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How to Write a Conclusion for Research Papers (with Examples)

The conclusion of a research paper is a crucial section that plays a significant role in the overall impact and effectiveness of your research paper. However, this is also the section that typically receives less attention compared to the introduction and the body of the paper. The conclusion serves to provide a concise summary of the key findings, their significance, their implications, and a sense of closure to the study. Discussing how can the findings be applied in real-world scenarios or inform policy, practice, or decision-making is especially valuable to practitioners and policymakers. The research paper conclusion also provides researchers with clear insights and valuable information for their own work, which they can then build on and contribute to the advancement of knowledge in the field.

The research paper conclusion should explain the significance of your findings within the broader context of your field. It restates how your results contribute to the existing body of knowledge and whether they confirm or challenge existing theories or hypotheses. Also, by identifying unanswered questions or areas requiring further investigation, your awareness of the broader research landscape can be demonstrated.

Remember to tailor the research paper conclusion to the specific needs and interests of your intended audience, which may include researchers, practitioners, policymakers, or a combination of these.

Table of Contents

What is a conclusion in a research paper, summarizing conclusion, editorial conclusion, externalizing conclusion, importance of a good research paper conclusion, how to write a conclusion for your research paper, research paper conclusion examples.

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Frequently Asked Questions

A conclusion in a research paper is the final section where you summarize and wrap up your research, presenting the key findings and insights derived from your study. The research paper conclusion is not the place to introduce new information or data that was not discussed in the main body of the paper. When working on how to conclude a research paper, remember to stick to summarizing and interpreting existing content. The research paper conclusion serves the following purposes: 1

• Warn readers of the possible consequences of not attending to the problem.
• Recommend specific course(s) of action.
• Restate key ideas to drive home the ultimate point of your research paper.
• Provide a “take-home” message that you want the readers to remember about your study.

Types of conclusions for research papers

In research papers, the conclusion provides closure to the reader. The type of research paper conclusion you choose depends on the nature of your study, your goals, and your target audience. I provide you with three common types of conclusions:

A summarizing conclusion is the most common type of conclusion in research papers. It involves summarizing the main points, reiterating the research question, and restating the significance of the findings. This common type of research paper conclusion is used across different disciplines.

An editorial conclusion is less common but can be used in research papers that are focused on proposing or advocating for a particular viewpoint or policy. It involves presenting a strong editorial or opinion based on the research findings and offering recommendations or calls to action.

An externalizing conclusion is a type of conclusion that extends the research beyond the scope of the paper by suggesting potential future research directions or discussing the broader implications of the findings. This type of conclusion is often used in more theoretical or exploratory research papers.

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The conclusion in a research paper serves several important purposes:

• Offers Implications and Recommendations : Your research paper conclusion is an excellent place to discuss the broader implications of your research and suggest potential areas for further study. It’s also an opportunity to offer practical recommendations based on your findings.
• Provides Closure : A good research paper conclusion provides a sense of closure to your paper. It should leave the reader with a feeling that they have reached the end of a well-structured and thought-provoking research project.
• Leaves a Lasting Impression : Writing a well-crafted research paper conclusion leaves a lasting impression on your readers. It’s your final opportunity to leave them with a new idea, a call to action, or a memorable quote.

Writing a strong conclusion for your research paper is essential to leave a lasting impression on your readers. Here’s a step-by-step process to help you create and know what to put in the conclusion of a research paper: 2

• Research Statement : Begin your research paper conclusion by restating your research statement. This reminds the reader of the main point you’ve been trying to prove throughout your paper. Keep it concise and clear.
• Key Points : Summarize the main arguments and key points you’ve made in your paper. Avoid introducing new information in the research paper conclusion. Instead, provide a concise overview of what you’ve discussed in the body of your paper.
• Address the Research Questions : If your research paper is based on specific research questions or hypotheses, briefly address whether you’ve answered them or achieved your research goals. Discuss the significance of your findings in this context.
• Significance : Highlight the importance of your research and its relevance in the broader context. Explain why your findings matter and how they contribute to the existing knowledge in your field.
• Implications : Explore the practical or theoretical implications of your research. How might your findings impact future research, policy, or real-world applications? Consider the “so what?” question.
• Future Research : Offer suggestions for future research in your area. What questions or aspects remain unanswered or warrant further investigation? This shows that your work opens the door for future exploration.
• Closing Thought : Conclude your research paper conclusion with a thought-provoking or memorable statement. This can leave a lasting impression on your readers and wrap up your paper effectively. Avoid introducing new information or arguments here.
• Proofread and Revise : Carefully proofread your conclusion for grammar, spelling, and clarity. Ensure that your ideas flow smoothly and that your conclusion is coherent and well-structured.

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Remember that a well-crafted research paper conclusion is a reflection of the strength of your research and your ability to communicate its significance effectively. It should leave a lasting impression on your readers and tie together all the threads of your paper. Now you know how to start the conclusion of a research paper and what elements to include to make it impactful, let’s look at a research paper conclusion sample.

How to write a research paper conclusion with Paperpal?

A research paper conclusion is not just a summary of your study, but a synthesis of the key findings that ties the research together and places it in a broader context. A research paper conclusion should be concise, typically around one paragraph in length. However, some complex topics may require a longer conclusion to ensure the reader is left with a clear understanding of the study’s significance. Paperpal, an AI writing assistant trusted by over 800,000 academics globally, can help you write a well-structured conclusion for your research paper. 

• Sign Up or Log In: Create a new Paperpal account or login with your details.  
• Navigate to Features : Once logged in, head over to the features’ side navigation pane. Click on Templates and you’ll find a suite of generative AI features to help you write better, faster.  
• Generate an outline: Under Templates, select ‘Outlines’. Choose ‘Research article’ as your document type.  
• Select your section: Since you’re focusing on the conclusion, select this section when prompted.  
• Choose your field of study: Identifying your field of study allows Paperpal to provide more targeted suggestions, ensuring the relevance of your conclusion to your specific area of research. 
• Provide a brief description of your study: Enter details about your research topic and findings. This information helps Paperpal generate a tailored outline that aligns with your paper’s content. 
• Generate the conclusion outline: After entering all necessary details, click on ‘generate’. Paperpal will then create a structured outline for your conclusion, to help you start writing and build upon the outline.  
• Write your conclusion: Use the generated outline to build your conclusion. The outline serves as a guide, ensuring you cover all critical aspects of a strong conclusion, from summarizing key findings to highlighting the research’s implications. 
• Refine and enhance: Paperpal’s ‘Make Academic’ feature can be particularly useful in the final stages. Select any paragraph of your conclusion and use this feature to elevate the academic tone, ensuring your writing is aligned to the academic journal standards. 

By following these steps, Paperpal not only simplifies the process of writing a research paper conclusion but also ensures it is impactful, concise, and aligned with academic standards. Sign up with Paperpal today and write your research paper conclusion 2x faster .  

The research paper conclusion is a crucial part of your paper as it provides the final opportunity to leave a strong impression on your readers. In the research paper conclusion, summarize the main points of your research paper by restating your research statement, highlighting the most important findings, addressing the research questions or objectives, explaining the broader context of the study, discussing the significance of your findings, providing recommendations if applicable, and emphasizing the takeaway message. The main purpose of the conclusion is to remind the reader of the main point or argument of your paper and to provide a clear and concise summary of the key findings and their implications. All these elements should feature on your list of what to put in the conclusion of a research paper to create a strong final statement for your work.

A strong conclusion is a critical component of a research paper, as it provides an opportunity to wrap up your arguments, reiterate your main points, and leave a lasting impression on your readers. Here are the key elements of a strong research paper conclusion: 1. Conciseness : A research paper conclusion should be concise and to the point. It should not introduce new information or ideas that were not discussed in the body of the paper. 2. Summarization : The research paper conclusion should be comprehensive enough to give the reader a clear understanding of the research’s main contributions. 3 . Relevance : Ensure that the information included in the research paper conclusion is directly relevant to the research paper’s main topic and objectives; avoid unnecessary details. 4 . Connection to the Introduction : A well-structured research paper conclusion often revisits the key points made in the introduction and shows how the research has addressed the initial questions or objectives. 5. Emphasis : Highlight the significance and implications of your research. Why is your study important? What are the broader implications or applications of your findings? 6 . Call to Action : Include a call to action or a recommendation for future research or action based on your findings.

The length of a research paper conclusion can vary depending on several factors, including the overall length of the paper, the complexity of the research, and the specific journal requirements. While there is no strict rule for the length of a conclusion, but it’s generally advisable to keep it relatively short. A typical research paper conclusion might be around 5-10% of the paper’s total length. For example, if your paper is 10 pages long, the conclusion might be roughly half a page to one page in length.

In general, you do not need to include citations in the research paper conclusion. Citations are typically reserved for the body of the paper to support your arguments and provide evidence for your claims. However, there may be some exceptions to this rule: 1. If you are drawing a direct quote or paraphrasing a specific source in your research paper conclusion, you should include a citation to give proper credit to the original author. 2. If your conclusion refers to or discusses specific research, data, or sources that are crucial to the overall argument, citations can be included to reinforce your conclusion’s validity.

The conclusion of a research paper serves several important purposes: 1. Summarize the Key Points 2. Reinforce the Main Argument 3. Provide Closure 4. Offer Insights or Implications 5. Engage the Reader. 6. Reflect on Limitations

Remember that the primary purpose of the research paper conclusion is to leave a lasting impression on the reader, reinforcing the key points and providing closure to your research. It’s often the last part of the paper that the reader will see, so it should be strong and well-crafted.

• Makar, G., Foltz, C., Lendner, M., & Vaccaro, A. R. (2018). How to write effective discussion and conclusion sections. Clinical spine surgery, 31(8), 345-346.
• Bunton, D. (2005). The structure of PhD conclusion chapters.  Journal of English for academic purposes ,  4 (3), 207-224.

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Organizing Your Social Sciences Research Paper

• 9. The Conclusion
• Purpose of Guide
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The conclusion is intended to help the reader understand why your research should matter to them after they have finished reading the paper. A conclusion is not merely a summary of the main topics covered or a re-statement of your research problem, but a synthesis of key points derived from the findings of your study and, if applicable, where you recommend new areas for future research. For most college-level research papers, two or three well-developed paragraphs is sufficient for a conclusion, although in some cases, more paragraphs may be required in describing the key findings and their significance.

Conclusions. The Writing Center. University of North Carolina; Conclusions. The Writing Lab and The OWL. Purdue University.

Importance of a Good Conclusion

A well-written conclusion provides you with important opportunities to demonstrate to the reader your understanding of the research problem. These include:

• Presenting the last word on the issues you raised in your paper . Just as the introduction gives a first impression to your reader, the conclusion offers a chance to leave a lasting impression. Do this, for example, by highlighting key findings in your analysis that advance new understanding about the research problem, that are unusual or unexpected, or that have important implications applied to practice.
• Summarizing your thoughts and conveying the larger significance of your study . The conclusion is an opportunity to succinctly re-emphasize  your answer to the "So What?" question by placing the study within the context of how your research advances past research about the topic.
• Identifying how a gap in the literature has been addressed . The conclusion can be where you describe how a previously identified gap in the literature [first identified in your literature review section] has been addressed by your research and why this contribution is significant.
• Demonstrating the importance of your ideas . Don't be shy. The conclusion offers an opportunity to elaborate on the impact and significance of your findings. This is particularly important if your study approached examining the research problem from an unusual or innovative perspective.
• Introducing possible new or expanded ways of thinking about the research problem . This does not refer to introducing new information [which should be avoided], but to offer new insight and creative approaches for framing or contextualizing the research problem based on the results of your study.

Bunton, David. “The Structure of PhD Conclusion Chapters.” Journal of English for Academic Purposes 4 (July 2005): 207–224; Conclusions. The Writing Center. University of North Carolina; Kretchmer, Paul. Twelve Steps to Writing an Effective Conclusion. San Francisco Edit, 2003-2008; Conclusions. The Writing Lab and The OWL. Purdue University; Assan, Joseph. "Writing the Conclusion Chapter: The Good, the Bad and the Missing." Liverpool: Development Studies Association (2009): 1-8.

Structure and Writing Style

I.  General Rules

The general function of your paper's conclusion is to restate the main argument . It reminds the reader of the strengths of your main argument(s) and reiterates the most important evidence supporting those argument(s). Do this by clearly summarizing the context, background, and necessity of pursuing the research problem you investigated in relation to an issue, controversy, or a gap found in the literature. However, make sure that your conclusion is not simply a repetitive summary of the findings. This reduces the impact of the argument(s) you have developed in your paper.

When writing the conclusion to your paper, follow these general rules:

• Present your conclusions in clear, concise language. Re-state the purpose of your study, then describe how your findings differ or support those of other studies and why [i.e., what were the unique, new, or crucial contributions your study made to the overall research about your topic?].
• Do not simply reiterate your findings or the discussion of your results. Provide a synthesis of arguments presented in the paper to show how these converge to address the research problem and the overall objectives of your study.
• Indicate opportunities for future research if you haven't already done so in the discussion section of your paper. Highlighting the need for further research provides the reader with evidence that you have an in-depth awareness of the research problem but that further investigations should take place beyond the scope of your investigation.

Consider the following points to help ensure your conclusion is presented well:

• If the argument or purpose of your paper is complex, you may need to summarize the argument for your reader.
• If, prior to your conclusion, you have not yet explained the significance of your findings or if you are proceeding inductively, use the end of your paper to describe your main points and explain their significance.
• Move from a detailed to a general level of consideration that returns the topic to the context provided by the introduction or within a new context that emerges from the data [this is opposite of the introduction, which begins with general discussion of the context and ends with a detailed description of the research problem]. 

The conclusion also provides a place for you to persuasively and succinctly restate the research problem, given that the reader has now been presented with all the information about the topic . Depending on the discipline you are writing in, the concluding paragraph may contain your reflections on the evidence presented. However, the nature of being introspective about the research you have conducted will depend on the topic and whether your professor wants you to express your observations in this way. If asked to think introspectively about the topics, do not delve into idle speculation. Being introspective means looking within yourself as an author to try and understand an issue more deeply, not to guess at possible outcomes or make up scenarios not supported by the evidence.

II.  Developing a Compelling Conclusion

Although an effective conclusion needs to be clear and succinct, it does not need to be written passively or lack a compelling narrative. Strategies to help you move beyond merely summarizing the key points of your research paper may include any of the following:

• If your essay deals with a critical, contemporary problem, warn readers of the possible consequences of not attending to the problem proactively.
• Recommend a specific course or courses of action that, if adopted, could address a specific problem in practice or in the development of new knowledge leading to positive change.
• Cite a relevant quotation or expert opinion already noted in your paper in order to lend authority and support to the conclusion(s) you have reached [a good source would be from your literature review].
• Explain the consequences of your research in a way that elicits action or demonstrates urgency in seeking change.
• Restate a key statistic, fact, or visual image to emphasize the most important finding of your paper.
• If your discipline encourages personal reflection, illustrate your concluding point by drawing from your own life experiences.
• Return to an anecdote, an example, or a quotation that you presented in your introduction, but add further insight derived from the findings of your study; use your interpretation of results from your study to recast it in new or important ways.
• Provide a "take-home" message in the form of a succinct, declarative statement that you want the reader to remember about your study.

III. Problems to Avoid

Failure to be concise Your conclusion section should be concise and to the point. Conclusions that are too lengthy often have unnecessary information in them. The conclusion is not the place for details about your methodology or results. Although you should give a summary of what was learned from your research, this summary should be relatively brief, since the emphasis in the conclusion is on the implications, evaluations, insights, and other forms of analysis that you make. Strategies for writing concisely can be found here .

Failure to comment on larger, more significant issues In the introduction, your task was to move from the general [the field of study] to the specific [the research problem]. However, in the conclusion, your task is to move from a specific discussion [your research problem] back to a general discussion framed around the implications and significance of your findings [i.e., how your research contributes new understanding or fills an important gap in the literature]. In short, the conclusion is where you should place your research within a larger context [visualize your paper as an hourglass--start with a broad introduction and review of the literature, move to the specific analysis and discussion, conclude with a broad summary of the study's implications and significance].

Failure to reveal problems and negative results Negative aspects of the research process should never be ignored. These are problems, deficiencies, or challenges encountered during your study. They should be summarized as a way of qualifying your overall conclusions. If you encountered negative or unintended results [i.e., findings that are validated outside the research context in which they were generated], you must report them in the results section and discuss their implications in the discussion section of your paper. In the conclusion, use negative results as an opportunity to explain their possible significance and/or how they may form the basis for future research.

Failure to provide a clear summary of what was learned In order to be able to discuss how your research fits within your field of study [and possibly the world at large], you need to summarize briefly and succinctly how it contributes to new knowledge or a new understanding about the research problem. This element of your conclusion may be only a few sentences long.

Failure to match the objectives of your research Often research objectives in the social and behavioral sciences change while the research is being carried out. This is not a problem unless you forget to go back and refine the original objectives in your introduction. As these changes emerge they must be documented so that they accurately reflect what you were trying to accomplish in your research [not what you thought you might accomplish when you began].

Resist the urge to apologize If you've immersed yourself in studying the research problem, you presumably should know a good deal about it [perhaps even more than your professor!]. Nevertheless, by the time you have finished writing, you may be having some doubts about what you have produced. Repress those doubts! Don't undermine your authority as a researcher by saying something like, "This is just one approach to examining this problem; there may be other, much better approaches that...." The overall tone of your conclusion should convey confidence to the reader about the study's validity and realiability.

Assan, Joseph. "Writing the Conclusion Chapter: The Good, the Bad and the Missing." Liverpool: Development Studies Association (2009): 1-8; Concluding Paragraphs. College Writing Center at Meramec. St. Louis Community College; Conclusions. The Writing Center. University of North Carolina; Conclusions. The Writing Lab and The OWL. Purdue University; Freedman, Leora  and Jerry Plotnick. Introductions and Conclusions. The Lab Report. University College Writing Centre. University of Toronto; Leibensperger, Summer. Draft Your Conclusion. Academic Center, the University of Houston-Victoria, 2003; Make Your Last Words Count. The Writer’s Handbook. Writing Center. University of Wisconsin Madison; Miquel, Fuster-Marquez and Carmen Gregori-Signes. “Chapter Six: ‘Last but Not Least:’ Writing the Conclusion of Your Paper.” In Writing an Applied Linguistics Thesis or Dissertation: A Guide to Presenting Empirical Research . John Bitchener, editor. (Basingstoke,UK: Palgrave Macmillan, 2010), pp. 93-105; Tips for Writing a Good Conclusion. Writing@CSU. Colorado State University; Kretchmer, Paul. Twelve Steps to Writing an Effective Conclusion. San Francisco Edit, 2003-2008; Writing Conclusions. Writing Tutorial Services, Center for Innovative Teaching and Learning. Indiana University; Writing: Considering Structure and Organization. Institute for Writing Rhetoric. Dartmouth College.

Writing Tip

Don't Belabor the Obvious!

Avoid phrases like "in conclusion...," "in summary...," or "in closing...." These phrases can be useful, even welcome, in oral presentations. But readers can see by the tell-tale section heading and number of pages remaining that they are reaching the end of your paper. You'll irritate your readers if you belabor the obvious.

Assan, Joseph. "Writing the Conclusion Chapter: The Good, the Bad and the Missing." Liverpool: Development Studies Association (2009): 1-8.

Another Writing Tip

New Insight, Not New Information!

Don't surprise the reader with new information in your conclusion that was never referenced anywhere else in the paper. This why the conclusion rarely has citations to sources. If you have new information to present, add it to the discussion or other appropriate section of the paper. Note that, although no new information is introduced, the conclusion, along with the discussion section, is where you offer your most "original" contributions in the paper; the conclusion is where you describe the value of your research, demonstrate that you understand the material that you’ve presented, and position your findings within the larger context of scholarship on the topic, including describing how your research contributes new insights to that scholarship.

Assan, Joseph. "Writing the Conclusion Chapter: The Good, the Bad and the Missing." Liverpool: Development Studies Association (2009): 1-8; Conclusions. The Writing Center. University of North Carolina.

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How to write a strong conclusion for your research paper

Last updated

17 February 2024

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Writing a research paper is a chance to share your knowledge and hypothesis. It's an opportunity to demonstrate your many hours of research and prove your ability to write convincingly.

Ideally, by the end of your research paper, you'll have brought your readers on a journey to reach the conclusions you've pre-determined. However, if you don't stick the landing with a good conclusion, you'll risk losing your reader’s trust.

Writing a strong conclusion for your research paper involves a few important steps, including restating the thesis and summing up everything properly.

Find out what to include and what to avoid, so you can effectively demonstrate your understanding of the topic and prove your expertise.

• Why is a good conclusion important?

A good conclusion can cement your paper in the reader’s mind. Making a strong impression in your introduction can draw your readers in, but it's the conclusion that will inspire them.

• What to include in a research paper conclusion

There are a few specifics you should include in your research paper conclusion. Offer your readers some sense of urgency or consequence by pointing out why they should care about the topic you have covered. Discuss any common problems associated with your topic and provide suggestions as to how these problems can be solved or addressed.

The conclusion should include a restatement of your initial thesis. Thesis statements are strengthened after you’ve presented supporting evidence (as you will have done in the paper), so make a point to reintroduce it at the end.

Finally, recap the main points of your research paper, highlighting the key takeaways you want readers to remember. If you've made multiple points throughout the paper, refer to the ones with the strongest supporting evidence.

• Steps for writing a research paper conclusion

Many writers find the conclusion the most challenging part of any research project . By following these three steps, you'll be prepared to write a conclusion that is effective and concise.

• Step 1: Restate the problem

Always begin by restating the research problem in the conclusion of a research paper. This serves to remind the reader of your hypothesis and refresh them on the main point of the paper. 

When restating the problem, take care to avoid using exactly the same words you employed earlier in the paper.

• Step 2: Sum up the paper

After you've restated the problem, sum up the paper by revealing your overall findings. The method for this differs slightly, depending on whether you're crafting an argumentative paper or an empirical paper.

Argumentative paper: Restate your thesis and arguments

Argumentative papers involve introducing a thesis statement early on. In crafting the conclusion for an argumentative paper, always restate the thesis, outlining the way you've developed it throughout the entire paper.

It might be appropriate to mention any counterarguments in the conclusion, so you can demonstrate how your thesis is correct or how the data best supports your main points.

Empirical paper: Summarize research findings

Empirical papers break down a series of research questions. In your conclusion, discuss the findings your research revealed, including any information that surprised you.

Be clear about the conclusions you reached, and explain whether or not you expected to arrive at these particular ones.

• Step 3: Discuss the implications of your research

Argumentative papers and empirical papers also differ in this part of a research paper conclusion. Here are some tips on crafting conclusions for argumentative and empirical papers.

Argumentative paper: Powerful closing statement

In an argumentative paper, you'll have spent a great deal of time expressing the opinions you formed after doing a significant amount of research. Make a strong closing statement in your argumentative paper's conclusion to share the significance of your work.

You can outline the next steps through a bold call to action, or restate how powerful your ideas turned out to be.

Empirical paper: Directions for future research

Empirical papers are broader in scope. They usually cover a variety of aspects and can include several points of view.

To write a good conclusion for an empirical paper, suggest the type of research that could be done in the future, including methods for further investigation or outlining ways other researchers might proceed.

If you feel your research had any limitations, even if they were outside your control, you could mention these in your conclusion.

After you finish outlining your conclusion, ask someone to read it and offer feedback. In any research project you're especially close to, it can be hard to identify problem areas. Having a close friend or someone whose opinion you value read the research paper and provide honest feedback can be invaluable. Take note of any suggested edits and consider incorporating them into your paper if they make sense.

• Things to avoid in a research paper conclusion

Keep these aspects to avoid in mind as you're writing your conclusion and refer to them after you've created an outline.

Dry summary

Writing a memorable, succinct conclusion is arguably more important than a strong introduction. Take care to avoid just rephrasing your main points, and don't fall into the trap of repeating dry facts or citations.

You can provide a new perspective for your readers to think about or contextualize your research. Either way, make the conclusion vibrant and interesting, rather than a rote recitation of your research paper’s highlights.

Clichéd or generic phrasing

Your research paper conclusion should feel fresh and inspiring. Avoid generic phrases like "to sum up" or "in conclusion." These phrases tend to be overused, especially in an academic context and might turn your readers off.

The conclusion also isn't the time to introduce colloquial phrases or informal language. Retain a professional, confident tone consistent throughout your paper’s conclusion so it feels exciting and bold.

New data or evidence

While you should present strong data throughout your paper, the conclusion isn't the place to introduce new evidence. This is because readers are engaged in actively learning as they read through the body of your paper.

By the time they reach the conclusion, they will have formed an opinion one way or the other (hopefully in your favor!). Introducing new evidence in the conclusion will only serve to surprise or frustrate your reader.

Ignoring contradictory evidence

If your research reveals contradictory evidence, don't ignore it in the conclusion. This will damage your credibility as an expert and might even serve to highlight the contradictions.

Be as transparent as possible and admit to any shortcomings in your research, but don't dwell on them for too long.

Ambiguous or unclear resolutions

The point of a research paper conclusion is to provide closure and bring all your ideas together. You should wrap up any arguments you introduced in the paper and tie up any loose ends, while demonstrating why your research and data are strong.

Use direct language in your conclusion and avoid ambiguity. Even if some of the data and sources you cite are inconclusive or contradictory, note this in your conclusion to come across as confident and trustworthy.

• Examples of research paper conclusions

Your research paper should provide a compelling close to the paper as a whole, highlighting your research and hard work. While the conclusion should represent your unique style, these examples offer a starting point:

Ultimately, the data we examined all point to the same conclusion: Encouraging a good work-life balance improves employee productivity and benefits the company overall. The research suggests that when employees feel their personal lives are valued and respected by their employers, they are more likely to be productive when at work. In addition, company turnover tends to be reduced when employees have a balance between their personal and professional lives. While additional research is required to establish ways companies can support employees in creating a stronger work-life balance, it's clear the need is there.

Social media is a primary method of communication among young people. As we've seen in the data presented, most young people in high school use a variety of social media applications at least every hour, including Instagram and Facebook. While social media is an avenue for connection with peers, research increasingly suggests that social media use correlates with body image issues. Young girls with lower self-esteem tend to use social media more often than those who don't log onto social media apps every day. As new applications continue to gain popularity, and as more high school students are given smartphones, more research will be required to measure the effects of prolonged social media use.

What are the different kinds of research paper conclusions?

There are no formal types of research paper conclusions. Ultimately, the conclusion depends on the outline of your paper and the type of research you’re presenting. While some experts note that research papers can end with a new perspective or commentary, most papers should conclude with a combination of both. The most important aspect of a good research paper conclusion is that it accurately represents the body of the paper.

Can I present new arguments in my research paper conclusion?

Research paper conclusions are not the place to introduce new data or arguments. The body of your paper is where you should share research and insights, where the reader is actively absorbing the content. By the time a reader reaches the conclusion of the research paper, they should have formed their opinion. Introducing new arguments in the conclusion can take a reader by surprise, and not in a positive way. It might also serve to frustrate readers.

How long should a research paper conclusion be?

There's no set length for a research paper conclusion. However, it's a good idea not to run on too long, since conclusions are supposed to be succinct. A good rule of thumb is to keep your conclusion around 5 to 10 percent of the paper's total length. If your paper is 10 pages, try to keep your conclusion under one page.

What should I include in a research paper conclusion?

A good research paper conclusion should always include a sense of urgency, so the reader can see how and why the topic should matter to them. You can also note some recommended actions to help fix the problem and some obstacles they might encounter. A conclusion should also remind the reader of the thesis statement, along with the main points you covered in the paper. At the end of the conclusion, add a powerful closing statement that helps cement the paper in the mind of the reader.

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• How to Write Discussions and Conclusions

The discussion section contains the results and outcomes of a study. An effective discussion informs readers what can be learned from your experiment and provides context for the results.

What makes an effective discussion?

When you’re ready to write your discussion, you’ve already introduced the purpose of your study and provided an in-depth description of the methodology. The discussion informs readers about the larger implications of your study based on the results. Highlighting these implications while not overstating the findings can be challenging, especially when you’re submitting to a journal that selects articles based on novelty or potential impact. Regardless of what journal you are submitting to, the discussion section always serves the same purpose: concluding what your study results actually mean.

A successful discussion section puts your findings in context. It should include:

• the results of your research,
• a discussion of related research, and
• a comparison between your results and initial hypothesis.

Tip: Not all journals share the same naming conventions.

You can apply the advice in this article to the conclusion, results or discussion sections of your manuscript.

Our Early Career Researcher community tells us that the conclusion is often considered the most difficult aspect of a manuscript to write. To help, this guide provides questions to ask yourself, a basic structure to model your discussion off of and examples from published manuscripts. 

Questions to ask yourself:

• Was my hypothesis correct?
• If my hypothesis is partially correct or entirely different, what can be learned from the results? 
• How do the conclusions reshape or add onto the existing knowledge in the field? What does previous research say about the topic? 
• Why are the results important or relevant to your audience? Do they add further evidence to a scientific consensus or disprove prior studies? 
• How can future research build on these observations? What are the key experiments that must be done? 
• What is the “take-home” message you want your reader to leave with?

How to structure a discussion

Trying to fit a complete discussion into a single paragraph can add unnecessary stress to the writing process. If possible, you’ll want to give yourself two or three paragraphs to give the reader a comprehensive understanding of your study as a whole. Here’s one way to structure an effective discussion:

Writing Tips

While the above sections can help you brainstorm and structure your discussion, there are many common mistakes that writers revert to when having difficulties with their paper. Writing a discussion can be a delicate balance between summarizing your results, providing proper context for your research and avoiding introducing new information. Remember that your paper should be both confident and honest about the results! 

• Read the journal’s guidelines on the discussion and conclusion sections. If possible, learn about the guidelines before writing the discussion to ensure you’re writing to meet their expectations. 
• Begin with a clear statement of the principal findings. This will reinforce the main take-away for the reader and set up the rest of the discussion. 
• Explain why the outcomes of your study are important to the reader. Discuss the implications of your findings realistically based on previous literature, highlighting both the strengths and limitations of the research. 
• State whether the results prove or disprove your hypothesis. If your hypothesis was disproved, what might be the reasons? 
• Introduce new or expanded ways to think about the research question. Indicate what next steps can be taken to further pursue any unresolved questions. 
• If dealing with a contemporary or ongoing problem, such as climate change, discuss possible consequences if the problem is avoided. 
• Be concise. Adding unnecessary detail can distract from the main findings. 

Don’t

• Rewrite your abstract. Statements with “we investigated” or “we studied” generally do not belong in the discussion. 
• Include new arguments or evidence not previously discussed. Necessary information and evidence should be introduced in the main body of the paper. 
• Apologize. Even if your research contains significant limitations, don’t undermine your authority by including statements that doubt your methodology or execution. 
• Shy away from speaking on limitations or negative results. Including limitations and negative results will give readers a complete understanding of the presented research. Potential limitations include sources of potential bias, threats to internal or external validity, barriers to implementing an intervention and other issues inherent to the study design. 
• Overstate the importance of your findings. Making grand statements about how a study will fully resolve large questions can lead readers to doubt the success of the research. 

Snippets of Effective Discussions:

Consumer-based actions to reduce plastic pollution in rivers: A multi-criteria decision analysis approach

Identifying reliable indicators of fitness in polar bears

• How to Write a Great Title
• How to Write an Abstract
• How to Write Your Methods
• How to Report Statistics
• How to Edit Your Work

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The contents of the Writing Center are also available as a live, interactive training session, complete with slides, talking points, and activities. …

There’s a lot to consider when deciding where to submit your work. Learn how to choose a journal that will help your study reach its audience, while reflecting your values as a researcher…

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Home » Research Recommendations – Examples and Writing Guide

Research Recommendations – Examples and Writing Guide

Table of Contents

Research Recommendations

Definition:

Research recommendations refer to suggestions or advice given to someone who is looking to conduct research on a specific topic or area. These recommendations may include suggestions for research methods, data collection techniques, sources of information, and other factors that can help to ensure that the research is conducted in a rigorous and effective manner. Research recommendations may be provided by experts in the field, such as professors, researchers, or consultants, and are intended to help guide the researcher towards the most appropriate and effective approach to their research project.

Parts of Research Recommendations

Research recommendations can vary depending on the specific project or area of research, but typically they will include some or all of the following parts:

• Research question or objective : This is the overarching goal or purpose of the research project.
• Research methods : This includes the specific techniques and strategies that will be used to collect and analyze data. The methods will depend on the research question and the type of data being collected.
• Data collection: This refers to the process of gathering information or data that will be used to answer the research question. This can involve a range of different methods, including surveys, interviews, observations, or experiments.
• Data analysis : This involves the process of examining and interpreting the data that has been collected. This can involve statistical analysis, qualitative analysis, or a combination of both.
• Results and conclusions: This section summarizes the findings of the research and presents any conclusions or recommendations based on those findings.
• Limitations and future research: This section discusses any limitations of the study and suggests areas for future research that could build on the findings of the current project.

How to Write Research Recommendations

Writing research recommendations involves providing specific suggestions or advice to a researcher on how to conduct their study. Here are some steps to consider when writing research recommendations:

• Understand the research question: Before writing research recommendations, it is important to have a clear understanding of the research question and the objectives of the study. This will help to ensure that the recommendations are relevant and appropriate.
• Consider the research methods: Consider the most appropriate research methods that could be used to collect and analyze data that will address the research question. Identify the strengths and weaknesses of the different methods and how they might apply to the specific research question.
• Provide specific recommendations: Provide specific and actionable recommendations that the researcher can implement in their study. This can include recommendations related to sample size, data collection techniques, research instruments, data analysis methods, or other relevant factors.
• Justify recommendations : Justify why each recommendation is being made and how it will help to address the research question or objective. It is important to provide a clear rationale for each recommendation to help the researcher understand why it is important.
• Consider limitations and ethical considerations : Consider any limitations or potential ethical considerations that may arise in conducting the research. Provide recommendations for addressing these issues or mitigating their impact.
• Summarize recommendations: Provide a summary of the recommendations at the end of the report or document, highlighting the most important points and emphasizing how the recommendations will contribute to the overall success of the research project.

Example of Research Recommendations

Example of Research Recommendations sample for students:

• Further investigate the effects of X on Y by conducting a larger-scale randomized controlled trial with a diverse population.
• Explore the relationship between A and B by conducting qualitative interviews with individuals who have experience with both.
• Investigate the long-term effects of intervention C by conducting a follow-up study with participants one year after completion.
• Examine the effectiveness of intervention D in a real-world setting by conducting a field study in a naturalistic environment.
• Compare and contrast the results of this study with those of previous research on the same topic to identify any discrepancies or inconsistencies in the findings.
• Expand upon the limitations of this study by addressing potential confounding variables and conducting further analyses to control for them.
• Investigate the relationship between E and F by conducting a meta-analysis of existing literature on the topic.
• Explore the potential moderating effects of variable G on the relationship between H and I by conducting subgroup analyses.
• Identify potential areas for future research based on the gaps in current literature and the findings of this study.
• Conduct a replication study to validate the results of this study and further establish the generalizability of the findings.

Applications of Research Recommendations

Research recommendations are important as they provide guidance on how to improve or solve a problem. The applications of research recommendations are numerous and can be used in various fields. Some of the applications of research recommendations include:

• Policy-making: Research recommendations can be used to develop policies that address specific issues. For example, recommendations from research on climate change can be used to develop policies that reduce carbon emissions and promote sustainability.
• Program development: Research recommendations can guide the development of programs that address specific issues. For example, recommendations from research on education can be used to develop programs that improve student achievement.
• Product development : Research recommendations can guide the development of products that meet specific needs. For example, recommendations from research on consumer behavior can be used to develop products that appeal to consumers.
• Marketing strategies: Research recommendations can be used to develop effective marketing strategies. For example, recommendations from research on target audiences can be used to develop marketing strategies that effectively reach specific demographic groups.
• Medical practice : Research recommendations can guide medical practitioners in providing the best possible care to patients. For example, recommendations from research on treatments for specific conditions can be used to improve patient outcomes.
• Scientific research: Research recommendations can guide future research in a specific field. For example, recommendations from research on a specific disease can be used to guide future research on treatments and cures for that disease.

Purpose of Research Recommendations

The purpose of research recommendations is to provide guidance on how to improve or solve a problem based on the findings of research. Research recommendations are typically made at the end of a research study and are based on the conclusions drawn from the research data. The purpose of research recommendations is to provide actionable advice to individuals or organizations that can help them make informed decisions, develop effective strategies, or implement changes that address the issues identified in the research.

The main purpose of research recommendations is to facilitate the transfer of knowledge from researchers to practitioners, policymakers, or other stakeholders who can benefit from the research findings. Recommendations can help bridge the gap between research and practice by providing specific actions that can be taken based on the research results. By providing clear and actionable recommendations, researchers can help ensure that their findings are put into practice, leading to improvements in various fields, such as healthcare, education, business, and public policy.

Characteristics of Research Recommendations

Research recommendations are a key component of research studies and are intended to provide practical guidance on how to apply research findings to real-world problems. The following are some of the key characteristics of research recommendations:

• Actionable : Research recommendations should be specific and actionable, providing clear guidance on what actions should be taken to address the problem identified in the research.
• Evidence-based: Research recommendations should be based on the findings of the research study, supported by the data collected and analyzed.
• Contextual: Research recommendations should be tailored to the specific context in which they will be implemented, taking into account the unique circumstances and constraints of the situation.
• Feasible : Research recommendations should be realistic and feasible, taking into account the available resources, time constraints, and other factors that may impact their implementation.
• Prioritized: Research recommendations should be prioritized based on their potential impact and feasibility, with the most important recommendations given the highest priority.
• Communicated effectively: Research recommendations should be communicated clearly and effectively, using language that is understandable to the target audience.
• Evaluated : Research recommendations should be evaluated to determine their effectiveness in addressing the problem identified in the research, and to identify opportunities for improvement.

Advantages of Research Recommendations

Research recommendations have several advantages, including:

• Providing practical guidance: Research recommendations provide practical guidance on how to apply research findings to real-world problems, helping to bridge the gap between research and practice.
• Improving decision-making: Research recommendations help decision-makers make informed decisions based on the findings of research, leading to better outcomes and improved performance.
• Enhancing accountability : Research recommendations can help enhance accountability by providing clear guidance on what actions should be taken, and by providing a basis for evaluating progress and outcomes.
• Informing policy development : Research recommendations can inform the development of policies that are evidence-based and tailored to the specific needs of a given situation.
• Enhancing knowledge transfer: Research recommendations help facilitate the transfer of knowledge from researchers to practitioners, policymakers, or other stakeholders who can benefit from the research findings.
• Encouraging further research : Research recommendations can help identify gaps in knowledge and areas for further research, encouraging continued exploration and discovery.
• Promoting innovation: Research recommendations can help identify innovative solutions to complex problems, leading to new ideas and approaches.

Limitations of Research Recommendations

While research recommendations have several advantages, there are also some limitations to consider. These limitations include:

• Context-specific: Research recommendations may be context-specific and may not be applicable in all situations. Recommendations developed in one context may not be suitable for another context, requiring adaptation or modification.
• I mplementation challenges: Implementation of research recommendations may face challenges, such as lack of resources, resistance to change, or lack of buy-in from stakeholders.
• Limited scope: Research recommendations may be limited in scope, focusing only on a specific issue or aspect of a problem, while other important factors may be overlooked.
• Uncertainty : Research recommendations may be uncertain, particularly when the research findings are inconclusive or when the recommendations are based on limited data.
• Bias : Research recommendations may be influenced by researcher bias or conflicts of interest, leading to recommendations that are not in the best interests of stakeholders.
• Timing : Research recommendations may be time-sensitive, requiring timely action to be effective. Delayed action may result in missed opportunities or reduced effectiveness.
• Lack of evaluation: Research recommendations may not be evaluated to determine their effectiveness or impact, making it difficult to assess whether they are successful or not.

About the author

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• Writing Tips

How to Write a Conclusion for a Research Paper

3-minute read

• 29th August 2023

If you’re writing a research paper, the conclusion is your opportunity to summarize your findings and leave a lasting impression on your readers. In this post, we’ll take you through how to write an effective conclusion for a research paper and how you can:

·   Reword your thesis statement

·   Highlight the significance of your research

·   Discuss limitations

·   Connect to the introduction

·   End with a thought-provoking statement

Rewording Your Thesis Statement

Begin your conclusion by restating your thesis statement in a way that is slightly different from the wording used in the introduction. Avoid presenting new information or evidence in your conclusion. Just summarize the main points and arguments of your essay and keep this part as concise as possible. Remember that you’ve already covered the in-depth analyses and investigations in the main body paragraphs of your essay, so it’s not necessary to restate these details in the conclusion.

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Highlighting the Significance of Your Research

The conclusion is a good place to emphasize the implications of your research . Avoid ambiguous or vague language such as “I think” or “maybe,” which could weaken your position. Clearly explain why your research is significant and how it contributes to the broader field of study.

Here’s an example from a (fictional) study on the impact of social media on mental health:

Discussing Limitations

Although it’s important to emphasize the significance of your study, you can also use the conclusion to briefly address any limitations you discovered while conducting your research, such as time constraints or a shortage of resources. Doing this demonstrates a balanced and honest approach to your research.

Connecting to the Introduction

In your conclusion, you can circle back to your introduction , perhaps by referring to a quote or anecdote you discussed earlier. If you end your paper on a similar note to how you began it, you will create a sense of cohesion for the reader and remind them of the meaning and significance of your research.

Ending With a Thought-Provoking Statement

Consider ending your paper with a thought-provoking and memorable statement that relates to the impact of your research questions or hypothesis. This statement can be a call to action, a philosophical question, or a prediction for the future (positive or negative). Here’s an example that uses the same topic as above (social media and mental health):

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Ensure that your essay ends on a high note by having our experts proofread your research paper. Our team has experience with a wide variety of academic fields and subjects and can help make your paper stand out from the crowd – get started today and see the difference it can make in your work.

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Writing the parts of scientific reports

22 Writing the conclusion & recommendations

There are probably some overlaps between the Conclusion and the Discussion section. Nevertheless, this section gives you the opportunity to highlight the most important points in your report, and is sometimes the only section read. Think about what your research/ study has achieved, and the most important findings and ideas you want the reader to know. As all studies have limitations also think about what you were not able to cover (this shows that you are able to evaluate your own work objectively).

Possible structure of this section:

Use present perfect to sum up/ evaluate:

This study has explored/ has attempted …

Use past tense to state what your aim was and to refer to actions you carried out:

• This study was intended to analyse …
• The aim of this study was to …

Use present tense to evaluate your study and to state the generalizations and implications that you draw from your findings.

• The results add to the knowledge of …
• These findings s uggest that …

You can either use present tense or past tense to summarize your results.

• The findings reveal …
• It was found that …

Achievements of this study (positive)

• This study provides evidence that …
• This work has contributed to a number of key issues in the field such as …

Limitations of the study (negative)

• Several limitations should be noted. First …

Combine positive and negative remarks to give a balanced assessment:

• Although this research is somewhat limited in scope, its findings can provide a basis for future studies.
• Despite the limitations, findings from the present study can help us understand …

Use more cautious language (modal verbs may, can, could)

• There are a number of possible extensions of this research …
• The findings suggest the possibility for future research on …
• These results may be important for future studies on …
• Examining a wider context could/ would lead …

Or indicate that future research is needed

• There is still a need for future research to determine …
• Further studies should be undertaken to discover…
• It would be worthwhile to investigate …

Academic Writing in a Swiss University Context Copyright © 2018 by Irene Dietrichs. All Rights Reserved.

The Ultimate Guide to Crafting Impactful Recommendations in Research

Are you ready to take your research to the next level? Crafting impactful recommendations is the key to unlocking the full potential of your study. By providing clear, actionable suggestions based on your findings, you can bridge the gap between research and real-world application.

In this ultimate guide, we'll show you how to write recommendations that make a difference in your research report or paper.

You'll learn how to craft specific, actionable recommendations that connect seamlessly with your research findings. Whether you're a student, writer, teacher, or journalist, this guide will help you master the art of writing recommendations in research. Let's get started and make your research count!

Understanding the Purpose of Recommendations

Recommendations in research serve as a vital bridge between your findings and their real-world applications. They provide specific, action-oriented suggestions to guide future studies and decision-making processes. Let's dive into the key purposes of crafting effective recommendations:

Guiding Future Research

Research recommendations play a crucial role in steering scholars and researchers towards promising avenues of exploration. By highlighting gaps in current knowledge and proposing new research questions, recommendations help advance the field and drive innovation.

Influencing Decision-Making

Well-crafted recommendations have the power to shape policies, programs, and strategies across various domains, such as:

• Policy-making
• Product development
• Marketing strategies
• Medical practice

By providing clear, evidence-based suggestions, recommendations facilitate informed decision-making and improve outcomes.

Connecting Research to Practice

Recommendations act as a conduit for transferring knowledge from researchers to practitioners, policymakers, and stakeholders. They bridge the gap between academic findings and their practical applications, ensuring that research insights are effectively translated into real-world solutions.

Enhancing Research Impact

By crafting impactful recommendations, you can amplify the reach and influence of your research, attracting attention from peers, funding agencies, and decision-makers.

Addressing Limitations

Recommendations provide an opportunity to acknowledge and address the limitations of your study. By suggesting concrete and actionable possibilities for future research, you demonstrate a thorough understanding of your work's scope and potential areas for improvement.

Identifying Areas for Future Research

Discovering research gaps is a crucial step in crafting impactful recommendations. It involves reviewing existing studies and identifying unanswered questions or problems that warrant further investigation. Here are some strategies to help you identify areas for future research:

Explore Research Limitations

Take a close look at the limitations section of relevant studies. These limitations often provide valuable insights into potential areas for future research. Consider how addressing these limitations could enhance our understanding of the topic at hand.

Critically Analyze Discussion and Future Research Sections

When reading articles, pay special attention to the discussion and future research sections. These sections often highlight gaps in the current knowledge base and propose avenues for further exploration. Take note of any recurring themes or unanswered questions that emerge across multiple studies.

Utilize Targeted Search Terms

To streamline your search for research gaps, use targeted search terms such as "literature gap" or "future research" in combination with your subject keywords. This approach can help you quickly identify articles that explicitly discuss areas for future investigation.

Seek Guidance from Experts

Don't hesitate to reach out to your research advisor or other experts in your field. Their wealth of knowledge and experience can provide valuable insights into potential research gaps and emerging trends.

By employing these strategies, you'll be well-equipped to identify research gaps and craft recommendations that push the boundaries of current knowledge. Remember, the goal is to refine your research questions and focus your efforts on areas where more understanding is needed.

Structuring Your Recommendations

When it comes to structuring your recommendations, it's essential to keep them concise, organized, and tailored to your audience. Here are some key tips to help you craft impactful recommendations:

Prioritize and Organize

• Limit your recommendations to the most relevant and targeted suggestions for your peers or colleagues in the field.
• Place your recommendations at the end of the report, as they are often top of mind for readers.
• Write your recommendations in order of priority, with the most important ones for decision-makers coming first.

Use a Clear and Actionable Format

• Write recommendations in a clear, concise manner using actionable words derived from the data analyzed in your research.
• Use bullet points instead of long paragraphs for clarity and readability.
• Ensure that your recommendations are specific, measurable, attainable, relevant, and timely (SMART).

Connect Recommendations to Research

By following this simple formula, you can ensure that your recommendations are directly connected to your research and supported by a clear rationale.

Tailor to Your Audience

• Consider the needs and interests of your target audience when crafting your recommendations.
• Explain how your recommendations can solve the issues explored in your research.
• Acknowledge any limitations or constraints of your study that may impact the implementation of your recommendations.

Avoid Common Pitfalls

• Don't undermine your own work by suggesting incomplete or unnecessary recommendations.
• Avoid using recommendations as a place for self-criticism or introducing new information not covered in your research.
• Ensure that your recommendations are achievable and comprehensive, offering practical solutions for the issues considered in your paper.

By structuring your recommendations effectively, you can enhance the reliability and validity of your research findings, provide valuable strategies and suggestions for future research, and deliver impactful solutions to real-world problems.

Crafting Actionable and Specific Recommendations

Crafting actionable and specific recommendations is the key to ensuring your research findings have a real-world impact. Here are some essential tips to keep in mind:

Embrace Flexibility and Feasibility

Your recommendations should be open to discussion and new information, rather than being set in stone. Consider the following:

• Be realistic and considerate of your team's capabilities when making recommendations.
• Prioritize recommendations based on impact and reach, but be prepared to adjust based on team effort levels.
• Focus on solutions that require the fewest changes first, adopting an MVP (Minimum Viable Product) approach.

Provide Detailed and Justified Recommendations

To avoid vagueness and misinterpretation, ensure your recommendations are:

• Detailed, including photos, videos, or screenshots whenever possible.
• Justified based on research findings, providing alternatives when findings don't align with expectations or business goals.

Use this formula when writing recommendations:

Observed problem/pain point/unmet need + consequence + potential solution

Adopt a Solution-Oriented Approach

Foster collaboration and participation.

• Promote staff education on current research and create strategies to encourage adoption of promising clinical protocols.
• Include representatives from the treatment community in the development of the research initiative and the review of proposals.
• Require active, early, and permanent participation of treatment staff in the development, implementation, and interpretation of the study.

Tailor Recommendations to the Opportunity

When writing recommendations for a specific opportunity or program:

• Highlight the strengths and qualifications of the researcher.
• Provide specific examples of their work and accomplishments.
• Explain how their research has contributed to the field.
• Emphasize the researcher's potential for future success and their unique contributions.

By following these guidelines, you'll craft actionable and specific recommendations that drive meaningful change and showcase the value of your research.

Connecting Recommendations with Research Findings

Connecting your recommendations with research findings is crucial for ensuring the credibility and impact of your suggestions. Here's how you can seamlessly link your recommendations to the evidence uncovered in your study:

Grounding Recommendations in Research

Your recommendations should be firmly rooted in the data and insights gathered during your research process. Avoid including measures or suggestions that were not discussed or supported by your study findings. This approach ensures that your recommendations are evidence-based and directly relevant to the research at hand.

Highlighting the Significance of Collaboration

Research collaborations offer a wealth of benefits that can enhance an agency's competitive position. Consider the following factors when discussing the importance of collaboration in your recommendations:

• Organizational Development: Participation in research collaborations depends on an agency's stage of development, compatibility with its mission and culture, and financial stability.
• Trust-Building: Long-term collaboration success often hinges on a history of increasing involvement and trust between partners.
• Infrastructure: A permanent infrastructure that facilitates long-term development is key to successful collaborative programs.

Emphasizing Commitment and Participation

Fostering quality improvement and organizational learning.

In your recommendations, highlight the importance of enhancing quality improvement strategies and fostering organizational learning. Show sensitivity to the needs and constraints of community-based programs, as this understanding is crucial for effective collaboration and implementation.

Addressing Limitations and Implications

If not already addressed in the discussion section, your recommendations should mention the limitations of the study and their implications. Examples of limitations include:

• Sample size or composition
• Participant attrition
• Study duration

By acknowledging these limitations, you demonstrate a comprehensive understanding of your research and its potential impact.

By connecting your recommendations with research findings, you provide a solid foundation for your suggestions, emphasize the significance of collaboration, and showcase the potential for future research and practical applications.

Crafting impactful recommendations is a vital skill for any researcher looking to bridge the gap between their findings and real-world applications. By understanding the purpose of recommendations, identifying areas for future research, structuring your suggestions effectively, and connecting them to your research findings, you can unlock the full potential of your study. Remember to prioritize actionable, specific, and evidence-based recommendations that foster collaboration and drive meaningful change.

As you embark on your research journey, embrace the power of well-crafted recommendations to amplify the impact of your work. By following the guidelines outlined in this ultimate guide, you'll be well-equipped to write recommendations that resonate with your audience, inspire further investigation, and contribute to the advancement of your field. So go forth, make your research count, and let your recommendations be the catalyst for positive change.

Q: What are the steps to formulating recommendations in research? A: To formulate recommendations in research, you should first gain a thorough understanding of the research question. Review the existing literature to inform your recommendations and consider the research methods that were used. Identify which data collection techniques were employed and propose suitable data analysis methods. It's also essential to consider any limitations and ethical considerations of your research. Justify your recommendations clearly and finally, provide a summary of your recommendations.

Q: Why are recommendations significant in research studies? A: Recommendations play a crucial role in research as they form a key part of the analysis phase. They provide specific suggestions for interventions or strategies that address the problems and limitations discovered during the study. Recommendations are a direct response to the main findings derived from data collection and analysis, and they can guide future actions or research.

Q: Can you outline the seven steps involved in writing a research paper? A: Certainly. The seven steps to writing an excellent research paper include:

• Allowing yourself sufficient time to complete the paper.
• Defining the scope of your essay and crafting a clear thesis statement.
• Conducting a thorough yet focused search for relevant research materials.
• Reading the research materials carefully and taking detailed notes.
• Writing your paper based on the information you've gathered and analyzed.
• Editing your paper to ensure clarity, coherence, and correctness.
• Submitting your paper following the guidelines provided.

Q: What tips can help make a research paper more effective? A: To enhance the effectiveness of a research paper, plan for the extensive process ahead and understand your audience. Decide on the structure your research writing will take and describe your methodology clearly. Write in a straightforward and clear manner, avoiding the use of clichés or overly complex language.

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Research Implications & Recommendations

A Plain-Language Explainer With Examples + FREE Template

By: Derek Jansen (MBA) | Reviewers: Dr Eunice Rautenbach | May 2024

The research implications and recommendations are closely related but distinctly different concepts that often trip students up. Here, we’ll unpack them using plain language and loads of examples , so that you can approach your project with confidence.

Overview: Implications & Recommendations

• What are research implications ?
• What are research recommendations ?
• Examples of implications and recommendations
• The “ Big 3 ” categories
• How to write the implications and recommendations
• Template sentences for both sections
• Key takeaways

Implications & Recommendations 101

Let’s start with the basics and define our terms.

At the simplest level, research implications refer to the possible effects or outcomes of a study’s findings. More specifically, they answer the question, “ What do these findings mean?” . In other words, the implications section is where you discuss the broader impact of your study’s findings on theory, practice and future research.

This discussion leads us to the recommendations section , which is where you’ll propose specific actions based on your study’s findings and answer the question, “ What should be done next?” . In other words, the recommendations are practical steps that stakeholders can take to address the key issues identified by your study.

In a nutshell, then, the research implications discuss the broader impact and significance of a study’s findings, while recommendations provide specific actions to take, based on those findings. So, while both of these components are deeply rooted in the findings of the study, they serve different functions within the write up.

Need a helping hand?

Examples: Implications & Recommendations

The distinction between research implications and research recommendations might still feel a bit conceptual, so let’s look at one or two practical examples:

Let’s assume that your study finds that interactive learning methods significantly improve student engagement compared to traditional lectures. In this case, one of your recommendations could be that schools incorporate more interactive learning techniques into their curriculums to enhance student engagement.

Let’s imagine that your study finds that patients who receive personalised care plans have better health outcomes than those with standard care plans. One of your recommendations might be that healthcare providers develop and implement personalised care plans for their patients.

Now, these are admittedly quite simplistic examples, but they demonstrate the difference (and connection ) between the research implications and the recommendations. Simply put, the implications are about the impact of the findings, while the recommendations are about proposed actions, based on the findings.

The “Big 3” Categories

Now that we’ve defined our terms, let’s dig a little deeper into the implications – specifically, the different types or categories of research implications that exist.

Broadly speaking, implications can be divided into three categories – theoretical implications, practical implications and implications for future research .

Theoretical implications relate to how your study’s findings contribute to or challenge existing theories. For example, if a study on social behaviour uncovers new patterns, it might suggest that modifications to current psychological theories are necessary.

Practical implications , on the other hand, focus on how your study’s findings can be applied in real-world settings. For example, if your study demonstrated the effectiveness of a new teaching method, this would imply that educators should consider adopting this method to improve learning outcomes.

Practical implications can also involve policy reconsiderations . For example, if a study reveals significant health benefits from a particular diet, an implication might be that public health guidelines be re-evaluated.

Last but not least, there are the implications for future research . As the name suggests, this category of implications highlights the research gaps or new questions raised by your study. For example, if your study finds mixed results regarding a relationship between two variables, it might imply the need for further investigation to clarify these findings.

To recap then, the three types of implications are the theoretical, the practical and the implications on future research. Regardless of the category, these implications feed into and shape the recommendations , laying the foundation for the actions you’ll propose.

How To Write The  Sections

Now that we’ve laid the foundations, it’s time to explore how to write up the implications and recommendations sections respectively.

Let’s start with the “ where ” before digging into the “ how ”. Typically, the implications will feature in the discussion section of your document, while the recommendations will be located in the conclusion . That said, layouts can vary between disciplines and institutions, so be sure to check with your university what their preferences are.

For the implications section, a common approach is to structure the write-up based on the three categories we looked at earlier – theoretical, practical and future research implications. In practical terms, this discussion will usually follow a fairly formulaic sentence structure – for example:

This research provides new insights into [theoretical aspect], indicating that…

The study’s outcomes highlight the potential benefits of adopting [specific practice] in..

This study raises several questions that warrant further investigation, such as…

Moving onto the recommendations section, you could again structure your recommendations using the three categories. Alternatively, you could structure the discussion per stakeholder group – for example, policymakers, organisations, researchers, etc.

Again, you’ll likely use a fairly formulaic sentence structure for this section. Here are some examples for your inspiration: 

Based on the findings, [specific group] should consider adopting [new method] to improve…

To address the issues identified, it is recommended that legislation should be introduced to…

Researchers should consider examining [specific variable] to build on the current study’s findings.

Remember, you can grab a copy of our tried and tested templates for both the discussion and conclusion sections over on the Grad Coach blog. You can find the links to those, as well as loads of other free resources, in the description 🙂

FAQs: Implications & Recommendations

How do i determine the implications of my study.

To do this, you’ll need to consider how your findings address gaps in the existing literature, how they could influence theory, practice, or policy, and the potential societal or economic impacts.

When thinking about your findings, it’s also a good idea to revisit your introduction chapter, where you would have discussed the potential significance of your study more broadly. This section can help spark some additional ideas about what your findings mean in relation to your original research aims. 

Should I discuss both positive and negative implications?

Absolutely. You’ll need to discuss both the positive and negative implications to provide a balanced view of how your findings affect the field and any limitations or potential downsides.

Can my research implications be speculative?

Yes and no. While implications are somewhat more speculative than recommendations and can suggest potential future outcomes, they should be grounded in your data and analysis. So, be careful to avoid overly speculative claims.

How do I formulate recommendations?

Ideally, you should base your recommendations on the limitations and implications of your study’s findings. So, consider what further research is needed, how policies could be adapted, or how practices could be improved – and make proposals in this respect.

How specific should my recommendations be?

Your recommendations should be as specific as possible, providing clear guidance on what actions or research should be taken next. As mentioned earlier, the implications can be relatively broad, but the recommendations should be very specific and actionable. Ideally, you should apply the SMART framework to your recommendations.

Can I recommend future research in my recommendations?

Absolutely. Highlighting areas where further research is needed is a key aspect of the recommendations section. Naturally, these recommendations should link to the respective section of your implications (i.e., implications for future research).

Wrapping Up: Key Takeaways

We’ve covered quite a bit of ground here, so let’s quickly recap.

• Research implications refer to the possible effects or outcomes of a study’s findings.
• The recommendations section, on the other hand, is where you’ll propose specific actions based on those findings.
• You can structure your implications section based on the three overarching categories – theoretical, practical and future research implications.
• You can carry this structure through to the recommendations as well, or you can group your recommendations by stakeholder.

Remember to grab a copy of our tried and tested free dissertation template, which covers both the implications and recommendations sections. If you’d like 1:1 help with your research project, be sure to check out our private coaching service, where we hold your hand throughout the research journey, step by step.

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Undergraduate Research Experiences for STEM Students: Successes, Challenges, and Opportunities (2017)

Chapter: 9 conclusions and recommendations, 9 conclusions and recommendations.

Practitioners designing or improving undergraduate research experiences (UREs) can build on the experiences of colleagues and learn from the increasingly robust literature about UREs and the considerable body of evidence about how students learn. The questions practitioners ask themselves during the design process should include questions about the goals of the campus, program, faculty, and students. Other factors to consider when designing a URE include the issues raised in the conceptual framework for learning and instruction, the available resources, how the program or experience will be evaluated or studied, and how to design the program from the outset to incorporate these considerations, as well as how to build in opportunities to improve the experience over time in light of new evidence. (Some of these topics are addressed in Chapter 8 .)

Colleges and universities that offer or wish to offer UREs to their students should undertake baseline evaluations of their current offerings and create plans to develop a culture of improvement in which faculty are supported in their efforts to continuously refine UREs based on the evidence currently available and evidence that they and others generate in the future. While much of the evidence to date is descriptive, it forms a body of knowledge that can be used to identify research questions about UREs, both those designed around the apprenticeship model and those designed using the more recent course-based undergraduate research experience (CURE) model. Internships and other avenues by which undergraduates do research provide many of the same sorts of experiences but are not well studied. In any case, it is clear that students value these experiences; that many faculty do as well; and that they contribute to broadening participation in science,

technology, engineering, and mathematics (STEM) education and careers. The findings from the research literature reported in Chapter 4 provide guidance to those designing both opportunities to improve practical and academic skills and opportunities for students to “try out” a professional role of interest.

Little research has been done that provides answers to mechanistic questions about how UREs work. Additional studies are needed to know which features of UREs are most important for positive outcomes with which students and to gain information about other questions of this type. This additional research is needed to better understand and compare different strategies for UREs designed for a diversity of students, mentors, and institutions. Therefore, the committee recommends steps that could increase the quantity and quality of evidence available in the future and makes recommendations for how faculty, departments, and institutions might approach decisions about UREs using currently available information. Multiple detailed recommendations about the kinds of research that might be useful are provided in the research agenda in Chapter 7 .

In addition to the specific research recommended in Chapter 7 , in this chapter the committee provides a series of interrelated conclusions and recommendations related to UREs for the STEM disciplines and intended to highlight the issues of primary importance to administrators, URE program designers, mentors to URE students, funders of UREs, those leading the departments and institutions offering UREs, and those conducting research about UREs. These conclusions and recommendations are based on the expert views of the committee and informed by their review of the available research, the papers commissioned for this report, and input from presenters during committee meetings. Table 9-1 defines categories of these URE “actors,” gives examples of specific roles included in each category, specifies key URE actions for which that category is responsible, and lists the conclusions and recommendations the committee views as most relevant to that actor category.

RESEARCH ON URES

Conclusion 1: The current and emerging landscape of what constitutes UREs is diverse and complex. Students can engage in STEM-based undergraduate research in many different ways, across a variety of settings, and along a continuum that extends and expands upon learning opportunities in other educational settings. The following characteristics define UREs. Due to the variation in the types of UREs, not all experiences include all of the following characteristics in the same way; experiences vary in how much a particular characteristic is emphasized.

TABLE 9-1 Audiences for Committee’s Conclusions and Recommendations

• They engage students in research practices including the ability to argue from evidence.
• They aim to generate novel information with an emphasis on discovery and innovation or to determine whether recent preliminary results can be replicated.
• They focus on significant, relevant problems of interest to STEM researchers and, in some cases, a broader community (e.g., civic engagement).
• They emphasize and expect collaboration and teamwork.
• They involve iterative refinement of experimental design, experimental questions, or data obtained.
• They allow students to master specific research techniques.
• They help students engage in reflection about the problems being investigated and the work being undertaken to address those problems.
• They require communication of results, either through publication or presentations in various STEM venues.
• They are structured and guided by a mentor, with students assuming increasing ownership of some aspects of the project over time.

UREs are generally designed to add value to STEM offerings by promoting an understanding of the ways that knowledge is generated in STEM fields and to extend student learning beyond what happens in the small group work of an inquiry-based course. UREs add value by enabling students to understand and contribute to the research questions that are driving the field for one or more STEM topics or to grapple with design challenges of interest to professionals. They help students understand what it means to be a STEM researcher in a way that would be difficult to convey in a lecture course or even in an inquiry-based learning setting. As participants in a URE, students can learn by engaging in planning, experimentation, evaluation, interpretation, and communication of data and other results in light of what is already known about the question of interest. They can pose relevant questions that can be solved only through investigative or design efforts—individually or in teams—and attempt to answer these questions despite the challenges, setbacks, and ambiguity of the process and the results obtained.

The diversity of UREs reflects the reality that different STEM disciplines operate from varying traditions, expectations, and constraints (e.g., lab safety issues) in providing opportunities for undergraduates to engage in research. In addition, individual institutions and departments have cultures that promote research participation to various degrees and at different stages in students’ academic careers. Some programs emphasize design and problem solving in addition to discovery. UREs in different disciplines can

take many forms (e.g., apprentice-style, course-based, internships, project-based), but the definitional characteristics described above are similar across different STEM fields.

Furthermore, students in today’s university landscape may have opportunities to engage with many different types of UREs throughout their education, including involvement in a formal program (which could include mentoring, tutoring, research, and seminars about research), an apprentice-style URE under the guidance of an individual or team of faculty members, an internship, or enrolling in one or more CUREs or in a consortium- or project-based program.

Conclusion 2: Research on the efficacy of UREs is still in the early stages of development compared with other interventions to improve undergraduate STEM education.

• The types of UREs are diverse, and their goals are even more diverse. Questions and methodologies used to investigate the roles and effectiveness of UREs in achieving those goals are similarly diverse.
• Most of the studies of UREs to date are descriptive case studies or use correlational designs. Many of these studies report positive outcomes from engagement in a URE.
• Only a small number of studies have employed research designs that can support inferences about causation. Most of these studies find evidence for a causal relationship between URE participation and subsequent persistence in STEM. More studies are needed to provide evidence that participation in UREs is a causal factor in a range of desired student outcomes.

Taking the entire body of evidence into account, the committee concludes that the published peer-reviewed literature to date suggests that participation in a URE is beneficial for students .

As discussed in the report’s Introduction (see Chapter 1 ) and in the research agenda (see Chapter 7 ), the committee considered descriptive, causal, and mechanistic questions in our reading of the literature on UREs. Scientific approaches to answering descriptive, causal, and mechanistic questions require deciding what to look for, determining how to examine it, and knowing appropriate ways to score or quantify the effect.

Descriptive questions ask what is happening without making claims as to why it is happening—that is, without making claims as to whether the research experience caused these changes. A descriptive statement about UREs only claims that certain changes occurred during or after the time the students were engaged in undergraduate research. Descriptive studies

cannot determine whether any benefits observed were caused by participation in the URE.

Causal questions seek to discover whether a specific intervention leads to a specific outcome, other things being equal. To address such questions, causal evidence can be generated from a comparison of carefully selected groups that do and do not experience UREs. The groups can be made roughly equivalent by random assignment (ensuring that URE and non-URE groups are the same on average as the sample size increases) or by controlling for an exhaustive set of characteristics and experiences that might render the groups different prior to the URE. Other quasi-experimental strategies can also be used. Simply comparing students who enroll in a URE with students who do not is not adequate for determining causality because there may be selection bias. For example, students already interested in STEM are more likely to seek out such opportunities and more likely to be selected for such programs. Instead the investigator would have to compare future enrollment patterns (or other measures) between closely matched students, some of whom enrolled in a URE and some of whom did not. Controlling for selection bias to enable an inference about causation can pose significant challenges.

Questions of mechanism or of process also can be explored to understand why a causal intervention leads to the observed effect. Perhaps the URE enhances a student’s confidence in her ability to succeed in her chosen field or deepens her commitment to the field by exposing her to the joy of discovery. Through these pathways that act on the participant’s purposive behavior, the URE enhances the likelihood that she persists in STEM. The question for the researcher then becomes what research design would provide support for this hypothesis of mechanism over other candidate explanations for why the URE is a causal factor in STEM persistence.

The committee has examined the literature and finds a rich descriptive foundation for testable hypotheses about the effects of UREs on student outcomes. These studies are encouraging; a few of them have generated evidence that a URE can be a positive causal factor in the progression and persistence of STEM students. The weight of the evidence has been descriptive; it relies primarily on self-reports of short-term gains by students who chose to participate in UREs and does not include direct measures of changes in the students’ knowledge, skills, or other measures of success across comparable groups of students who did and did not participate in UREs.

While acknowledging the scarcity of strong causal evidence on the benefits of UREs, the committee takes seriously the weight of the descriptive evidence. Many of the published studies of UREs show that students who participate report a range of benefits, such as increased understanding of the research process, encouragement to persist in STEM, and support that helps them sustain their identity as researchers and continue with their

plans to enroll in a graduate program in STEM (see Chapter 4 ). These are effective starting points for causal studies.

Conclusion 3: Studies focused on students from historically underrepresented groups indicate that participation in UREs improves their persistence in STEM and helps to validate their disciplinary identity.

Various UREs have been specifically designed to increase the number of historically underrepresented students who go on to become STEM majors and ultimately STEM professionals. While many UREs offer one or more supplemental opportunities to support students’ academic or social success, such as mentoring, tutoring, summer bridge programs, career or graduate school workshops, and research-oriented seminars, those designed for underrepresented students appear to emphasize such features as integral and integrated components of the program. In particular, studies of undergraduate research programs targeting underrepresented minority students have begun to document positive outcomes such as degree completion and persistence in interest in STEM careers ( Byars-Winston et al., 2015 ; Chemers et al., 2011 ; Jones et al., 2010 ; Nagda et al., 1998 ; Schultz et al., 2011 ). Most of these studies collected data on apprentice-style UREs, in which the undergraduate becomes a functioning member of a research group along with the graduate students, postdoctoral fellows, and mentor.

Recommendation 1: Researchers with expertise in education research should conduct well-designed studies in collaboration with URE program directors to improve the evidence base about the processes and effects of UREs. This research should address how the various components of UREs may benefit students. It should also include additional causal evidence for the individual and additive effects of outcomes from student participation in different types of UREs. Not all UREs need be designed to undertake this type of research, but it would be very useful to have some UREs that are designed to facilitate these efforts to improve the evidence base .

As the focus on UREs has grown, so have questions about their implementation. Many articles have been published describing specific UREs (see Chapter 2 ). Large amounts of research have also been undertaken to explore more generally how students learn, and the resulting body of evidence has led to the development and adoption of “active learning” strategies and experiences. If a student in a URE has an opportunity to, for example, analyze new data or to reformulate a hypothesis in light of the student’s analysis, this activity fits into the category that is described as active learning. Surveys of student participants and unpublished evaluations pro-

vide additional information about UREs but do not establish causation or determine the mechanism(s). Consequently, little is currently known about the mechanisms of precisely how UREs work and which aspects of UREs are most powerful. Important components that have been reported include student ownership of the URE project, time to tackle a question iteratively, and opportunities to report and defend one’s conclusions ( Hanauer and Dolan, 2014 ; Thiry et al., 2011 ).

There are many unanswered questions and opportunities for further research into the role and mechanism of UREs. Attention to research design as UREs are planned is important; more carefully designed studies are needed to understand the ways that UREs influence a student’s education and to evaluate the outcomes that have been reported for URE participants. Appropriate studies, which include matched samples or similar controls, would facilitate research on the ways that UREs benefit students, enabling both education researchers and implementers of UREs to determine optimal features for program design and giving the community a more robust understanding of how UREs work.

See the research agenda ( Chapter 7 ) for specific recommendations about research topics and approaches.

Recommendation 2: Funders should provide appropriate resources to support the design, implementation, and analysis of some URE programs that are specifically designed to enable detailed research establishing the effects on participant outcomes and on other variables of interest such as the consequences for mentors or institutions.

Not all UREs need to be the subject of extensive study. In many cases, a straightforward evaluation is adequate to determine whether the URE is meeting its goals. However, to achieve more widespread improvement in both the types and quality of the UREs offered in the future, additional evidence about the possible causal effects and mechanisms of action of UREs needs to be systematically collected and disseminated. This includes a better understanding of the implementation differences for a variety of institutions (e.g., community colleges, primarily undergraduate institutions, research universities) to ensure that the desired outcomes can translate across settings. Increasing the evidence about precisely how UREs work and which aspects of UREs are most powerful will require careful attention to study design during planning for the UREs.

Not all UREs need to be designed to achieve this goal; many can provide opportunities to students by relying on pre-existing knowledge and iterative improvement as that knowledge base grows. However, for the knowledge base to grow, funders must provide resources for some URE designers and social science researchers to undertake thoughtful and well-planned studies

on causal and mechanistic issues. This will maximize the chances for the creation and dissemination of information that can lead to the development of sustainable and effective UREs. These studies can result from a partnership formed as the URE is designed and funded, or evaluators and social scientists could identify promising and/or effective existing programs and then raise funds on their own to support the study of those programs to answer the questions of interest. In deciding upon the UREs that are chosen for these extensive studies, it will be important to consider whether, collectively, they are representative of UREs in general. For example, large and small UREs at large and small schools targeted at both introductory and advanced students and topics should be studied.

CONSTRUCTION OF URES

Conclusion 4: The committee was unable to find evidence that URE designers are taking full advantage of the information available in the education literature on strategies for designing, implementing, and evaluating learning experiences. STEM faculty members do not generally receive training in interpreting or conducting education research. Partnerships between those with expertise in education research and those with expertise in implementing UREs are one way to strengthen the application of evidence on what works in planning and implementing UREs.

As discussed in Chapters 3 and 4 , there is an extensive body of literature on pedagogy and how people learn; helping STEM faculty to access the existing literature and incorporate those concepts as they design UREs could improve student experiences. New studies that specifically focus on UREs may provide more targeted information that could be used to design, implement, sustain, or scale up UREs and facilitate iterative improvements. Information about the features of UREs that elicit particular outcomes or best serve certain populations of students should be considered when implementing a new instantiation of an existing model of a URE or improving upon an existing URE model.

Conclusion 5: Evaluations of UREs are often conducted to inform program providers and funders; however, they may not be accessible to others. While these evaluations are not designed to be research studies and often have small sample sizes, they may contain information that could be useful to those initiating new URE programs and those refining UREs. Increasing access to these evaluations and to the accumulated experience of the program providers may enable URE designers and implementers to build upon knowledge gained from earlier UREs.

As discussed in Chapter 1 , the committee searched for evaluations of URE programs in several different ways but was not able to locate many published evaluations to study. Although some evaluations were found in the literature, the committee could not determine a way to systematically examine the program evaluations that have been prepared. The National Science Foundation and other funders generally require grant recipients to submit evaluation data, but that information is not currently aggregated and shared publicly, even for programs that are using a common evaluation tool. 1

Therefore, while program evaluation likely serves a useful role in providing descriptive data about a program for the institutions and funders supporting the program, much of the summative evaluation work that has been done to date adds relatively little to the broader knowledge base and overall conversations around undergraduate research. Some of the challenges of evaluation include budget and sample size constraints.

Similarly, it is difficult for designers of UREs to benefit systematically from the work of others who have designed and run UREs in the past because of the lack of an easy and consistent mechanism for collecting, analyzing, and sharing data. If these evaluations were more accessible they might be beneficial to others designing and evaluating UREs by helping them to gather ideas and inspiration from the experiences of others. A few such stories are provided in this report, and others can be found among the many resources offered by the Council on Undergraduate Research 2 and on other websites such as CUREnet. 3

Recommendation 3: Designers of UREs should base their design decisions on sound evidence. Consultations with education and social science researchers may be helpful as designers analyze the literature and make decisions on the creation or improvement of UREs. Professional development materials should be created and made available to faculty. Educational and disciplinary societies should consider how they can provide resources and connections to those working on UREs.

Faculty and other organizers of UREs can use the expanding body of scholarship as they design or improve the programs and experiences offered to their students. URE designers will need to make decisions about how to adapt approaches reported in the literature to make the programs they develop more suitable to their own expertise, student population(s), and available resources. Disciplinary societies and other national groups, such as those focused on improving pedagogy, can play important roles in

___________________

1 Personal knowledge of Janet Branchaw, member of the Committee on Strengthening Research Experiences for Undergraduate STEM Students.

2 See www.cur.org [November 2016].

3 See ( curenet.cns.utexas.edu ) [November 2016].

bringing these issues to the forefront through events at their national and regional meetings and through publications in their journals and newsletters. They can develop repositories for various kinds of resources appropriate for their members who are designing and implementing UREs. The ability to travel to conferences and to access and discuss resources created by other individuals and groups is a crucial aspect of support (see Recommendations 7 and 8 for further discussion).

See Chapter 8 for specific questions to consider when one is designing or implementing UREs.

CURRENT OFFERINGS

Conclusion 6: Data at the institutional, state, or national levels on the number and type of UREs offered, or who participates in UREs overall or at specific types of institutions, have not been collected systematically. Although the committee found that some individual institutions track at least some of this type of information, we were unable to determine how common it is to do so or what specific information is most often gathered.

There is no one central database or repository that catalogs UREs at institutions of higher education, the nature of the research experiences they provide, or the relevant demographics (student, departmental, and institutional). The lack of comprehensive data makes it difficult to know how many students participate in UREs; where UREs are offered; and if there are gaps in access to UREs across different institutional types, disciplines, or groups of students. One of the challenges of describing the undergraduate research landscape is that students do not have to be enrolled in a formal program to have a research experience. Informal experiences, for example a work-study job, are typically not well documented. Another challenge is that some students participate in CUREs or other research experiences (such as internships) that are not necessarily labeled as such. Institutional administrators may be unaware of CUREs that are already part of their curriculum. (For example, establishment of CUREs may be under the purview of a faculty curriculum committee and may not be recognized as a distinct program.) Student participation in UREs may occur at their home institution or elsewhere during the summer. Therefore, it is very difficult for a science department, and likely any other STEM department, to know what percentage of their graduating majors have had a research experience, let alone to gather such information on students who left the major. 4

4 This point was made by Marco Molinaro, University of California, Davis, in a presentation to the Committee on Strengthening Research Experience for Undergraduate STEM Students, September 16, 2015.

Conclusion 7: While data are lacking on the precise number of students engaged in UREs, there is some evidence of a recent growth in course-based undergraduate research experiences (CUREs), which engage a cohort of students in a research project as part of a formal academic experience.

There has been an increase in the number of grants and the dollar amount spent on CUREs over the past decade (see Chapter 3 ). CUREs can be particularly useful in scaling UREs to reach a much larger population of students ( Bangera and Brownell, 2014 ). By using a familiar mechanism—enrollment in a course—a CURE can provide a more comfortable route for students unfamiliar with research to gain their first experience. CUREs also can provide such experiences to students with diverse backgrounds, especially if an institution or department mandates participation sometime during a student’s matriculation. Establishing CUREs may be more cost-effective at schools with little on-site research activity. However, designing a CURE is a new and time-consuming challenge for many faculty members. Connecting to nationally organized research networks can provide faculty with helpful resources for the development of a CURE based around their own research or a local community need, or these networks can link interested faculty to an ongoing collaborative project. Collaborative projects can provide shared curriculum, faculty professional development and community, and other advantages when starting or expanding a URE program. See the discussion in the report from a convocation on Integrating Discovery-based Research into the Undergraduate Curriculum ( National Academies of Sciences, Engineering, and Medicine, 2015 ).

Recommendation 4: Institutions should collect data on student participation in UREs to inform their planning and to look for opportunities to improve quality and access.

Better tracking of student participation could lead to better assessment of outcomes and improved quality of experience. Such metrics could be useful for both prospective students and campus planners. An integrated institutional system for research opportunities could facilitate the creation of tiered research experiences that allow students to progress in skills and responsibility and create support structures for students, providing, for example, seminars in communications, safety, and ethics for undergraduate researchers. Institutions could also use these data to measure the impact of UREs on student outcomes, such as student success rates in introductory courses, retention in STEM degree programs, and completion of STEM degrees.

While individual institutions may choose to collect additional information depending on their goals and resources, relevant student demographics

and the following design elements would provide baseline data. At a minimum, such data should include

• Type of URE;
• Each student’s discipline;
• Duration of the experience;
• Hours spent per week;
• When the student began the URE (e.g., first year, capstone);
• Compensation status (e.g., paid, unpaid, credit); and
• Location and format (e.g., on home campus, on another campus, internship, co-op).

National aggregation of some of the student participation variables collected by various campuses might be considered by funders. The existing Integrated Postsecondary Education Data System database, organized by the National Center for Education Statistics at the U.S. Department of Education, may be a suitable repository for certain aspects of this information.

Recommendation 5: Administrators and faculty at all types of colleges and universities should continually and holistically evaluate the range of UREs that they offer. As part of this process, institutions should:

• Consider how best to leverage available resources (including off-campus experiences available to students and current or potential networks or partnerships that the institution may form) when offering UREs so that they align with their institution’s mission and priorities;
• Consider whether current UREs are both accessible and welcoming to students from various subpopulations across campus (e.g., historically underrepresented students, first generation college students, those with disabilities, non-STEM majors, prospective kindergarten-through-12th-grade teachers); and
• Gather and analyze data on the types of UREs offered and the students who participate, making this information widely available to the campus community and using it to make evidence-based decisions about improving opportunities for URE participation. This may entail devising or implementing systems for tracking relevant data (see Conclusion 4 ).

Resources available for starting, maintaining, and expanding UREs vary from campus to campus. At some campuses, UREs are a central focus and many resources are devoted to them. At other institutions—for example, many community colleges—UREs are seen as extra, and new resources may be required to ensure availability of courses and facilities. Resource-

constrained institutions may need to focus more on ensuring that students are aware of potential UREs that already exist on campus and elsewhere in near proximity to campus. All institutional discussions about UREs must consider both the financial resources and physical resources (e.g., laboratories, field stations, engineering design studios) required, while remembering that faculty time is a crucial resource. The incentives and disincentives for faculty to spend time on UREs are significant. Those institutions with an explicit mission to promote undergraduate research may provide more recognition and rewards to departments and faculty than those with another focus. The culture of the institution with respect to innovation in pedagogy and support for faculty development also can have a major influence on the extent to which UREs are introduced or improved.

Access to UREs may vary across campus and by department, and participation in UREs may vary across student groups. It is important for campuses to consider the factors that may facilitate or discourage students from participation in UREs. Inconsistent procedures or a faculty preference for students with high grades or previous research experience may limit options for some student populations.

UREs often grow based on the initiative of individual faculty members and other personnel, and an institution may not have complete or even rudimentary knowledge of all of the opportunities available or whether there are gaps or inconsistencies in its offerings. A uniform method for tracking the UREs available on a given campus would be useful to students and would provide a starting point for analyzing the options. Tracking might consist of notations in course listings and, where feasible, on student transcripts. Analysis might consider the types of UREs offered, the resources available to each type of URE, and variations within or between various disciplines and programs. Attention to whether all students or groups of students have appropriate access to UREs would foster consideration of how to best allocate resources and programming on individual campuses, in order to focus resources and opportunities where they are most needed.

Conclusion 8: The quality of mentoring can make a substantial difference in a student’s experiences with research. However, professional development in how to be a good mentor is not available to many faculty or other prospective mentors (e.g., graduate students, postdoctoral fellows).

Engagement in quality mentored research experiences has been linked to self-reported gains in research skills and productivity as well as retention in STEM (see Chapter 5 ). Quality mentoring in UREs has been shown

to increase persistence in STEM for historically underrepresented students ( Hernandez et al., 2016 ). In addition, poor mentoring during UREs has been shown to decrease retention of students ( Hernandez et al., 2016 ).

More general research on good mentoring in the STEM environment has been positively associated with self-reported gains in identity as a STEM researcher, a sense of belonging, and confidence to function as a STEM researcher ( Byars-Winston et al., 2015 ; Chemers et al., 2011 ; Pfund et al., 2016 ; Thiry et al., 2011 ). The frequency and quality of mentee-mentor interactions has been associated with students’ reports of persistence in STEM, with mentoring directly or indirectly improving both grades and persistence in college. For students from historically underrepresented ethnic/racial groups, quality mentoring has been associated with self-reported enhanced recruitment into graduate school and research-related career pathways ( Byars-Winston et al., 2015 ). Therefore, it is important to ensure that faculty and mentors receive the proper development of mentoring skills.

Recommendation 6: Administrators and faculty at colleges and universities should ensure that all who mentor undergraduates in research experiences (this includes faculty, instructors, postdoctoral fellows, graduate students, and undergraduates serving as peer mentors) have access to appropriate professional development opportunities to help them grow and succeed in this role.

Although many organizations recognize effective mentors (e.g., the National Science Foundation’s Presidential Awards for Excellence in Science, Mathematics, and Engineering Mentoring), there currently are no standard criteria for selecting, evaluating, or recognizing mentors specifically for UREs. In addition, there are no requirements that mentors meet some minimum level of competency before engaging in mentoring or participate in professional development to obtain a baseline of knowledge and skills in mentoring, including cultural competence in mentoring diverse groups of students. Traditionally, the only experience required for being a mentor is having been mentored, regardless of whether the experience was negative or positive ( Handelsman et al., 2005 ; Pfund et al., 2015 ). Explicit consideration of how the relationships are formed, supported, and evaluated can improve mentor-mentee relationships. To ensure that the mentors associated with a URE are prepared appropriately, thereby increasing the chances of a positive experience for both mentors and mentees, all prospective mentors should prepare for their role. Available resources include the Entering Mentoring course (see Pfund et al., 2015 ) and the book Successful STEM Mentoring Initiative for Underrepresented Students ( Packard, 2016 ).

A person who is an ineffective mentor for one student might be inspiring for another, and the setting in which the mentoring takes place (e.g., a CURE or apprentice-style URE, a laboratory or field-research environment) may also influence mentor effectiveness. Thus, there should be some mechanism for monitoring such relationships during the URE, or there should be opportunity for a student who is unhappy with the relationship to seek other mentors. Indeed, cultivating a team of mentors with different experiences and expertise may be the best strategy for any student. A parallel volume to the Entering Mentoring curriculum mentioned above, Entering Research Facilitator’s Manual ( Branchaw et al., 2010 ), is designed to help students with their research mentor-mentee relationships and to coach them on building teams of mentors to guide them. As mentioned in Chapter 5 , the Entering Research curriculum also contains information designed to support a group of students as they go through their first apprentice-style research experience, each working in separate research groups and also meeting together as a cohort focused on learning about research.

PRIORITIES FOR THE FUTURE

Conclusion 9: The unique assets, resources, priorities, and constraints of the department and institution, in addition to those of individual mentors, impact the goals and structures of UREs. Schools across the country are showing considerable creativity in using unique resources, repurposing current assets, and leveraging student enthusiasm to increase research opportunities for their students.

Given current calls for UREs and the growing conversation about their benefits, an increasing number of two- and four-year colleges and universities are increasing their efforts to support undergraduate research. Departments, institutions, and individual faculty members influence the precise nature of UREs in multiple ways and at multiple levels. The physical resources available, including laboratories, field stations, and engineering design studios and testing facilities, make a difference, as does the ability to access resources in the surrounding community (including other parts of the campus). Institutions with an explicit mission to promote undergraduate research may provide more time, resources (e.g., financial, support personnel, space, equipment), and recognition and rewards to departments and faculty in support of UREs than do institutions without that mission. The culture of the institution with respect to innovation in pedagogy and support for faculty development also affects the extent to which UREs are introduced or improved.

Development of UREs requires significant time and effort. Whether or not faculty attempt to implement UREs can depend on whether departmental

or institutional reward and recognition systems compensate for or even recognize the time required to initiate and implement them. The availability of national consortia can help to alleviate many of the time and logistical problems but not those obstacles associated with recognition and resources.

It will be harder for faculty to find the time to develop UREs at institutions where they are required to teach many courses per semester, although in some circumstances faculty can teach CUREs that also advance their own research ( Shortlidge et al., 2016 ). Faculty at community colleges generally have the heaviest teaching expectations, little or no expectations or incentives to maintain a research program, limited access to lab or design space or to scientific and engineering journals, and few resources to undertake any kind of a research program. These constraints may limit the extent to which UREs can be offered to the approximately 40 percent of U.S. undergraduates who are enrolled in the nation’s community colleges (which collectively also serve the highest percentage of the nation’s underrepresented students). 5

Recommendation 7: Administrators and faculty at all types of colleges and universities should work together within and, where feasible, across institutions to create a culture that supports the development of evidence-based, iterative, and continuous refinement of UREs, in an effort to improve student learning outcomes and overall academic success. This should include the development, evaluation, and revision of policies and practices designed to create a culture supportive of the participation of faculty and other mentors in effective UREs. Policies should consider pedagogy, professional development, cross-cultural awareness, hiring practices, compensation, promotion (incentives, rewards), and the tenure process.

Colleges and universities that would like to expand or improve the UREs offered to their students should consider the campus culture and climate and the incentives that affect faculty choices. Those campuses that cultivate an environment supportive of the iterative and continuous refinement of UREs and that offer incentives for evaluation and evidence-based improvement of UREs seem more likely to sustain successful programs. Faculty and others who develop and implement UREs need support to be able to evaluate their courses or programs and to analyze evidence to make decisions about URE design. This kind of support may be fostered by expanding the mission of on-campus centers for learning and teaching to focus more on UREs or by providing incentives for URE developers from the natural sciences and engineering to collaborate with colleagues in the social sciences or colleges of education with expertise in designing studies

5 See http://nces.ed.gov/programs/coe/indicator_cha.asp [November 2016].

involving human subjects. Supporting closer communication between URE developers and the members of the campus Institutional Review Board may help projects to move forward more seamlessly. Interdepartmental and intercampus connections (especially those between two- and four-year institutions) can be valuable for linking faculty with the appropriate resources, colleagues, and diverse student populations. Faculty who have been active in professional development on how students learn in the classroom may have valuable experiences and expertise to share.

The refinement or expansion of UREs should build on evidence from data on student participation, pedagogy, and outcomes, which are integral components of the original design. As UREs are validated and refined, institutions should make efforts to facilitate connections among different departments and disciplines, including the creation of multidisciplinary UREs. Student engagement in learning in general, and with UREs more specifically, depends largely on the culture of the department and the institution and on whether students see their surroundings as inclusive and energetic places to learn and thrive. A study that examined the relationship between campus missions and the five benchmarks for effective educational practice (measured by the National Survey of Student Engagement) showed that different programs, policies, and approaches may work better, depending on the institution’s mission ( Kezar and Kinzie, 2006 ).

The Council on Undergraduate Research (2012) document Characteristics of Excellence in Undergraduate Research outlines several best practices for UREs based on the apprenticeship model (see Chapter 8 ). That document is not the result of a detailed analysis of the evidence but is based on the extensive experiences and expertise of the council’s members. It suggests that undergraduate research should be a normal part of the undergraduate experience regardless of the type of institution. It also identifies changes necessary to include UREs as part of the curriculum and culture changes necessary to support curricular reform, co-curricular activities, and modifications to the incentives and rewards for faculty to engage with undergraduate research. In addition, professional development opportunities specifically designed to help improve the pedagogical and mentoring skills of instructional staff in using evidence-based practices can be important for a supportive learning culture.

Recommendation 8: Administrators and faculty at all types of colleges and universities should work to develop strong and sustainable partnerships within and between institutions and with educational and professional societies for the purpose of sharing resources to facilitate the creation of sustainable URE programs.

Networks of faculty, institutions, regionally and nationally coordinated URE initiatives, professional societies, and funders should be strengthened

to facilitate the exchange of evidence and experience related to UREs. These networks could build on the existing work of professional societies that assist faculty with pedagogy. They can help provide a venue for considering the policy context and larger implications of increasing the number, size, and scope of UREs. Such networks also can provide a more robust infrastructure, to improve the sustainability and expansion of URE opportunities. The sharing of human, financial, scientific, and technical resources can strengthen the broad implementation of effective, high-quality, and more cost-efficient UREs. It may be especially important for community colleges and minority-serving institutions to engage in partnerships in order to expand the opportunities for undergraduates (both transfer and technical students) to participate in diverse UREs (see discussion in National Academies of Sciences, Engineering, and Medicine, 2015 , and Elgin et al., 2016 ). Consortia can facilitate the sharing of resources across disciplines and departments within the same institution or at different institutions, organizations, and agencies. Consortia that employ research methodologies in common can share curriculum, research data collected, and common assessment tools, lessening the time burden for individual faculty and providing a large pool of students from which to assess the efficacy of individual programs.

Changes in the funding climate can have substantial impacts on the types of programs that exist, iterative refinement of programs, and whether and how programs might be expanded to broaden participation by more undergraduates. For those institutions that have not yet established URE programs or are at the beginning phases of establishing one, mechanisms for achieving success and sustainability may include increased institutional ownership of programs of undergraduate research, development of a broad range of programs of different types and funding structures, formation of undergraduate research offices or repurposing some of the responsibilities and activities of those which already exist, and engagement in community promotion and dissemination of student accomplishments (e.g., student symposia, support for undergraduate student travel to give presentations at professional meetings).

Over time, institutions must develop robust plans for ensuring the long-term sustained funding of high-quality UREs. Those plans should include assuming that more fiscal responsibility for sustaining such efforts will be borne by the home institution as external support for such efforts decreases and ultimately ends. Building UREs into the curriculum and structure of a department’s courses and other programs, and thus its funding model, can help with sustainability. Partnerships with nonprofit organizations and industry, as well as seeking funding from diverse agencies, can also facilitate programmatic sustainability, especially if the UREs they fund can also support the mission and programs of the funders (e.g., through research internships or through CUREs that focus on community-

based research questions and challenges). Partnerships among institutions also may have greater potential to study and evaluate student outcomes from URE participation across broader demographic groups and to reduce overall costs through the sharing of administrative or other resources (such as libraries, microscopes, etc.).

Bangera, G., and Brownell, S.E. (2014). Course-based undergraduate research experiences can make scientific research more inclusive. CBE–Life Sciences Education , 13 (4), 602-606.

Branchaw, J.L., Pfund, C., and Rediske, R. (2010) Entering Research Facilitator’s Manual: Workshops for Students Beginning Research in Science . New York: Freeman & Company.

Byars-Winston, A.M., Branchaw, J., Pfund, C., Leverett, P., and Newton, J. (2015). Culturally diverse undergraduate researchers’ academic outcomes and perceptions of their research mentoring relationships. International Journal of Science Education , 37 (15), 2,533-2,554.

Chemers, M.M., Zurbriggen, E.L., Syed, M., Goza, B.K., and Bearman, S. (2011). The role of efficacy and identity in science career commitment among underrepresented minority students. Journal of Social Issues , 67 (3), 469-491.

Council on Undergraduate Research. (2012). Characteristics of Excellence in Undergraduate Research . Washington, DC: Council on Undergraduate Research.

Elgin, S.C.R., Bangera, G., Decatur, S.M., Dolan, E.L., Guertin, L., Newstetter, W.C., San Juan, E.F., Smith, M.A., Weaver, G.C., Wessler, S.R., Brenner, K.A., and Labov, J.B. 2016. Insights from a convocation: Integrating discovery-based research into the undergraduate curriculum. CBE–Life Sciences Education, 15 , 1-7.

Hanauer, D., and Dolan, E. (2014) The Project Ownership Survey: Measuring differences in scientific inquiry experiences, CBE–Life Sciences Education , 13 , 149-158.

Handelsman, J., Pfund, C., Lauffer, S.M., and Pribbenow, C.M. (2005). Entering Mentoring . Madison, WI: The Wisconsin Program for Scientific Teaching.

Hernandez, P.R., Estrada, M., Woodcock, A., and Schultz, P.W. (2016). Protégé perceptions of high mentorship quality depend on shared values more than on demographic match. Journal of Experimental Education. Available: http://www.tandfonline.com/doi/full/10.1080/00220973.2016.1246405 [November 2016].

Jones, P., Selby, D., and Sterling, S.R. (2010). Sustainability Education: Perspectives and Practice Across Higher Education . New York: Earthscan.

Kezar, A.J., and Kinzie, J. (2006). Examining the ways institutions create student engagement: The role of mission. Journal of College Student Development , 47 (2), 149-172.

National Academies of Sciences, Engineering, and Medicine. (2015). Integrating Discovery-Based Research into the Undergraduate Curriculum: Report of a Convocation . Washington, DC: National Academies Press.

Nagda, B.A., Gregerman, S.R., Jonides, J., von Hippel, W., and Lerner, J.S. (1998). Undergraduate student-faculty research partnerships affect student retention. Review of Higher Education, 22 , 55-72. Available: http://scholar.harvard.edu/files/jenniferlerner/files/nagda_1998_paper.pdf [February 2017].

Packard, P. (2016). Successful STEM Mentoring Initiatives for Underrepresented Students: A Research-Based Guide for Faculty and Administrators . Sterling, VA: Stylus.

Pfund, C., Branchaw, J.L., and Handelsman, J. (2015). Entering Mentoring: A Seminar to Train a New Generation of Scientists (2nd ed). New York: Macmillan Learning.

Pfund, C., Byars-Winston, A., Branchaw, J.L., Hurtado, S., and Eagan, M.K. (2016). Defining attributes and metrics of effective research mentoring relationships. AIDS and Behavior, 20 , 238-248.

Schultz, P.W., Hernandez, P.R., Woodcock, A., Estrada, M., Chance, R.C., Aguilar, M., and Serpe, R.T. (2011). Patching the pipeline reducing educational disparities in the sciences through minority training programs. Educational Evaluation and Policy Analysis , 33 (1), 95-114.

Shortlidge, E.E., Bangera, G., and Brownell, S.E. (2016). Faculty perspectives on developing and teaching course-based undergraduate research experiences. BioScience, 66 (1), 54-62.

Thiry, H., Laursen, S.L., and Hunter, A.B. (2011). What experiences help students become scientists? A comparative study of research and other sources of personal and professional gains for STEM undergraduates. Journal of Higher Education, 82 (4), 358-389.

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Undergraduate research has a rich history, and many practicing researchers point to undergraduate research experiences (UREs) as crucial to their own career success. There are many ongoing efforts to improve undergraduate science, technology, engineering, and mathematics (STEM) education that focus on increasing the active engagement of students and decreasing traditional lecture-based teaching, and UREs have been proposed as a solution to these efforts and may be a key strategy for broadening participation in STEM. In light of the proposals questions have been asked about what is known about student participation in UREs, best practices in UREs design, and evidence of beneficial outcomes from UREs.

Undergraduate Research Experiences for STEM Students provides a comprehensive overview of and insights about the current and rapidly evolving types of UREs, in an effort to improve understanding of the complexity of UREs in terms of their content, their surrounding context, the diversity of the student participants, and the opportunities for learning provided by a research experience. This study analyzes UREs by considering them as part of a learning system that is shaped by forces related to national policy, institutional leadership, and departmental culture, as well as by the interactions among faculty, other mentors, and students. The report provides a set of questions to be considered by those implementing UREs as well as an agenda for future research that can help answer questions about how UREs work and which aspects of the experiences are most powerful.

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• How to Write a Thesis or Dissertation Conclusion

How to Write a Dissertation Conclusion | Checklist and Examples

Published on 9 September 2022 by Tegan George and Shona McCombes. Revised on 10 October 2022.

The conclusion is the very last part of your thesis or dissertation . It should be concise and engaging, leaving your reader with a clear understanding of your main findings, as well as the answer to your research question .

In it, you should:

• Clearly state the answer to your main research question
• Summarise and reflect on your research process
• Make recommendations for future work on your topic
• Show what new knowledge you have contributed to your field
• Wrap up your thesis or dissertation

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Table of contents

Discussion vs. conclusion, how long should your conclusion be, step 1: answer your research question, step 2: summarise and reflect on your research, step 3: make future recommendations, step 4: emphasise your contributions to your field, step 5: wrap up your thesis or dissertation, full conclusion example, conclusion checklist, frequently asked questions about conclusion sections.

While your conclusion contains similar elements to your discussion section , they are not the same thing.

Your conclusion should be shorter and more general than your discussion. Instead of repeating literature from your literature review , discussing specific research results , or interpreting your data in detail, concentrate on making broad statements that sum up the most important insights of your research.

As a rule of thumb, your conclusion should not introduce new data, interpretations, or arguments.

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Depending on whether you are writing a thesis or dissertation, your length will vary. Generally, a conclusion should make up around 5–7% of your overall word count.

An empirical scientific study will often have a short conclusion, concisely stating the main findings and recommendations for future research. A humanities topic or systematic review , on the other hand, might require more space to conclude its analysis, tying all the previous sections together in an overall argument.

Your conclusion should begin with the main question that your thesis or dissertation aimed to address. This is your final chance to show that you’ve done what you set out to do, so make sure to formulate a clear, concise answer.

• Don’t repeat a list of all the results that you already discussed
• Do synthesise them into a final takeaway that the reader will remember.

An empirical thesis or dissertation conclusion may begin like this:

A case study –based thesis or dissertation conclusion may begin like this:

In the second example, the research aim is not directly restated, but rather added implicitly to the statement. To avoid repeating yourself, it is helpful to reformulate your aims and questions into an overall statement of what you did and how you did it.

Your conclusion is an opportunity to remind your reader why you took the approach you did, what you expected to find, and how well the results matched your expectations.

To avoid repetition , consider writing more reflectively here, rather than just writing a summary of each preceding section. Consider mentioning the effectiveness of your methodology , or perhaps any new questions or unexpected insights that arose in the process.

You can also mention any limitations of your research, but only if you haven’t already included these in the discussion. Don’t dwell on them at length, though – focus on the positives of your work.

• While x limits the generalisability of the results, this approach provides new insight into y .
• This research clearly illustrates x , but it also raises the question of y .

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You may already have made a few recommendations for future research in your discussion section, but the conclusion is a good place to elaborate and look ahead, considering the implications of your findings in both theoretical and practical terms.

• Based on these conclusions, practitioners should consider …
• To better understand the implications of these results, future studies could address …
• Further research is needed to determine the causes of/effects of/relationship between …

When making recommendations for further research, be sure not to undermine your own work. Relatedly, while future studies might confirm, build on, or enrich your conclusions, they shouldn’t be required for your argument to feel complete. Your work should stand alone on its own merits.

Just as you should avoid too much self-criticism, you should also avoid exaggerating the applicability of your research. If you’re making recommendations for policy, business, or other practical implementations, it’s generally best to frame them as ‘shoulds’ rather than ‘musts’. All in all, the purpose of academic research is to inform, explain, and explore – not to demand.

Make sure your reader is left with a strong impression of what your research has contributed to the state of your field.

Some strategies to achieve this include:

• Returning to your problem statement to explain how your research helps solve the problem
• Referring back to the literature review and showing how you have addressed a gap in knowledge
• Discussing how your findings confirm or challenge an existing theory or assumption

Again, avoid simply repeating what you’ve already covered in the discussion in your conclusion. Instead, pick out the most important points and sum them up succinctly, situating your project in a broader context.

The end is near! Once you’ve finished writing your conclusion, it’s time to wrap up your thesis or dissertation with a few final steps:

• It’s a good idea to write your abstract next, while the research is still fresh in your mind.
• Next, make sure your reference list is complete and correctly formatted. To speed up the process, you can use our free APA citation generator .
• Once you’ve added any appendices , you can create a table of contents and title page .
• Finally, read through the whole document again to make sure your thesis is clearly written and free from language errors. You can proofread it yourself , ask a friend, or consider Scribbr’s proofreading and editing service .

Here is an example of how you can write your conclusion section. Notice how it includes everything mentioned above:

V. Conclusion

The current research aimed to identify acoustic speech characteristics which mark the beginning of an exacerbation in COPD patients.

The central questions for this research were as follows: 1. Which acoustic measures extracted from read speech differ between COPD speakers in stable condition and healthy speakers? 2. In what ways does the speech of COPD patients during an exacerbation differ from speech of COPD patients during stable periods?

All recordings were aligned using a script. Subsequently, they were manually annotated to indicate respiratory actions such as inhaling and exhaling. The recordings of 9 stable COPD patients reading aloud were then compared with the recordings of 5 healthy control subjects reading aloud. The results showed a significant effect of condition on the number of in- and exhalations per syllable, the number of non-linguistic in- and exhalations per syllable, and the ratio of voiced and silence intervals. The number of in- and exhalations per syllable and the number of non-linguistic in- and exhalations per syllable were higher for COPD patients than for healthy controls, which confirmed both hypotheses.

However, the higher ratio of voiced and silence intervals for COPD patients compared to healthy controls was not in line with the hypotheses. This unpredicted result might have been caused by the different reading materials or recording procedures for both groups, or by a difference in reading skills. Moreover, there was a trend regarding the effect of condition on the number of syllables per breath group. The number of syllables per breath group was higher for healthy controls than for COPD patients, which was in line with the hypothesis. There was no effect of condition on pitch, intensity, center of gravity, pitch variability, speaking rate, or articulation rate.

This research has shown that the speech of COPD patients in exacerbation differs from the speech of COPD patients in stable condition. This might have potential for the detection of exacerbations. However, sustained vowels rarely occur in spontaneous speech. Therefore, the last two outcome measures might have greater potential for the detection of beginning exacerbations, but further research on the different outcome measures and their potential for the detection of exacerbations is needed due to the limitations of the current study.

Checklist: Conclusion

I have clearly and concisely answered the main research question .

I have summarized my overall argument or key takeaways.

I have mentioned any important limitations of the research.

I have given relevant recommendations .

I have clearly explained what my research has contributed to my field.

I have  not introduced any new data or arguments.

You've written a great conclusion! Use the other checklists to further improve your dissertation.

In a thesis or dissertation, the discussion is an in-depth exploration of the results, going into detail about the meaning of your findings and citing relevant sources to put them in context.

The conclusion is more shorter and more general: it concisely answers your main research question and makes recommendations based on your overall findings.

While it may be tempting to present new arguments or evidence in your thesis or disseration conclusion , especially if you have a particularly striking argument you’d like to finish your analysis with, you shouldn’t. Theses and dissertations follow a more formal structure than this.

All your findings and arguments should be presented in the body of the text (more specifically in the discussion section and results section .) The conclusion is meant to summarize and reflect on the evidence and arguments you have already presented, not introduce new ones.

For a stronger dissertation conclusion , avoid including:

• Generic concluding phrases (e.g. “In conclusion…”)
• Weak statements that undermine your argument (e.g. “There are good points on both sides of this issue.”)

Your conclusion should leave the reader with a strong, decisive impression of your work.

The conclusion of your thesis or dissertation shouldn’t take up more than 5-7% of your overall word count.

The conclusion of your thesis or dissertation should include the following:

• A restatement of your research question
• A summary of your key arguments and/or results
• A short discussion of the implications of your research

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Evans D, Coad J, Cottrell K, et al. Public involvement in research: assessing impact through a realist evaluation. Southampton (UK): NIHR Journals Library; 2014 Oct. (Health Services and Delivery Research, No. 2.36.)

Public involvement in research: assessing impact through a realist evaluation.

Chapter 9 conclusions and recommendations for future research.

• How well have we achieved our original aim and objectives?

The initially stated overarching aim of this research was to identify the contextual factors and mechanisms that are regularly associated with effective and cost-effective public involvement in research. While recognising the limitations of our analysis, we believe we have largely achieved this in our revised theory of public involvement in research set out in Chapter 8 . We have developed and tested this theory of public involvement in research in eight diverse case studies; this has highlighted important contextual factors, in particular PI leadership, which had not previously been prominent in the literature. We have identified how this critical contextual factor shapes key mechanisms of public involvement, including the identification of a senior lead for involvement, resource allocation for involvement and facilitation of research partners. These mechanisms then lead to specific outcomes in improving the quality of research, notably recruitment strategies and materials and data collection tools and methods. We have identified a ‘virtuous circle’ of feedback to research partners on their contribution leading to their improved confidence and motivation, which facilitates their continued contribution. Following feedback from the HS&DR Board on our original application we did not seek to assess the cost-effectiveness of different mechanisms of public involvement but we did cost the different types of public involvement as discussed in Chapter 7 . A key finding is that many research projects undercost public involvement.

In our original proposal we emphasised our desire to include case studies involving young people and families with children in the research process. We recruited two studies involving parents of young children aged under 5 years, and two projects involving ‘older’ young people in the 18- to 25-years age group. We recognise that in doing this we missed studies involving children and young people aged under 18 years; in principle we would have liked to have included studies involving such children and young people, but, given the resources at our disposal and the additional resource, ethical and governance issues this would have entailed, we regretfully concluded that this would not be feasible for our study. In terms of the four studies with parental and young persons’ involvement that we did include, we have not done a separate analysis of their data, but the themes emerging from those case studies were consistent with our other case studies and contributed to our overall analysis.

In terms of the initial objectives, we successfully recruited the sample of eight diverse case studies and collected and analysed data from them (objective 1). As intended, we identified the outcomes of involvement from multiple stakeholders‘ perspectives, although we did not get as many research partners‘ perspectives as we would have liked – see limitations below (objective 2). It was more difficult than expected to track the impact of public involvement from project inception through to completion (objective 3), as all of our projects turned out to have longer time scales than our own. Even to track involvement over a stage of a case study research project proved difficult, as the research usually did not fall into neatly staged time periods and one study had no involvement activity over the study period.

Nevertheless, we were able to track seven of the eight case studies prospectively and in real time over time periods of up to 9 months, giving us an unusual window on involvement processes that have previously mainly been observed retrospectively. We were successful in comparing the contextual factors, mechanisms and outcomes associated with public involvement from different stakeholders‘ perspectives and costing the different mechanisms for public involvement (objective 4). We only partly achieved our final objective of undertaking a consensus exercise among stakeholders to assess the merits of the realist evaluation approach and our approach to the measurement and valuation of economic costs of public involvement in research (objective 5). A final consensus event was held, where very useful discussion and amendment of our theory of public involvement took place, and the economic approach was discussed and helpfully critiqued by participants. However, as our earlier discussions developed more fully than expected, we decided to let them continue rather than interrupt them in order to run the final exercise to assess the merits of the realist evaluation approach. We did, however, test our analysis with all our case study participants by sending a draft of this final report for comment. We received a number of helpful comments and corrections but no disagreement with our overall analysis.

• What were the limitations of our study?

Realist evaluation is a relatively new approach and we recognise that there were a number of limitations to our study. We sought to follow the approach recommended by Pawson, but we acknowledge that we were not always able to do so. In particular, our theory of public involvement in research evolved over time and initially was not as tightly framed in terms of a testable hypothesis as Pawson recommends. In his latest book Pawson strongly recommends that outcomes should be measured with quantitative data, 17 but we did not do so; we were not aware of the existence of quantitative data or tools that would enable us to collect such data to answer our research questions. Even in terms of qualitative data, we did not capture as much information on outcomes as we initially envisaged. There were several reasons for this. The most important was that capturing outcomes in public involvement is easier the more operational the focus of involvement, and more difficult the more strategic the involvement. Thus, it was relatively easy to see the impact of a patient panel on the redesign of a recruitment leaflet but harder to capture the impact of research partners in a multidisciplinary team discussion of research design.

We also found it was sometimes more difficult to engage research partners as participants in our research than researchers or research managers. On reflection this is not surprising. Research partners are generally motivated to take part in research relevant to their lived experience of a health condition or situation, whereas our research was quite detached from their lived experience; in addition people had many constraints on their time, so getting involved in our research as well as their own was likely to be a burden too far for some. Researchers clearly also face significant time pressures but they had a more direct interest in our research, as they are obliged to engage with public involvement to satisfy research funders such as the NIHR. Moreover, researchers were being paid by their employers for their time during interviews with us, while research partners were not paid by us and usually not paid by their research teams. Whatever the reasons, we had less response from research partners than researchers or research managers, particularly for the third round of data collection; thus we have fewer data on outcomes from research partners‘ perspectives and we need to be aware of a possible selection bias towards more engaged research partners. Such a bias could have implications for our findings; for example payment might have been a more important motivating factor for less engaged advisory group members.

There were a number of practical difficulties we encountered. One challenge was when to recruit the case studies. We recruited four of our eight case studies prior to the full application, but this was more than 1 year before our project started and 15 months or more before data collection began. In this intervening period, we found that the time scales of some of the case studies were no longer ideal for our project and we faced the choice of whether to continue with them, although this timing was not ideal, or seek at a late moment to recruit alternative ones. One of our case studies ultimately undertook no involvement activity over the study period, so we obtained fewer data from it, and it contributed relatively little to our analysis. Similarly, one of the four case studies we recruited later experienced some delays itself in beginning and so we had a more limited period for data collection than initially envisaged. Research governance approvals took much longer than expected, particularly as we had to take three of our research partners, who were going to collect data within NHS projects, through the research passport process, which essentially truncated our data collection period from 1 year to 9 months. Even if we had had the full year initially envisaged for data collection, our conclusion with hindsight was that this was insufficiently long. To compare initial plans and intentions for involvement with the reality of what actually happened required a longer time period than a year for most of our case studies.

In the light of the importance we have placed on the commitment of PIs, there is an issue of potential selection bias in the recruitment of our sample. As our sampling strategy explicitly involved a networking approach to PIs of projects where we thought some significant public involvement was taking place, we were likely (as we did) to recruit enthusiasts and, at worst, those non-committed who were at least open to the potential value of public involvement. There were, unsurprisingly, no highly sceptical PIs in our sample. We have no data therefore on how public involvement may work in research where the PI is sceptical but may feel compelled to undertake involvement because of funder requirements or other factors.

• What would we do differently next time?

If we were to design this study again, there are a number of changes we would make. Most importantly we would go for a longer time period to be able to capture involvement through the whole research process from initial design through to dissemination. We would seek to recruit far more potential case studies in principle, so that we had greater choice of which to proceed with once our study began in earnest. We would include case studies from the application stage to capture the important early involvement of research partners in the initial design period. It might be preferable to research a smaller number of case studies, allowing a more in-depth ethnographic approach. Although challenging, it would be very informative to seek to sample sceptical PIs. This might require a brief screening exercise of a larger group of PIs on their attitudes to and experience of public involvement.

The economic evaluation was challenging in a number of ways, particularly in seeking to obtain completed resource logs from case study research partners. Having a 2-week data collection period was also problematic in a field such as public involvement, where activity may be very episodic and infrequent. Thus, collecting economic data alongside other case study data in a more integrated way, and particularly with interviews and more ethnographic observation of case study activities, might be advantageous. The new budgeting tool developed by INVOLVE and the MHRN may provide a useful resource for future economic evaluations. 23

We have learned much from the involvement of research partners in our research team and, although many aspects of our approach worked well, there are some things we would do differently in future. Even though we included substantial resources for research partner involvement in all aspects of our study, we underestimated how time-consuming such full involvement would be. We were perhaps overambitious in trying to ensure such full involvement with the number of research partners and the number and complexity of the case studies. We were also perhaps naive in expecting all the research partners to play the same role in the team; different research partners came with different experiences and skills, and, like most of our case studies, we might have been better to be less prescriptive and allow the roles to develop more organically within the project.

• Implications for research practice and funding

If one of the objectives of R&D policy is to increase the extent and effectiveness of public involvement in research, then a key implication of this research is the importance of influencing PIs to value public involvement in research or to delegate to other senior colleagues in leading on involvement in their research. Training is unlikely to be the key mechanism here; senior researchers are much more likely to be influenced by peers or by their personal experience of the benefits of public involvement. Early career researchers may be shaped by training but again peer learning and culture may be more influential. For those researchers sceptical or agnostic about public involvement, the requirement of funders is a key factor that is likely to make them engage with the involvement agenda. Therefore, funders need to scrutinise the track record of research teams on public involvement to ascertain whether there is any evidence of commitment or leadership on involvement.

One of the findings of the economic analysis was that PIs have consistently underestimated the costs of public involvement in their grant applications. Clearly the field will benefit from the guidance and budgeting tool recently disseminated by MHRN and INVOLVE. It was also notable that there was a degree of variation in the real costs of public involvement and that effective involvement is not necessarily costly. Different models of involvement incur different costs and researchers need to be made aware of the costs and benefits of these different options.

One methodological lesson we learned was the impact that conducting this research had on some participants’ reflection on the impact of public involvement. Particularly for research staff, the questions we asked sometimes made them reflect upon what they were doing and change aspects of their approach to involvement. Thus, the more the NIHR and other funders can build reporting, audit and other forms of evaluation on the impact of public involvement directly into their processes with PIs, the more likely such questioning might stimulate similar reflection.

• Recommendations for further research

There are a number of gaps in our knowledge around public involvement in research that follow from our findings, and would benefit from further research, including realist evaluation to extend and further test the theory we have developed here:

• In-depth exploration of how PIs become committed to public involvement and how to influence agnostic or sceptical PIs would be very helpful. Further research might compare, for example, training with peer-influencing strategies in engendering PI commitment. Research could explore the leadership role of other research team members, including research partners, and how collective leadership might support effective public involvement.
• More methodological work is needed on how to robustly capture the impact and outcomes of public involvement in research (building as well on the PiiAF work of Popay et al. 51 ), including further economic analysis and exploration of impact when research partners are integral to research teams.
• Research to develop approaches and carry out a full cost–benefit analysis of public involvement in research would be beneficial. Although methodologically challenging, it would be very useful to conduct some longer-term studies which sought to quantify the impact of public involvement on such key indicators as participant recruitment and retention in clinical trials.
• It would also be helpful to capture qualitatively the experiences and perspectives of research partners who have had mixed or negative experiences, since they may be less likely than enthusiasts to volunteer to participate in studies of involvement in research such as ours. Similarly, further research might explore the (relatively rare) experiences of marginalised and seldom-heard groups involved in research.
• Payment for public involvement in research remains a contested issue with strongly held positions for and against; it would be helpful to further explore the value research partners and researchers place on payment and its effectiveness for enhancing involvement in and impact on research.
• A final relatively narrow but important question that we identified after data collection had finished is: what is the impact of the long periods of relative non-involvement following initial periods of more intense involvement for research partners in some types of research, particularly clinical trials?

Included under terms of UK Non-commercial Government License .

• Cite this Page Evans D, Coad J, Cottrell K, et al. Public involvement in research: assessing impact through a realist evaluation. Southampton (UK): NIHR Journals Library; 2014 Oct. (Health Services and Delivery Research, No. 2.36.) Chapter 9, Conclusions and recommendations for future research.
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Table of Contents

• Defining the Terms: What Is a Finding, a Conclusion, and a Recommendation in M&E?
• Why It Matters: Understanding the Importance of Differentiating between Findings, Conclusions, and Recommendations in M&E
• How to Identify and Distinguish between Findings, Conclusions, and Recommendations in M&E
• How to Communicate Findings, Conclusions, and Recommendations Effectively in M&E Reports
• The Benefits of Clear and Accurate Reporting of Findings, Conclusions, and Recommendations in M&E

1. Defining the Terms: What Is a Finding, a Conclusion, and a Recommendation in M&E?

Monitoring and Evaluation (M&E) is a critical process for assessing the effectiveness of development programs and policies. During the M&E process, evaluators collect and analyze data to draw conclusions and make recommendations for program improvement. In M&E, it is essential to differentiate between findings, conclusions, and recommendations to ensure that the evaluation report accurately reflects the program’s strengths, weaknesses, and potential areas for improvement.

In an evaluation report, a finding, a conclusion, and a recommendation serve different purposes and convey different information. Here are the differences between these three elements:

1.1 Finding

A finding is a factual statement that is based on evidence collected during the evaluation . It describes what was observed, heard, or experienced during the evaluation process. A finding should be objective, unbiased, and supported by data. Findings are typically presented in the form of a summary or a list of key points, and they provide the basis for the evaluation’s conclusions and recommendations.

Findings are an important part of the evaluation process, as they provide objective and unbiased information about what was observed, heard, or experienced during the evaluation. Findings are based on the evidence collected during the evaluation, and they should be supported by data and other relevant information. They are typically presented in a summary or list format, and they serve as the basis for the evaluation’s conclusions and recommendations. By presenting clear and accurate findings, evaluators can help stakeholders understand the strengths and weaknesses of the program or initiative being evaluated, and identify opportunities for improvement.

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1.2 Examples of Finding

Here are some examples of findings in M&E:

• “Program participants reported a high level of satisfaction with the quality of training provided, with 85% rating it as good or excellent.”
• “The program was successful in increasing the number of girls enrolled in secondary school, with a 25% increase observed in the target communities.”
• “Program beneficiaries reported improved access to healthcare services, with a 40% increase in the number of individuals accessing healthcare facilities in the program area.”
• “The program’s training curriculum was found to be outdated and ineffective, with only 30% of participants reporting that the training was useful.”
• “The program’s monitoring and evaluation system was found to be inadequate, with data quality issues and insufficient capacity among staff to carry out effective monitoring and evaluation activities.”

These findings represent objective, measurable results of the data collected during the M&E process, and can be used to inform program design and implementation, as well as to draw conclusions and make recommendations for improvement.

1.3 Conclusion

A conclusion is a judgment or interpretation of the findings based on the evidence collected during the evaluation. It is typically expressed in terms of what the findings mean or what can be inferred from them. Conclusions should be logical, evidence-based, and free from personal bias or opinion.

Conclusions often answer the evaluation questions or objectives, and they provide insights into the effectiveness or impact of the program, project, or intervention being evaluated. By synthesizing the findings into a cohesive narrative, evaluators can provide stakeholders with a clear and actionable understanding of the program or initiative being evaluated. Conclusions can also inform future planning and decision-making, by identifying areas for improvement and highlighting successful strategies or interventions. Overall, conclusions are a crucial component of the evaluation process, as they help stakeholders make informed decisions about the programs and initiatives they are involved in.

1.4 Examples of Conclusion

Here are some examples of conclusions in M&E:

• Based on the data collected, it can be concluded that the program was successful in achieving its objective of increasing access to clean water in the target communities.”
• “The data indicates that the program’s training curriculum is ineffective and in need of revision in order to better meet the needs of participants.”
• “It can be concluded that the program’s community mobilization efforts were successful in increasing community participation and ownership of the program.”
• “Based on the data collected, it is concluded that the program’s impact on improving maternal and child health outcomes is limited and further efforts are needed to address the underlying health system and infrastructure issues.”
• “The data collected indicates that the program’s impact on reducing poverty in the target area is modest, but still significant, and further investment in complementary programs may be needed to achieve more substantial reductions in poverty rates.”
• These conclusions are based on the evidence presented in the findings and represent the interpretation or explanation of the meaning of the findings. They help to provide insight into the impact and effectiveness of the program and can be used to make recommendations for improvement.

1.5 Recommendation

A recommendation is a specific action or set of actions proposed based on the findings and conclusions of the evaluation. Recommendations should be practical, feasible, and tailored to the needs of the stakeholders who will be implementing them. They should be supported by evidence and aligned with the goals of the program, project, or intervention being evaluated.

Recommendations often provide guidance on how to improve the effectiveness or efficiency of the program, project, or intervention, and they can help to inform decision-making and resource allocation. By presenting clear and actionable recommendations, evaluators can help stakeholders identify and prioritize areas for improvement, and develop strategies to address identified issues. Recommendations can also serve as a roadmap for future planning and implementation and can help to ensure that the program or initiative continues to achieve its intended outcomes over time.

Overall, recommendations are an essential component of the evaluation process, as they help to bridge the gap between evaluation findings and programmatic action. By proposing specific and evidence-based actions, evaluators can help to ensure that evaluation results are translated into meaningful improvements in program design, implementation, and outcomes.

1.6 Examples of Recommendation

Here are some examples of recommendations in M&E:

• “To improve the effectiveness of the program’s training, the curriculum should be revised to better meet the needs of participants, with a focus on practical, hands-on learning activities.”
• “To address the data quality issues identified in the monitoring and evaluation system, staff should receive additional training on data collection and management, and the system should be revised to incorporate additional quality control measures.”
• “To build on the success of the program’s community mobilization efforts, further investments should be made in strengthening community-based organizations and networks, and in promoting greater community participation in program planning and decision-making.”
• “To improve the program’s impact on maternal and child health outcomes, efforts should be made to address underlying health system and infrastructure issues, such as improving access to health facilities and training health workers.”
• “To achieve more substantial reductions in poverty rates in the target area, complementary programs should be implemented to address issues such as economic development, education, and social protection.”

These recommendations are specific actions that can be taken based on the findings and conclusions of the M&E process. They should be practical, feasible, and based on the evidence presented in the evaluation report. By implementing these recommendations, development practitioners can improve program effectiveness and impact, and better meet the needs of the target population.

2. Why It Matters: Understanding the Importance of Differentiating between Findings, Conclusions, and Recommendations in M&E

Differentiating between findings, conclusions, and recommendations is crucial in M&E for several reasons. First, it ensures accuracy and clarity in the evaluation report. Findings, conclusions, and recommendations are distinct components of an evaluation report, and they serve different purposes. By clearly defining and differentiating these components, evaluators can ensure that the report accurately reflects the program’s strengths and weaknesses, potential areas for improvement, and the evidence supporting the evaluation’s conclusions.

Second, differentiating between findings, conclusions, and recommendations helps to facilitate evidence-based decision-making. By clearly presenting the evidence supporting the evaluation’s findings and conclusions, and making recommendations based on that evidence, evaluators can help program managers and policymakers make informed decisions about program design, implementation, and resource allocation.

Finally, differentiating between findings, conclusions, and recommendations can help to increase the credibility and trustworthiness of the evaluation report. Clear and accurate reporting of findings, conclusions, and recommendations helps to ensure that stakeholders understand the evaluation’s results and recommendations, and can have confidence in the evaluation’s rigor and objectivity.

In summary, differentiating between findings, conclusions, and recommendations is essential in M&E to ensure accuracy and clarity in the evaluation report, facilitate evidence-based decision-making, and increase the credibility and trustworthiness of the evaluation.

3. How to Identify and Distinguish between Findings, Conclusions, and Recommendations in M&E

Identifying and distinguishing between findings, conclusions, and recommendations in M&E requires careful consideration of the evidence and the purpose of each component. Here are some tips for identifying and distinguishing between findings, conclusions, and recommendations in M&E:

• Findings: Findings are the results of the data analysis and should be objective and evidence-based. To identify findings, look for statements that summarize the data collected and analyzed during the evaluation. Findings should be specific, measurable, and clearly stated.
• Conclusions: Conclusions are interpretations of the findings and should be supported by the evidence. To distinguish conclusions from findings, look for statements that interpret or explain the meaning of the findings. Conclusions should be logical and clearly explained, and should take into account any limitations of the data or analysis.
• Recommendations: Recommendations are specific actions that can be taken based on the findings and conclusions. To distinguish recommendations from conclusions, look for statements that propose actions to address the issues identified in the evaluation. Recommendations should be practical, feasible, and clearly explained, and should be based on the evidence presented in the findings and conclusions.

It is also important to ensure that each component is clearly labeled and presented in a logical order in the evaluation report. Findings should be presented first, followed by conclusions and then recommendations.

In summary, identifying and distinguishing between findings, conclusions, and recommendations in M&E requires careful consideration of the evidence and the purpose of each component. By ensuring that each component is clearly labeled and presented in a logical order, evaluators can help to ensure that the evaluation report accurately reflects the program’s strengths, weaknesses, and potential areas for improvement, and facilitates evidence-based decision-making.

4. How to Communicate Findings, Conclusions, and Recommendations Effectively in M&E Reports

Communicating findings, conclusions, and recommendations effectively in M&E reports is critical to ensuring that stakeholders understand the evaluation’s results and recommendations and can use them to inform decision-making. Here are some tips for communicating findings, conclusions, and recommendations effectively in M&E reports:

• Use clear and concise language: Use clear, simple language to explain the findings, conclusions, and recommendations. Avoid technical jargon and use examples to illustrate key points.
• Present data visually: Use tables, graphs, and charts to present data visually, making it easier for stakeholders to understand and interpret the findings.
• Provide context: Provide context for the findings, conclusions, and recommendations by explaining the evaluation’s purpose, methodology, and limitations. This helps stakeholders understand the scope and significance of the evaluation’s results and recommendations.
• Highlight key points: Use headings, bullet points, and other formatting techniques to highlight key points, making it easier for stakeholders to identify and remember the most important findings, conclusions, and recommendations.
• Be objective: Present the findings, conclusions, and recommendations objectively and avoid bias. This helps to ensure that stakeholders have confidence in the evaluation’s rigor and objectivity.
• Tailor the report to the audience: Tailor the report to the audience by using language and examples that are relevant to their interests and needs. This helps to ensure that the report is accessible and useful to stakeholders.

In summary, communicating findings, conclusions, and recommendations effectively in M&E reports requires clear and concise language, visual presentation of data, contextualization, highlighting of key points, objectivity, and audience-tailoring. By following these tips, evaluators can help to ensure that stakeholders understand the evaluation’s results and recommendations and can use them to inform decision-making.

5. The Benefits of Clear and Accurate Reporting of Findings, Conclusions, and Recommendations in M&E

Clear and accurate reporting of M&E findings, conclusions, and recommendations has many benefits for development programs and policies. One of the most significant benefits is improved program design and implementation. By clearly identifying areas for improvement, program designers and implementers can make adjustments that lead to more effective and efficient programs that better meet the needs of the target population.

Another important benefit is evidence-based decision-making. When M&E findings, conclusions, and recommendations are reported accurately and clearly, decision-makers have access to reliable information on which to base their decisions. This can lead to more informed decisions about program design, implementation, and resource allocation.

Clear and accurate reporting of M&E findings, conclusions, and recommendations also supports accountability. By reporting transparently on program performance, development practitioners can build trust and support among stakeholders, including program beneficiaries, donors, and the general public.

M&E findings, conclusions, and recommendations also support continuous learning and improvement. By identifying best practices, lessons learned, and areas for improvement, development practitioners can use this information to improve future programming.

Finally, clear and accurate reporting of M&E findings, conclusions, and recommendations can increase program impact. By identifying areas for improvement and supporting evidence-based decision-making, development programs can have a greater positive impact on the communities they serve.

In summary, clear and accurate reporting of M&E findings, conclusions, and recommendations is critical for improving program design and implementation, supporting evidence-based decision-making, ensuring accountability, supporting continuous learning and improvement, and increasing program impact. By prioritizing clear and accurate reporting, development practitioners can ensure that their programs are effective, efficient, and have a positive impact on the communities they serve.

Very interesting reading which clearly explain the M&E finding, recommendation and conclusion, which sometimes the terms can be confusing

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• 18 Arthritis Unit, Department of Rheumatology , Hospital Clínic Barcelona , Barcelona , Spain
• 19 FCRB , IDIBAPS , Barcelona , Spain
• 20 Rheumatology , AP-HP, Henri Mondor University Hospital , Creteil , France
• 21 EA Epiderme , UPEC , Creteil , France
• 22 Department of Medicine, University of Toronto , Women's College Hospital , Toronto , Toronto , Canada
• 23 The Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics , Rigshospitalet Glostrup , Glostrup , Denmark
• 24 Department of Clinical Medicine, Faculty of Health and Medical Sciences , University of Copenhagen , Copenhagen , Denmark
• 25 Academic Rheumatology Centre, Dipartimento Scienze Cliniche Biologiche , Università di Torino - AO Mauriziano Torino , Turin , Italy
• 26 The Parker Institute , Bispebjerg , Denmark
• 27 Frederiksberg Hospital , Copenhagen University , Copenhagen , Denmark
• 28 Laboratory of Tissue Homeostasis and Disease, Skeletal Biology and Engineering Research Center , KU Leuven , Leuven , Belgium
• 29 Division of Rheumatology , University Hospitals Leuven , Leuven , Belgium
• 30 Rheumatology , Hospital Universitario Central de Asturias , Oviedo , Spain
• 31 Translational Immunology Division, Biohealth Research Institute of the Principality of Asturias , Oviedo University School of Medicine , Oviedo , Spain
• 32 Department of Precision Medicine , University of Campania Luigi Vanvitelli , Naples , Italy
• 33 Rheumatology Research , Providence Swedish , Seattle , Washington , USA
• 34 University of Washington School of Medicine , Seattle , Washington , USA
• 35 School of Medicine , Griffith University , Brisbane , Queensland , Australia
• 36 Tranzo, Tilburg School of Social and Behavioral Sciences , Tilburg University , Tilburg , The Netherlands
• 37 Young PARE Patient Research Partner , EULAR , Zurich , Switzerland
• 38 School of Medicine and Dermatology, Leeds Teaching Hospitals NHS Trust , University of Leeds , Leeds , UK
• 39 Department of Internal Medicine 3, Rheumatology and Immunology and Universitätsklinikum Erlangen , Friedrich-Alexander-Universität Erlangen-Nürnberg , Erlangen , Germany
• 40 Children and Young Person’s Rheumatology Research Programme, Centre for Musculoskeletal Research , The University of Manchester , Manchester , UK
• 41 First Department of Internal Medicine , University of Occupational and Environmental Health, Japan , Kitakyushu , Japan
• 42 Department of Internal Medicine and Pediatrics, VIB Center for Inflammation Research , Ghent University , Gent , Belgium
• 43 Rheumatology , Leiden University Medical Center , Leiden , The Netherlands
• 44 Department of Medical and Biological Sciences , Azienda sanitaria universitaria Friuli Centrale , Udine , Italy
• Correspondence to Laure Gossec, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Universite, Paris, France; laure.gossec{at}aphp.fr

Objective New modes of action and more data on the efficacy and safety of existing drugs in psoriatic arthritis (PsA) required an update of the EULAR 2019 recommendations for the pharmacological treatment of PsA.

Methods Following EULAR standardised operating procedures, the process included a systematic literature review and a consensus meeting of 36 international experts in April 2023. Levels of evidence and grades of recommendations were determined.

Results The updated recommendations comprise 7 overarching principles and 11 recommendations, and provide a treatment strategy for pharmacological therapies. Non-steroidal anti-inflammatory drugs should be used in monotherapy only for mild PsA and in the short term; oral glucocorticoids are not recommended. In patients with peripheral arthritis, rapid initiation of conventional synthetic disease-modifying antirheumatic drugs is recommended and methotrexate preferred. If the treatment target is not achieved with this strategy, a biological disease-modifying antirheumatic drug (bDMARD) should be initiated, without preference among modes of action. Relevant skin psoriasis should orient towards bDMARDs targeting interleukin (IL)-23p40, IL-23p19, IL-17A and IL-17A/F inhibitors. In case of predominant axial or entheseal disease, an algorithm is also proposed. Use of Janus kinase inhibitors is proposed primarily after bDMARD failure, taking relevant risk factors into account, or in case bDMARDs are not an appropriate choice. Inflammatory bowel disease and uveitis, if present, should influence drug choices, with monoclonal tumour necrosis factor inhibitors proposed. Drug switches and tapering in sustained remission are also addressed.

Conclusion These updated recommendations integrate all currently available drugs in a practical and progressive approach, which will be helpful in the pharmacological management of PsA.

• Psoriatic Arthritis
• Biological Therapy
• Biosimilar Pharmaceuticals

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ .

https://doi.org/10.1136/ard-2024-225531

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Introduction

Psoriatic arthritis (PsA) is a disease which has benefited from notable progress over recent years. Concepts have evolved, such as very early diagnosis and pre-PsA, as well as defining treatment targets and applying a holistic approach to comorbidity management. 1–4 Pharmacological options have extended, with the approval of new agents targeting various modes of action for PsA (as well as skin psoriasis). Drugs licensed for PsA now include (1) conventional synthetic (cs) disease-modifying antirheumatic drugs (DMARDs), such as methotrexate (MTX), sulfasalazine and leflunomide; (2) biological (b) DMARDs targeting tumour necrosis factor (TNF), the interleukin (IL)-12/23 or IL-23 pathway, and the IL-17A and IL-17A/F pathway; and (3) targeted synthetic (ts) DMARDs that inhibit Janus kinases (JAKs) or phosphodiesterase 4 (PDE4) ( table 1 ). 5 New safety data have emerged in inflammatory arthritis, particularly a worldwide cautionary comment regarding JAK inhibitors (JAKis), following a large randomised controlled trial (RCT) of tofacitinib in rheumatoid arthritis (RA). 6–8 Since the last EULAR recommendations for the pharmacological management of PsA in 2019, the field has changed significantly. 9–12 An update of the EULAR PsA management recommendations was therefore timely. 9

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Disease-modifying treatment options for psoriatic arthritis in 2023

This update addresses the non-topical, pharmacological management of PsA, with a specific focus on musculoskeletal (MSK) manifestations, while also addressing the spectrum of PsA, including how skin psoriasis, extra-MSK manifestations and comorbidities should influence treatment choices.

In accordance with the EULAR updated standardised operating procedures, 13 the process leading to this update included a data-driven approach and expert opinion.

After approval for an update by the EULAR Council in September 2022, taskforce members were selected by the convenor (JSS) and the methodologist (LG), to include more than one-third of new members, as well as country and gender representation. For the first time, experts from Australia, Japan and North America participated. Representatives from the health professionals in rheumatology (HPR) committee, patient research partners from PARE (People with Arthritis/Rheumatism) and young colleagues from the EMEUNET (EMerging EUlar NETwork) were included. Five members were recruited through an open call to EULAR countries via a competitive application process.

In October 2022, the steering group had its first meeting. The steering group consisted of seven rheumatologists (including the convenor, the methodologist and the fellow: JSS, LG, AK, DA, XB, IBM and DGM), a dermatologist (W-HB), an infectious disease specialist (KLW), an experienced fellow rheumatologist (AK), a patient research partner (HB) and two health professionals (BAE and RJOF, the latter acting in the capacity of a junior methodologist). Questions were then defined and addressed through a systematic literature review (SLR), performed by the fellow (AK) between November 2022 and April 2023, for the literature pertaining to pharmacological treatments of PsA and published since the previous SLR (ie, since the end of 2018). 5

The taskforce comprised the steering group and 23 other experts; members came from 19 different countries (of which 15 were EULAR countries), and included 27 rheumatology specialists, 2 dermatologists, 1 infectious disease specialist, 2 people affected with PsA acting as patient research partners, 2 HPRs and 3 rheumatology/epidemiology fellows/trainees. Overall, 47% of the taskforce members had not participated in the previous update in 2019. In April 2023, the taskforce met for a physical meeting to develop the updated bullet points. Each point was discussed in detail both in smaller (breakout) groups and in plenary sessions until consensus was reached. Group approval was sought through votes (by raised hands) for each bullet point; the limit for acceptance of individual recommendations was set at ≥75% majority among the taskforce for the first voting round; then (after discussions and potential reformulations) at ≥67% majority; and finally, if required, the last round of votes was accepted with >50% acceptance or else a proposal was rejected. 13

Although the SLR was a strong component of the discussions, the process was not only evidence-based but also experience-based and consensus-based, and included consideration of safety, efficacy, cost and long-term data. The levels of evidence (LoE) and grades of recommendation (GoR) were determined for each recommendation based on the Oxford Evidence Based System. 13 14 In May 2023, an anonymised email-based voting on the level of agreement (LoA) among the taskforce members was performed on a 0–10 scale (with 10 meaning full agreement) allowing calculation of mean LoA.

These recommendations address non-topical pharmacological treatments with a main focus on MSK manifestations. These recommendations concern stakeholders, such as experts involved in the care of patients with PsA, particularly rheumatologists and other health professionals (such as rheumatology nurses), general practitioners, dermatologists and other specialists; and also people with PsA as well as other stakeholders, for example, government and hospital officials, patient organisations, regulatory agencies and reimbursement institutions.

The overarching principles (OAPs) and recommendations are shown in table 2 , with LoE, GoR and LoA. The updated recommendations include 7 OAPs (vs 6 in 2019) and 11 recommendations (vs 12 in 2019, due to merges). Of the 11 recommendations, only 4 are unchanged compared with 2019 (the modifications compared with the 2019 recommendations are represented in table 3 ).

2023 updated EULAR recommendations for the pharmacological management of psoriatic arthritis

Comparison of the 2019 and 2023 EULAR recommendations for the management of psoriatic arthritis

Overarching principles

Of the seven OAPs, three remain unchanged, three were reworded and one has been added (overarching principle G). For more information on the thought process leading to the OAPs (unchanged or slightly changed), please refer to the 2015 and 2019 recommendations manuscripts. 9 15 Key points from the discussion of the OAPs are addressed in the following:

A. Psoriatic arthritis is a heterogeneous and potentially severe disease, which may require multidisciplinary treatment (unchanged) .

Although PsA is potentially severe, not all patients will develop severe forms. 16 17 Multidisciplinary management is helpful for many patients, through collaboration between physicians of different specialties and HPRs with the appropriate expertise. 18 19

B. Treatment of psoriatic arthritis patients should aim at the best care and must be based on a shared decision between the patient and the rheumatologist, considering efficacy, safety, patient preferences and costs.

This OAP was modified from 2019 to add patient preferences as an element to be considered and emphasise the importance of shared decision-making to maximise treatment adherence and efficacy while at the same time minimise complications driven by uncontrolled (active) disease as well as potential side effects of pharmacological drugs. 20 21

C. Rheumatologists are the specialists who should primarily care for the musculoskeletal manifestations of patients with psoriatic arthritis; in the presence of clinically relevant skin involvement, a rheumatologist and a dermatologist should collaborate in diagnosis and management.

We consider that rheumatology experts provide the best care for patients with PsA, given their experience with the many drugs used to treat these and other rheumatic and musculoskeletal diseases (RMDs), including the important aspects of safety and comorbidities. Consultation with dermatologists and sometimes other specialists may be helpful in individual clinical scenarios (see also overarching principles F and G). A very slight rewording was performed to discuss skin involvement as ‘clinically relevant’ rather than ‘clinically significant’ for more homogeneity with other bullet points. This bullet point does not address the role of HPRs, who are usually not prescribers in EULAR countries.

D. The primary goal of treating patients with psoriatic arthritis is to maximise health-related quality of life, through control of symptoms, prevention of structural damage, normalisation of function and social participation; abrogation of inflammation is an important component to achieve these goals (unchanged).

For more details, please see the 2019 update of these recommendations. 9

E. In managing patients with psoriatic arthritis, consideration should be given to each musculoskeletal manifestation and treatment decisions made accordingly (unchanged).

For more details, please refer to the 2019 update. 9

F. When managing patients with psoriatic arthritis, non-musculoskeletal manifestations (skin, eye and gastrointestinal tract) should be taken into account; comorbidities such as obesity, metabolic syndrome, cardiovascular disease or depression should also be considered.

The wording ‘such as obesity’ was added, since obesity is frequent in PsA and can influence outcomes. 22 23 Obesity concerns excess body fat, while metabolic syndrome is a collection of risk factors that increase the likelihood of developing cardiovascular disease and type 2 diabetes. Obesity is a significant contributor to the development of metabolic syndrome. The taskforce members discussed if other comorbidities should be added, but it was felt that the term ‘such as’ entails that comorbidities overall should be considered, without a need to list them. Depression and potentially other mental health issues may influence treatment choice. Central sensitisation to pain perception is frequent in PsA and also influences outcomes; this may lead to difficulties in disease management. 24 25 Bone health and malignancies were also specifically highlighted. The management of comorbidities poses specific issues, in particular as to who is responsible for managing distinct disease domains. Solutions need to be applied according to the individual patient, each country’s specific setting and healthcare system organisation.

G. The choice of treatment should take account of safety considerations regarding individual modes of action to optimise the benefit–risk profile (new).

Given new data on the safety of different modes of action, the taskforce proposed this new OAP to emphasise the importance of taking into account safety considerations for each patient. 6 The taskforce was aware that this item is somewhat redundant with overarching principle B but wished to emphasise the importance of benefit–risk assessment when considering the use of specific agents.

Recommendations

Of note, these recommendations are centred on non-topical pharmacological treatments; topical and non-pharmacological treatments are also important in PsA but are outside our scope. Figure 1 shows a summarised algorithm of the treatment proposals.

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2023 EULAR recommendations algorithm for the management of PsA. bDMARD, biological disease-modifying antirheumatic drug; csDMARD, conventional synthetic disease-modifying antirheumatic drug; IBD, inflammatory bowel disease; L, interleukin; JAK, Janus kinase inhibitor; JAKi, Janus kinase inhibitor; NSAID, non-steroidal anti-inflammatory drugs; TNF, tumour necrosis factor; TNFI, tumour necrosis factor inhibitor.

Some safety issues will be briefly addressed, but for a full picture of the adverse event profile of different drugs the package inserts should be consulted.

Recommendation 1

Treatment should be aimed at reaching the target of remission or, alternatively, low disease activity, by regular disease activity assessment and appropriate adjustment of therapy.

This (unchanged) recommendation is in keeping with the principles of treating-to-target. 26 27 Given the lack of new data to support treat-to-target in PsA, the LoE and GoR are also unchanged. The use of instruments to assess disease activity has been addressed in the treat-to-target recommendations. 26 The definition of remission in PsA remains a subject of debate. 28–30 For the context of these recommendations, remission should be seen as an abrogation of inflammation.

The taskforce members emphasised that disease activity should be regularly assessed across individual involved manifestations (eg, joints, skin, enthesitis, dactylitis, axial disease), and that treatment adjustments will depend on the predominant manifestation of the disease at a given moment. 31

Recommendation 2

Non-steroidal anti-inflammatory drugs may be used to relieve musculoskeletal signs and symptoms; local injections of glucocorticoids may be considered as adjunctive therapy.

This recommendation deals with the short-term use of symptomatic treatment. It was developed by merging the two previous recommendations 2 and 3, which dealt separately with non-steroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids, as both only serve to relieve symptoms in the short term. It was decided to no longer allude to systemic glucocorticoids in a bullet point, since the data underlying the prescription of systemic glucocorticoids in PsA are scarce. Moreover, glucocorticoids harbour many potential safety issues, in particular when taking into account the high prevalence of comorbidities and cardiovascular risk factors in PsA. 3 32 However, the taskforce members agreed that, in some selected cases, systemic glucocorticoid therapy may be helpful for some patients, especially for polyarticular forms and/or as bridging therapy.

NSAIDs offer symptomatic relief to patients with MSK involvement, but have not shown any efficacy in psoriasis. NSAIDs and local glucocorticoid injections are useful to relieve symptoms and local inflammation temporarily, and may be used combined with DMARDs as needed (please see recommendation 3). However, the safety aspects of (potentially long-term) NSAID use have to be taken into account.

The taskforce emphasised that the vast majority of patients should not be treated with NSAIDs alone (without DMARDs), in keeping with a proactive treat-to-target approach to PsA. Only patients with very mild peripheral disease, or with predominant entheseal or axial disease, may sufficiently benefit from NSAIDs as monotherapy. Even in these cases, it is proposed that the use of symptomatic treatments alone should usually be short term, for example, limited to 4 weeks or so. In peripheral arthritis, this duration is based on the opinion of the group; in predominant axial disease, it is in keeping with the Assesment of Spondyloarthritis International Society (ASAS)/EULAR recommendations for axial spondyloarthritis (axSpA) whereby persistent disease after 4 weeks of treatment is considered a failure of NSAIDs. 33 On the other hand, for patients with predominant axial disease who experience significant improvement in clinical symptoms, continuous NSAID use may be proposed if needed to control symptoms, always taking the risks and benefits into account. Of note, data regarding the efficacy of NSAIDs in enthesitis are limited.

Recommendation 3

In patients with polyarthritis or those with monoarthritis/oligoarthritis and poor prognostic factors (eg, structural damage, elevated acute phase reactants, dactylitis or nail involvement), a csDMARD should be initiated rapidly, with methotrexate preferred in those with clinically relevant skin involvement.

Among patients with peripheral arthritis, 34 35 a distinction is made according to the number of swollen joints and according to prognostic factors. 36 In 2019, polyarthritis and monoarthritis/oligoarthritis with poor prognostic markers were addressed in separate bullet points, which were merged for clarity in this update ( table 3 ). Oligoarticular disease is defined as arthritis (swollen joints) of up to four (included) joints. 9 This definition applies to clinical detection (rather than imaging). The prognostic factors have also been previously defined 9 17 and are unchanged.

We recommend rapid csDMARD start, concomitant (or close) with the initiation of symptomatic therapy, for both patients with polyarticular disease and patients with oligoarticular disease and poor prognostic factors. Patients with oligoarticular disease and lack of poor prognostic factors should also receive a csDMARD, but there is less urgency for these patients given the more favourable long-term prognosis. The latter may receive csDMARDs after a longer delay, and potentially a period of symptomatic treatment alone (see recommendation 2). Since there is a lack of strong evidence to support this approach of rapid treatment introduction, this recommendation was mainly based on expert opinion.

Of note, there is no specific recommendation for dactylitis. We consider dactylitis as an association of (oligo)synovitis, tenosynovitis and enthesitis. Patients with isolated dactylitis should be treated similarly to patients with oligoarthritis; this includes the use of joint glucocorticoid injections and csDMARDs, which have shown efficacy in relieving dactylitis. 37

The first DMARD should be a csDMARD (meaning MTX, leflunomide or sulfasalazine). The decision concerning the first-line DMARD is important and led to much taskforce discussion, and has been put as an element for further research in the research agenda ( table 4 ). The continued prioritisation of csDMARDs reflects consensual expert opinion within the taskforce that favoured the benefit–risk–cost balance of csDMARDs and in particular MTX over targeted drugs. The absence of new data indicating the superiority of a b/tsDMARD as first-line, and in the presence of new data on MTX, was seen as confirming the efficacy of this drug in PsA. 5 37–39

Research agenda indicating priorities for future research in PsA

Since the EULAR recommendations adhere to a treat-to-target (T2T) approach which implies a reduction of disease activity by at least 50% within 3 months and reaching the treatment target within 6 months, a csDMARD should not be continued if these therapeutic goals are not attained. On csDMARD inefficacy, another DMARD, such as a bDMARD (see recommendation 4), can be rapidly instituted. Generally speaking, we recommend assessing the efficacy of the csDMARD and deciding if it should be pursued as monotherapy or not, after 12 weeks, in line with the T2T recommendations. 26 Although MTX use in PsA has typically been founded on evidence from other immune-mediated diseases such as RA and psoriasis, 40 there is also evidence for its efficacy in PsA, with recent confirmatory data both from observational data sources and from a randomised trial indicating that a proportion of patients will respond to escalation of doses of MTX. 39 41–43 The efficacy–safety balance of MTX should be assessed regularly, given the general metabolic profile of patients with PsA which can put them at a higher risk for adverse events such as hepatotoxicity. 42–44 The MTX dose should be sufficient, that is, usually between 20 mg and 25 mg weekly (about 0.3 mg/kg), and use of folate supplementation is recommended to reduce the adverse effects of MTX. 45

Other csDMARDs (ie, leflunomide and sulfasalazine) are potential treatment options and have demonstrated efficacy in PsA peripheral arthritis. 15 A recent trial of the combination of MTX with leflunomide indicated a low efficacy to safety ratio; thus, this association is not recommended. 38

Recommendation 4

In patients with peripheral arthritis and an inadequate response to at least one csDMARD, therapy with a bDMARD should be commenced.

This recommendation is relevant to patients with peripheral arthritis and therefore is meant to include both those with monoarticular/oligoarticular and those with polyarticular disease. However, where peripheral involvement is limited and without poor prognostic factors, it is not unreasonable to apply a second csDMARD course before initiating a bDMARD/tsDMARD, when this decision is agreed by the prescriber and the patient.

After failure of at least one csDMARD, the taskforce proposed as next step one of the many available bDMARDs ( table 1 ). 5

JAKi is efficacious in PsA, but the taskforce decided that at present the efficacy–safety balance, costs and long-term experience with many bDMARDs clearly favour their recommendation over JAKi. Relevant comorbidities in many patients with PsA also favour bDMARD selection.

Regarding bDMARDs, no order of preference is given since no bDMARD has demonstrated superiority for joint involvement over other bDMARDs ( table 1 ). 46–48 Herein they are listed in numeric order of the targeted cytokine, and not in order of preference. However, in the context of the present recommendation, CTLA4 (cytotoxic T-lymphocyte–associated antigen 4) inhibition is not considered a good option due to its limited efficacy in clinical trials. 49 The GoR is high for this bullet point, reflecting robust accrued data. 50

Unlike MSK manifestations, non-MSK domains of PsA allow differential order of bDMARD recommendation (se recommendation 9). 5 Two head-to-head trials of bDMARDs in PsA, both comparing an IL-17A inhibitor with adalimumab, showed similar efficacy for IL-17A inhibition and TNF inhibition, as regards efficacy on the joints, while skin responses are better with the former. 46 47 We also note that there is evidence on the better efficacy of a bDMARD compared with MTX in skin psoriasis (and evidence for differences between bDMARDs, please see recommendation 9). 51 52

All bDMARDs and JAKi showed efficacy regarding inhibition of radiographic progression; such data are lacking for apremilast.

The safety of the different available categories of bDMARDs appears acceptable in our SLR. 5 All bDMARDs increase the risk of infections. 5 The risks of TNF inhibitors (TNFis) are well known. Candidiasis (usually mucocutaneous) is more frequent with IL-17A and IL-17A/F inhibition, particularly the latter. 53 54 While IL-23-p19i is a more recent addition to the armament, its safety appears satisfactory, in line with ustekinumab which also interferes with IL-23 (p40 chain) whose adverse event profile is well known and appears satisfactory. 5

As a general rule, safety and comorbidities need to be taken into account when a decision to start a new drug is taken. More complete information regarding the safety aspects of bDMARDs is provided in the individual drug’s product information. Costs should also be taken into account, but these may vary at the country level; cost savings will occur in many countries due to the availability of biosimilar TNF blockers and potentially other biosimilars in due course. Personalised medicine, to facilitate an optimal choice of the first bDMARD, is currently difficult due to the lack of individualised predictors of response to treatment. 55 As previously discussed, it is of key importance to take into account the patient phenotype and potential extra-MSK features ( figure 1 ). Comorbidities are also to be considered. 23 56 More research is needed on the predictors of drug response, including the effect of sex. 57 58

Combination of a bDMARD with a csDMARD

First-line bDMARDs are often given in combination with csDMARDs, such as MTX. 41 59 However, there are conflicting data regarding the added benefit of concomitant MTX with targeted DMARDs in patients with peripheral disease and no evidence of a benefit of MTX in patients with axial symptoms. 33 60 61

MTX combination with bDMARDs has been explored mainly for TNFi; studies have generally found similar efficacy with or without concomitant MTX, although with increased drug survival when using MTX, in some studies. 41 59 62 A recent large study reported increased remission rates with TNFi plus MTX combination therapy. 59 With other modes of action, there is a lack of data to support comedication. Overall, the taskforce proposed to combine a first bDMARD with the previously prescribed csDMARD, in all cases where such a treatment has already been tolerated by the patient and in particular when the first bDMARD is a TNFi. For other modes of action, given the lack of data, we cannot recommend comedication, although the usual practice would be to continue a csDMARD when initiating a bDMARD (doses of the csDMARD can be diminished if needed).

Recommendation 5

In patients with peripheral arthritis and an inadequate response to at least one bDMARD, or when a bDMARD is not appropriate, a JAKi may be considered, taking safety considerations into account.

This recommendation elicited much debate. On the one hand, since 2019, new data have accrued on JAKis in terms of efficacy, such as the publication of positive trials on upadacitinib in PsA. 63 On the other hand, there is currently a worldwide cautionary statement issued by both the Food and Drug Administration and the European Medicine Agency restricting the use of JAKis in all diseases including PsA, based on an increased risk of cardiovascular and malignancy events observed with tofacitinib in older patients with RA with cardiovascular risk factors. 6–8 JAKis lead to increased general infection rates of similar magnitude to bDMARDs, but higher for herpes zoster infections. 5 Drug safety for the JAKis tofacitinib and upadacitinib in the specific context of PsA was recently reported and appeared reassuring; however, follow-up was short and further data are warranted. 64 65 While currently long-term extension data do not show increased cardiovascular/cancer risk related to JAKi use in PsA, there are no RCTs similar to the ORAL-Surveillance trial available at present in PsA. Therefore, the taskforce felt that the precautions related to RA also have to be taken for PsA, especially since various comorbidities important for the JAKi risk profile may be more prevalent in PsA than in RA (eg, obesity and cardiovascular risk factors). On the other hand, controlling inflammation is important to decrease cardiovascular risk.

Safety of JAKis should be carefully considered 66 ; we propose in table 2 and figure 1 a shortened version of the EMA warning/limitation to use, which includes age, smoking status and other cardiovascular/venous/cancer risk factors. 7 8

After much discussion, we considered that the efficacy–safety balance of JAKis did not justify putting JAKis on the same level as bDMARDs for order of choice (ie, proposing JAKis as usual treatment after insufficient response and/or intolerance to csDMARD treatment).

Therefore, JAKis are proposed usually as second-line targeted therapies (or third-line DMARDs). Of note, we recognise that, for some patients, JAKis may be a relevant option after a csDMARD; this is reflected in the wording of the bullet point (‘when a bDMARD is not appropriate’). This ‘non-appropriateness’ may include contraindications to bDMARDs, practical issues leading to a strong preference for oral administrations (eg, lack of proper conservation at regulated temperatures) and patient preferences, including risk of non-adherence to injections (in accordance with the first OAP concerning shared decision-making). Nevertheless, patients will have to weigh their preferences against potential risks.

The GoR was low for this recommendation, in particular regarding safety considerations, since the data are sparse in PsA and we had to rely on data taken from RA. The taskforce suggests using JAKi after bDMARDs have failed because several new bDMARDs with excellent effects on skin involvement and relatively good safety data are now available (IL-23, IL-17 inhibitors) and more long-term data on JAKi efficacy and safety are needed in PsA. The efficacy to safety ratio of JAKis was also put into the research agenda ( table 4 ).

Currently, drugs from the tyrosine kinase 2 (TYK2) pathway inhibition are being assessed in PsA 5 ; they are not currently licensed for use, and indeed the data are at this point limited in particular for safety (including in psoriasis where such therapy is licensed). Thus, we did not include TYK2 inhibition in the current recommendations.

Recommendation 6

In patients with mild disease and an inadequate response to at least one csDMARD, in whom neither a bDMARD nor a JAKi is appropriate, a PDE4 inhibitor may be considered.

This recommendation is unchanged from 2019, with unchanged LoE. ‘Mild disease’ is defined as oligoarticular or entheseal disease without poor prognostic factors and limited skin involvement. 9 67 The FOREMOST trial recently confirmed the efficacy of apremilast compared with placebo in oligoarticular PsA. 67 Nevertheless, the reason to place apremilast differently from bDMARDs or other tsDMARDs is not only based on its consistently relatively low efficacy, but also on the lack of structural efficacy data (thus putting the term ‘DMARD’ at risk since there are no data on inhibition of damage progression).

This recommendation received the lowest LoA within the taskforce, reflecting that more than a quarter of the taskforce participants were in favour of only discussing apremilast in the text without a specific bullet point.

The use of apremilast in combination with TNFi is off-label, and is a more costly drug combination with no supporting data and cannot be recommended.

Recommendation 7

In patients with unequivocal enthesitis and an insufficient response to NSAIDs or local glucocorticoid injections, therapy with a bDMARD should be considered.

This bullet point remains unchanged. Unequivocal enthesitis refers (as in 2019) to definite entheseal inflammation (which might need additional diagnostic imaging) to avoid overtreatment of entheseal pain not related to PsA (eg, in the context of widespread pain syndrome or repetitive mechanical stress). 68 69 In terms of treatment options, the taskforce discussed the recent data indicating indirectly some efficacy for MTX in enthesitis. 5 38 39 However, it was felt that the data for MTX were not sufficiently strong to propose MTX in the bullet point. We do acknowledge that, for some patients with enthesitis, MTX may be an option ( figure 1 ).

For unequivocal predominant enthesitis, the proposal is to introduce a bDMARD (without a preference for a specific mode of action) since all currently approved bDMARDs have demonstrated efficacy on enthesitis, with similar magnitudes of response, although head-to-head trials are missing ( figure 1 ). 5 Here, costs may be important, but other manifestations will also have to be taken into account (see recommendations 8 and 9). Of note, although tsDMARDs are not mentioned specifically in the bullet point, they are an option in some cases of enthesitis (always considering benefit to risk ratios, in particular for JAKis). 7 8

Recommendation 8

In patients with clinically relevant axial disease with an insufficient response to NSAIDs, therapy with an IL-17Ai, a TNFi, an IL-17 A/Fi or a JAKi should be considered.

The formulation for axial disease was modified from predominant to clinically relevant. For axial disease, in agreement also with the recently updated ASAS/EULAR axSpA recommendations, 33 we continue to judge csDMARDs as not relevant. bDMARDs targeting TNF and IL-17A and IL-17A/F as well as tsDMARDs targeting JAK are recommended. For JAKis, safety issues should be considered. Of note, we propose a choice between the drugs, not a combination of the drugs.

For this recommendation, the order of the drugs listed is of relevance, meaning that IL-17A inhibition has been put first due to the availability of currently only one trial specifically investigating axial PsA and using secukinumab (the MAXIMISE trial), 70 with the other drugs listed thereafter. Thus, the LoE is stronger for IL-17A inhibition than for the other drugs, where the data are derived from axial SpA. 33

The other drugs are listed with TNF inhibition first due to long-term safety data, then IL-17 A/F inhibition which has been recently licensed for axial SpA and JAK inhibition as an option taking into account safety. JAKis are here proposed in the same recommendation as bDMARDs, also reflecting that comorbidity profiles of patients with predominant or isolated axial PsA may be more comparable to patients with axial SpA and therefore may have a more favourable safety profile with respect to cardiovascular and cancer risks than many patients with predominant peripheral arthritis. The taskforce discussed the circumstantial evidence that IL-23 inhibition may be efficacious for axial PsA; however, given negative trials for IL-12/23 inhibition in axSpA, the IL-23 pathway is not recommended here. 33 71–73 Axial PsA remains a challenging form of PsA in terms of definition and differences with axial SpA; thus, this phenotype is part of the research agenda ( table 4 ).

Recommendation 9

The choice of the mode of action should reflect non-musculoskeletal manifestations related to PsA; with clinically relevant skin involvement, preference should be given to an IL-17A or IL-17A/F or IL-23 or IL-12/23 inhibitor; with uveitis to an anti-TNF monoclonal antibody; and with IBD to an anti-TNF monoclonal antibody or an IL-23 inhibitor or IL-12/23 inhibitor or a JAKi.

This is a new recommendation to clarify more visibly than in 2019 ( table 3 ) that the choice of drug should take into account not only the MSK PsA phenotype but also extra-MSK manifestations.

The first extra-MSK manifestation of interest in PsA is skin psoriasis. Although most patients with PsA present with skin psoriasis or have a personal history of skin psoriasis, registry data indicate that many patients with PsA have mild skin involvement. 74 However, even limited skin psoriasis can be troublesome, since relevant skin involvement is defined as either extensive (body surface area involvement >10%), or as important to the patient, that is, impacting negatively their quality of life (such as is the case with face or genital involvement). 9 For these patients, we recommend preferentially considering drugs targeting the IL-17A, IL-17A/F or IL-23 pathway (here, the order between drugs is cited in order of numbered cytokine, not preference). There are strong data, including head-to-head trials, in the field of skin psoriasis showing that drugs targeting the IL-23 and IL-17 pathways are superior to TNFis and to JAKis for skin psoriasis. 51 52 75–78 This justified proposing these modes of action preferentially in case of relevant skin involvement. This is in keeping with psoriasis recommendations. 79

Uveitis is not as frequent in PsA as it is in axial SpA; the prevalence is reported around 5%. 80 However, uveitis can be severe and should influence treatment decisions. Currently, the only mode of action with direct proof of efficacy on uveitis is TNF inhibition through monoclonal antibodies (ie, adalimumab and infliximab). Thus, for patients with uveitis, an anti-TNF monoclonal antibody is preferred.

Inflammatory bowel disease (IBD) concerns 2%–4% of patients with PsA. 80 The armamentarium for IBD has widened recently, and this recommendation reflects this fact, proposing that one of the modes of action currently licensed for IBD should be prescribed when it coexists with PsA. No order of preference is given here and prescribers are urged to adhere to EMA authorisations for IBD and take into account safety. For informative purposes, as of mid-2023, drugs authorised for IBD include anti-TNF monoclonal antibodies (ie, adalimumab and infliximab), the IL-12/23i ustekinumab, the IL-23i risankizumab (for Crohn’s disease) and two JAKis (one of which, tofacitinib, only for Crohn’s disease). 81–85 IL-17is (both A and A/F) are not recommended in case of active IBD, given indications of a heightened risk of flares. 86–88

Decisions for patients presenting with major skin involvement, with uveitis or with IBD should be discussed with the relevant specialist colleagues, as needed.

In all cases, the prescriber must refer to current drug authorisations and take into account safety and comorbidities.

To present an order for choosing drugs, we propose that the first element to take into account is the PsA subtype, then as a second element extra-MSK manifestations (always considering safety and comorbidities).

Recommendation 10

In patients with an inadequate response or intolerance to a bDMARD or a JAKi, switching to another bDMARD or JAKi should be considered, including one switch within a class.

This recommendation is unchanged from 2019, with unchanged LoE. 9 After failing one targeted drug, it is logical to switch to another targeted drug; there are currently no strong data to prefer a switch with a change in mode of action to a switch within the same mode of action. Of note, this recommendation does not limit the total number of switches for a given patient. It also does not necessarily mean that more switches within a class could not be done, but the taskforce felt that a switch should not necessarily be done after one drug of a class has failed. Switches can be made, as appropriate, between bDMARDs, or between bDMARDs and JAKis. We include abatacept as a treatment option ( table 1 ), 49 but note that it demonstrated modest efficacy and hence this is an option to be used only after failing one or more other targeted drugs. The efficacy of bimekizumab, the dual IL-17 A/F inhibitor, appeared similar in TNF-naïve and TNF-experienced populations; this will warrant confirmation. 53 54 Finally, a combination of bDMARDs is being explored, but cannot be recommended at this time.

Recommendation 11

In patients in sustained remission, tapering of DMARDs may be considered.

This bullet point is unchanged. However, more data have accrued on tapering, leading to a higher grade of recommendation. 89–91 By tapering we mean ‘dose reduction’ not drug discontinuation since the latter usually leads to flares. Drug tapering is a logical step when patients are doing well over time, from a safety and a cost perspective (tapering is often performed by the patient himself/herself alone). On the other hand, long-term data are missing and currently drug tapering is off-label. For all of these reasons, the taskforce kept the tentative wording of ‘may be considered’ (to ensure it is not made mandatory) and of course in the context of a shared decision with the patient (as is the case also for the other treatment decisions).

Research agenda

The taskforce felt that many issues needed more data, and an extensive research agenda was developed ( table 4 ).

This paper presents updated recommendations for the management of PsA, a treatment algorithm and a research agenda. This update addresses all currently available drugs and modes of action, and recommends an order to their use, taking into account the phenotype of the MSK and the non-MSK manifestations.

These elements should be helpful in the management of individual patients, but also in the advocacy for better access to care and for research.

This 2023 update is a major update since most of the recommendations were modified substantially. The EULAR standardised operating procedures propose a voting system for updates which discourages minor modifications for rewordings. 13 Since 2019, many new drugs have become available in PsA; the choice of which drug to prescribe to which patients rests on data related to efficacy, clinical phenotype, adverse event risk profile, tolerance, long-term data, cost and access. While laboratory biomarkers for stratified treatment approaches are lacking, the taskforce used clinical markers to develop clinical phenotypic preferences for specific drugs. In these updated recommendations, the taskforce applied expert opinion to the available data, to propose a pragmatic, logical order of a step-up approach to targeted treatments of PsA. The taskforce felt that proposing an order is helpful both for clinicians and to advocate for access to drugs for patients with PsA.

The drug options considered in these recommendations are currently licensed for PsA. We are aware that other drugs are being tested, or are available in other related conditions, especially skin psoriasis; however, these drugs are considered out of the scope of the present recommendations. Brodalumab was at the time of these recommendations only approved for psoriasis; TYK2 inhibitors such as deucravacitinib and brepocitinib have also been developed or in development for skin psoriasis and PsA; izokibep is a novel antibody mimetic, a small IL-17i currently undergoing testing; and an oral IL-23i is also in development. 5

The taskforce had extensive discussions on the positioning of JAKi in the recommendations. 63 92 We as a group feel that it is important to make haste slowly , and to uphold high safety standards when promoting drugs with only short-to-medium-term experience and for which long-term data are lacking—not least in PsA. In fact, this cautious attitude was also adhered to in the 2019 recommendations, and further safety developments have later confirmed that this attitude was appropriate. 7 8 It is of key importance to continue monitoring the drugs and, ideally, perform controlled trials, as only hard and high-level data can be reassuring.

Costs are also an important aspect in patient management, and it is generally recommended to prescribe the cheaper drug if two agents have similar efficacy and safety. Of note, even if one mode of action may have somewhat better efficacy on certain manifestations, a less expensive agent could still be preferred as long as it does not bear much lesser efficacy in that disease domain. Biosimilars are available for several TNFis and have led to significant reduction in expenditure and more use in many countries, while their price is not much lower than that of originators in many other ones. Tofacitinib will soon become generic, and the same is true for apremilast, which should also lower the costs for these agents and allow wider application especially in less affluent countries. Thus, overall, the taskforce felt that the prescription of drugs would account for the relationships between efficacy, safety and cost, in line with the OAPs and the 11 recommendations which are summarised in the algorithm ( figure 1 ). Many points are still to be confirmed in the management of PsA, leading to an extensive research agenda. 93

In conclusion, the updated 2023 recommendations should be helpful to clinicians but also to health professionals and patients when discussing treatment options. They can also be helpful to promote access to optimal care. As new data become available and new drugs are authorised in PsA, these recommendations should be again updated.

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Handling editor Dimitrios T Boumpas

X @LGossec, @FerreiraRJO, @lihi_eder, @dranielmar, @drpnash, @sshoopworrall

Contributors All authors have contributed to this work and approved the final version.

Funding Supported by EULAR (QoC016).

Competing interests No support to any author for the present work. Outside the submitted work: LG: research grants: AbbVie, Biogen, Lilly, Novartis, UCB; consulting fees: AbbVie, Amgen, BMS, Celltrion, Janssen, Lilly, MSD, Novartis, Pfizer, UCB; non-financial support: AbbVie, Amgen, Galapagos, Janssen, MSD, Novartis, Pfizer, UCB; membership on an entity’s Board of Directors or advisory committees: EULAR Treasurer. AK: speakers bureau, consultancy: AbbVie, Amgen, Galapagos, Janssen, Eli Lilly, MSD, Novartis, Pfizer, UCB. RJOF: research grants: Medac, Lilly; consulting fees: Sanofi. DA: research grants: Galapagos, Lilly; consulting fees: AbbVie, Gilead, Janssen, Lilly, Merck, Novartis, Sanofi. XB: research grants: AbbVie, MSD, Novartis; consultancies: AbbVie, Amgen, Celltrion, Chugai, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Pfizer, Roche, Sandoz, UCB; membership on an entity’s Board of Directors or advisory committees: ASAS President, EULAR President Elect. W-HB: honoraria: AbbVie, Almirall, BMS, Janssen, Leo, Eli Lilly, Novartis, UCB; expert testimony: Novartis; participation on a Data Safety Monitoring Board or Advisory Board: AbbVie, Almirall, BMS, Janssen, Leo, Eli Lilly, Novartis, UCB. IBM: honoraria/consultation fees non-exec roles: NHS GGC Board Member, Evelo Board of Directors, Versus Arthritis Trustee Status; stock or stock options: Evelo, Cabaletta, Compugen, Causeway Therapeutics, Dextera. DGM: research grants: Janssen, AbbVie, Lilly, Novartis, UCB, BMS, Moonlake; consulting fees: Janssen, AbbVie, Lilly, Novartis, UCB, BMS, Moonlake, Celgene; honoraria: Janssen, AbbVie, Lilly, Novartis, UCB, BMS, Moonlake. KLW: research grants: BMS, Pfizer; consulting: Pfizer, AbbVie, AstraZeneca, BMS, Eli Lilly, Galapagos, GlaxoSmithKline (GSK), Gilead, Novartis, Moderna, Regeneron, Roche, Sanofi, UCB Pharma. AB: speakers fees: AbbVie, Amgen, AlphaSigma, AstraZeneca, Angelini, Biogen, BMS, Berlin-Chemie, Boehringer Ingelheim, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, Sandoz, Teva, UCB, Zentiva; consultancies: Akros, AbbVie, Amgen, AlphaSigma, Biogen, Boehringer Ingelheim, Lilly, Mylan, MSD, Novartis, Pfizer, Roche, Sandoz, Sobi, UCB. PVB: consulting fees: AbbVie, Janssen-Cilag, Pfizer; honoraria: AbbVie, Bausch Health, Celltrion Healthcare, Eli Lilly, Gedeon Richter, IBSA Pharma, Infomed, Janssen-Cilag, Novartis, Pfizer, Sandoz; payment for expert testimony: Gedeon Richter; other: President, Hungarian Association of Rheumatologists. GRB: honoraria and/or speaker fees: AbbVie, BMS, Janssen, Lilly, Novartis, Pfizer. JDC: honoraria: UCB. PC: research grants: AbbVie, Amgen, Biogen, Jansen, Lilly, Novartis, UCB; consulting fees: AbbVie, Amgen, Celltrion, Janssen, Lilly, MSD, Novartis, Pfizer, UCB. LE: consultation fee/advisory board: AbbVie, Novartis, Janssen, UCB, BMS, Eli Lilly; research/educational grants: AbbVie, Fresenius Kabi, Janssen, Amgen, UCB, Novartis, Eli Lilly, Sandoz, Pfizer. MLH: grant support: AbbVie, Biogen, BMS, Celltrion, Eli Lilly, Janssen Biologics BV, Lundbeck Foundation, MSD, Pfizer, Roche, Samsung Bioepis, Sandoz, Novartis, Nordforsk; honoraria: Pfizer, Medac, Sandoz; advisory board: AbbVie; past-chair of the steering committee of the Danish Rheumatology Quality Registry (DANBIO, DRQ), which receives public funding from the hospital owners and funding from pharmaceutical companies; cochair of EuroSpA, partly funded by Novartis. AI: research grants from AbbVie, Pfizer, Novartis; honoraria for lectures, presentations, speakers bureaus from AbbVie, Alfasigma, BMS, Celgene, Celltrion, Eli Lilly, Galapagos, Gilead, Janssen, MSD, Novartis, Pfizer, Sanofi Genzyme, Sobi; EULAR Board Member; EULAR Congress Committee, Education Committee and Advocacy Committee Advisor; EULAR Past President. LEK: consultancies: AbbVie, Amgen, Biogen, BMS, Celgene, Eli Lilly, Pfizer, UCB, Sanofi, GSK, Galapagos, Forward Pharma, MSD, Novartis, Janssen; has been representing rheumatology FOREUM scientific chair. RQ: consultancy and/or speaker’s honoraria from and/or participated in clinical trials and/or research projects sponsored by AbbVie, Amgen-Celgene, Eli Lilly, Novartis, Janssen, Pfizer, MSD, UCB. DM: honoraria: UCB, Janssen, GSK, AstraZeneca, AbbVie; support to meetings: Janssen. HM-O: grant support: Janssen, Novartis, UCB; honoraria and/or speaker fees: AbbVie, Biogen, Eli Lilly, Janssen, Moonlake, Novartis, Pfizer, Takeda, UCB. PJM: grant support: AbbVie, Acelyrin, Amgen, Bristol Myers Squibb, Eli Lilly, Genascence, Janssen, Novartis, Pfizer, UCB; consulting fees: AbbVie, Acelyrin, Aclaris, Alumis, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Genascence, Inmagene, Janssen, Moonlake, Novartis, Pfizer, Takeda, UCB, Ventyx, Xinthera; honoraria: AbbVie, Amgen, Eli Lilly, Janssen, Novartis, Pfizer, UCB. PN: consulting fees and honoraria: AbbVie, Amgen, BMS, Lilly, Janssen, GSK, Novartis, UCB, Servatus; boards: Amgen, BMS, Janssen, GSK, Novartis, UCB; GRAPPA Steering Committee, Chair ASMPOC, ARA. LS: consulting fees: AbbVie, Almirall, Novartis, Janssen, Lilly, UCB, Pfizer, Bristol Myers Squibb, Boehringer Ingelheim; honoraria: AbbVie, Almirall, Novartis, Janssen, UCB, Pfizer, Takeda, Galderma, Biogen, Celgene, Celltrion, Lilly, Sanofi, Bristol Myers Squibb, Boehringer Ingelheim; support to attending meetings: AbbVie, Janssen, Lilly, Novartis, UCB, Galderma, Bristol Myers Squibb, Boehringer Ingelheim; participation in boards: AbbVie, Almirall, Novartis, Janssen, UCB, Pfizer, Galderma, Biogen, Lilly, Sanofi, Bristol Myers Squibb, Boehringer Ingelheim; GRAPPA Executive Board (elected), British Society for Medical Dermatology (BSMD) Committee. GS: honoraria: Novartis, Janssen. SJWS-W: grant support: Medical Research Council (MR/W027151/1). YT: research grants from Mitsubishi Tanabe, Eisai, Chugai, Taisho; speaking fees and/or honoraria from Eli Lilly, AstraZeneca, AbbVie, Gilead, Chugai, Boehringer Ingelheim, GlaxoSmithKline, Eisai, Taisho, Bristol Myers, Pfizer, Taiho. FEVdB: consultancy honoraria from AbbVie, Amgen, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer, UCB. AZ: speakers bureau: AbbVie, Novartis, Janssen, Lilly, UCB, Amgen; paid instructor for AbbVie, Novartis, UCB. DvdH: consulting fees AbbVie, Argenx, Bayer, BMS, Galapagos, Gilead, GlaxoSmithKline, Janssen, Lilly, Novartis, Pfizer, Takeda, UCB Pharma; Director of Imaging Rheumatology bv; Associate Editor for Annals of the Rheumatic Diseases ; Editorial Board Member for Journal of Rheumatology and RMD Open ; Advisor Assessment Axial Spondyloarthritis International Society. JSS: research grants from AbbVie, AstraZeneca, Lilly, Galapagos; royalties from Elsevier (textbook); consulting fees from AbbVie, Galapagos/Gilead, Novartis-Sandoz, BMS, Samsung, Sanofi, Chugai, R-Pharma, Lilly; honoraria from Samsung, Lilly, R-Pharma, Chugai, MSD, Janssen, Novartis-Sandoz; participation in advisory board from AstraZeneca.

Provenance and peer review Not commissioned; externally peer reviewed.

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Economic complexity, greenfield investments, and energy innovation: policy implications for sustainable development goals in newly industrialised economies

• Research Article
• Published: 15 May 2024

Cite this article

• Muhammad Farhan Bashir   ORCID: orcid.org/0000-0001-5103-4639 1 ,
• Roula Inglesi-Lotz 2 ,
• Ummara Razi 3 , 4 &
• Luqman Shahzad 5  

The crucial role of environmental assessment quality has been recognised by environmental and sustainable development goals in addressing climate change challenges. By focusing on the key identifier of environmental assessment, progress can be made towards overcoming climate change issues effectively. The current study considers environmental commitments under COP28 to study the role of economic complexity, greenfield investments, and energy innovation in environmental degradation in newly industrialised economies from 1995 to 2021. We employ novel panel estimations from CS-ARDL, CS-DL, AMG, and CCEMG to confirm that economic growth and greenfield investments degrade environmental quality. On the other hand, energy innovation and urbanisation improve environmental sustainability. Lastly, we confirm the EKC hypothesis for economic complexity as well. Given the reported empirical findings, the study suggests policymakers must focus on economic complexity to transform industrial sectors’ economic potential. Furthermore, foreign investment projects must be linked with environmental goals to increase renewable energy capacity.

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Turkey, Thailand, South Africa, Philippines, Mexico, Malaysia, Indonesia, India, China, Brazil.

Hydrofluorocarbons sulphur, hexafluoride, and perfluorocarbons.

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Bashir, M.F., Inglesi-Lotz, R., Razi, U. et al. Economic complexity, greenfield investments, and energy innovation: policy implications for sustainable development goals in newly industrialised economies. Environ Sci Pollut Res (2024). https://doi.org/10.1007/s11356-024-33433-4

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Improving Public Health by Advancing the Medicolegal Death Investigation Profession

Medicolegal death investigations produce vital information on fatal illnesses and injuries in the United States, yet the system is fractured and underfunded . Less than half of deaths are reported and investigated by medicolegal death investigation agencies. In addition to providing cause and manner of death determinations, the investigations are instrumental in identifying public health trends, including early identification of the opioid epidemic and fatal fentanyl overdoses. Data from death investigations is used by over 40 federal agency programs in creating policies and regulations. Medicolegal death investigations agencies are generally underresourced, with insufficient infrastructure for data-sharing and computerized record management. These critical shortfalls are combined with a dire shortage of board-certified forensic pathologists to complete postmortem examinations and a lack of mass fatality preparedness, which can directly affect community health and well-being.

The last time medicolegal death investigation policies were reviewed by the Executive Branch was during the Obama Administration. In 2016, the National Science and Technology Council (NSTC) Committee on Science’s Medicolegal Death Investigation Working Group noted the essential role medicolegal death investigation agencies play in establishing a scientific cause and manner of death while serving public health and reporting emerging health threats. The working group outlined the importance of accrediting medicolegal death investigation offices and certifying medicolegal death investigators. In the seven years since the report, there has only been an increase of 23.7% in certified death investigators, with more jurisdictions requiring certification to maintain employment. The NSTC’s Fast-Track Action Committee found the need to improve infrastructure and support for medicolegal death investigation agencies to reinforce the integrity of public health and criminal justice systems.

Key recommendations for improving public health by advancing the medicolegal profession include:

• Creating national foundational medicolegal death investigation training standards.
• Funding data infrastructure modernization and enhanced surveillance efforts.
• Researching the current efficacy of mass fatality response policies and efforts to create standardized procedures.
• Increasing certification and accreditation to enhance professionalism, knowledge, and skills.
• Supporting forensic pathologist pathways and debt reduction.

Challenge and Opportunity

Medicolegal death investigation is at the intersection of medicine, public health, and the criminal justice system, yet it does not have a formal place in any system nationally. Public health trends, including early detection of outbreaks and emerging health threats, are found during autopsies and reported on death certificates. The data from death certificates is used in public health surveillance at a local, regional, state, and national level to determine trends and the impact of interventions, shape policy, and help recognize health disparities. The information from the death certificates is obtained through death scene investigations, evidence collection, medical record reviews, postmortem examinations, and toxicology testing, coupled with interviews of witnesses, family, and friends of the decedent. Data obtained during medicolegal death investigations not only provides an accurate cause and manner of death but also helps the living by showing the health of our communities and tracking death trends and health threats.

The coroner system in the United States stems from the English system dating to the 12th century. A physician-headed medical examiner system was created in Massachusetts in the late 1800s, leading to versions of our current systems. State statutes and local jurisdictional charters create the structure of medicolegal death investigation offices. There is no standardized medicolegal death investigation system across the United States. Coroners are typically elected officials who run for the political role through normal voting processes. Coroners can also be appointed based on the jurisdiction and are regularly non-medical professionals. In contrast, medical examiner’s offices generally have a physician leading the office, except in Wisconsin , where the appointed medical examiner can be a non-physician. The jurisdiction of a coroner or medical examiner’s office is most commonly a county, though 16 states have a centralized state medical examiner system. There are 14 states with a county or district-based coroner system, 14 states with a mixture of coroner and medical examiner offices, and six states with county or district medical examiner systems. Texas has Justice of the Peace positions where the elected role hears misdemeanor, traffic, and civil disputes in addition to holding medicolegal duties without a requirement for any legal or medical experience or education. California is unique with four different medicolegal investigation agency types, including a Sheriff-Coroner, Coroner, Medical Examiner, and Coroner-Medical Examiner. The Sheriff-Coroner’s position , which is in 48 of California’s 58 counties, is the most contentious due to concerns about the independence of investigations when the medicolegal agency head also serves as the sheriff. A 2022 attempt to separate sheriff and coroner positions was unsuccessful. Medicolegal death investigation agencies range from having one part-time elected official responsible for the entire jurisdiction to having over 100 employees, with most agencies across the nation having few full-time employees and significantly limited resources.

Medicolegal death investigation systems, by state. ( Source: Centers for Disease Control and Prevention’s Death Investigation Systems . )

The varied names and jurisdictions for medicolegal death investigation offices do not change the foundation of the duties: investigating unexpected and unnatural deaths. Typically, the medicolegal death investigation agency receives a call from a law enforcement agency, medical first responder, hospital, care facility, or other medical professional to report a death. Basic demographic information, the known circumstances behind the death, medical history, and other vital information are obtained to determine jurisdiction. Based on agency practices and state law, the medicolegal death investigator may respond to the death scene to assume jurisdiction and custody of the decedent. For natural deaths where a physician will certify the death to natural causes, the medicolegal death investigator may be able to release the decedent to a funeral home or mortuary of the family’s choice. When a medicolegal death scene investigation is required, the investigation includes photography, collecting evidence, identifying the decedent, locating and notifying kin, writing an investigative report, and providing information to the forensic pathologist, who will determine the cause of death. Death certificates are commonly generated by the medicolegal office, with the manner of death determined by the chief medicolegal officer. Medicolegal death investigation offices are also tasked with identifying decedents, which may require advanced scientific testing. Less than 50% of medicolegal agencies collect DNA samples from unidentified decedents, which is essential in present-day scientific identification and adds information to national databases. Not collecting DNA can significantly delay the identification of decedents and notification to friends and family of missing and unidentified people.

Medicolegal death investigation offices also participate in specialized fatality review teams, which include multidisciplinary stakeholders from social services, public health, law enforcement, emergency medical services, and other areas to find systemic gaps in treatment and identify potential missed intervention points. Fatality review teams can be regional and can include overdose fatality review, infant and child death fatality review, domestic violence fatality review, and elder abuse fatality review. Meeting findings are summarized into actionable items to prevent future deaths. The medicolegal investigative and autopsy reports and the reviewed medical and social history provide the requisite information to allow the multidisciplinary teams to make prevention determinations. 

Medicolegal death investigation agencies report to local, state, and national organizations to assist with surveillance and injury prevention. Many states require medicolegal death investigators to report workplace injuries and deaths to the regional Occupational Safety and Health Administration branch, with death certificates reporting contagious diseases and drug toxicity-related deaths to local health departments. The United States Consumer Product Safety Commission relies on medical examiners and coroners to report consumer product-related deaths so they can further investigate products, create appropriate warning labels, and potentially prevent injuries and deaths. For deaths relating to medical misadventure, medicolegal death investigation agencies must also report deaths to the state medical board, dental board, nursing board, or county-level emergency medical services board. There are two national reporting systems, both overseen by the Centers for Disease Control and Prevention (CDC), for violent deaths and overdoses. The National Violent Death Reporting System records violent death data from medicolegal and law enforcement reports to link over 600 data points to create a context behind the death and develop violence prevention strategies. The State Unintentional Drug Overdose Reporting System oversees 49 states and Washington, DC, to obtain inclusive overdose fatality data. The data includes information on the known circumstances behind the death and identification of the substances involved to gain nearly real-time information about emerging drug threats and determine the effect of prevention efforts. Coroner and medical examiner agencies may also be required to enter unidentified persons into missing and unidentified person systems and the National Missing and Unidentified Persons System to assist with future identification efforts. Data review and entry are complicated, with limited resources, a lack of case management systems, and time constraints with part-time employee offices.

The data and information obtained from medicolegal death investigations have many uses that can assist in local, state, and national prevention efforts. The challenges for the reporting systems are that they are voluntary, and many agencies do not have the resources to provide hundreds of data sources to multiple systems. Having data organized and in a searchable database is key for access and data-sharing, though less than 50% of medicolegal offices with a population of less than 250,000 people have a computerized case management system. Only 87% of agencies with a population of over 250,000 people have a case management system, with 40% of coroner offices not having internet access outside of their personal devices. Computerized case management systems help reduce errors and lost paperwork while increasing efficiency and resource allocation. Less than 70% of coroner offices have access to fingerprint databases, compared to 91% of medical examiner agencies, and 82% of agencies have access to bloodborne pathogen training. The average budget of a medicolegal office is $470,000, with each decedent autopsy and investigation costing approximately $3000. With about 2,040 medicolegal death investigation offices nationally and almost 11,000 full-time equivalent employees, there is an average of just five full-time employees per office. A large portion of the budget is commonly spent on personnel, leaving little funding for improving infrastructure and training.

There is no standardized oversight or required training of medicolegal death investigation personnel. Only 16 states require training for medicolegal death investigations. For example, California requires 80 hours of training for medicolegal death investigators, the highest of all state requirements. In contrast, New York requires training for the coroner and deputy coroners but does not outline the required number of hours or duration. The American Board of Medicolegal Death Investigators (ABMDI) is a national certifying board that the Forensic Specialties Accreditation Board accredits. ABMDI tests medicolegal death investigators on foundational and advanced knowledge, awarding registry and board certifications. ABMDI certification requires continuing education to maintain certification, though most medicolegal agencies do not require certification for employment. The lack of standardized training of medicolegal death investigation personnel can lead to gaps in knowledge and recognizing evidence, dramatically reducing the accuracy of death certificates and reporting. Limited budgets, personnel, and resources contribute to a lack of investigative awareness that can lead to incorrect causes and manners of death. Inaccuracies on death certificates can have a profoundly negative effect on families and the community and contribute to public mistrust.

Training is not the only constraint in accurate and timely medicolegal death investigations. There is an extreme shortage of board-certified forensic pathologists, who are the physicians conducting postmortem examinations and determining the cause of death. In 2020, there were approximately 500 practicing forensic pathologists , but the workload required 1,280 forensic pathologists. The gap is now likely even greater, with workloads having increased with the rise of the opioid epidemic, fentanyl deaths, gun violence, and COVID-19. The 2018 coroner/medical examiner census noted 890 forensic pathologists employed by medicolegal agencies, though forensic pathologists commonly work in neighboring counties or other states as a locum tenens, a temporary, per-diem physician. The shared nature of some forensic pathologists inflates the number of physicians who appear to be working, shrouding the significantly lower number of practicing physicians. In medical examiner officers, such as in Los Angeles and New York City, the department head is a forensic pathologist assigned solely to administrative work, limiting the number of available forensic pathologists to complete postmortem examinations. Some jurisdictions resort to using non-board-certified forensic pathologists for postmortem examinations, which can result in inaccurate causes and manners of death. The lack of available forensic pathologists also allows for non-qualified people to falsify credentials and autopsy reports, even in high-profile cases, defrauding grieving people and the government alike. A 2015 report on increasing the number of board-certified forensic pathologists mentioned that physicians should work in a nationally accredited office. Agency accreditation is important to ensure proper working conditions and a high standard for policies and procedures to create an environment for the best possible medicolegal death investigations. Yet the last coroner/medical examiner census showed that only 17% of medicolegal death investigation offices were accredited. Some agencies will never be able to reach accreditation, as there is a limit of 325 autopsies per year, and workload shortages restrict the number of available forensic pathologists to complete autopsies.

The medicolegal profession is highlighted in the media in high-profile deaths and mass fatality situations. A significant amount of time and effort by medicolegal administrators should be devoted to mass fatality planning to provide an efficient, effective response, coordinate with allied agencies, and safely recover and identify decedents. There is no specific number for what constitutes a mass fatality incident , as mass fatality is when the number of deaths exceeds agency resources. In some jurisdictions, a mass fatality may be three decedents from one incident, while others may request allied resources when 50 decedents are from an incident, such as in the October 1, 2017 mass shooting in Las Vegas, NV. All states have an Office of Emergency Response or similarly named emergency response commission, where medicolegal death investigation agencies should be integrated into mutual aid and planning committees. There are significant limitations with the response to and accurate handling of medicolegal death investigations without a case management system and internet access, impacting smaller and underresourced jurisdictions.  The federal-level Disaster Mortuary Operational Response Team (DMORT), run by the National Disaster Medical System, deploys to mass fatality scenes to assist with recovery, examination, identification, and collecting ante- and postmortem decedent data. DMORT responds with qualified personnel, including forensic pathologists and investigators, to set up a mobile autopsy suite and bring decedent storage facilities. With the high cost of deployment, DMORT only responds to large-scale mass fatality scenes and needs to be requested by a state Office of Emergency of Response when other mutual aid responses have been exhausted. A vast majority of medicolegal agencies lack the resources to handle a mass fatality. Less than 30% of agencies had specialized response training, and nearly half of agencies reported that they were only moderately prepared for a mass fatality.

The challenges of advancing mass fatality planning and improving medicolegal infrastructure are restricted by agency budgets and limited grant funding. Due to the specialty of the field and because it crosses the medicine, public health, and the criminal justice systems, there are few federal grant opportunities. The Bureau of Justice Assistance’s Strengthening the Medical Examiner-Coroner System Program helps with accreditation, including purchasing supplies and upgrades to meet standards and assisting with funding for forensic pathology fellowships. There were 14 awards in 2023 totaling over $2 million, with funding ranging from $53,878 to $300,000. Most of the awards were to larger agencies, including Los Angeles and New York City, where there are resources for grant writing and administration. The competitive Paul Coverdell Forensic Science Improvement Grant Program is offered to forensic science and medicolegal agencies with forensic science laboratories. In 2023, more than $4.6 million was awarded to 15 agencies, with only one grant awarded to a medicolegal death investigation agency. The National Network of Public Health Institutes funded $200,000 to 10 medicolegal death investigation agencies in 2023 to improve data collection from medicolegal agencies for surveillance of overdose-related mortality reporting. Nationwide, there are more than 2,000 medicolegal death investigation agencies, but in 2023 just 25 received federal or national-level grant funding.

Plan of Action

A multi-stage, multi-agency approach is needed to improve medicolegal death investigations in the United States to provide accurate mortality data to shape prevention and policy efforts. In addition to increasing minimum medicolegal death investigation operating budgets, funding is needed to improve training, attract physicians to forensic pathology, and advance infrastructure upgrades for timely and accurate mortality data reporting. National standards for medicolegal death investigation should be established and integrated into state systems for reliable, reproducible, and scientifically valid investigative results and analysis.

Recommendation 1. Create national foundational training standards.

Building from the National Institute of Justice’s 2011 Death Investigation: A Guide for the Scene Investigator Technical Update and fundamental tasks of medicolegal death investigation from the American Board of Medicolegal Death Investigators , the NIST should convene a multidisciplinary group of subject matter experts to develop foundational training standards guided by NIST’s Organized Scientific Area Committees for Forensic Science best practices and standards. The DOL should be involved in reviewing and structuring training standards and programming from a labor and workforce perspective. Subject matter experts should determine a continuing education structure to allow for continuous training for contemporary topics in the field, similar to requirements for maintaining medical licensure. Although NIST is not an enforcing agency, the created standards should be made widely available to state legislation and the medicolegal community. States that adopt the standards should have access to additional NIJ funding to improve medicolegal offices. Similar to NIJ funding requiring credentials for discretionary funding for law enforcement agencies for use-of-force policies and the prohibition of chokeholds, the discretionary funding can be limited to agencies that have adopted the NIST standards.   

Funding for training should be available through grants and legislation for funding from burial permits. Since 1991, California has designated $1 from each burial permit to fund medicolegal death investigation training. Creating similar legislation for every state can allow for sustainable funding for continued training, alleviating the need for continued federal funding.

Foundational training standards will create a minimum and standardized training nationally to improve medicolegal death investigations and utilize best practices to best serve communities. The training will also allow medicolegal death investigation agencies to provide more accurate and timely data for public health surveillance and participate in multidisciplinary task forces, which can potentially reduce future deaths. Requirements for foundational and continued training can be shared widely by COMEC, with virtual training programs created by COMEC and available for continuing education credit. COMEC currently hosts virtual training for sudden unexpected infant death investigation, the investigation and certification of drug toxicity-related deaths, and death investigation after natural disasters and radiation emergencies. Existing training and structure can be used to create and distribute foundational training and continuing education at a national level without reinventing a new nationally available website and training structure.

Recommendation 2. Fund data infrastructure modernization and enhanced surveillance efforts.

The health of communities lies in early recognition and timely reporting of causes of death. With less than 50% of medicolegal death investigation agencies having a computerized case management system and under 40% of coroner offices having business-related internet access, the field cannot progress without a significant investment in infrastructure. The lack of computerized case management will continue to severely limit timely data-sharing with local, state, and federal public health agencies, restricting near real-time analysis of death trends and disease tracking. Public health surveillance of mortality data assists in recognition, intervention, and preventive efforts, which cannot be accurately completed without timely and complete data from medicolegal death investigation agencies.

With the current state of the opioid epidemic and fentanyl drug toxicity-related deaths, rapid and accurate toxicology testing is needed for public health surveillance. Advanced toxicology panels, including the ever-growing novel psychoactive substances, are expensive, and agencies need to make difficult budgetary decisions around personnel and toxicology testing. Funding is needed to subsidize advanced, rapid toxicology testing to provide the most accurate types of drugs involved with the death. Additional funding, awarded through a cooperative agreement by the CDC, should be allocated to advanced panel toxicology testing and the purchase of rapid toxicology screening machines that can be housed in the medicolegal office. Rapid toxicology screening machines do not quantify all drug levels, which commonly requires secondary toxicology testing through an accredited laboratory. But the screening does allow for nearly immediate identification of fatal drug trends, allowing for early notification to public health officials. The NIJ should specifically request research and development of a rapid toxicology testing process with an accuracy level that does not require secondary testing in their research grant for forensic science for criminal justice purposes to provide additional options for medicolegal agencies. The precise cause of death, involved drugs, and thorough investigations significantly contribute to multidisciplinary overdose fatality review teams. The fatality review teams can use the information to identify timely intervention strategies and strengthen services to reduce future drug toxicity-related deaths in near real-time.

Recommendation 3. Research the current efficacy of mass fatality response policies and efforts to create standardized procedures.

In the focus on current caseload and office needs, mass fatality preparedness and training tend to be overlooked. This deprioritization is dangerous for medicolegal death investigation personnel responding to scenes and is concerning for the community with underprepared and underresourced investigators working to navigate a mass fatality incident . The declaration of a federal state of emergency does not always provide funding for medicolegal death investigation agencies for fatality management operations, and the nature of the mass fatality may limit mutual aid response to assist jurisdictions, such as in the case of earthquakes, biological acts of terrorism, and other large-scale natural disasters. Research is needed to determine best practices in mass fatality planning and resourcing for all jurisdictional sizes, including determining the current state of planning and available resources. DOJ should fund the research through BJA or BJS via a grant process to find the most qualified and knowledgeable researchers. Findings should be shared widely via open-source academic journals, at national and regional medicolegal conferences, and via webinars to ensure the information is readily available. The findings should also be published in a guide on the DOJ website to assist agencies in creating personalized mass fatality plans and practical exercises.

Recommendation 4. Increase certification and accreditation to enhance professionalism, knowledge, and skills.

The National Commission on Forensic Science supported recommendations for the accreditation of medicolegal death investigation offices and the certification of medicolegal death investigators in 2015. Despite these recommendations, only 17% of medicolegal death investigation offices were accredited in 2018. In November 2023, there were 2,049 actively certified diplomates with the American Board of Medicolegal Death Investigators , from an approximate 11,000 full-time equivalent positions,   totaling approximately 19% of full-time equivalent medicolegal death investigators. Increasing the number of accredited offices and certified medicolegal death investigators can provide consistency in practice, improve data quality, enhance facilities, incorporate evidence-based best practices, and elevate surveillance efforts. 

Recommendation 5. Support forensic pathologist pathways and debt reduction.

There is no end in sight to the critical shortage of forensic pathologists, who are neutral scientists specializing in determining the cause of death while providing valuable data for public health surveillance. A federal grant is available to provide a stipend for forensic pathology fellows in training, including limited loan repayment and travel for fellowship recruitment. Funding is limited and requires medicolegal death investigation agencies to be knowledgeable about the grants and be awarded funding. A more grassroots approach to creating more forensic pathologists should begin earlier, both in medical school and in offering scholarships for current medicolegal investigative personnel to attend medical school to become forensic pathologists. The field should be highlighted during the early years of medical school, requiring a rotation through a local medicolegal death investigation office, and increasing residency and fellowship pay to encourage physicians to enter the field and become board-certified. Similar to other loan repayment programs, loan forgiveness for forensic pathologists should be reduced to five years in public practice as a board-certified forensic pathologist. Funding should be provided to medical schools, residency, and fellowship programs and not dependent on a limited competitive federal grant funding process.

Budget Proposal

A budget of $90 million is proposed to create national medicolegal death investigation training standards, fund data infrastructure modernization and enhance surveillance efforts, research the current efficacy of mass fatality response, increase medicolegal certification and accreditation, and support forensic pathologist career pathways. NIST should receive $2.5 million to hire and support subject matter experts to create the national foundational medicolegal death investigation training standards. The DOL should be awarded $500,000 to support standards development with a focus on the workforce and labor. Circulating the standards through a standards-developing agency, such as the American Academy of Forensic Science’s Academy Standards Board, should occur at no cost.

The CDC should be provided with $32 million to create and manage low-barrier infrastructure improvement grants focusing on smaller and medium medicolegal jurisdictions to ensure agencies have computerized case management systems and basic internet connection at a minimum. Medicolegal death investigation data elements for reporting and information exchange have been outlined by the Medicolegal Death Investigation Subcommittee of NIST’s Organization of Scientific Area Committees , providing a baseline of data needs for a computerized case management system. At least $1 million of the funding should focus on low-barrier scholarship-type funding for individual medicolegal death investigator certification, with the certifying agency accredited by the Forensic Specialties Accreditation Board for monitoring professional board certification. At least $5 million should be available for low-barrier grants to assist medicolegal agencies in achieving accreditation through one of the two medicolegal death investigation agency accreditation boards. Annual reporting on the number of agencies and individuals funded for infrastructure improvements, accreditation, and certification should be transparently listed on the CDC funding website.

The DOJ should receive $4 million for nationwide research on the efficacy of mass fatality response policies and the creation of standardized procedures. Portions of the funding should be dedicated to open-source publishing to allow broad access to the research findings, with a guide on best practices and standards made available on a federal government website to help agencies create and hone their policies. The information should also be presented at national, state, and regional medicolegal and forensic science conferences with at least one recorded webinar to provide data and support to the most agencies possible. 

Similar to providing grants for physicians and healthcare professionals to work in health professional shortage areas , medically underserved areas, or primary care shortage areas, funding should be provided to state Departments of Health Care Access and Information or similarly positioned state-level departments. Each state and the District of Columbia should receive $1 million for scholarships, loan forgiveness, and fellowship reimbursement for physicians on track to become board-certified forensic pathologists. State funding should also be used to introduce forensic pathology as a subspecialty during medical school rotations to provide exposure to the career.  

The current state of medicolegal death investigations in the United States is plagued with significant variations in practices, budgets, and training across jurisdictions. The heterogeneity creates disparities in the quality of investigations, data reporting, participation in fatality review teams, and overall professionalism in the field. The continued shortage of board-certified forensic pathologists to complete postmortem examinations and the lack of standardized training exacerbates the challenges. Increased federal funding to support medicolegal death investigation efforts can lead to more accurate and timely data reporting, improved public health surveillance, better-informed policy creation, and enhanced capabilities to respond to mass fatality incidents. Ultimately, these measures will contribute to the well-being of communities and assist public health prevention efforts.

The Model Postmortem Examinations Act , created by the National Conference of Commissioners on Uniform State Laws in 1954, outlined a state medical examiner system, allowing states to modify the model to fit its jurisdictional needs, though most states have not followed the Act’s suggestions. The overseeing body is now referred to as the Uniform Laws Commission , and no changes have been made despite multiple attempts for review requested by the National Association of Medical Examiners. The National Commission on Forensic Science recommended drafting a new model of medicolegal death investigation legislation to support states in improving their medicolegal death investigation frameworks and death investigations themselves. The Commission voted overwhelmingly to adopt the recommendation in January 2017, though no action has been taken by the Attorney General to date. While it is unlikely a national framework will be adopted by all states, model legislation for medicolegal death investigation systems can allow states to adjust the legislation to best fit their needs while maintaining a minimum standard.

Accurate death reporting is necessary for public health surveillance, timely health interventions, and reduction in avoidable deaths, but our current system is disjointed and disorganized.

SYSTEMATIC REVIEW article

This article is part of the research topic.

New thoughts on emerging and classical contributors to male reproductive toxicology

Does pyrethroid exposure lower human semen quality? A systematic review and metaanalysis Provisionally Accepted

• 1 Ladoke Akintola University of Technology, Nigeria
• 2 Osun State University, Nigeria
• 3 Reproductive Biology and Toxicology Research Laboratory (ReBTReL), Nigeria
• 4 Acrolytics LLC, Fort Collins, Colorado, USA, United States

The final, formatted version of the article will be published soon.

Background: Pyrethroids are natural organic compounds extracted from flowers of pyrethrums and commonly used as domestic and commercial insecticides. Although it is effective in insect and parasitic control, its associated toxicity, including spermotoxicity, remains a challenge globally. Currently, the available reports on the effect of pyrethroids on semen quality are conflicting, hence an evaluation of its detrimental effect is pertinent. This study conducts a detailed systematic review and meta-analysis of the effects of pyrethroids on sperm quality.Materials and methods. The present study was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Using a pre-defined strategic protocol, an internet search was done using combined text words. The criteria for eligibility were selected based on Population, Exposure, Comparator, Outcome, and Study Designs (PECO) framework, and relevant data were collected. Appraisal was done using The Office of Health Assessment and Translation (OHAT) tool for the evaluation of the Risk of Bias and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group guidelines for the certainty of evidence. A quantitative meta-analysis was conducted with the Review Manager (RevMan). Results: Only 12 out of the 4, 050 studies screened were eligible for inclusion in this study. The eligible studies were from China (4), Japan (3), Poland (3), and USA (2). All the eligible studies were cross-sectional. A total of 2, 050 male subjects were included in the meta-analysis. Pyrethroid exposure significantly reduced sperm motility. Region-stratified subgroup analyses revealed that pyrethroid significantly reduced sperm motility among men in Poland and USA, and decreased sperm count among men in Japan. Pyrethroid exposure also reduced sperm concentration among men in Poland but increased sperm concentration among men in the USA. Conclusion: Although the study revealed inconsistent evidence on the detrimental effect of pyrethroids on semen quality, the findings showed that pyrethroids have deleterious potentials on sperm motility, count, and concentration. Studies focusing on the assessment of semen quality in pyrethroid-exposed men, especially at specific varying levels of exposure, and employing prospective cohort studies or controlled cross-sectional designs are recommended.

Keywords: Endocrine disruptor, Environmental toxicant, male infertility, Oxidative Stress, pyrethroids, Semen

Received: 02 Mar 2024; Accepted: 13 May 2024.

Copyright: © 2024 Akhigbe, Oyedokun, Akhigbe, Hassan, Oladipo and Hughes. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Roland E. Akhigbe, Ladoke Akintola University of Technology, Ogbomosho, Nigeria

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