0.001
Model 2		0.06	0.00	0.866	0.377					0.001
	Year of formal document submission					0.140	0.237	0.068-0.213	<0.001
	Mode of document preparation					0.023	0.011	-0.250-0.297	0.866
Model 3		0.06	0.00	0.803	0.323					0.002
	Year of formal document submission					0.141	0.238	0.068-0.214	<0.001
	Mode of document preparation					0.029	0.013	-0.248-0.305	0.839
	Second professional specialty in dentistry					0.006	0.015	-0.038-0.049	0.803
Model 4		0.06	0.00	0.442	0.484					0.004
	Year of formal document submission					0.144	0.244	0.071-0.218	<0.001
	Mode of document preparation					0.011	0.005	-0.269-0.292	0.936
	Second professional specialty in dentistry					0.005	0.015	-0.039-0.049	0.815
	Sex					-0.106	-0.048	-0.378-0.166	0.442

Discussion

The present study provides valuable insights into the terminal efficiency (TE) of Peruvian university students enrolled in second specialty programs in dentistry at a single institution over a seven-year period (2017–2023). The findings indicate an average TE of 0.93 years, with 72.37% of students completing their programs within ≤1 year of document submission and 27.63% requiring ≥2 years. These results suggest a generally efficient degree completion process within Peru’s postgraduate dental education framework, as governed by University Law 30220, which mandates a minimum of two academic semesters and a thesis or academic paper for second professional specialty titles.⁷ However, significant variations in TE were observed across dental specialties (e.g., Oral Radiology at 0.30 years vs. Periodontics at 1.76 years) and years of document submission (lowest in 2018, highest in 2023), underscoring the influence of specialty-specific demands and temporal factors on program completion times. Multivariate analysis identified the year of document submission as a significant predictor of mean TE, albeit with limited explanatory power.

Comparative analysis with existing literature reveals both consistencies and divergences. Locally, Girano-Arévalo et al. (2021) reported a higher TE of 1.67 years for undergraduate dental students at the same institution (Universidad Peruana Cayetano Heredia, UPCH), with 60.51% completing in ≤1 year,⁵ while Carrizales-Poma et al. (2024) found a TE of 1.52 years for UPCH master’s and doctoral dental programs.¹⁸ The lower TE in our postgraduate cohort may reflect greater student commitment or streamlined research processes at the specialty level. Regionally, Costa Rican undergraduate dental students exhibited far lower efficiency, with only 6–8.5% completing in ≤1 year across multiple cohorts,^8,19 suggesting that Peru’s postgraduate dental programs outperform some Latin American undergraduate programs. Globally, Mexican studies during the COVID-19 pandemic reported disrupted graduation rates,²⁰ while Chinese postgraduate medical students faced similar delays.²¹ These comparisons highlight the relative efficiency of this study population, though contextual differences in program structure and external disruptions limit direct equivalence.

The research period (2017–2023) overlaps with the COVID-19 pandemic, which likely influenced TE trends, particularly from 2020 onward. The highest TE (1.76 years) in 2023 suggests prolonged completion times for documents submitted during or post-pandemic, potentially due to backlogs or persistent administrative delays. International parallels reinforce this hypothesis: Lange et al. (2023) noted greater graduation delays among United States postgraduate students compared to Swedish peers during the pandemic,²² while Latin American studies identified barriers such as limited digital literacy and connectivity²³ and negative impacts on student well-being.²⁴ In Peru, the shift to remote learning and virtual thesis defenses²⁵ may have differentially affected specialties, with research-intensive fields like Periodontics potentially facing greater disruption than others like Oral Radiology. These findings suggest that pandemic-related challenges contributed to TE variability.

Practically, the specialty-specific TE disparities—Oral Radiology’s 0.30-year mean versus Periodontics’ 1.76 years—carry substantial implications for educational policy and administration. With an effect size indicating a 1.46-year difference, these variations likely stem from differences in research complexity, clinical requirements, or resource availability (e.g., imaging facilities vs. surgical training). Institutions could address lagging specialties through targeted interventions, such as structured mentorship programs or methodological workshops for Periodontics students, mirroring successful undergraduate strategies.⁵ Notably, all submissions in this study were theses, despite UPCH regulations permitting academic papers.²⁶ So that, introducing hybrid thesis formats, as proposed elsewhere,²⁷ could reduce bottlenecks while aligning with Law 30220’s flexibility.⁷ Such adaptations could enhance TE across specialties, balancing academic rigor with efficiency, and warrant pilot testing at the institutional level.

Despite its contributions, this study has limitations. Its single-institution focus at UPCH restricts generalizability to other Peruvian or Latin American contexts, where resource availability and student demographics may differ. The cross-sectional design, while robust for descriptive analysis, precludes causal inferences regarding covariates like specialty or submission year, and unexamined factors (e.g., sociodemographic profiles, institutional support) may also influence TE. Future multi-institutional and longitudinal studies tracking regional student cohorts could elucidate predictive factors and pandemic-specific effects.^4,8 Multicenter investigations across Peru and Latin America²⁰ would further contextualize findings, while pre- and post-COVID-19 cohort comparisons could quantify long-term disruptions.^22,24 These approaches would strengthen the evidence base for optimizing TE in dental education.

Actionable steps for stakeholders emerge from these insights. Institutions should enhance digital infrastructure to support remote learning and research continuity, mitigating future disruptions as seen during COVID-19.^23,28 Policymakers could standardize TE metrics within regional accreditation frameworks, fostering consistency across Latin America.^7,8 Specialty-specific support—e.g., tailored supervision for high-TE fields like Periodontics—should be prioritized, alongside incentives for hybrid thesis formats under existing legal provisions.^7,26 Collectively, these measures could optimize TE, aligning educational efficiency with Peru’s scientific and professional development goals.²⁹

In conclusion, this study provides a detailed evaluation of terminal efficiency (TE) among Peruvian university students in second specialty dental programs at a single institution from 2017 to 2023. Most students achieved TE within one year, with a mean completion time under one year, though significant variations emerged across submission years and dental specialties. Temporal analysis revealed that the year of document submission significantly influenced mean TE, with longer completion times in later years, particularly post-2020, likely reflecting the impact of the COVID-19 pandemic. Specialty-specific differences were also pronounced, with some programs demonstrating markedly shorter completion times than others, suggesting variations in research complexity or resource demands. In contrast, neither the mode of document preparation nor sex significantly affected TE, indicating that these factors may not be primary drivers of efficiency in this context.

These findings highlight the resilience of the studied postgraduate framework amidst external disruptions, while identifying areas for improvement, such as specialty-specific support to address prolonged completion times and can guide targeted interventions to optimize postgraduate dental education, supporting Peru’s goals for advancing health sciences training.

Ethical considerations

The study protocol was approved by the UPCH Institutional Research Ethics Committee (ethics file CONSTANCIA-CIEI-428-39-23, approved on October 2, 2023). All extraction and cleaning processes adhered to ethical guidelines, using anonymized data from public repository sources.

Consent to participate

Consent to participate was not required, due to the study used secondary data, which was anonymized, ensuring that such modification does not distort the scientific meaning of the information. An accredited committee, the Universidad Peruana Cayetano Heredia Institutional Research Ethics Committee approved the study protocol in the “Exempt” category, which exempts the study protocol from expedited review and the need for consent to participate because the study uses information that is public in the university’s institutional repository.

Author contributions

Karen Llajaida Cabanillas-Yllesca

Roles: Conceptualization, Methodology

Karla Lucero Avalos-Baltodano

Roles: Investigation, Resources

Roberto A. León-Manco

Roles: Conceptualization, Methodology, Writing – Review & Editing

María Claudia Garcés-Elías

Roles: Conceptualization, Methodology, Writing – Review & Editing

Cesar D. Rojas-Senador

Roles: Data Curation, Formal Analysis, Investigation, Writing – Review & Editing

Data availability

Zenodo: Terminal efficiency of Peruvian university students in the second specialty programs of a dental school over seven years - Dataset. https://doi.org/10.5281/zenodo.13901816.³⁰

The project contains the following underlying data:

• Dataset-Terminal efficiency.xls. (Anonymised and codified data, with legend).

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

Reporting guidelines

Zenodo: STROBE checklist for “Terminal efficiency of Peruvian university students in the second specialty programs of a dental school over seven years”. https://doi.org/10.5281/zenodo.13939895.³¹

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

Acknowledgements

Authors would like to thank the Facultad de Estomatología de la Universidad Peruana Cayetano Heredia (UPCH) for covering the article processing costs (APC).

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Version 2

VERSION 2 PUBLISHED 31 Oct 2024

Author details Author details

¹ Facultad de Estomatología, Universidad Peruana Cayetano Heredia, Lima, Peru

Karen Llajaida Cabanillas-Yllesca
Roles: Conceptualization, Methodology

Karla Lucero Avalos-Baltodano
Roles: Investigation, Resources

Roberto A. León-Manco
Roles: Conceptualization, Methodology, Writing – Review & Editing

María Claudia Garcés-Elías
Roles: Conceptualization, Methodology, Writing – Review & Editing

Cesar D. Rojas-Senador
Roles: Data Curation, Formal Analysis, Investigation, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

Article Versions (2)

version 2

Revised

Published: 09 May 2025, 13:1307

https://doi.org/10.12688/f1000research.157705.2

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Published: 31 Oct 2024, 13:1307

https://doi.org/10.12688/f1000research.157705.1

© 2025 Cabanillas-Yllesca KL et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Cabanillas-Yllesca KL, Avalos-Baltodano KL, León-Manco RA et al. Terminal efficiency of Peruvian university students in the second specialty programs of a dental school over seven years [version 2; peer review: 2 approved]. F1000Research 2025, 13:1307 (https://doi.org/10.12688/f1000research.157705.2)

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Open Peer Review

Version 2

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PUBLISHED 09 May 2025

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Reviewer Report 29 May 2025

Dharmashree Satyarup, Department of Public Health Dentistry, Institute of Dental Sciences, Siksha ‘O’ Anusandhan (Deemed to be University), Bhubaneswar, Odisha, India

Manish Kumar, GITAM, Visakhapatnam, Andhra Pradesh, India

Approved

https://doi.org/10.5256/f1000research.181537.r385055

The manuscript is clearly and accurately presented. The authors have structured the work in a coherent and logical manner, allowing the reader to follow the progression of the study with ease.
The study design is cross-sectional but backed by relevant regression analysis to demonstrate the associations.
Sufficient methodological details are provided to allow for independent replication of the study.
The statistical analyses employed in the study are appropriate for the type and scale of data collected. The authors provide clear explanations of the statistical methods used, including the rationale for their selection.
The conclusions drawn are well-supported by the results. The authors provide a balanced discussion, considering the implications of their findings within the context of the field, and recommendations are stated based on the findings of the study conducted for relevant stakeholders.

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Oral health promotion, oral health education, prevention

We confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Reviewer Report 16 May 2025

Avita Rath, SEGi University, Kota Damansara, Malaysia

Approved

https://doi.org/10.5256/f1000research.181537.r383879

I appreciate the authors' comprehensive effort to revise the manuscript in accordance with the earlier peer review. The improvements in methodological transparency, statistical rationale, and contextual analysis are commendable. The enhanced clarity in the Introduction and Discussion, inclusion of multivariate ... Continue reading

The Methods section is now much more replicable, with clear articulation of the data extraction, cleaning, verification, and statistical procedures.
The Discussion more thoroughly addresses the implications of COVID-19, specialty-specific disparities, and cross-regional relevance.
The Conclusions are appropriately tempered to reflect the exploratory nature of the study and now align better with the presented data.

The revisions align with the earlier recommendations, and I find the current version suitable for indexing.

Competing Interests: No competing interests were disclosed.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Reviewer Report 12 Feb 2025

Avita Rath, SEGi University, Kota Damansara, Malaysia

Approved with Reservations

https://doi.org/10.5256/f1000research.173196.r365454

Summary of the Article:
This study evaluates the terminal efficiency (TE) of Peruvian university students enrolled in second specialty programs at a dental school over a seven-year period (2017-2023). Using a cross-sectional design, the authors analyzed all available records from the institutional repository of Universidad Peruana Cayetano Heredia. Terminal efficiency was assessed both quantitatively (mean TE in years) and qualitatively (categorized TE as “Up to 1 year” or “2 years or more”). The study utilized descriptive statistics and bivariate analyses (Chi-square, Mann-Whitney U, and Kruskal-Wallis tests) to explore associations between TE and variables such as year of document submission, mode of document preparation, dental specialty, and sex.

Overall Assessment:
The study addresses a relevant topic in dental education, particularly the efficiency of postgraduate programs. While the article is generally well-structured and the data are publicly available, several aspects of the methodology, statistical analysis, and interpretation require clarification and refinement to ensure the study is scientifically sound.

1. Clarity and Accuracy of Presentation (Partly)

The manuscript is generally clear but could benefit from simplifying some complex sentences in the Introduction and Discussion sections to enhance readability.
The Results section is dense with data, and incorporating more visual aids (e.g., graphs, detailed tables) would improve clarity and help readers better interpret the findings.
While relevant literature is cited, the manuscript would benefit from including more recent international studies on terminal efficiency in postgraduate dental education to broaden its context.

Recommendations:

Simplify overly complex sentences and enhance the flow of the Introduction and Discussion.
Add more visual elements to the Results section to present key findings more effectively.
Incorporate recent international studies to strengthen the literature review.

2. Study Design and Technical Soundness (Partly)

The cross-sectional design is appropriate for the study’s aims, but it inherently limits causal inferences about factors influencing terminal efficiency.
The study includes all available records, reducing selection bias. However, the analysis would be strengthened by incorporating multivariate analysis to control for potential confounders such as specialty, sex, and year of submission.

Recommendations:

Consider performing a multivariate regression analysis to control for confounding variables.
Clearly articulate the limitations of the cross-sectional design in the Discussion.

3. Methods and Replicability (Partly)

While the methods are described in detail, some aspects need further clarification to ensure full replicability:
- The data collection process should be described in more detail, particularly how data were extracted, cleaned, and verified.
- The manuscript should specify how missing data were handled.
- The sensitivity analyses are mentioned but lack detail on the specific procedures used.

Recommendations:

Provide detailed descriptions of the data extraction, cleaning, and verification processes.
Clarify how missing or incomplete data were addressed.
Expand on the sensitivity analyses, including criteria for identifying outliers and how they were handled.

4. Statistical Analysis and Interpretation (Partly)

The use of Chi-square, Mann-Whitney U, and Kruskal-Wallis tests is appropriate for the data; however, the rationale for selecting these tests over others should be explained.
The manuscript focuses on statistical significance but does not discuss effect sizes or the practical significance of the findings.
Post hoc analyses following the Kruskal-Wallis test are not sufficiently detailed.

Recommendations:

Provide a clear rationale for the selection of specific statistical tests.
Include effect sizes and discuss the practical implications of the findings.
Expand on the post hoc analyses, detailing how they were conducted and interpreted.

5. Data Availability and Reproducibility (Yes)

The manuscript meets the F1000Research standard for data availability. The dataset and STROBE checklist are publicly accessible via Zenodo, ensuring reproducibility.

No action required.
6. Conclusions and Support from Results (Partly)

The conclusions are generally supported by the results, particularly regarding the mean terminal efficiency and its variation across specialties and submission years.
However, the conclusions overgeneralize the findings without fully considering the study’s limitations (e.g., single-institution focus, lack of multivariate analysis).
The impact of external factors like COVID-19 is mentioned but not deeply analyzed in relation to the data.

Recommendations:

Temper the conclusions to reflect the exploratory nature of the study and its limitations.
Discuss the practical implications of the findings for educational policy and administration.
Analyze the potential impact of external factors (e.g., COVID-19) more thoroughly.

Final Recommendation:
Approved with Reservations
The study has academic merit and provides valuable insights into terminal efficiency in postgraduate dental education. However, addressing the methodological, statistical, and interpretative issues outlined above is necessary to ensure the manuscript meets the highest standards of scientific rigor.
Thank you for your contributions to the field.

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

Partly
Are sufficient details of methods and analysis provided to allow replication by others?

Partly
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Partly

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Health professional education, DEI, Scholarship of traching and learning, TEL

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Author Response 24 Jun 2025

Cesar David Rojas-Senador, Facultad de Estomatología, Universidad Peruana Cayetano Heredia, Lima, Peru

24 Jun 2025

Author Response
Lima, May 2nd, 2025.

Dear Dr. Avita Rath
Reviewer, F1000 Research

I am writing to greet you and at the same time to ask you to kindly review ... Continue reading
Lima, May 2nd, 2025.

Dear Dr. Avita Rath
Reviewer, F1000 Research

I am writing to greet you and at the same time to ask you to kindly review the document corresponding to the response to comments and recommendations in your Reviewer Report to the Research Article entitled "Terminal efficiency of Peruvian university students in the second specialty programs of a dental school over seven years", according to the following detail:

Clarity and Accuracy of Presentation

Comment: The manuscript is generally clear but could benefit from simplifying some complex sentences in the Introduction and Discussion sections to enhance readability.

Recommendation: Simplify overly complex sentences and enhance the flow of the Introduction and Discussion.

Response: The authors appreciate your feedback regarding the complexity of sentences in the Introduction and Discussion sections. We have revised these sections to simplify overly complex sentences, improve readability, and enhance the overall flow while maintaining scientific rigor.

Comment: The Results section is dense with data, and incorporating more visual aids (e.g., graphs, detailed tables) would improve clarity and help readers better interpret the findings.

Recommendation: Add more visual elements to the Results section to present key findings more effectively.

Response: The authors thank you for your suggestion to enhance the Results section with visual aids. We have added graphs and refined tables to present key findings more clearly and improve readability.

Comment: While relevant literature is cited, the manuscript would benefit from including more recent international studies on terminal efficiency in postgraduate dental education to broaden its context.

Recommendation: Incorporate recent international studies to strengthen the literature review.

Response: The authors appreciate your suggestion to broaden the literature review. We have incorporated recent international studies to enhance the manuscript’s context and relevance.

Study Design and Technical Soundness

Comment: The cross-sectional design is appropriate for the study’s aims, but it inherently limits causal inferences about factors influencing terminal efficiency.

Recommendation: Consider performing a multivariate regression analysis to control for confounding variables.

Response: The authors appreciate your suggestion addressing the limitations of cross-sectional design. We have incorporated a multivariate regression analysis to control for confounding variables, enhancing the robustness of our findings on factors influencing terminal efficiency.

Comment: The study includes all available records, reducing selection bias. However, the analysis would be strengthened by incorporating multivariate analysis to control for potential confounders such as specialty, sex, and year of submission.

Recommendation: Clearly articulate the limitations of the cross-sectional design in the Discussion.

Response: The authors thank you for your suggestion to enhance the analysis with multivariate regression and clarify limitations. We have added multivariate regression analyses to control for confounders and revised the Discussion to explicitly address the cross-sectional design’s limitations.

Methods and Replicability

Comment: The data collection process should be described in more detail, particularly how data were extracted, cleaned, and verified.

Recommendation: Provide detailed descriptions of the data extraction, cleaning, and verification processes.

Response: The authors appreciate your request for a more detailed description of the data collection process. We have revised the Methods section to provide comprehensive details on data extraction, cleaning, and verification processes, ensuring transparency and reproducibility.

Comment: The manuscript should specify how missing data were handled.

Recommendation: Clarify how missing or incomplete data were addressed.

Response: The authors thank you for your request to clarify the handling of the missing data. We have revised the Methods section to explicitly state that no missing or incomplete data were encountered, as all 258 records met the inclusion criteria, ensuring a complete dataset.

Comment: The sensitivity analyses are mentioned but lack detail on the specific procedures used.

Recommendation: Expand on the sensitivity analyses, including criteria for identifying outliers and how they were handled.

Response: The authors appreciate your request for detailed sensitivity analyses. We have revised the Methods and Results sections to clarify that one outlier was removed and to describe sensitivity analyses conducted, including logarithmic transformation and model robustness checks for the multivariate regressions.

Statistical Analysis and Interpretation

Comment: The use of Chi-square, Mann-Whitney U, and Kruskal-Wallis tests is appropriate for the data; however, the rationale for selecting these tests over others should be explained.

Recommendation: Provide a clear rationale for the selection of specific statistical tests.
Response: The authors appreciate your suggestion to clarify the rationale for statistical test selection. We have revised the Methods section to explicitly justify the use of Chi-square, Mann-Whitney U, and Kruskal-Wallis tests based on data characteristics and study design.

Comment: The manuscript focuses on statistical significance but does not discuss effect sizes or the practical significance of the findings.

Recommendation: Include effect sizes and discuss the practical implications of the findings.

Response: The authors appreciate your suggestion addressing effect sizes and practical significance. We have revised the Results section to include effect sizes for statistical tests and regressions and updated the Discussion to highlight the practical implications of the findings.

Comment: Post hoc analyses following the Kruskal-Wallis test are not sufficiently detailed.

Recommendation: Expand on the post hoc analyses, detailing how they were conducted and interpreted.

Response: The authors appreciate your request for more details on post hoc analyses following the Kruskal-Wallis test. We have revised the Methods and Results sections to clearly describe the post hoc Mann-Whitney U tests, including their execution and interpretation.

Conclusions and Support from Results

Comment: The conclusions are generally supported by the results, particularly regarding the mean terminal efficiency and its variation across specialties and submission years.

Recommendation: Temper the conclusions to reflect the exploratory nature of the study and its limitations.

Response: The authors appreciate your feedback on the conclusions’ alignment with the results and your suggestion to temper them. We have revised the Conclusions section to reflect the exploratory nature of the study and its limitations, emphasizing the preliminary insights on terminal efficiency variations.

Comment: However, the conclusions overgeneralize the findings without fully considering the study’s limitations (e.g., single-institution focus, lack of multivariate analysis).

Recommendations: Discuss the practical implications of the findings for educational policy and administration.

Response: The authors thank you for noting the need to address overgeneralization and discuss practical implications. We have revised the Conclusions to acknowledge the single-institution focus and incorporated multivariate analysis, while adding a Discussion subsection on practical implications for educational policy and administration.

Comment: The impact of external factors like COVID-19 is mentioned but not deeply analyzed in relation to the data.

Recommendation: Analyze the potential impact of external factors (e.g., COVID-19) more thoroughly.

Response: The authors thank you for highlighting the need for a deeper analysis of external factors like COVID-19. We have revised the Discussion to thoroughly analyze the potential impact of COVID-19 and other external factors on terminal efficiency, supported by data trends.

Kind regards,

Corresponding Author
Lima, May 2nd, 2025.

Dear Dr. Avita Rath
Reviewer, F1000 Research

I am writing to greet you and at the same time to ask you to kindly review the document corresponding to the response to comments and recommendations in your Reviewer Report to the Research Article entitled "Terminal efficiency of Peruvian university students in the second specialty programs of a dental school over seven years", according to the following detail:

Clarity and Accuracy of Presentation

Comment: The manuscript is generally clear but could benefit from simplifying some complex sentences in the Introduction and Discussion sections to enhance readability.

Recommendation: Simplify overly complex sentences and enhance the flow of the Introduction and Discussion.

Response: The authors appreciate your feedback regarding the complexity of sentences in the Introduction and Discussion sections. We have revised these sections to simplify overly complex sentences, improve readability, and enhance the overall flow while maintaining scientific rigor.

Comment: The Results section is dense with data, and incorporating more visual aids (e.g., graphs, detailed tables) would improve clarity and help readers better interpret the findings.

Recommendation: Add more visual elements to the Results section to present key findings more effectively.

Response: The authors thank you for your suggestion to enhance the Results section with visual aids. We have added graphs and refined tables to present key findings more clearly and improve readability.

Comment: While relevant literature is cited, the manuscript would benefit from including more recent international studies on terminal efficiency in postgraduate dental education to broaden its context.

Recommendation: Incorporate recent international studies to strengthen the literature review.

Response: The authors appreciate your suggestion to broaden the literature review. We have incorporated recent international studies to enhance the manuscript’s context and relevance.

Study Design and Technical Soundness

Comment: The cross-sectional design is appropriate for the study’s aims, but it inherently limits causal inferences about factors influencing terminal efficiency.

Recommendation: Consider performing a multivariate regression analysis to control for confounding variables.

Response: The authors appreciate your suggestion addressing the limitations of cross-sectional design. We have incorporated a multivariate regression analysis to control for confounding variables, enhancing the robustness of our findings on factors influencing terminal efficiency.

Comment: The study includes all available records, reducing selection bias. However, the analysis would be strengthened by incorporating multivariate analysis to control for potential confounders such as specialty, sex, and year of submission.

Recommendation: Clearly articulate the limitations of the cross-sectional design in the Discussion.

Response: The authors thank you for your suggestion to enhance the analysis with multivariate regression and clarify limitations. We have added multivariate regression analyses to control for confounders and revised the Discussion to explicitly address the cross-sectional design’s limitations.

Methods and Replicability

Comment: The data collection process should be described in more detail, particularly how data were extracted, cleaned, and verified.

Recommendation: Provide detailed descriptions of the data extraction, cleaning, and verification processes.

Response: The authors appreciate your request for a more detailed description of the data collection process. We have revised the Methods section to provide comprehensive details on data extraction, cleaning, and verification processes, ensuring transparency and reproducibility.

Comment: The manuscript should specify how missing data were handled.

Recommendation: Clarify how missing or incomplete data were addressed.

Response: The authors thank you for your request to clarify the handling of the missing data. We have revised the Methods section to explicitly state that no missing or incomplete data were encountered, as all 258 records met the inclusion criteria, ensuring a complete dataset.

Comment: The sensitivity analyses are mentioned but lack detail on the specific procedures used.

Recommendation: Expand on the sensitivity analyses, including criteria for identifying outliers and how they were handled.

Response: The authors appreciate your request for detailed sensitivity analyses. We have revised the Methods and Results sections to clarify that one outlier was removed and to describe sensitivity analyses conducted, including logarithmic transformation and model robustness checks for the multivariate regressions.

Statistical Analysis and Interpretation

Comment: The use of Chi-square, Mann-Whitney U, and Kruskal-Wallis tests is appropriate for the data; however, the rationale for selecting these tests over others should be explained.

Recommendation: Provide a clear rationale for the selection of specific statistical tests.
Response: The authors appreciate your suggestion to clarify the rationale for statistical test selection. We have revised the Methods section to explicitly justify the use of Chi-square, Mann-Whitney U, and Kruskal-Wallis tests based on data characteristics and study design.

Comment: The manuscript focuses on statistical significance but does not discuss effect sizes or the practical significance of the findings.

Recommendation: Include effect sizes and discuss the practical implications of the findings.

Response: The authors appreciate your suggestion addressing effect sizes and practical significance. We have revised the Results section to include effect sizes for statistical tests and regressions and updated the Discussion to highlight the practical implications of the findings.

Comment: Post hoc analyses following the Kruskal-Wallis test are not sufficiently detailed.

Recommendation: Expand on the post hoc analyses, detailing how they were conducted and interpreted.

Response: The authors appreciate your request for more details on post hoc analyses following the Kruskal-Wallis test. We have revised the Methods and Results sections to clearly describe the post hoc Mann-Whitney U tests, including their execution and interpretation.

Conclusions and Support from Results

Comment: The conclusions are generally supported by the results, particularly regarding the mean terminal efficiency and its variation across specialties and submission years.

Recommendation: Temper the conclusions to reflect the exploratory nature of the study and its limitations.

Response: The authors appreciate your feedback on the conclusions’ alignment with the results and your suggestion to temper them. We have revised the Conclusions section to reflect the exploratory nature of the study and its limitations, emphasizing the preliminary insights on terminal efficiency variations.

Comment: However, the conclusions overgeneralize the findings without fully considering the study’s limitations (e.g., single-institution focus, lack of multivariate analysis).

Recommendations: Discuss the practical implications of the findings for educational policy and administration.

Response: The authors thank you for noting the need to address overgeneralization and discuss practical implications. We have revised the Conclusions to acknowledge the single-institution focus and incorporated multivariate analysis, while adding a Discussion subsection on practical implications for educational policy and administration.

Comment: The impact of external factors like COVID-19 is mentioned but not deeply analyzed in relation to the data.

Recommendation: Analyze the potential impact of external factors (e.g., COVID-19) more thoroughly.

Response: The authors thank you for highlighting the need for a deeper analysis of external factors like COVID-19. We have revised the Discussion to thoroughly analyze the potential impact of COVID-19 and other external factors on terminal efficiency, supported by data trends.

Kind regards,

Corresponding Author
Competing Interests: None. Close
Report a concern
Respond or Comment

COMMENTS ON THIS REPORT

Author Response 24 Jun 2025

Cesar David Rojas-Senador, Facultad de Estomatología, Universidad Peruana Cayetano Heredia, Lima, Peru

24 Jun 2025

Author Response
Lima, May 2nd, 2025.

Dear Dr. Avita Rath
Reviewer, F1000 Research

I am writing to greet you and at the same time to ask you to kindly review ... Continue reading
Lima, May 2nd, 2025.

Dear Dr. Avita Rath
Reviewer, F1000 Research

I am writing to greet you and at the same time to ask you to kindly review the document corresponding to the response to comments and recommendations in your Reviewer Report to the Research Article entitled "Terminal efficiency of Peruvian university students in the second specialty programs of a dental school over seven years", according to the following detail:

Clarity and Accuracy of Presentation

Comment: The manuscript is generally clear but could benefit from simplifying some complex sentences in the Introduction and Discussion sections to enhance readability.

Recommendation: Simplify overly complex sentences and enhance the flow of the Introduction and Discussion.

Response: The authors appreciate your feedback regarding the complexity of sentences in the Introduction and Discussion sections. We have revised these sections to simplify overly complex sentences, improve readability, and enhance the overall flow while maintaining scientific rigor.

Comment: The Results section is dense with data, and incorporating more visual aids (e.g., graphs, detailed tables) would improve clarity and help readers better interpret the findings.

Recommendation: Add more visual elements to the Results section to present key findings more effectively.

Response: The authors thank you for your suggestion to enhance the Results section with visual aids. We have added graphs and refined tables to present key findings more clearly and improve readability.

Comment: While relevant literature is cited, the manuscript would benefit from including more recent international studies on terminal efficiency in postgraduate dental education to broaden its context.

Recommendation: Incorporate recent international studies to strengthen the literature review.

Response: The authors appreciate your suggestion to broaden the literature review. We have incorporated recent international studies to enhance the manuscript’s context and relevance.

Study Design and Technical Soundness

Comment: The cross-sectional design is appropriate for the study’s aims, but it inherently limits causal inferences about factors influencing terminal efficiency.

Recommendation: Consider performing a multivariate regression analysis to control for confounding variables.

Response: The authors appreciate your suggestion addressing the limitations of cross-sectional design. We have incorporated a multivariate regression analysis to control for confounding variables, enhancing the robustness of our findings on factors influencing terminal efficiency.

Comment: The study includes all available records, reducing selection bias. However, the analysis would be strengthened by incorporating multivariate analysis to control for potential confounders such as specialty, sex, and year of submission.

Recommendation: Clearly articulate the limitations of the cross-sectional design in the Discussion.

Response: The authors thank you for your suggestion to enhance the analysis with multivariate regression and clarify limitations. We have added multivariate regression analyses to control for confounders and revised the Discussion to explicitly address the cross-sectional design’s limitations.

Methods and Replicability

Comment: The data collection process should be described in more detail, particularly how data were extracted, cleaned, and verified.

Recommendation: Provide detailed descriptions of the data extraction, cleaning, and verification processes.

Response: The authors appreciate your request for a more detailed description of the data collection process. We have revised the Methods section to provide comprehensive details on data extraction, cleaning, and verification processes, ensuring transparency and reproducibility.

Comment: The manuscript should specify how missing data were handled.

Recommendation: Clarify how missing or incomplete data were addressed.

Response: The authors thank you for your request to clarify the handling of the missing data. We have revised the Methods section to explicitly state that no missing or incomplete data were encountered, as all 258 records met the inclusion criteria, ensuring a complete dataset.

Comment: The sensitivity analyses are mentioned but lack detail on the specific procedures used.

Recommendation: Expand on the sensitivity analyses, including criteria for identifying outliers and how they were handled.

Response: The authors appreciate your request for detailed sensitivity analyses. We have revised the Methods and Results sections to clarify that one outlier was removed and to describe sensitivity analyses conducted, including logarithmic transformation and model robustness checks for the multivariate regressions.

Statistical Analysis and Interpretation

Comment: The use of Chi-square, Mann-Whitney U, and Kruskal-Wallis tests is appropriate for the data; however, the rationale for selecting these tests over others should be explained.

Recommendation: Provide a clear rationale for the selection of specific statistical tests.
Response: The authors appreciate your suggestion to clarify the rationale for statistical test selection. We have revised the Methods section to explicitly justify the use of Chi-square, Mann-Whitney U, and Kruskal-Wallis tests based on data characteristics and study design.

Comment: The manuscript focuses on statistical significance but does not discuss effect sizes or the practical significance of the findings.

Recommendation: Include effect sizes and discuss the practical implications of the findings.

Response: The authors appreciate your suggestion addressing effect sizes and practical significance. We have revised the Results section to include effect sizes for statistical tests and regressions and updated the Discussion to highlight the practical implications of the findings.

Comment: Post hoc analyses following the Kruskal-Wallis test are not sufficiently detailed.

Recommendation: Expand on the post hoc analyses, detailing how they were conducted and interpreted.

Response: The authors appreciate your request for more details on post hoc analyses following the Kruskal-Wallis test. We have revised the Methods and Results sections to clearly describe the post hoc Mann-Whitney U tests, including their execution and interpretation.

Conclusions and Support from Results

Comment: The conclusions are generally supported by the results, particularly regarding the mean terminal efficiency and its variation across specialties and submission years.

Recommendation: Temper the conclusions to reflect the exploratory nature of the study and its limitations.

Response: The authors appreciate your feedback on the conclusions’ alignment with the results and your suggestion to temper them. We have revised the Conclusions section to reflect the exploratory nature of the study and its limitations, emphasizing the preliminary insights on terminal efficiency variations.

Comment: However, the conclusions overgeneralize the findings without fully considering the study’s limitations (e.g., single-institution focus, lack of multivariate analysis).

Recommendations: Discuss the practical implications of the findings for educational policy and administration.

Response: The authors thank you for noting the need to address overgeneralization and discuss practical implications. We have revised the Conclusions to acknowledge the single-institution focus and incorporated multivariate analysis, while adding a Discussion subsection on practical implications for educational policy and administration.

Comment: The impact of external factors like COVID-19 is mentioned but not deeply analyzed in relation to the data.

Recommendation: Analyze the potential impact of external factors (e.g., COVID-19) more thoroughly.

Response: The authors thank you for highlighting the need for a deeper analysis of external factors like COVID-19. We have revised the Discussion to thoroughly analyze the potential impact of COVID-19 and other external factors on terminal efficiency, supported by data trends.

Kind regards,

Corresponding Author
Lima, May 2nd, 2025.

Dear Dr. Avita Rath
Reviewer, F1000 Research

I am writing to greet you and at the same time to ask you to kindly review the document corresponding to the response to comments and recommendations in your Reviewer Report to the Research Article entitled "Terminal efficiency of Peruvian university students in the second specialty programs of a dental school over seven years", according to the following detail:

Clarity and Accuracy of Presentation

Comment: The manuscript is generally clear but could benefit from simplifying some complex sentences in the Introduction and Discussion sections to enhance readability.

Recommendation: Simplify overly complex sentences and enhance the flow of the Introduction and Discussion.

Response: The authors appreciate your feedback regarding the complexity of sentences in the Introduction and Discussion sections. We have revised these sections to simplify overly complex sentences, improve readability, and enhance the overall flow while maintaining scientific rigor.

Comment: The Results section is dense with data, and incorporating more visual aids (e.g., graphs, detailed tables) would improve clarity and help readers better interpret the findings.

Recommendation: Add more visual elements to the Results section to present key findings more effectively.

Response: The authors thank you for your suggestion to enhance the Results section with visual aids. We have added graphs and refined tables to present key findings more clearly and improve readability.

Comment: While relevant literature is cited, the manuscript would benefit from including more recent international studies on terminal efficiency in postgraduate dental education to broaden its context.

Recommendation: Incorporate recent international studies to strengthen the literature review.

Response: The authors appreciate your suggestion to broaden the literature review. We have incorporated recent international studies to enhance the manuscript’s context and relevance.

Study Design and Technical Soundness

Comment: The cross-sectional design is appropriate for the study’s aims, but it inherently limits causal inferences about factors influencing terminal efficiency.

Recommendation: Consider performing a multivariate regression analysis to control for confounding variables.

Response: The authors appreciate your suggestion addressing the limitations of cross-sectional design. We have incorporated a multivariate regression analysis to control for confounding variables, enhancing the robustness of our findings on factors influencing terminal efficiency.

Comment: The study includes all available records, reducing selection bias. However, the analysis would be strengthened by incorporating multivariate analysis to control for potential confounders such as specialty, sex, and year of submission.

Recommendation: Clearly articulate the limitations of the cross-sectional design in the Discussion.

Response: The authors thank you for your suggestion to enhance the analysis with multivariate regression and clarify limitations. We have added multivariate regression analyses to control for confounders and revised the Discussion to explicitly address the cross-sectional design’s limitations.

Methods and Replicability

Comment: The data collection process should be described in more detail, particularly how data were extracted, cleaned, and verified.

Recommendation: Provide detailed descriptions of the data extraction, cleaning, and verification processes.

Response: The authors appreciate your request for a more detailed description of the data collection process. We have revised the Methods section to provide comprehensive details on data extraction, cleaning, and verification processes, ensuring transparency and reproducibility.

Comment: The manuscript should specify how missing data were handled.

Recommendation: Clarify how missing or incomplete data were addressed.

Response: The authors thank you for your request to clarify the handling of the missing data. We have revised the Methods section to explicitly state that no missing or incomplete data were encountered, as all 258 records met the inclusion criteria, ensuring a complete dataset.

Comment: The sensitivity analyses are mentioned but lack detail on the specific procedures used.

Recommendation: Expand on the sensitivity analyses, including criteria for identifying outliers and how they were handled.

Response: The authors appreciate your request for detailed sensitivity analyses. We have revised the Methods and Results sections to clarify that one outlier was removed and to describe sensitivity analyses conducted, including logarithmic transformation and model robustness checks for the multivariate regressions.

Statistical Analysis and Interpretation

Comment: The use of Chi-square, Mann-Whitney U, and Kruskal-Wallis tests is appropriate for the data; however, the rationale for selecting these tests over others should be explained.

Recommendation: Provide a clear rationale for the selection of specific statistical tests.
Response: The authors appreciate your suggestion to clarify the rationale for statistical test selection. We have revised the Methods section to explicitly justify the use of Chi-square, Mann-Whitney U, and Kruskal-Wallis tests based on data characteristics and study design.

Comment: The manuscript focuses on statistical significance but does not discuss effect sizes or the practical significance of the findings.

Recommendation: Include effect sizes and discuss the practical implications of the findings.

Response: The authors appreciate your suggestion addressing effect sizes and practical significance. We have revised the Results section to include effect sizes for statistical tests and regressions and updated the Discussion to highlight the practical implications of the findings.

Comment: Post hoc analyses following the Kruskal-Wallis test are not sufficiently detailed.

Recommendation: Expand on the post hoc analyses, detailing how they were conducted and interpreted.

Response: The authors appreciate your request for more details on post hoc analyses following the Kruskal-Wallis test. We have revised the Methods and Results sections to clearly describe the post hoc Mann-Whitney U tests, including their execution and interpretation.

Conclusions and Support from Results

Comment: The conclusions are generally supported by the results, particularly regarding the mean terminal efficiency and its variation across specialties and submission years.

Recommendation: Temper the conclusions to reflect the exploratory nature of the study and its limitations.

Response: The authors appreciate your feedback on the conclusions’ alignment with the results and your suggestion to temper them. We have revised the Conclusions section to reflect the exploratory nature of the study and its limitations, emphasizing the preliminary insights on terminal efficiency variations.

Comment: However, the conclusions overgeneralize the findings without fully considering the study’s limitations (e.g., single-institution focus, lack of multivariate analysis).

Recommendations: Discuss the practical implications of the findings for educational policy and administration.

Response: The authors thank you for noting the need to address overgeneralization and discuss practical implications. We have revised the Conclusions to acknowledge the single-institution focus and incorporated multivariate analysis, while adding a Discussion subsection on practical implications for educational policy and administration.

Comment: The impact of external factors like COVID-19 is mentioned but not deeply analyzed in relation to the data.

Recommendation: Analyze the potential impact of external factors (e.g., COVID-19) more thoroughly.

Response: The authors thank you for highlighting the need for a deeper analysis of external factors like COVID-19. We have revised the Discussion to thoroughly analyze the potential impact of COVID-19 and other external factors on terminal efficiency, supported by data trends.

Kind regards,

Corresponding Author
Competing Interests: None. Close
Report a concern

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Version 2

VERSION 2 PUBLISHED 31 Oct 2024

Open Peer Review

Reviewer Status

Reviewer Reports

	Invited Reviewers
	1	2
Version 2 (revision) 09 May 25	read	read
Version 1 31 Oct 24	read

Avita Rath, SEGi University, Kota Damansara, Malaysia
Dharmashree Satyarup, Siksha ‘O’ Anusandhan (Deemed to be University), Bhubaneswar, India

Manish Kumar, GITAM, Visakhapatnam, India

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Reviewer Report

4 Views

29 May 2025 | for Version 2

Dharmashree Satyarup, Department of Public Health Dentistry, Institute of Dental Sciences, Siksha ‘O’ Anusandhan (Deemed to be University), Bhubaneswar, Odisha, India

Manish Kumar, GITAM, Visakhapatnam, Andhra Pradesh, India

4 Views Cite this report Responses(0)

Approved

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Oral health promotion, oral health education, prevention

We confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Reviewer Report

6 Views

16 May 2025 | for Version 2

Avita Rath, SEGi University, Kota Damansara, Malaysia

6 Views Cite this report Responses(0)

Approved

The Methods section is now much more replicable, with clear articulation of the data extraction, cleaning, verification, and statistical procedures.
The Discussion more thoroughly addresses the implications of COVID-19, specialty-specific disparities, and cross-regional relevance.
The Conclusions are appropriately tempered to reflect the exploratory nature of the study and now align better with the presented data.

The revisions align with the earlier recommendations, and I find the current version suitable for indexing.

Competing Interests

No competing interests were disclosed.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Reviewer Report

13 Views

12 Feb 2025 | for Version 1

Avita Rath, SEGi University, Kota Damansara, Malaysia

13 Views Cite this report Responses(1)

Approved With Reservations

The manuscript is generally clear but could benefit from simplifying some complex sentences in the Introduction and Discussion sections to enhance readability.
The Results section is dense with data, and incorporating more visual aids (e.g., graphs, detailed tables) would improve clarity and help readers better interpret the findings.
While relevant literature is cited, the manuscript would benefit from including more recent international studies on terminal efficiency in postgraduate dental education to broaden its context.

Recommendations:

Simplify overly complex sentences and enhance the flow of the Introduction and Discussion.
Add more visual elements to the Results section to present key findings more effectively.
Incorporate recent international studies to strengthen the literature review.

2. Study Design and Technical Soundness (Partly)

The cross-sectional design is appropriate for the study’s aims, but it inherently limits causal inferences about factors influencing terminal efficiency.
The study includes all available records, reducing selection bias. However, the analysis would be strengthened by incorporating multivariate analysis to control for potential confounders such as specialty, sex, and year of submission.

Recommendations:

Consider performing a multivariate regression analysis to control for confounding variables.
Clearly articulate the limitations of the cross-sectional design in the Discussion.

3. Methods and Replicability (Partly)

While the methods are described in detail, some aspects need further clarification to ensure full replicability:
- The data collection process should be described in more detail, particularly how data were extracted, cleaned, and verified.
- The manuscript should specify how missing data were handled.
- The sensitivity analyses are mentioned but lack detail on the specific procedures used.

Recommendations:

Provide detailed descriptions of the data extraction, cleaning, and verification processes.
Clarify how missing or incomplete data were addressed.
Expand on the sensitivity analyses, including criteria for identifying outliers and how they were handled.

4. Statistical Analysis and Interpretation (Partly)

The use of Chi-square, Mann-Whitney U, and Kruskal-Wallis tests is appropriate for the data; however, the rationale for selecting these tests over others should be explained.
The manuscript focuses on statistical significance but does not discuss effect sizes or the practical significance of the findings.
Post hoc analyses following the Kruskal-Wallis test are not sufficiently detailed.

Recommendations:

Provide a clear rationale for the selection of specific statistical tests.
Include effect sizes and discuss the practical implications of the findings.
Expand on the post hoc analyses, detailing how they were conducted and interpreted.

5. Data Availability and Reproducibility (Yes)

The manuscript meets the F1000Research standard for data availability. The dataset and STROBE checklist are publicly accessible via Zenodo, ensuring reproducibility.

No action required.
6. Conclusions and Support from Results (Partly)

The conclusions are generally supported by the results, particularly regarding the mean terminal efficiency and its variation across specialties and submission years.
However, the conclusions overgeneralize the findings without fully considering the study’s limitations (e.g., single-institution focus, lack of multivariate analysis).
The impact of external factors like COVID-19 is mentioned but not deeply analyzed in relation to the data.

Recommendations:

Temper the conclusions to reflect the exploratory nature of the study and its limitations.
Discuss the practical implications of the findings for educational policy and administration.
Analyze the potential impact of external factors (e.g., COVID-19) more thoroughly.

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

Partly
Are sufficient details of methods and analysis provided to allow replication by others?

Partly
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Partly

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Health professional education, DEI, Scholarship of traching and learning, TEL

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Responses (1)

Author Response

24 Jun 2025

Cesar David Rojas-Senador, Facultad de Estomatología, Universidad Peruana Cayetano Heredia, Lima, Peru

Lima, May 2nd, 2025.

Dear Dr. Avita Rath
Reviewer, F1000 Research

I am writing to greet you and at the same time to ask you to kindly review the document corresponding to the response to comments and recommendations in your Reviewer Report to the Research Article entitled "Terminal efficiency of Peruvian university students in the second specialty programs of a dental school over seven years", according to the following detail:

Clarity and Accuracy of Presentation

Comment: The manuscript is generally clear but could benefit from simplifying some complex sentences in the Introduction and Discussion sections to enhance readability.
Recommendation: Simplify overly complex sentences and enhance the flow of the Introduction and Discussion.

Response: The authors appreciate your feedback regarding the complexity of sentences in the Introduction and Discussion sections. We have revised these sections to simplify overly complex sentences, improve readability, and enhance the overall flow while maintaining scientific rigor.

Comment: The Results section is dense with data, and incorporating more visual aids (e.g., graphs, detailed tables) would improve clarity and help readers better interpret the findings.
Recommendation: Add more visual elements to the Results section to present key findings more effectively.

Response: The authors thank you for your suggestion to enhance the Results section with visual aids. We have added graphs and refined tables to present key findings more clearly and improve readability.

Comment: While relevant literature is cited, the manuscript would benefit from including more recent international studies on terminal efficiency in postgraduate dental education to broaden its context.
Recommendation: Incorporate recent international studies to strengthen the literature review.

Response: The authors appreciate your suggestion to broaden the literature review. We have incorporated recent international studies to enhance the manuscript’s context and relevance.

Study Design and Technical Soundness

Comment: The cross-sectional design is appropriate for the study’s aims, but it inherently limits causal inferences about factors influencing terminal efficiency.
Recommendation: Consider performing a multivariate regression analysis to control for confounding variables.

Response: The authors appreciate your suggestion addressing the limitations of cross-sectional design. We have incorporated a multivariate regression analysis to control for confounding variables, enhancing the robustness of our findings on factors influencing terminal efficiency.

Comment: The study includes all available records, reducing selection bias. However, the analysis would be strengthened by incorporating multivariate analysis to control for potential confounders such as specialty, sex, and year of submission.
Recommendation: Clearly articulate the limitations of the cross-sectional design in the Discussion.

Response: The authors thank you for your suggestion to enhance the analysis with multivariate regression and clarify limitations. We have added multivariate regression analyses to control for confounders and revised the Discussion to explicitly address the cross-sectional design’s limitations.

Methods and Replicability

Comment: The data collection process should be described in more detail, particularly how data were extracted, cleaned, and verified.
Recommendation: Provide detailed descriptions of the data extraction, cleaning, and verification processes.

Response: The authors appreciate your request for a more detailed description of the data collection process. We have revised the Methods section to provide comprehensive details on data extraction, cleaning, and verification processes, ensuring transparency and reproducibility.

Comment: The manuscript should specify how missing data were handled.
Recommendation: Clarify how missing or incomplete data were addressed.

Response: The authors thank you for your request to clarify the handling of the missing data. We have revised the Methods section to explicitly state that no missing or incomplete data were encountered, as all 258 records met the inclusion criteria, ensuring a complete dataset.

Comment: The sensitivity analyses are mentioned but lack detail on the specific procedures used.
Recommendation: Expand on the sensitivity analyses, including criteria for identifying outliers and how they were handled.

Response: The authors appreciate your request for detailed sensitivity analyses. We have revised the Methods and Results sections to clarify that one outlier was removed and to describe sensitivity analyses conducted, including logarithmic transformation and model robustness checks for the multivariate regressions.

Statistical Analysis and Interpretation

Comment: The use of Chi-square, Mann-Whitney U, and Kruskal-Wallis tests is appropriate for the data; however, the rationale for selecting these tests over others should be explained.

Recommendation: Provide a clear rationale for the selection of specific statistical tests.
Response: The authors appreciate your suggestion to clarify the rationale for statistical test selection. We have revised the Methods section to explicitly justify the use of Chi-square, Mann-Whitney U, and Kruskal-Wallis tests based on data characteristics and study design.

Comment: The manuscript focuses on statistical significance but does not discuss effect sizes or the practical significance of the findings.
Recommendation: Include effect sizes and discuss the practical implications of the findings.

Response: The authors appreciate your suggestion addressing effect sizes and practical significance. We have revised the Results section to include effect sizes for statistical tests and regressions and updated the Discussion to highlight the practical implications of the findings.

Comment: Post hoc analyses following the Kruskal-Wallis test are not sufficiently detailed.
Recommendation: Expand on the post hoc analyses, detailing how they were conducted and interpreted.

Response: The authors appreciate your request for more details on post hoc analyses following the Kruskal-Wallis test. We have revised the Methods and Results sections to clearly describe the post hoc Mann-Whitney U tests, including their execution and interpretation.

Conclusions and Support from Results

Comment: The conclusions are generally supported by the results, particularly regarding the mean terminal efficiency and its variation across specialties and submission years.
Recommendation: Temper the conclusions to reflect the exploratory nature of the study and its limitations.

Response: The authors appreciate your feedback on the conclusions’ alignment with the results and your suggestion to temper them. We have revised the Conclusions section to reflect the exploratory nature of the study and its limitations, emphasizing the preliminary insights on terminal efficiency variations.

Comment: However, the conclusions overgeneralize the findings without fully considering the study’s limitations (e.g., single-institution focus, lack of multivariate analysis).
Recommendations: Discuss the practical implications of the findings for educational policy and administration.

Response: The authors thank you for noting the need to address overgeneralization and discuss practical implications. We have revised the Conclusions to acknowledge the single-institution focus and incorporated multivariate analysis, while adding a Discussion subsection on practical implications for educational policy and administration.

Comment: The impact of external factors like COVID-19 is mentioned but not deeply analyzed in relation to the data.
Recommendation: Analyze the potential impact of external factors (e.g., COVID-19) more thoroughly.

Response: The authors thank you for highlighting the need for a deeper analysis of external factors like COVID-19. We have revised the Discussion to thoroughly analyze the potential impact of COVID-19 and other external factors on terminal efficiency, supported by data trends.

Kind regards,

Corresponding Author

View more View less

Competing Interests

None.

Alongside their report, reviewers assign a status to the article:

Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions

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Terminal efficiency of Peruvian university students in the second specialty programs of a dental school over seven years

Abstract

Background

Methods

Results:

Conclusion

Keywords

Revised Amendments from Version 1

Introduction

Methods

Study design

Variables

Data collection

Data analysis

Results

Table 1. Categorized terminal efficiency of Peruvian university students in the second professional specialty programs of a dental school over seven years.

Table 2. Mean terminal efficiency of Peruvian university students in the second professional specialty programs of a dental school over seven years.

Figure 1. Categorized terminal efficiency of Peruvian university students in the second professional specialty programs of a dental school by year of formal document submission.

Figure 2. Boxplot of mean terminal efficiency of Peruvian university students in the second professional specialty programs of a dental school by year of formal document submission.

Figure 3. Boxplot of mean terminal efficiency of Peruvian university students over seven years by second professional specialty in dentistry.

Table 3. Multivariate analysis of the categorized terminal efficiency among Peruvian university students in the second professional specialty programs of a dental school over seven years.

Table 4. Multivariate analysis of the mean terminal efficiency among Peruvian university students in the second professional specialty programs of a dental school over seven years.

Discussion

Ethical considerations

Consent to participate

Author contributions

Data availability

Reporting guidelines

Acknowledgements

References

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