what is dissertation in medical term

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• Indian J Anaesth
• v.66(1); 2022 Jan

Dissertation writing in post graduate medical education

Department of Anaesthesiology, Dr. B R Ambedkar Medical College, Bengaluru, Karnataka, India

Mridul M Panditrao

1 Department of Anaesthesiology and Intensive Care, Adesh Institute of Medical Sciences and Research (AIMSR), Bathinda, Punjab, India

2 Department of Anaesthesiology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India

Sukhminder Jit Singh Bajwa

3 Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Patiala, Punjab, India

Nishant Sahay

4 Department of Anaesthesiology, All India Institute of Medical Sciences, Patna, Bihar, India

Thrivikrama Padur Tantry

5 Department of Anaesthesiology, A J Institute of Medical Sciences and Research Centre, Kuntikana, Mangalore, Karnataka, India

Associated Data

A dissertation is a practical exercise that educates students about basics of research methodology, promotes scientific writing and encourages critical thinking. The National Medical Commission (India) regulations make assessment of a dissertation by a minimum of three examiners mandatory. The candidate can appear for the final examination only after acceptance of the dissertation. An important role in a dissertation is that of the guide who has to guide his protégés through the process. This manuscript aims to assist students and guides on the basics of conduct of a dissertation and writing the dissertation. For students who will ultimately become researchers, a dissertation serves as an early exercise. Even for people who may never do research after their degree, a dissertation will help them discern the merits of new treatment options available in literature for the benefit of their patients.

INTRODUCTION

The zenith of clinical residency is the completion of the Master's Dissertation, a document formulating the result of research conducted by the student under the guidance of a guide and presenting and publishing the research work. Writing a proper dissertation is most important to present the research findings in an acceptable format. It is also reviewed by the examiners to determine a part of the criteria for the candidate to pass the Masters’ Degree Examination.

The predominant role in a dissertation is that of the guide who has to mentor his protégés through the process by educating them on research methodology, by: (i) identifying a pertinent and topical research question, (ii) formulating the “type” of study and the study design, (iii) selecting the sample population, (iv) collecting and collating the research data accurately, (v) analysing the data, (vi) concluding the research by distilling the outcome, and last but not the least (vii) make the findings known by publication in an acceptable, peer-reviewed journal.[ 1 ] The co-guide could be a co-investigator from another department related to the study topic, and she/he will play an equivalent role in guiding the student.

Research is a creative and systematic work undertaken to increase the stock of knowledge.[ 2 ] This work, known as a study may be broadly classified into two groups in a clinical setting:

• Trials: Here the researcher intervenes to either prevent a disease or to treat it.
• Observational studies: Wherein the investigator makes no active intervention and merely observes the patients or subjects allocated the treatment based on clinical decisions.[ 3 ]

The research which is described in a dissertation needs to be presented under the following headings: Introduction, Aim of the Study, Description of devices if any or pharmacology of drugs, Review of Literature, Material and Methods, Observations and Results, Discussion, Conclusions, Limitations of the study, Bibliography, Proforma, Master chart. Some necessary certificates from the guide and the institute are a requirement in certain universities. The students often add an acknowledgement page before the details of their dissertation proper. It is their expression of gratitude to all of those who they feel have been directly or indirectly helpful in conduct of the study, data analysis, and finally construction of the dissertation.

Framing the research question (RQ)

It is the duty of the teacher to suggest suitable research topics to the residents, based on resources available, feasibility and ease of conduct at the centre. Using the FINER criteria, the acronym for feasibility, topical interest, novelty, ethicality and relevance would be an excellent way to create a correct RQ.[ 4 ]

The PICOT method which describes the patient, intervention, comparison, outcome and time, would help us narrow down to a specific and well-formulated RQ.[ 5 , 6 ] A good RQ leads to the derivation of a research hypothesis, which is an assumption or prediction of the outcome that will be tested by the research. The research topic could be chosen from among the routine clinical work regarding clinical management, use of drugs e.g., vasopressors to prevent hypotension or equipment such as high flow nasal oxygen to avoid ventilation.

Review of literature

To gather this information may be a difficult task for a fresh trainee however, a good review of the available literature is a tool to identify and narrow down a good RQ and generate a hypothesis. Literature sources could be primary (clinical trials, case reports), secondary (reviews, meta-analyses) or tertiary (e.g., reference books, compilations). Methods of searching literature could be manual (journals) or electronic (online databases), by looking up references or listed citations in existing articles. Electronic database searches are made through the various search engines available online e.g., scholar.google.com, National Library of Medicine (NLM) website, clinical key app and many more. Advanced searches options may help narrow down the search results to those that are relevant for the student. This could be based on synthesising keywords from the RQ, or by searching for phrases, Boolean operators, or utilising filters.

After choosing the topic, an apt and accurate title has to be chosen. This should be guided by the use of Medical Subject Headings (MeSH) terminology from the NLM, which is used for indexing, cataloguing, and searching of biomedical and health-related information.[ 7 ] The dissertation requires a detailed title which may include the objective of the study, key words and even the PICOT components. One may add the study design in the title e.g. “a randomised cross over study” or “an observational analytical study” etc.

Aim and the objectives

The Aims and the Objectives of the research study have to be listed clearly, before initiating the study.[ 8 ] “Gaps” or deficiencies in existing knowledge should be clearly cited. The Aim by definition is a statement of the expected outcome, while the Objectives (which might be further classed into primary and secondary based on importance) should be specific, measurable, achievable, realistic or relevant, time-bound and challenging; in short, “SMART!” To simplify, the aim is a statement of intent, in terms of what we hope to achieve at the end of the project. Objectives are specific, positive statements of measurable outcomes, and are a list of steps that will be taken to achieve the outcome.[ 9 ] Aim of a dissertation, for example, could be to know which of two nerve block techniques is better. To realise this aim, comparing the duration of postoperative analgesia after administration of the block by any measurable criteria, could be an objective, such as the time to use of first rescue analgesic drug. Similarly, total postoperative analgesic drug consumption may form a secondary outcome variable as it is also measurable. These will generate data that may be used for analysis to realise the main aim of the study.

Inclusion and exclusions

The important aspect to consider after detailing when and how the objectives will be measured is documenting the eligibility criteria for inclusion of participants. The exclusion criteria must be from among the included population/patients only. e.g., If only American Society of Anesthesiologists (ASA) I and II are included, then ASA III and IV cannot be considered as exclusion criteria, since they were never a part of the study. The protocol must also delineate the setting of the study, locations where data would be collected, and specify duration of conduct of the dissertation. A written informed consent after explaining the aim, objectives and methodology of the study is legally mandatory before embarking upon any human study. The study should explicitly clarify whether it is a retrospective or a prospective study, where the study is conducted and the duration of the study.

Sample size: The sample subjects in the study should be representative of the population upon whom the inference has to be drawn. Sampling is the process of selecting a group of representative people from a larger population and subjecting them for the research.[ 10 ] The sample size represents a number, beyond which the addition of population is unlikely to change the conclusion of the study. The sample size is calculated taking into consideration the primary outcome criteria, confidence interval (CI), power of the study, and the effect size the researcher wishes to observe in the primary objective of the study. Hence a typical sample size statement can be - “Assuming a duration of analgesia of 150 min and standard deviation (SD) of 15 min in first group, keeping power at 80% and CIs at 95% (alpha error at 0.05), a sample of 26 patients would be required to detect a minimum difference (effect size) of 30% in the duration of analgesia between the two groups. Information regarding the different sampling methods and sample size calculations may be found in the Supplementary file 1 .

Any one research question may be answered using a number of research designs.[ 11 ] Research designs are often described as either observational or experimental. The various research designs may be depicted graphically as shown in Figure 1 .

Graphical description of available research designs

The observational studies lack “the three cornerstones of experimentation” – controls, randomisation, and replication. In an experimental study on the other hand, in order to assess the effect of treatment intervention on a participant, it is important to compare it with subjects similar to each other but who have not been given the studied treatment. This group, also called the control group, may help distinguish the effect of the chosen intervention on outcomes from effects caused by other factors, such as the natural history of disease, placebo effects, or observer or patient expectations.

All the proposed dissertations must be submitted to the scientific committee for any suggestion regarding the correct methodology to be followed, before seeking ethical committee approval.

Ethical considerations

Ethical concerns are an important part of the research project, right from selection of the topic to the dissertation writing. It must be remembered, that the purpose of a dissertation given to a post-graduate student is to guide him/her through the process by educating them on the very basics of research methodology. It is therefore not imperative that the protégés undertake a complicated or risky project. If research involves human or animal subjects, drugs or procedures, research ethics guidelines as well as drug control approvals have to be obtained before tabling the proposal to the Institutional Ethics Committee (IEC). The roles, responsibilities and composition of the Ethics Committee has been specified by the Directorate General of Health Services, Government of India. Documented approval of the Ethics committee is mandatory before any subject can be enroled for any dissertation in India. Even retrospective studies require approval from the IEC. Details of this document is available at: https://cdsco.gov.in/opencms/resources/UploadCDSCOWeb/2018/UploadEthicsRegistration/Applmhrcrr.pdf .

The candidate and the guide are called to present their proposal before the committee. The ethical implications, risks and management, subjects’ rights and responsibilities, informed consent, monetary aspects, the research and analysis methods are all discussed. The patient safety is a topmost priority and any doubts of the ethical committee members should be explained in medically layman's terms. The dissertation topics should be listed as “Academic clinical trials” and must involve only those drugs which are already approved by the Drugs Controller General of India. More commonly, the Committee suggests rectifications, and then the researchers have to resubmit the modified proposal after incorporating the suggestions, at the next sitting of the committee or seek online approval, as required. At the conclusion of the research project, the ethics committee has to be updated with the findings and conclusions, as well as when it is submitted for publication. Any deviation from the approved timeline, as well as the research parameters has to be brought to the attention of the IEC immediately, and re-approval sought.

Clinical trial registration

Clinical Trial Registry of India (CTRI) is a free online searchable system for prospective registration of all clinical studies conducted in India. It is owned and managed by the National Institute of Medical Statistics, a division of Indian Council of Medical Research, Government of India. Registration of clinical trials will ensure transparency, accountability and accessibility of trials and their results to all potential beneficiaries.

After the dissertation proposal is passed by the scientific committee and IEC, it may be submitted for approval of trial registration to the CTRI. The student has to create a login at the CTRI website, and submit all the required data with the help of the guides. After submission, CTRI may ask for corrections, clarifications or changes. Subject enrolment and the actual trial should begin only after the CTRI approval.

Randomisation

In an experimental study design, the method of randomisation gives every subject an equal chance to get selected in any group by preventing bias. Primarily, three basic types employed in post-graduate medical dissertations are simple randomisation, block randomisation and stratified randomisation. Simple randomisation is based upon a single sequence of random assignments such as flipping a coin, rolling of dice (above 3 or below 3), shuffling of cards (odd or even) to allocate into two groups. Some students use a random number table found in books or use computer-generated random numbers. There are many random number generators, randomisation programs as well as randomisation services available online too. ( https://www-users.york.ac.uk/~mb55/guide/randsery.htm ).

There are many applications which generate random number sequences and a research student may use such computer-generated random numbers [ Figure 2 ]. Simple randomisation has higher chances of unequal distribution into the two groups, especially when sample sizes are low (<100) and thus block randomisation may be preferred. Details of how to do randomisation along with methods of allocation concealment may be found in Supplementary file 2 .

Figure depicting how to do block randomisation using online resources. (a) generation of a random list (b) transfer of the list to an MS excel file

Allocation concealment

If it is important in a study to generate a random sequence of intervention, it is also important for this sequence to be concealed from all stake-holders to prevent any scope of bias.[ 12 ] Allocation concealment refers to the technique used to implement a random sequence for allocation of intervention, and not to generate it.[ 13 ] In an Indian post-graduate dissertation, the sequentially numbered, opaque, sealed envelopes (SNOSE) technique is commonly used [ Supplementary file 2 ].

To minimise the chances of differential treatment allocation or assessments of outcomes, it is important to blind as many individuals as possible in the trial. Blinding is not an all-or-none phenomenon. Thus, it is very desirable to explicitly state in the dissertation, which individuals were blinded, how they achieved blinding and whether they tested the success of blinding.

Commonly used terms for blinding are

• Single blinding: Masks the participants from knowing which intervention has been given.
• Double blinding: Blinds both the participants as well as researchers to the treatment allocation.
• Triple blinding: By withholding allocation information from the subjects, researchers, as well as data analysts. The specific roles of researchers involved in randomisation, allocation concealment and blinding should be stated clearly in the dissertation.

Data which can be measured as numbers are called quantitative data [ Table 1 ]. Studies which emphasise objective measurements to generate numerical data and then apply statistical and mathematical analysis constitute quantitative research. Qualitative research on the other hand focuses on understanding people's beliefs, experiences, attitudes, behaviours and thus these generate non-numerical data called qualitative data, also known as categorical data, descriptive data or frequency counts. Importance of differentiating data into qualitative and quantitative lies in the fact that statistical analysis as well as the graphical representation may be very different.

Data collection types

In order to obtain data from the outcome variable for the purpose of analysis, we need to design a study which would give us the most valid information. A valid data or measurement tool, is the degree to which the tool measures what it claims to measure. For example, appearance of end tidal carbon dioxide waveform is a more valid measurement to assess correct endotracheal tube placement than auscultation of breath sounds on chest inflation.

The compilation of all data in a ‘Master Chart’ is a necessary step for planning, facilitating and appropriate preparation and processing of the data for analysis. It is a complete set of raw research data arranged in a systematic manner forming a well-structured and formatted, computable data matrix/database of the research to facilitate data analysis. The master chart is prepared as a Microsoft Excel sheet with the appropriate number of columns depicting the variable parameters for each individual subjects/respondents enlisted in the rows.

Statistical analysis

The detailed statistical methodology applied to analyse the data must be stated in the text under the subheading of statistical analysis in the Methods section. The statistician should be involved in the study during the initial planning stage itself. Following four steps have to be addressed while planning, performing and text writing of the statistical analysis part in this section.

Step 1. How many study groups are present? Whether analysis is for an unpaired or paired situation? Whether the recorded data contains repeated measurements? Unpaired or paired situations decide again on the choice of a test. The latter describes before and after situations for collected data (e.g. Heart rate data ‘before’ and ‘after’ spinal anaesthesia for a single group). Further, data should be checked to find out whether they are from repeated measurements (e.g., Mean blood pressure at 0, 1 st , 2 nd , 5 th , 10 th minutes and so on) for a group. Different types of data are commonly encountered in a dissertation [ Supplementary file 3A ].

Step 2. Does the data follow a normal distribution?[ 14 ]

Each study group as well as every parameter has to be checked for distribution analysis. This step will confirm whether the data of a particular group is normally distributed (parametric data) or does not follow the normal distribution (non-parametric data); subsequent statistical test selection mainly depends on the results of the distribution analysis. For example, one may choose the Student's’ test instead of the ‘Mann-Whitney U’ for non-parametric data, which may be incorrect. Each study group as well as every parameter has to be checked for distribution analysis [ Supplementary File 3B ].

Step 3. Calculation of measures of central tendency and measures of variability.

Measures of central tendency mainly include mean, median and mode whereas measures of variability include range, interquartile range (IQR), SD or variance not standard error of mean. Depending on Step 2 findings, one needs to make the appropriate choice. Mean and SD/variance are more often for normally distributed and median with IQR are the best measure for not normal (skewed) distribution. Proportions are used to describe the data whenever the sample size is ≥100. For a small sample size, especially when it is approximately 25-30, describe the data as 5/25 instead of 20%. Software used for statistical analysis automatically calculates the listed step 3 measures and thus makes the job easy.

Step 4. Which statistical test do I choose for necessary analysis?

Choosing a particular test [ Figure 3 ] is based on orderly placed questions which are addressed in the dissertation.[ 15 ]

Chosing a statistical test, (a). to find a difference between the groups of unpaired situations, (b). to find a difference between the groups of paired situations, (c). to find any association between the variables, (d). to find any agreement between the assessment techniques. ANOVA: Analysis of Variance. Reproduced with permission from Editor of Indian Journal of Ophthalmology, and the author, Dr Barun Nayak[ 15 ]

• Is there a difference between the groups of unpaired situations?
• Is there a difference between the groups of paired situations?
• Is there any association between the variables?
• Is there any agreement between the assessment techniques?

Perform necessary analysis using user-friendly software such as GraphPad Prism, Minitab or MedCalc,etc. Once the analysis is complete, appropriate writing in the text form is equally essential. Specific test names used to examine each part of the results have to be described. Simple listing of series of tests should not be done. A typical write-up can be seen in the subsequent sections of the supplementary files [Supplementary files 3C – E ]. One needs to state the level of significance and software details also.

Role of a statistician in dissertation and data analysis

Involving a statistician before planning a study design, prior to data collection, after data have been collected, and while data are analysed is desirable when conducting a dissertation. On the contrary, it is also true that self-learning of statistical analysis reduces the need for statisticians’ help and will improve the quality of research. A statistician is best compared to a mechanic of a car which we drive; he knows each element of the car, but it is we who have to drive it. Sometimes the statisticians may not be available for a student in an institute. Self-learning software tools, user-friendly statistical software for basic statistical analysis thus gain importance for students as well as guides. The statistician will design processes for data collection, gather numerical data, collect, analyse, and interpret data, identify the trends and relationships in data, perform statistical analysis and its interpretation, and finally assist in final conclusion writing.

Results are an important component of the dissertation and should follow clearly from the study objectives. Results (sometimes described as observations that are made by the researcher) should be presented after correct analysis of data, in an appropriate combination of text, charts, tables, graphs or diagrams. Decision has to be taken on each outcome; which outcome has to be presented in what format, at the beginning of writing itself. These should be statistically interpreted, but statistics should not surpass the dissertation results. The observations should always be described accurately and with factual or realistic values in results section, but should not be interpreted in the results section.

While writing, classification and reporting of the Results has to be done under five section paragraphs- population data, data distribution analysis, results of the primary outcome, results of secondary outcomes, any additional observations made such as a rare adverse event or a side effect (intended or unintended) or of any additional analysis that may have been done, such as subgroup analysis.

At each level, one may either encounter qualitative (n/N and %) or quantitative data (mean [SD], median [IQR] and so on.

In the first paragraph of Results while describing the population data, one has to write about included and excluded patients. One needs to cite the Consolidated Standards of Reporting Trials (CONSORT) flow chart to the text, at this stage. Subsequently, highlighting of age, sex, height, body mass index (BMI) and other study characteristics referring to the first table of ‘patients data’ should be considered. It is not desirable to detail all values and their comparison P values in the text again in population data as long as they are presented in a cited table. An example of this pattern can be seen in Supplementary file 3D .

In the second paragraph, one needs to explain how the data is distributed. It should be noted that, this is not a comparison between the study groups but represents data distribution for the individual study groups (Group A or Group B, separately)[ Supplementary file 3E ].

In the subsequent paragraph of Results , focused writing on results of the primary outcomes is very important. It should be attempted to mention most of the data outputs related to the primary outcomes as the study is concluded based on the results of this outcome analysis. The measures of central tendency and dispersion (Mean or median and SD or IQR etc., respectively), alongside the CIs, sample number and P values need to be mentioned. It should be noted that the CIs can be for the mean as well as for the mean difference and should not be interchanged. An example of this pattern can be seen in Supplementary file 3F .

A large number of the dissertations are guided for single primary outcome analysis, and also the results of multiple secondary outcomes are needed to be written. The primary outcome should be presented in detail, and secondary outcomes can be presented in tables or graphs only. This will help in avoiding a possible evaluator's fatigue. An example of this pattern can be seen in Supplementary file 3G .

In the last paragraph of the Results, mention any additional observations, such as a rare adverse event or side effect or describe the unexpected results. The results of any additional analysis (subgroup analysis) then need to be described too. An example of this pattern can be seen in Supplementary file 3H .

The most common error observed in the Results text is duplication of the data and analytical outputs. While using the text for summarising the results, at each level, it should not be forgotten to cite the table or graph but the information presented in a table should not be repeated in the text. Further, results should not be given to a greater degree of accuracy than that of the measurement. For example, mean (SD) age need to be presented as 34.5 (11.3) years instead of 34.5634 (11.349). The latter does not carry any additional information and is unnecessary. The actual P values need to be mentioned. The P value should not be simply stated as ‘ P < 0.05’; P value should be written with the actual numbers, such as ‘ P = 0.021’. The symbol ‘<’ should be used only when actual P value is <0.001 or <0.0001. One should try avoiding % calculations for a small sample especially when n < 100. The sample size calculation is a part of the methodology and should not be mentioned in the Results section.

The use of tables will help present actual data values especially when in large numbers. The data and their relationships can be easily understood by an appropriate table and one should avoid overwriting of results in the text format. All values of sample size, central tendency, dispersions, CIs and P value are to be presented in appropriate columns and rows. Preparing a dummy table for all outcomes on a rough paper before proceeding to Microsoft Excel may be contemplated. Appropriate title heading (e.g., Table 1 . Study Characteristics), Column Headings (e.g., Parameter studied, P values) should be presented. A footnote should be added whenever necessary. For outputs, where statistically significant P values are recorded, the same should be highlighted using an asterisk (*) symbol and the same *symbol should be cited in the footnote describing its value (e.g., * P < 0.001) which is self-explanatory for statistically significance. One should not use abbreviations such as ‘NS’ or ‘Sig’ for describing (non-) significance. Abbreviations should be described for all presented tables. A typical example of a table can be seen in Figure 4 .

Example of presenting a table

Graphical images

Similar to tables, the graphs and diagrams give a bird's-eye view of the entire data and therefore may easily be understood. bar diagrams (simple, multiple or component), pie charts, line diagrams, pictograms and spot maps suit qualitative data more whereas the histograms, frequency polygons, cumulative frequency, polygon scatter diagram, box and whisker plots and correlation diagrams are used to depict quantitative data. Too much presentation of graphs and images, selection of inappropriate or interchanging of graphs, unnecessary representation of three-dimensional graph for one-dimensional graphs, disproportionate sizes of length and width and incorrect scale and labelling of an axis should be avoided. All graphs should contain legends, abbreviation descriptions and a footnote. Appropriate labelling of the x - and the y -axis is also essential. Priori decided scale for axis data should be considered. The ‘error bar’ represents SDs or IQRs in the graphs and should be used irrespective of whether they are bar charts or line graphs. Not showing error bars in a graphical image is a gross mistake. An error bar can be shown on only one side of the line graph to keep it simple. A typical example of a graphical image can be seen in Figure 5 . The number of subjects (sample) is to be mentioned for each time point on the x -axis. An asterisk (*) needs to be put for data comparisons having statistically significant P value in the graph itself and they are self-explanatory with a ‘stand-alone’ graph.

Example of an incorrect (a) and correct (b) image

Once the results have been adequately analysed and described, the next step is to draw conclusions from the data and study. The main goal is to defend the work by staging a constructive debate with the literature.[ 16 ] Generally, the length of the ‘ Discussion ’ section should not exceed the sum of other sections (introduction, material and methods, and results).[ 17 ] Here the interpretation, importance/implications, relevance, limitations of the results are elaborated and should end in recommendations.

It is advisable to start by mentioning the RQ precisely, summarising the main findings without repeating the entire data or results again. The emphasis should be on how the results correlate with the RQ and the implications of these results, with the relevant review of literature (ROL). Do the results coincide with and add anything to the prevalent knowledge? If not, why not? It should justify the differences with plausible explanation. Ultimately it should be made clear, if the study has been successful in making some contribution to the existing evidence. The new results should not be introduced and any exaggerated deductions which cannot be corroborated by the outcomes should not be made.

The discussion should terminate with limitations of the study,[ 17 ] mentioned magnanimously. Indicating limitations of the study reflects objectivity of the authors. It should not enlist any errors, but should acknowledge the constraints and choices in designing, planning methodology or unanticipated challenges that may have cropped up during the actual conduct of the study. However, after listing the limitations, the validity of results pertaining to the RQ may be emphasised again.

This section should convey the precise and concise message as the take home message. The work carried out should be summarised and the answer found to the RQ should be succinctly highlighted. One should not start dwelling on the specific results but mention the overall gain or insights from the observations, especially, whether it fills the gap in the existing knowledge if any. The impact, it may have on the existing knowledge and practices needs to be reiterated.

What to do when we get a negative result?

Sometimes, despite the best research framework, the results obtained are inconclusive or may even challenge a few accepted assumptions.[ 18 ] These are frequently, but inappropriately, termed as negative results and the data as negative data. Students must believe that if the study design is robust and valid, if the confounders have been carefully neutralised and the outcome parameters measure what they are intended to, then no result is a negative result. In fact, such results force us to critically re-evaluate our current understanding of concepts and knowledge thereby helping in better decision making. Studies showing lack of prolongation of the apnoea desaturation safety periods at lower oxygen flows strengthened belief in the difficult airway guidelines which recommend nasal insufflations with at least 15 L/min oxygen.[ 19 , 20 , 21 ]

Publishing the dissertation work

There are many reporting guidelines based upon the design of research. These are a checklist, flow diagram, or structured text to guide authors in reporting a specific type of research, developed using explicit methodology. The CONSORT[ 22 ] and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) initiatives,[ 23 ] both included in the Enhancing the Quality and Transparency of Health Research (EQUATOR) international network, have elaborated appropriate suggestions to improve the transparency, clarity and completeness of scientific literature [ Figure 6 ].

Equator publishing tree

All authors are advised to follow the CONSORT/STROBE checklist attached as Supplementary file 4 , when writing and reporting their dissertation.

For most dissertations in Anaesthesiology, the CONSORT, STROBE, Standards for Reporting Diagnostic accuracy studies (STARD) or REporting recommendations for tumour MARKer prognostic studies (REMARK) guidelines would suffice.

Abstract and Summary

These two are the essential sections of a dissertation.

It should be at the beginning of the manuscript, after the title page and acknowledgments, but before the table of contents. The preparation varies as per the University guidelines, but generally ranges between 150 to 300 words. Although it comes at the very beginning of the thesis, it is the last part one writes. It must not be a ‘copy-paste job’ from the main manuscript, but well thought out miniaturisation, giving the overview of the entire text. As a rule, there should be no citation of references here.

Logically, it would have four components starting with aims, methods, results, and conclusion. One should begin the abstract with the research question/objectives precisely, avoiding excessive background information. Adjectives like, evaluate, investigate, test, compare raise the curiosity quotient of the reader. This is followed by a brief methodology highlighting only the core steps used. There is no need of mentioning the challenges, corrections, or modifications, if any. Finally, important results, which may be restricted to fulfilment (or not), of the primary objective should be mentioned. Abstracts end with the main conclusion stating whether a specific answer to the RQ was found/not found. Then recommendations as a policy statement or utility may be made taking care that it is implementable.

Keywords may be included in the abstract, as per the recommendations of the concerned university. The keywords are primarily useful as markers for future searches. Lastly, the random reader using any search engine may use these, and the identifiability is increased.

The summary most often, is either the last part of the Discussion or commonly, associated with the conclusions (Summary and Conclusions). Repetition of introduction, whole methodology, and all the results should be avoided. Summary, if individually written, should not be more than 150 to 300 words. It highlights the research question, methods used to investigate it, the outcomes/fallouts of these, and then the conclusion part may start.

References/bibliography

Writing References serves mainly two purposes. It is the tacit acknowledgement of the fact that someone else's written words or their ideas or their intellectual property (IP) are used, in part or in toto , to avoid any blame of plagiarism. It is to emphasise the circumspective and thorough literature search that has been carried out in preparation of the work.

Vancouver style for referencing is commonly used in biomedical dissertation writing. A reference list contains details of the works cited in the text of the document. (e.g. book, journal article, pamphlet, government reports, conference material, internet site). These details must include sufficient details so that others may locate and access those references.[ 24 ]

How much older the references can be cited, depends upon the university protocol. Conventionally accepted rule is anywhere between 5-10 years. About 85% of references should be dispersed in this time range. Remaining 15%, which may include older ones if they deal with theories, historical aspects, and any other factual content. Rather than citing an entire book, it is prudent to concentrate on the chapter or subsection of the text. There are subjective variations between universities on this matter. But, by and large, these are quoted as and when deemed necessary and with correct citation.

Bibliography is a separate list from the reference list and should be arranged alphabetically by writing name of the ‘author or title’ (where no author name is given) in the Vancouver style.

There are different aspects of writing the references.[ 24 ]

Citing the reference in the form of a number in the text. The work of other authors referred in the manuscript should be given a unique number and quoted. This is done in the order of their appearance in the text in chronological order by using Arabic numerals. The multiple publications of same author shall be written individually. If a reference article has more than six authors, all six names should be written, followed by “ et al .” to be used in lieu of other author names. It is desirable to write the names of the journals in abbreviations as per the NLM catalogue. Examples of writing references from the various sources may be found in the Supplementary file 5 .

Both the guide and the student have to work closely while searching the topic initially and also while finalising the submission of the dissertation. But the role of the guide in perusing the document in detail, and guiding the candidate through the required corrections by periodic updates and discussions cannot be over-emphasised.

Assessment of dissertations

Rarely, examiners might reject a dissertation for failure to choose a contemporary topic, a poor review of literature, defective methodology, biased analysis or incorrect conclusions. If these cannot be corrected satisfactorily, it will then be back to the drawing board for the researchers, who would have to start from scratch to redesign the study, keeping the deficiencies in mind this time.

Before submission, dissertation has to be run through “plagiarism detector” software, such as Turnitin or Grammarly to ensure that plagiarism does not happen even unwittingly. Informal guidelines state that the percentage plagiarism picked up by these tools should be <10%.

No work of art is devoid of mistakes/errors. Logically, a dissertation, being no exception, may also have errors. Our aim, is to minimise them.

The dissertation is an integral part in the professional journey of any medical post-graduate student. It is also an important responsibility for a guide to educate his protégé, the basics of research methodology through the process. Searching for a gap in literature and identification of a pertinent research question is the initial step. Careful planning of the study design is a vitally important aspect. After the conduct of study, writing the dissertation is an art for which the student often needs guidance. A good dissertation is a good description of a meticulously conducted study under the different headings described, utilising the various reporting guidelines. By avoiding some common errors as discussed in this manuscript, a good dissertation can result in a very fruitful addition to medical literature.

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Conflicts of interest.

There are no conflicts of interest.

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Formal MD Thesis Requirement

All students at Yale School of Medicine engage in research and are required to write an MD thesis during medical school. The only exceptions are students who have earned a PhD degree in the health sciences before matriculation and students enrolled in Yale’s MD/PhD program. The YSM MD Thesis is under the governance of the EPCC, which meets regularly to recommend rules, regulations, and deadlines.

Deadlines/Important Dates

Thesis approval process, thesis awards, required formatting and components of the md thesis, examples for reference section formatting, avoiding the risk of copyright violation and liability when submitting your md thesis, instructions for submitting a thesis to the yale medicine thesis digital library, thesis depositors declaration form, evaluations of advisor, student evaluation of thesis advisor.

• Yale School of Medicine Digital Thesis Depositor’s Declaration Form
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Thesis Deadlines for the 2023-2024 Academic Year

Md students:.

The Office of Student Research, in conjunction with the Dean’s Office, has established the following deadlines for theses submitted in partial fulfillment of the requirements for graduation in May 2024. The deadlines ensure that (1) students have sufficient time to complete their theses; (2) that there is sufficient time for rigorous departmental review and subsequent revision by students before final approval. These deadlines are strictly followed. Students are strongly encouraged to submit their theses well before the Class of 2024 Thesis Deadlines provided below. This timeliness will provide students, advisors, and sponsoring departments sufficient time for useful review and revision. It should be recognized by all concerned that the integrity of the thesis requirement and effective, rigorous review requires adherence to these deadlines. OSR will hold periodic “Thesis Check-in Sessions” via zoom for the Class of 2024 and will send periodic reminder emails with more detailed instructions as these deadlines approach.

*Students missing the August 4th, January 19th, and/or March 29th deadlines will be referred to the Progress Committee to ensure they receive adequate support to make progress towards this graduation requirement. Students missing the January 19th and/or March 29th deadlines will be ineligible for thesis prizes at graduation.

Extensions beyond the above thesis deadlines will be granted only for special circumstances and must have the approval of the student’s thesis mentor/advisor, academic advisor, and the Departmental Thesis Chairperson . Students seeking an extension for the January 19, 2024, deadline must submit a Thesis Deadline Extension Request Form to their Academic Advisor, and the Departmental Thesis Chair, for approval. Students missing the August 4th, January 19th, and/or March 29th deadlines will be referred to the Progress Committee to ensure they receive adequate support to make progress towards this graduation requirement. In the event of an extension, if granted, the following ABSOLUTE Class of 2024 Thesis Extension Deadlines will apply:

*All late theses require an extension. The student must submit the Thesis Deadline Extension Request Form before January 19, 2024.

MD/MHS Students:

Consistent with degree requirements, MD/MHS students must present their thesis to their three-person committee prior to the January 19th deadline. Students are encouraged to start arranging the date of this committee meeting in the fall to avoid unanticipated delays.

MD/PhD Students:

A different process applies to students in the MD/PhD program. For students enrolled in the combined MD/PhD Program, the dissertation submitted to and approved by the Graduate School will satisfy the MD thesis requirement. Therefore, MD/PhD students who have already defended their dissertation and received their PhD should provide this information to OSR via email as soon as possible.

To ensure compliance with YSM graduation deadlines, MD/PhD students in the class of 2024 who have not defended and submitted their dissertation to the Graduate School by the October 1, 2023, deadline will need to submit a copy of their dissertation directly to OSR via the MD/PhD Box Upload Link by March 15, 2024. OSR will convene a committee to review the dissertation, obtain feedback, and provide approval for graduation. Please note that MD/PhD students must also defend and submit their dissertation to the Graduate School no later than March 15, 2024, to meet the Graduate School spring degree deadline for conferral of the PhD degree. MD/PhD students who have not yet defended their dissertation should provide this information to OSR. If there are any questions about the process, please contact the MD/PhD Office.

Financial support is not provided for writing the thesis.

Thesis Preparation and Approval

Preparation for thesis submission begins in the summer of the fourth year with the OSR leadership. At this time, timeline and practices are distributed via email and reviewed with students in class meetings. Because thesis approval is a lengthy process involving three levels of review, students are encouraged to manage their time well and start writing their first draft early in the fall semester of their final year of medical school. A suggested timeline is provided below.

July : Thesis deadlines are distributed via email to all students in the graduating class and an informational session is held. Students should be on track to complete their thesis research by mid-fall. Any student anticipating a challenge in this regard should contact the OSR as soon as possible. All students expecting to graduate in May of a given year must, provide the OSR with information regarding their thesis title and mentor/advisor. Students will receive an email from the OSR containing a Medtrics link requesting this information. The OSR will contact all thesis mentors/advisors to confirm this role and to provide information and expectations regarding the thesis process.

August – December : Students should be finalizing research and writing their thesis draft. As the semester progresses, activities should shift from the data generation/analysis to the writing of the actual thesis. Students should do their best to complete the first draft of the thesis by mid-late December. Because students are also involved in the residency application and interview process, they are discouraged from starting new projects at this time.

December – January : This period is devoted to reviewing and editing of thesis draft that is ultimately approved by their thesis mentor/advisor and submitted by the student to the Thesis Chair of their sponsoring department. The YSM thesis mentor/advisor will be asked to complete a thesis assessment that evaluates the student’s mastery of YSM’s research-related educational objectives and provides formative summative feedback to the student.

January – March : The Departmental Thesis Chair coordinates thesis review by external reviewers. An “external reviewer” is defined as an individual who is not directly involved in the project. This individual may be a Yale faculty member internal or external to YSM or may hold a faculty appointment at an outside institution. This reviewer is required to complete a thesis assessment and provide formative summative feedback, as well as recommendations for any required changes, to the thesis. Departmental Thesis Chairs review assessments, notify students of departmental approval, and transmit these approvals to the OSR.

March : Theses and their associated assessments undergo school-level review by the OSR. Students receive YSM approval of their thesis along with summative feedback obtained during the review process. Students incorporate any required changes into their thesis and upload to the Yale Medicine Digital Thesis Library/Eli Scholar via the ProQuest platform (see below).

April : The OSR confirms that theses have been deposited into the Yale Medicine Digital Thesis Library and the registrar receives the names of students who have completed the thesis requirement.

The central role of the medical student thesis is to assess student’s performance on the YSM’s research-related educational objectives. As such, all students are expected to produce an excellent piece of scholarly work. In recognition of these achievements, the OSR has worked to develop an award process that celebrates the wonderful research being done by our students without creating a competitive atmosphere surrounding the thesis. Hence, thesis awards are based on competency-based assessments submitted by thesis mentors/advisors and reviewers during the approval process, and internal review of the final thesis that was deposited into the Yale Medicine Digital Thesis Library. Consistent with all other graduation prizes, YSM MD Thesis Awards will remain confidential until they are announced in the YSM Commencement Program on May 20, 2024. While some departments may elect to confer thesis “honors” based upon their own internal review, this recognition is distinct from YSM graduation prizes and is not under OSR’s purview.

Read about the required formatting and components for the thesis .

See helpful examples for reference section formatting.

Read about avoiding the risk of copyright violation and liability when submitting your MD Thesis.

Learn more about submitting a thesis to the Yale Medicine Thesis Digital Library .

Learn more about the Thesis Depositors Declaration Form.

Learn more about evaluating your experience with your thesis advisor .

Apply for a Thesis Extension

Read about the required formatting and components for the thesis.

Yale Journal of Biology and Medicine

Learn more about the journal or submit a manuscript.

What Exactly Is A Dissertation (Or Thesis)?

If you’ve landed on this article, chances are you’ve got a dissertation or thesis project coming up (hopefully it’s not due next week!), and you’re now asking yourself the classic question, “what the #%#%^ is a dissertation?”…

In this post, I’ll break down the basics of exactly what a dissertation is, in plain language. No ivory tower academia.

So, let’s get to the pressing question – what is a dissertation?

A dissertation (or thesis) = a research project

Simply put, a dissertation (or thesis – depending on which country you’re studying in) is a research project . In other words, your task is to ask a research question (or set of questions) and then set about finding the answer(s). Simple enough, right?

Well, the catch is that you’ve got to undertake this research project in an academic fashion , and there’s a wealth of academic language that makes it all (look) rather confusing (thanks, academia). However, at its core, a dissertation is about undertaking research (investigating something). This is really important to understand, because the key skill that your university is trying to develop in you (and will be testing you on) is your ability to undertake research in a well-structured structured, critical and academically rigorous way.

This research-centric focus is significantly different from assignments or essays, where the main concern is whether you can understand and apply the prescribed module theory. I’ll explain some other key differences between dissertations or theses and assignments a bit later in this article, but for now, let’s dig a little deeper into what a dissertation is.

A dissertation (or thesis) is a process.

Okay, so now that you understand that a dissertation is a research project (which is testing your ability to undertake quality research), let’s go a little deeper into what that means in practical terms.

The best way to understand a dissertation is to view it as a process – more specifically a research process (it is a research project, after all). This process involves four essential steps, which I’ll discuss below.

Step 1 – You identify a worthy research question

The very first step of the research process is to find a meaningful research question, or a set of questions. In other words, you need to find a suitable topic for investigation. Since a dissertation is all about research, identifying the key question(s) is the critical first step. Here’s an example of a well-defined research question:

“Which factors cultivate or erode customer trust in UK-based life insurance brokers?”

This clearly defined question sets the direction of the research . From the question alone, you can understand exactly what the outcome of the research might look like – i.e. a set of findings about which factors help brokers develop customer trust, and which factors negatively impact trust.

But how on earth do I find a suitable research question, you ask? Don’t worry about this right now – when you’re ready, you can read our article about finding a dissertation topic . However, right now, the important thing to understand is that the first step in the dissertation process is identifying the key research question(s). Without a clear question, you cannot move forward.

Step 2 – You review the existing research

Once the research question is clearly established, the next step is to review the existing research/literature (both academic and professional/industry) to understand what has already been said with regard to the question. In academic speak, this is called a literature review .

This step is critically important as, in all likelihood, someone else has asked a similar question to yours, and therefore you can build on the work of others . Good academic research is not about reinventing the wheel or starting from scratch – it’s about familiarising yourself with the current state of knowledge, and then using that as your basis for further research.

Simply put, the first step to answering your research question is to look at what other researchers have to say about it. Sometimes this will lead you to change your research question or direction slightly (for example, if the existing research already provides a comprehensive answer). Don’t stress – this is completely acceptable and a normal part of the research process.

Step 3 – You carry out your own research

Once you’ve got a decent understanding of the existing state of knowledge, you will carry out your own research by collecting and analysing the relevant data. This could take to form of primary research (collecting your own fresh data), secondary research (synthesising existing data) or both, depending on the nature of your degree, research question(s) and even your university’s specific requirements.

Exactly what data you collect and how you go about analysing it depends largely on the research question(s) you are asking, but very often you will take either a qualitative approach (e.g. interviews or focus groups) or a quantitative approach (e.g. online surveys). In other words, your research approach can be words-based, numbers-based, or both . Don’t let the terminology scare you and don’t worry about these technical details for now – we’ll explain research methodology in later posts .

Step 4 – You develop answers to your research question(s)

Combining your understanding of the existing research (Step 2) with the findings from your own original research (Step 3), you then (attempt to) answer your original research question (s). The process of asking, investigating and then answering has gone full circle.

Of course, your research won’t always provide rock-solid answers to your original questions, and indeed you might find that your findings spur new questions altogether. Don’t worry – this is completely acceptable and is a natural part of the research process.

So, to recap, a dissertation is best understood as a research process, where you are:

• Ask a meaningful research question(s)
• Carry out the research (both existing research and your own)
• Analyse the results to develop an answer to your original research question(s).

Depending on your specific degree and the way your university designs its coursework, you might be asking yourself “but isn’t this just a longer version of a normal assignment?”. Well, it’s quite possible that your previous assignments required a similar research process, but there are some key differences you need to be aware of, which I’ll explain next.

Same same, but different…

While there are, naturally, similarities between dissertations/theses and assignments, its important to understand the differences  so that you approach your dissertation with the right mindset and focus your energy on the right things. Here, I’ll discuss four ways in which writing a dissertation differs substantially from assignments and essays, and why this matters.

Difference #1 – You must decide (and live with) the direction.

Unlike assignments or essays, where the general topic is determined for you, for your dissertation, you will (typically) be the one who decides on your research questions and overall direction. This means that you will need to:

• Find a suitable research question (or set of questions)
• Justify why its worth investigating (in the form of a research proposal )
• Find all the relevant existing research and familiarise yourself with the theory

This is very different from assignments, where the theory is given to you on a platter, and the direction is largely pre-defined. Therefore, before you start the dissertation process, you need to understand the basics of academic research, how to find a suitable research topic and how to source the relevant literature.

Difference #2 – It’s a long project, and you’re on your own.

A dissertation is a long journey, at least compared to assignments. Typically, you will spend 3 – 6 months writing around 15,000 – 25,000 words (for Masters-level, much more for PhD) on just one subject. Therefore, successfully completing your dissertation requires a substantial amount of stamina .

To make it even more challenging, your classmates will not be researching the same thing as you are, so you have limited support, other than your supervisor (who may be very busy). This can make it quite a lonely journey . Therefore, you need a lot of self-discipline and self-direction in order to see it through to the end. You should also try to build a support network of people who can help you through the process (perhaps alumni, faculty or a private coach ).

Difference #3 – They’re testing research skills.

We touched on this earlier. Unlike assignments or essays, where the markers are assessing your ability to understand and apply the theories, models and frameworks that they provide you with, your dissertation will be is assessing your ability to undertake high-quality research in an academically rigorous manner.

Of course, your ability to understand the relevant theory (i.e. within your literature review) is still very important, but this is only one piece of the research skills puzzle. You need to demonstrate the full spectrum of research skills.

It’s important to note that your research does not need to be ground-breaking, revolutionary or world-changing – that is not what the markers are assessing. They are assessing whether you can apply well-established research principles and skills to a worthwhile topic of enquiry. Don’t feel like you need to solve the world’s major problems. It’s simply not going to happen (you’re a first-time researcher, after all) – and doesn’t need to happen in order to earn good marks.

Difference #4 – Your focus needs to be narrow and deep.

In your assignments, you were likely encouraged to take a broad, interconnected, high-level view of the theory and connect as many different ideas and concepts as possible. In your dissertation, however, you typically need to narrow your focus and go deep into one particular topic. Think about the research question we looked at earlier:

The focus is intentionally very narrow – specifically the focus is on:

• The UK only – no other countries are being considered.
• Life insurance brokers only – not financial services, not vehicle insurance, not medical insurance, etc.
• Customer trust only – not reputation, not customer loyalty, not employee trust, supplier trust, etc.

By keeping the focus narrow, you enable yourself to deeply probe whichever topic you choose – and this depth is essential for earning good marks. Importantly, ringfencing your focus doesn’t mean ignoring the connections to other topics – you should still acknowledge all the linkages, but don’t get distracted – stay focused on the research question(s).

So, as you can see, a dissertation is more than just an extended assignment or essay. It’s a unique research project that you (and only you) must lead from start to finish. The good news is that, if done right, completing your dissertation will equip you with strong research skills, which you will most certainly use in the future, regardless of whether you follow an academic or professional path.

Wrapping up

Hopefully in this post, I’ve answered your key question, “what is a dissertation?”, at least at a big picture-level. To recap on the key points:

• A dissertation is simply a structured research project .
• It’s useful to view a dissertation as a process involving asking a question, undertaking research and then answering that question.
• First and foremost, your marker(s) will be assessing your research skills , so its essential that you focus on producing a rigorous, academically sound piece of work (as opposed to changing the world or making a scientific breakthrough).
• While there are similarities, a dissertation is different from assignments and essays in multiple ways. It’s important to understand these differences if you want to produce a quality dissertation.

In this post, I’ve gently touched on some of the intricacies of the dissertation, including research questions, data types and research methodologies. Be sure to check out the Grad Coach Blog  for more detailed discussion of these areas.

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34 Comments

Hello Derek

Yes, I struggle with literature review and am highly frustrated (with myself).

Thank you for the guide that you have sent, especially the apps. I am working through the guide and busy with the implementation of it.

Hope to hear from you again!

Regards Micheal

Great to hear that, Michael. All the best with your research!

Thank you. That was quite something to move forward with. Despite the fact that I was lost. I will now be able to do something with the information given.

That’s great, Pheladi. Good luck!

Thank you so much for your videos and writing research proposal and dissertation. These videos are useful. I was struggling, but now I am starting to write. I hope to watch your more videos to learn more about the dissertation.

Before this post, I didn’t know where to start my research, today I have some light and do certain % of my research. I may need for direction on literature review. Big thanks to you.

Very very good Derek

Thanks immensely Derek

You’re welcome 🙂 Good luck with your dissertation/thesis.

Thank you Derek for widening my scope on research, this can be likened to a blind man whose eyes can now see.

Remain bless sir🙏

You guys are doing really great… I am extremely grateful for your help… Keep going.. Please activate that research help for indian students as well I couldn’t access it being an indian.

Hello Derek,

I got stuck in the concept paper because I changed my topic. Now I don’t know where to pick up the pieces again. How can I focus and stay on track. I am getting scared.

Thank you so much Derek, I am a new comer, learning for the first time how to write a good research. These in information’s to me is a mind opener, I hope to learn more from you in the future, Thanks and God bless.

Thanks Guys this means so much to me

A pretty good and insightful piece for beginners like me. Looking forward to more helpful hints and guide. Thanks to Derek.

This is so helpful…really appreciate your work.

Great to hear that

On cybersecurity Analytics research to banking transactions

This was of great help to me and quite informative .

Thank you so much GradCoach,

This is like a light at the end of the tunnel. You are a lifesaver. Thank you once again.

hello, I’m so grateful for such great information. It appears basic, but it is so relevant in understanding the research process.

Your website is very helpful for writing thesis. A big well done to the team. Do you have a website for paper writing and academic publishing or how to publish my thesis, how to land a fully funded PhD, etc. Just the general upward trajectory in the academia. Thank you

I have learned a lot from the lectures, it was beneficial and helped me a lot in my research journey. Thank you very much

Thank you for your gifts of enlightenment to a person like me who’s always a student. May your ‘well’not dry out.

It’s quite a fun and superb, now I have come to believe that the way one teach can have an impact in understanding and can change one’s assumption and position about a subject or a problem, before I came here and learn I consider research methodology a hard thing because, I wasn’t taught by a mentor like this one. Thanks so much who ever have make this effort to make this something easy and engaging

I can’t imagine that world has achieved major aspects of every field of study

Thank you very much for all the valuable, wonderful and comprehensive amount of information… I highly appreciate your support, 100% I recommend you

This topic is intended for my MPhil. Work (The perception of parents on Technical and Vocational Education, the impact on educational policy). May you consider the suitability of the topic for me and refine if the need be. Thank you,

Hello here…

i have gone through the notes and it is interesting. All i need now is a pdf file that contain a whole dissertation writing inclusive of chapter 1 to 5 on motivation as a topic… thanks

Remarkable!!! You made it sound so simple

I got stuck in my writing because I need to change my topic. I am getting scared as I have a semester left 🙁

Thanks for such an educational opportunity and support

Thanks for your educational opportunity and support

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