Dr Md. Yunus Additional Professor

&Coordinator, Medical Education Unit, NEIGRIHMS, Shillong

PLANNING A THESISFOR POSTGRADUATE MEDICAL STUDENT

&HOW TO WRITE A DISSERTATION

A Dictionary meaning of a Thesis

• The·sis  (thss)n. pl. the·ses (-sz)

• 1. A proposition that is maintained by argument

• 2. A dissertation advancing an original point of view as a result

of research, especially as a requirement for an

academic degree

• 3. A hypothetical proposition, especially one put forth without

proof

• 4. The first stage of the Hegelian dialectic process

“Thesis” & “Dissertation”

• Words “Thesis” & “Dissertation” are used interchangeably

• Thesis is much shorter than Dissertation (1 year versus 3-4 years)

• Thesis & Doctoral Dissertation have different objectives

• Objective of Thesis is to teach & train a PG student in Research

Methodology & in Thesis process is more important than outcome

• Whereas in Doctoral Dissertation (PhD) there is bound to be a

new outcome & it reflects the critical thinking of the candidate on the

research topic

What is Dissertation?

• “A formal, often lengthy treatise or discourse, especially

one written by a candidate for a doctoral degree”

• “It is an exercise to train a PG student to plan, execute,

evaluate, write & report a scientific project”

• “It is an in depth study of a particular topic which

contributes new information & knowledge in the field”

Why to do a Dissertation?

AS FAR AS POST GRADUATE DEGREE COURSE IS

CONCERNED THE TERM

‘DISSERTATION’ IS USED INSTEAD OF ‘THESIS’

As per the guidelines of MCI, many

universities/Institute in India including

NEIGRIHMS have made Dissertation a

mandatory part of PG degree curriculum

Requirements for a PG dissertation

• 1. Competent guide &

• A determined student

• 2. Adequate time

• 3. Instrument, Equipments, Consumable &

Drugs with technical know-how to use them

The Dissertation

• 1. Teaches the fundamentals of Research

Methodology & stimulates interest in research

• 2. Helps to develop scientific attitude

• 3. Teaches to probe in depth of a topic

• 4. Teaches the critical appraisal of the medical

literature

• 5. Encourages to develop special technical skills

The Dissertation Cont..

• 6. Encourages the students to use library & electronic

medical data bases

• 7. Contributes new knowledge

• 8. Teaches publishing of a scientific data

• 9. Satisfies the academic /scientific instincts of PG

students

• 10. Brings about a behavioural change in a student

Role of Postgraduate Students

• They must realize its importance

• Get truly involved in their projects

• Work sincerely & honestly to make use of this best

opportunity of learning

• Wrong notion amongst the students & inability to

relate the need of dissertation with their clinical goal

leads to malpractice like cooking the data, statistics, &

copying from other sources

Role of Guides & Responsibility of Faculty Mentors

• Supervision & guidance of the candidate at all stages of the dissertation

• Helping from all angles to conduct a proper study

• • The faculty mentor should make every effort to orient the student to a

practical problem that can be addressed within the available time

• 1. background of the problem being investigated

• 2. hypothesis that will be examined

• 3. specific aims of the study

• 4. methods that will be used including details of the specific design of the

study

• 5. selected references

Submission of Dissertation Protocol

• It should be submitted at the end of six months after admission in the course

• Protocol in essence should consist of:

• a. Introduction & objectives of the research project

• b. Brief review of literature

• c. Suggested materials and methods, & (scheme of work)

• d. Statistician should be consulted at the time of selection of groups, number

of cases & method of study

• e. References

Where and How to Start?Selection of the topic

• 1). Idea: Invariably comes from the guide

• The guide is an experienced person with the knowledge of

the research

• The limitations of the facilities available in the institution

• Moreover it is a maiden experience for the PG student

Guide for Dissertation

• 1. Chief guide will be from the parent

department

• 2. Co-guide(s) will be from the parent

department or from other disciplines

related to

2) Formulation of Hypothesis

• Hypothesis is nothing but an idea, which is yet to be

proved

• example a Research hypothesis can be formulated

• “Epidural Ketamine in sub-anaesthetic doses provides effective

post operative pain relief following upper abdominal surgeries”

Formulation of Hypothesis Cont..

• ‘Null Hypothesis’: also known as statistical

hypothesis states exactly opposite of the research

hypothesis

• eg: “Epidural Ketamine in subanaestheic doses does

not provide postoperative pain relief following upper

abdominal surgeries”

• Null hypothesis is the one that will be tested by the

statistical significance tests & is either rejected or not

rejected

Useful hints for the selection of a topic:

• 1) Avoid topics on which dissertation has already been carried out in

the previous 5 years, in the same institution

• 2) As far as possible select a topic, which requires minimal help from

other departments (equipments or personnel)

• If unavoidable official appointment of a co-guide from the

collaborating department will be useful

Objectives

• These are more specific & relate directly to research question

• They may be divided into two types:Primary objectives (bound to be achieved)

Secondary objectives (by the way)

Defining an objective

• The objectives have to be simple, clear, precise and should be only

one or two

• Please keep in mind the limitation of available time

• At this stage only vague objective can be formed

• To define a clear objective more information may be needed

• Next thing is to search for available literature on the topic

• A thorough reading of Anaesthesia/Pharmacology textbooks on

Ketamine will be helpful

• The cross reference from the original articles should be gathered

Defining an objective Cont..

• In our example the objective will be:

• “To study the analgesic efficacy of sub-

anaesthetic doses of epidural Ketamine for post

operative pain relief in patients undergoing upper

abdominal surgeries

SMART Objectives• S Specific• M Measurable• A Achievable• R Relevant• T Time-bound

Difference between Aims and Objectives

• There is no real difference between an Aim (Goal) and an

Objective

• Aims point out the general purpose of the study, whereas

Objectives spell out specifically what one intends to do in the

study

• eg: Aim is to study the analgesic efficacy of epidural Ketamine

• Objective is to compare the duration of pain relief, pain score

(VAS) in Ketamine group Vs. Saline (Placebo) group

• In any study objectives must be justifiable & the PG

student must be able to defend them

Doing a Literature Review

Review of Literature (ROL)

• Sources: Books: * Textbooks & Reference books

• * Journals Index Medicus • * Electronic Database: Medline

Literature Review as a Process

ROL reveals

• One should also find out whether similar studies have been

conducted or published elsewhere, to avoid duplication

• Now the objective can be defined with precision

• If the literature search reveals that the idea has already been

tested by many, one has to drop that idea and go for another

one

• If it is found that the other studies have missed an important

aspect, your study can be modified to explore that aspect

PROTOCOL - PROFORMA

• A Proforma consisting of the details of the patient,

details of the methodology, technical details,

observations (in the convenient format for recording),

complications & all the relevant details needed for the

study have to be prepared by the students with, of

course the help of guide/co-guide for approval by

Dissertation committee

Approval by Ethical committee

• Any scientific study epidemiological microbiological,

pharmacological, pathological, clinical, nonclinical which involves

human subjects, requires clearance from ethical committee

• There is no clear line to demarcate what is ethical and what is

non-ethical

• A self-test such as asking oneself - Would I conduct this study on

myself or my child (or parent)

• This is one way of solving this dilemma

• If the answer is ‘yes‘ go ahead & plan the study

Consent & Logbook

• Consent of all Patients enrolled in the study is very

essential

• The Performa are to be Xeroxed and kept ready in the place

of work and one copy is to be utilized for one patient

• A separate logbook for all the cases of the dissertation has

to be maintained by the students

• A logbook is the only document, which can bailout a student

if the credibility of his dissertation is challenged

PILOT STUDYRegistration of the Dissertation

• Once all the requirements for the study are satisfied,

perform the pilot study always in the physical

presence of the guide

• Some or many of the unanticipated difficulties /

problems/ complications may be encountered

EXECUTION - Useful hints

• * Be meticulous in recording the data

• * Interact with the guide/co guide as frequently as possible (at least once

a month)

• * The dissertation team (candidate, guide and co-guide) should meet at

least once in 3 months & quarterly report should be submitted to the

Departmental Dissertation Committee

• * Collection of data should be complete in one year

• * Consult a statistician for scientific analysis of the study including for

calculation of sample size at the beginning of the study itself

• * Six months would sufficient for writing the dissertation

• * Dissertation should be submitted six months prior to the examination as

per University

Details to be worked out before execution

• 1) Study design & methods of elimination of errors, in the study

• 2) Sample size & number of groups

• 3) Inclusion/Exclusion criteria

• 4) Technical details

• 5) Parameters to be measured

• 6) Data collection, organization & analysis

• 7) Statistical methods

Strategies to Eliminate Errors

• Errors may creep into a study at any time, even during interpretation of results

• They can be: • * Random or Systematic • * Due to bias or oversight

• Error elimination can be done by: • * Controls • * Randomization • * Cross over designs • * Placebo • * Blinding

STUDY DESIGNS

• i) Prospective: - Data collected from the follow up of patients/ volunteers over a period of

time. Look forward after the exposure (drug /intervention) to observe the outcome

• ii) Retrospective: Data collected from past records. Look back with the aim of finding a

cause.

• i) Descriptive: - Describe the characteristics of a disease in relation to a person, place or

time. They are mainly epidemiological studies necessary for planning of preventive/ control

/eradication programs

• Three sub types viz. Correlational, Case studies, Cross sectional surveys.

• ii) Analytical: - A hypothesis is tested

• Two sub types –i) Observational (Case Control & Cohort)

• ii) Interventional (Experimental) Clinical trials

SAMPLE SIZE ( SS) • Denotes the number of subjects to

be used in the study

• A correct sample/size is the real

strength of a study, the results of

which can be applied to a population

• Incorrect sample size will lead to

• i) Wrong Conclusion

• ii) Poor quality research

• iii) Wastage of resources & invite

• iv) Ethical problem

• Factors affecting sample size

• 1) Prevalence rate of the factor

• 2) Degree of difference expected

• 3) Degree of variation among

subjects

• 4) Desired level of significances

• 5) Power of the study

• 6) Drop out cases

• 7) Non compliance to treatment

• 8) Resources available

SAMPLE SIZE ( SS) Cont..

• The correct method to calculate the sample size of

a study is to use one of formulae depending upon

type of a study and study design

• One of the commonest formula often used.

• n= 4pq/ d² {n= Sample size, p= Prevalence of a

factor in the population, q= (1-p) / (100-p), d= error

allowed}

ANATOMY OF A DISSERTATION

• * Title

• * Introduction including aims & objectives

• * Review of the literature

• * Material and methods

• * Results

• * Discussion

• * Summary & conclusion

• * References

• * Acknowledgement

• * Certificate

The Title

• It should be concise

• but informative

• short

• active

• & brisk

• No abbreviations are to be used

• The title must indicate in fewest possible words the

• i) objective of the study

• ii) the type of study

• iii) the place where the study was conducted & the duration of the study

Introduction

• Avoid Long preambles in the introduction

• Should answer why did you start?

• The introduction should include (in 200-500 words)

the purpose of the study, the hypothesis being tested

& the methods employed for the study

• Need for the study has to funneled down

• What is known of a topic through What‘s not

known to identify the unexplored aspect of a topic

Review Of Literature

• Strictly pertinent references are to be written

• Critical approach to the reliability of previous work has to

be performed

• A retrospective ramble is boring & so – use your

discrimination in including various studies

• Evolve a consistent theme in the narration

• Avoid data / conclusion from the work being reported, in

the review

Material & Methods

• It should contain that much information (& no

more) for a competent worker to repeat your work

• It should contain sample size, sampling procedure

selection criteria, randomization, blinding if any,

data collection procedure, instrument, &

investigation

Results

• This is usually the shortest part of the dissertation & should precisely

state your findings, analysis plan, statistical measures employed,

confidence interval, level of significance etc

• Present the data wherever possible in the form of

• a) Graphics, histogram, bar diagram, pie chart, frequency polygon

• b) Illustrations

• c) Photographs

Discussion

• The discussion should contain

• i) Present principles, relationships & generalizations shown by

the results

• ii) Point out exceptions or lack of correction

• iii) Indicate agreement or contrast with previously published work

• iv) State the implications of your results

• v) Give reasons for your conclusions

• vi).Mention limitation of your work

• vii).Indicate the scope for further work

The Summary & conclusion

• The summary should concisely describe,

(within 150-200 words)

• i) the problem

• ii) the solution

• iii) the principle conclusion

• In the summary, avoid all experimental details

& references to previous work

References: References should be written in the Vancouver style

• Vancouver Style:

• References are numbered according to their appearance in the

text

• The first author cited in the text is reference number 1 the second

author cited is reference number 2 and so on

• These numbers are written as Superscripts in the text at their

relevant places and enlisted at the end serially

Certificate

• Certificate from

• 1) Self (declaration)

• 2) Guide & Co-guide

• 3) Head of the department must be included in the

dissertation

• The head of the institution must countersign the

dissertation

Submission of thesis

• The thesis shall relate to the

candidate own work on a

specific research problem or a

series of clinical case studies in

accordance with the approved

plan

Evaluation of thesis

• The thesis shall be referred by the University evaluation

to the Examiners appointed by the University

• The examiners will report independently to the Controller

of Examinations and recommend whether the

Dissertation is:

• a) approved

• b) returned for improvements as suggested or

• c) rejected ( reasons for rejection should be detailed)

• The thesis shall be deemed to have been accepted when

it has been approved by a minimum of three examiners;

one internal and two external examiners, who shall not

be the examiners for theory and clinical examinations

Evaluation of thesis Cont..

• The thesis shall be deemed to have been accepted when it has been

approved by at least two examiners

• Where improvements have been suggested by two or more of the

examiners, the candidate shall be required to re-submit the thesis, after

making the requisite improvements for evaluation

• When a thesis is rejected by the examiners, it shall be returned to the

candidate who shall have to write it again

• The second thesis, as and when submitted shall be treated as a fresh

thesis and processed

• Acceptance of thesis submitted by the candidate shall be a pre-condition for

his/her admission to the written, oral and practical/clinical part of the

examination

Acknowledgement

• Acknowledge without fail

• 1) all persons who have helped directly or

indirectly

• 2) source of funds if any

Time management

• Phase—I (0-6 Months)

• •Problem identification

• •Review of Literature

• •Proforma

• •Pilot study

• •Synopsis

• Phase II --- (7-18 Months)

• Data Collection

• Phase III – (19-24 Months)

• Analysis

• Discussion

• Publication

• The thesis or dissertation

certainly has an impact on

that future

• Trying to figure out how

your topic will help or hurt

is the most time-

consuming part of

narrowing down the

choices

Has thesis has any impact on your future ???

• Some guides / mentors are too adamant,

stick to their outdated knowledge

creating conflicts in selecting the topics

and completing the thesis.

• Choose modern topics which can serve

your progress in your career

• Best option remains with guides, advisers &

mentors, every research is a progress in

Science

• By repeating a grand old ideas will

stagnate departments

•

Go forward with research – be a master of future rather than creating conflicts

Do not get disappointed if your thesis cannot meet the academic standards

Our research in medicine is uncertain do not plan thesis for explosive ideas

Books for Further Readings

• A practical approach to PG dissertation by R. Raveendran. Jay pee Publishers, 1997.

• WHO Health Research Methodology ; A guide for training in Research Methods.

• Oxford University press 1993.

• International committee of Medical Journal Editors. Uniform requirements for

• Manuscripts submitted to biomedical journals. N.Eng. J Med; 324: 424-8‖ 22

• An Epidemiologic Approach to Reproductive Health. CDC Atlanta, Georgia,

• USA World Health Organization Geneva, Switawrland. Editor Phyllis. A Wingo

• & others. 1994.

Created by Dr Md. Yunusfor Learning & Development of Post Graduate Medical Student

Email: drmdyunus@hotmail.com

Web: www.neigrihms.nic.in