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Yale Medicine Thesis Digital Library

Starting with the Yale School of Medicine (YSM) graduating class of 2002, the Cushing/Whitney Medical Library and YSM Office of Student Research have collaborated on the Yale Medicine Thesis Digital Library (YMTDL) project, publishing the digitized full text of medical student theses on the web as a valuable byproduct of Yale student research efforts. The digital thesis deposit has been a graduation requirement since 2006. Starting in 2012, alumni of the Yale School of Medicine were invited to participate in the YMTDL project by granting scanning and hosting permission to the Cushing/Whitney Medical Library, which digitized the Library’s print copy of their thesis or dissertation. A grant from the Arcadia Fund in 2017 provided the means for digitizing over 1,000 additional theses. IF YOU ARE A MEMBER OF THE YALE COMMUNITY AND NEED ACCESS TO A THESIS RESTRICTED TO THE YALE NETWORK, PLEASE MAKE SURE YOUR VPN (VIRTUAL PRIVATE NETWORK) IS ON.

Theses/Dissertations from 2024 2024

Refractory Neurogenic Cough Management: The Non-Inferiority Of Soluble Steroids To Particulate Suspensions For Superior Laryngeal Nerve Blocks , Hisham Abdou

Percutaneous Management Of Pelvic Fluid Collections: A 10-Year Series , Chidumebi Alim

Behavioral Outcomes In Patients With Metopic Craniosynostosis: Relationship With Radiographic Severity , Mariana Almeida

Ventilator Weaning Parameters Revisited: A Traditional Analysis And A Test Of Artificial Intelligence To Predict Successful Extubation , John James Andrews

Developing Precision Genome Editors: Peptide Nucleic Acids Modulate Crispr Cas9 To Treat Autosomal Dominant Disease , Jem Atillasoy

Radiology Education For U.s. Medical Students In 2024: A State-Of-The-Art Analysis , Ryan Bahar

Out-Of-Pocket Spending On Medications For Diabetes In The United States , Baylee Bakkila

Imaging Markers Of Microstructural Development In Neonatal Brains And The Impact Of Postnatal Pathologies , Pratheek Sai Bobba

A Needs Assessment For Rural Health Education In United States Medical Schools , Kailey Carlson

Racial Disparities In Behavioral Crisis Care: Investigating Restraint Patterns In Emergency Departments , Erika Chang-Sing

Social Determinants Of Health & Barriers To Care In Diabetic Retinopathy Patients Lost To Follow-Up , Thomas Chang

Association Between Fine Particulate Matter And Eczema: A Cross-Sectional Study Of The All Of Us Research Program And The Center For Air, Climate, And Energy Solutions , Gloria Chen

Predictors Of Adverse Outcomes Following Surgical Intervention For Cervical Spondylotic Myelopathy , Samuel Craft

Genetic Contributions To Thoracic Aortic Disease , Ellelan Arega Degife

Actigraphy And Symptom Changes With A Social Rhythm Intervention In Young Persons With Mood Disorders , Gabriela De Queiroz Campos

Incidence Of Pathologic Nodal Disease In Clinically Node Negative, Microinvasive/t1a Breast Cancers , Pranammya Dey

Spinal Infections: Pathophysiology, Diagnosis, Prevention, And Management , Meera Madhav Dhodapkar

Childen's Reentry To School After Psychiatric Hospitalization: A Qualitative Study , Madeline Digiovanni

Bringing Large Language Models To Ophthalmology: Domain-Specific Ontologies And Evidence Attribution , Aidan Gilson

Surgical Personalities: A Cultural History Of Early 20th Century American Plastic Surgery , Joshua Zev Glahn

Implications Of Acute Brain Injury Following Transcatheter Aortic Valve Replacement , Daniel Grubman

Latent Health Status Trajectory Modelling In Patients With Symptomatic Peripheral Artery Disease , Scott Grubman

The Human Claustrum Tracks Slow Waves During Sleep , Brett Gu

Patient Perceptions Of Machine Learning-Enabled Digital Mental Health , Clara Zhang Guo

Variables Affecting The 90-Day Overall Reimbursement Of Four Common Orthopaedic Procedures , Scott Joseph Halperin

The Evolving Landscape Of Academic Plastic Surgery: Understanding And Shaping Future Directions In Diversity, Equity, And Inclusion , Sacha C. Hauc

Association Of Vigorous Physical Activity With Psychiatric Disorders And Participation In Treatment , John L. Havlik

Long-Term Natural History Of Ush2a-Retinopathy , Michael Heyang

Clinical Decision Support For Emergency Department-Initiated Buprenorphine For Opioid Use Disorder , Wesley Holland

Applying Deep Learning To Derive Noninvasive Imaging Biomarkers For High-Risk Phenotypes Of Prostate Cancer , Sajid Hossain

The Hardships Of Healthcare Among People With Lived Experiences Of Homelessness In New Haven, Ct , Brandon James Hudik

Outcomes Of Peripheral Vascular Interventions In Patients Treated With Factor Xa Inhibitors , Joshua Joseph Huttler

Janus Kinase Inhibition In Granuloma Annulare: Two Single-Arm, Open-Label Clinical Trials , Erica Hwang

Medicaid Coverage For Undocumented Children In Connecticut: A Political History , Chinye Ijeli

Population Attributable Fraction Of Reproductive Factors In Triple Negative Breast Cancer By Race , Rachel Jaber Chehayeb

Evaluation Of Gastroesophageal Reflux And Hiatal Hernia As Risk Factors For Lobectomy Complications , Michael Kaminski

Health-Related Social Needs Before And After Critical Illness Among Medicare Beneficiaries , Tamar A. Kaminski

Effects Of Thoracic Endovascular Aortic Repair On Cardiac Function At Rest , Nabeel Kassam

Conditioned Hallucinations By Illness Stage In Individuals With First Episode Schizophrenia, Chronic Schizophrenia, And Clinical High Risk For Psychosis , Adam King

The Choroid Plexus Links Innate Immunity To Dysregulation Of Csf Homeostasis In Diverse Forms Of Hydrocephalus , Emre Kiziltug

Health Status Changes After Stenting For Stroke Prevention In Carotid Artery Stenosis , Jonathan Kluger

Rare And Undiagnosed Liver Diseases: New Insights From Genomic And Single Cell Transcriptomic Analyses , Chigoziri Konkwo

“Teen Health” Empowers Informed Contraception Decision-Making In Adolescents And Young Adults , Christina Lepore

Barriers To Mental Health Care In Us Military Veterans , Connor Lewis

Barriers To Methadone For Hiv Prevention Among People Who Inject Drugs In Kazakhstan , Amanda Rachel Liberman

Unheard Voices: The Burden Of Ischemia With No Obstructive Coronary Artery Disease In Women , Marah Maayah

Partial And Total Tonsillectomy For Pediatric Sleep-Disordered Breathing: The Role Of The Cas-15 , Jacob Garn Mabey

Association Between Insurance, Access To Care, And Outcomes For Patients With Uveal Melanoma In The United States , Victoria Anne Marks

Urinary Vegf And Cell-Free Dna As Non-Invasive Biomarkers For Diabetic Retinopathy Screening , Mitchelle Matesva

Pain Management In Facial Trauma: A Narrative Review , Hunter Mccurdy

Meningioma Relational Database Curation Using A Pacs-Integrated Tool For Collection Of Clinical And Imaging Features , Ryan Mclean

Colonoscopy Withdrawal Time And Dysplasia Detection In Patients With Inflammatory Bowel Disease , Chandler Julianne Mcmillan

Cerebral Arachnoid Cysts Are Radiographic Harbingers Of Epigenetics Defects In Neurodevelopment , Kedous Mekbib

Regulation And Payment Of New Medical Technologies , Osman Waseem Moneer

Permanent Pacemaker Implantation After Tricuspid Valve Repair Surgery , Alyssa Morrison

Non-Invasive Epidermal Proteome-Based Subclassification Of Psoriasis And Eczema And Identification Of Treatment Relevant Biomarkers , Michael Murphy

Ballistic And Explosive Orthopaedic Trauma Epidemiology And Outcomes In A Global Population , Jamieson M. O'marr

Dermatologic Infectious Complications And Mimickers In Cancer Patients On Oncologic Therapy , Jolanta Pach

Distressed Community Index In Patients Undergoing Carotid Endarterectomy In Medicare-Linked Vqi Registry , Carmen Pajarillo

Preoperative Psychosocial Risk Burden Among Patients Undergoing Major Thoracic And Abdominal Surgery , Emily Park

Volumetric Assessment Of Imaging Response In The Pnoc Pediatric Glioma Clinical Trials , Divya Ramakrishnan

Racial And Sex Disparities In Adult Reconstructive Airway Surgery Outcomes: An Acs Nsqip Analysis , Tagan Rohrbaugh

A School-Based Study Of The Prevalence Of Rheumatic Heart Disease In Bali, Indonesia , Alysha Rose

Outcomes Following Hypofractionated Radiotherapy For Patients With Thoracic Tumors In Predominantly Central Locations , Alexander Sasse

Healthcare Expenditure On Atrial Fibrillation In The United States: The Medical Expenditure Panel Survey 2016-2021 , Claudia See

A Cost-Effectiveness Analysis Of Oropharyngeal Cancer Post-Treatment Surveillance Practices , Rema Shah

Machine Learning And Risk Prediction Tools In Neurosurgery: A Rapid Review , Josiah Sherman

Maternal And Donor Human Milk Support Robust Intestinal Epithelial Growth And Differentiation In A Fetal Intestinal Organoid Model , Lauren Smith

Constructing A Fetal Human Liver Atlas: Insights Into Liver Development , Zihan Su

Somatic Mutations In Aging, Paroxysmal Nocturnal Hemoglobinuria, And Myeloid Neoplasms , Tho Tran

Illness Perception And The Impact Of A Definitive Diagnosis On Women With Ischemia And No Obstructive Coronary Artery Disease: A Qualitative Study , Leslie Yingzhijie Tseng

Advances In Keratin 17 As A Cancer Biomarker: A Systematic Review , Robert Tseng

Regionalization Strategy To Optimize Inpatient Bed Utilization And Reduce Emergency Department Crowding , Ragini Luthra Vaidya

Survival Outcomes In T3 Laryngeal Cancer Based On Staging Features At Diagnosis , Vickie Jiaying Wang

Analysis Of Revertant Mosaicism And Cellular Competition In Ichthyosis With Confetti , Diana Yanez

A Hero's Journey: Experiences Using A Therapeutic Comicbook In A Children’s Psychiatric Inpatient Unit , Idil Yazgan

Prevalence Of Metabolic Comorbidities And Viral Infections In Monoclonal Gammopathy , Mansen Yu

Automated Detection Of Recurrent Gastrointestinal Bleeding Using Large Language Models , Neil Zheng

Vascular Risk Factor Treatment And Control For Stroke Prevention , Tianna Zhou

Theses/Dissertations from 2023 2023

Radiomics: A Methodological Guide And Its Applications To Acute Ischemic Stroke , Emily Avery

Characterization Of Cutaneous Immune-Related Adverse Events Due To Immune Checkpoint Inhibitors , Annika Belzer

An Investigation Of Novel Point Of Care 1-Tesla Mri Of Infants’ Brains In The Neonatal Icu , Elisa Rachel Berson

Understanding Perceptions Of New-Onset Type 1 Diabetes Education In A Pediatric Tertiary Care Center , Gabriel BetancurVelez

Effectiveness Of Acitretin For Skin Cancer Prevention In Immunosuppressed And Non-Immunosuppressed Patients , Shaman Bhullar

Adherence To Tumor Board Recommendations In Patients With Hepatocellular Carcinoma , Yueming Cao

Clinical Trials Related To The Spine & Shoulder/elbow: Rates, Predictors, & Reasons For Termination , Dennis Louis Caruana

Improving Delivery Of Immunomodulator Mpla With Biodegradable Nanoparticles , Jungsoo Chang

Sex Differences In Patients With Deep Vein Thrombosis , Shin Mei Chan

Incorporating Genomic Analysis In The Clinical Practice Of Hepatology , David Hun Chung

Emergency Medicine Resident Perceptions Of A Medical Wilderness Adventure Race (medwar) , Lake Crawford

Surgical Outcomes Following Posterior Spinal Fusion For Adolescent Idiopathic Scoliosis , Wyatt Benajmin David

Representing Cells As Sentences Enables Natural Language Processing For Single Cell Transcriptomics , Rahul M. Dhodapkar

Life Vs. Liberty And The Pursuit Of Happiness: Short-Term Involuntary Commitment Laws In All 50 US States , Sofia Dibich

Healthcare Disparities In Preoperative Risk Management For Total Joint Arthroplasty , Chloe Connolly Dlott

Toll-Like Receptors 2/4 Directly Co-Stimulate Arginase-1 Induction Critical For Macrophage-Mediated Renal Tubule Regeneration , Natnael Beyene Doilicho

Associations Of Atopic Dermatitis With Neuropsychiatric Comorbidities , Ryan Fan

International Academic Partnerships In Orthopaedic Surgery , Michael Jesse Flores

Young Adults With Adhd And Their Involvement In Online Communities: A Qualitative Study , Callie Marie Ginapp

Becoming A Doctor, Becoming A Monster: Medical Socialization And Desensitization In Nazi Germany And 21st Century USA , SimoneElise Stern Hasselmo

Comparative Efficacy Of Pharmacological Interventions For Borderline Personality Disorder: A Network Meta-Analysis , Olivia Dixon Herrington

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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.

Students should review the 2024-2025 Research Guide for Students , known as the Thesis Guide, for all information pertaining to the YSM thesis and associated processes and deadlines.

Deadlines/Important Dates

Thesis approval process, thesis prizes, required formatting and components of the md thesis, examples for reference section formatting, avoiding the risk of copyright violation when submitting the md thesis, thesis deadlines for the 2024-2025 academic year, md students:.

The Office of Student Research has worked with the Dean’s Office and other educational stakeholders to establish deadlines for theses submitted in partial fulfillment of the requirements for graduation in May 2025. The deadlines ensure that students have sufficient time to complete their theses and that there is sufficient time for rigorous assessment and revision before final approval. These deadlines are strictly followed. Students are strongly encouraged to submit their theses well before the Class of 2025 Thesis Deadlines provided below. This timeline provides students, mentors/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 Zoom “Class of 2025 Thesis Check-in Sessions” and will distribute reminder emails with more detailed instructions as these deadlines approach.

*Students missing the August 22nd, January 17th, and/or March 28th 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 17th and/or March 28th 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 17, 2025, deadline must submit a Thesis Deadline Extension Request Form to their Academic Advisor, and the Departmental Thesis Chairperson, for approval. Extensions, if granted, are granted in 2-week increments. An OSR staff member will confirm that an extension for the student has been received and will provide an updated timetable of deadlines that the student must adhere to. If a student is unable to meet the extended deadline for thesis submission, they must submit a new Thesis Deadline Extension Request Form following the same process listed above. A new Thesis Deadline Extension Request Form is required for each 2-week extension period. In the event of an extension, if granted, the following ABSOLUTE Class of 2025 Thesis Extension Deadlines will apply:

*All late theses require an extension. The student must submit the Thesis Deadline Extension Request Form by January 17, 2025, at 5 pm.

MD/MHS Students:

Consistent with degree requirements, MD-MHS students must present their thesis to their three-person committee prior to the January 17th deadline. Students are encouraged to start arranging the date of this committee meeting in the fall to avoid unanticipated delays. The MD-MHS process will be tracked in Medtrics.

*Students missing the August 22nd, January 17th, and/or March 28th 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 17th and/or March 28th deadlines will be ineligible for thesis prizes at graduation.

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 Medtrics.

To ensure compliance with YSM graduation deadlines, MD-PhD students in the class of 2025 who have not defended and submitted their dissertation to the Graduate School by the October 1, 2024, deadline will be required to submit a copy of their dissertation directly to the OSR in order to fulfill the MD thesis requirement. Further instructions and deadlines will be provided in the fall of 2024. Please note that MD-PhD students must also defend and submit their dissertation to the Graduate School no later than March 15, 2025, 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 via Medtrics. 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. At this time, timeline and practices are posted to the OSR website, 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. The thesis approval process will be tracked in Medtrics.

July: OSR website is updated, 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 early-fall. Any student anticipating a challenge in this regard should contact the OSR as soon as possible. By mid-August, all students expecting to graduate in May must submit their tentative thesis title and thesis mentor/advisor through Medtrics. The OSR will contact all thesis mentors/advisors to confirm this role and to provide information and expectations regarding the thesis process. Therefore, students should confirm the faculty member’s willingness to serve as thesis mentor. Students missing this deadline, or whose mentors/advisors express concern regarding the student’s progress, will be referred to the Progress Committee to ensure adequate support for this graduation requirements.

August – December: Students should finalize research and draft their thesis. As the semester progresses, activities should shift from the data generation/analysis to thesis writing. 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 the thesis draft that is ultimately approved by the faculty thesis mentor/advisor and submitted by the student to the Thesis Chair of their sponsoring department. The YSM faculty thesis mentor/advisor will be asked to complete a thesis assessment that evaluates the student’s performance on YSM’s research-related educational objectives and provides formative summative feedback via Medtrics.

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/external to YSM or may hold a faculty appointment at an outside institution. This reviewer reads the thesis, completes the assessment, provides formative summative feedback, and makes recommendations for any required changes to the thesis. Departmental Thesis Chairs review assessments and transmit thesis approvals to the OSR. These assessments and approvals will be managed via Medtrics.

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.

April: The OSR confirms that theses have been deposited into the Yale Medicine Digital Thesis Library and the YSM 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 program 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 outstanding research done by YSM students without creating a competitive atmosphere. Hence, thesis awards are based on milestone-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 19, 2025. 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 when submitting the MD Thesis.

2024-2025 Research Guide for Students

Apply for a thesis extension.

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How to write a Doctoral Thesis

Prof. HR Ahmad, Department of Biological and Biomedical Sciences, The Aga Khan University, Karachi, Pakistan. E-mail: [email protected]

Note: * Ahmad HR. In: Medical Writing. Eds. SA Jawaid, MH Jafary & SJ Zuberi. PMJA, 1997 Ed II: 133-142.

PATIENT care and teaching are rather well established components of our medical career. However, with the passage of time a third component has started to influence our medical culture, namely research. 1 - 4 How to accept this challenge is a question. 5 Indeed, teaching and research form a dialectic unit, meaning that teaching without a research component is like a soup without salt. It is a well-established fact that the research activity of an institution is directly proportional to the number of qualified and committed PhD candidates. An inspiring infrastructure, laboratory facilities and libraries are pre-requisites for a research culture to grow. 6 - 8 This forms the basis of a generation cycle for an institution, so that research activity and its culture continues to grow from one generation to the next. The main objective of doctoral work in biomedical sciences is to develop a galaxy of scientist physicians and surgeons possessing high degree of humility, selflessness and ethical superiority. Such a programme will add a scholastic dimension to the clinical faculty.

Education in how to write a doctoral thesis or dissertation should be a part of the postgraduate curriculum, parallel to the laboratory work and Journal Club activities during the PhD studies and/or residency levels. 9 , 10 The overall structure of a doctoral thesis is internationally standardized. However, it varies in style and quality, depending upon how original the work is, and how much the author has understood the work. Therefore a thorough discussion with supervisor, colleagues and assistance from other authors through correspondence can be useful sources for consultation.

The choice of a topic for a doctoral thesis is a crucial step. It should be determined by scanning the literature whether the topic is original or similar work has already been done even a hundred years ago. It is the responsibility of both the supervisor and the PhD candidate to sort out this problem by continuous use of internet and a library. 11 The work leading to the PhD degree can originate from research in following spheres: 12

• b) Methodology
• c) Diagnostic
• d) Therapeutic and Management
• e) Epidemiology

The availability of internationally standardized methods, as well as research committed supervisors can enable physicians and surgeons to do PhD work in both basic and clinical health sciences. The importance of research in basic health sciences cannot be overemphasized. It is rather the base of the applied sciences. There are many instances where the elucidation of a mechanism involved in a process awaits the development of an adequate methodology. 13 In such a scenario; a new method is like a new eye. Research activity in the field of (a) and (b) illuminates the research directions for (c) (d) and (e). It is worth noting that sometimes important basic questions can come from (e) and stimulate research activity in the domain of basic health sciences. 14 , 15

Types of Doctoral Thesis

TYPE-I: Book Form: a classical style. The blueprint of this form is shown in Table-I .

Type-I: The Classical Book Form

TYPE-II: Cumulative Doctoral thesis: A modem but quite useful practice.

INTRODUCTION

A book containing the pearls of a PhD work has standardized divisions and formats, where the number of pages should be weighted in terms of content rather than container. The book includes summary, introduction, materials and methods, results, discussion, conclusions, references and acknowledgements.

Two exercises are mandatory before starting a PhD programme:

• Literature survey using a regular library hours and internet surfing
• Familiarization with the hands-on-experience of methodology involved in the work
• The importance of a continuous literature survey using library, internet and direct correspondence with authors across the globe in the same field cannot be over-emphasized. The main goal of this exercise is to pinpoint the unresolved problem in the literature. An attempt to solve this problem now becomes the topic of the PhD thesis. All the relevant references should be collected, and carefully preserved in the form of a card system arranged alphabetically according to themes and authors. The introduction of the thesis should be styled like a review article with a critical analysis of the work of authors in the literature. The aims of the present PhD work can then also be addressed in the form of questions. The objectives would then deal with how to achieve the aims of the proposed study.

MATERIALS / SUBJECTS AND METHODS

Now comes the most crucial and functional part of the doctoral work, the materials/subjects and methods section. This part can be considered as the motor of the PhD work. The reliability, sensitivity and specificity of the motor must be checked before embarking on a long journey. Controlling the controls is the best guide for a precise and authentic work. Usually materials and methods contain components such as a description of the species involved, their number, age, weight and anthropometric parameters, types of surgical procedures and anesthesia if applied, and a detailed description of methodology. Continuous or point measurements should be thoroughly described. However, a dynamic method should always be preferred to static one.

The experimental protocol should be designed after a small pilot study, which is especially advisable in research on human subjects. A detailed and well-thought experimental protocol forms the basis of conditions under which the results would be obtained. Any deviation from the experimental protocol will affect the outcome, and the interpretation of results. It may be noted that great discoveries are usually accidental and without a protocol, based merely on careful observation! However, for the sake of a publication, a protocol has to be designed after the discovery. After having described the different phases of the experimental protocol with the help of a schematic diagram e.g., showing variables, time period and interventions, the selection of a statistical method should be discussed. Negative results should not be disregarded because they represent the boundary conditions of positive results. Sometimes the negative results are the real results.

It is usual practice that most PhD candidates start writing the methodological components first. This is followed by writing the results. The pre-requisites for writing results are that all figures, tables, schematic diagrams of methods and a working model should be ready. They should be designed in such a way that the information content of each figure should, when projected as a frame be visually clear to audience viewing it from a distance of about fifty feet. It is often observed that the presenters themselves have difficulty in deciphering a frame of the Power-Point being projected in a conference.

The results of a doctoral thesis should be treated like a bride. The flow of writing results becomes easier if all figures and tables are well prepared. This promotes the train of thoughts required to analyze the data in a quantitative fashion. The golden rule of writing results of a thesis is to describe what the figure shows. No explanation is required. One should avoid writing anything which is not there in a figure. Before writing one should observe each diagram for some time and make a list of observations in the form of key words. The more one has understood the information content of a figure; the better will be the fluency of writing. The interruption of the flow in writing most often indicates that an author has not understood the results. Discussion with colleagues or reference to the literature is the only remedy, and it functions sometimes like a caesarean procedure.

Statistical methods are good devices to test the degree of authenticity and precision of results if appropriately applied. The application of statistical technique in human studies poses difficulties because of large standard deviations. Outliers must be discussed, if they are excluded for the sake of statistical significance. Large standard deviations can be minimized by increasing the number of observations. If a regression analysis is not weighted, it gives faulty information. The correlation coefficient value can change from 0.7 to 0.4 if the regression analysis is weighted using Fisher’s test. The dissection of effect from artifact should be analysed in such a way that the signal to noise ratio of a parameter should be considered. A competent statistician should always be consulted in order to avoid the danger of distortion of results.

The legend of a figure should be well written. It contains a title, a brief description of variables and interventions, the main effect and a concluding remark conveying the original message. The writing of PhD work is further eased by a well maintained collection of data in the form of log book, original recordings, analyzed references with summaries and compiling the virgin data of the study on master plan sheet to understand the original signals before submitting to the procedures of statistics. The original data belong to the laboratory of an institution where it came into being and should be preserved for 5-7 years in the archive for the sake of brevity.

This is the liveliest part of a thesis. Its main goal is to defend the work by staging a constructive debate with the literature. The golden rule of this written debate should be that a rigid explanation looks backward and a design looks forward. The object is to derive a model out of a jig-saw puzzle of information. It should be designed in such a way that the results of the present study and those of authors from the literature can be better discussed and interpreted. Agreement and disagreement can be better resolved if one considers under what experimental conditions the results were obtained by the various authors. It means that the boundary conditions for each result should be carefully analyzed and compared.

The discussion can be divided into the following parts:

• criticism of material/subjects and methods
• a list of important observations of the present study
• interpretation and comparison of results of other authors using a literature table
• design of a model
• claim of an original research work
• The criticism of the methodological procedure enables a candidate to demonstrate how precisely the research work has been carried out. The interpretation of results depends critically on the strict experimental protocol and methods. For example, an epidemiological work is a study of a population. However, if the population sampling is done regularly at a specific location; the question arises as to how a result derived from a localized place can be applied to the whole population.
• After having discussed at length the strong and weak points of material/subjects and methods, one should list in a telegraphic design the most important observations of the present study. This may form a good agenda to initiate interpretation, argument, reasoning and comparison with results of other authors. The outcome of this constructive debate should permit the design of a working model in the form of a block diagram. All statements should be very carefully referenced. The ratio of agreement and disagreement should indicate the ability of the author to reconcile conflicting data in an objective and quantitative way. Attempts should be made to design a solution out of the given quantum of information. It is also well known that most of the processes of human physiology can only be understood if their time course is known. The dynamic aspect of interpretation of results is therefore more powerful and superior to the static one. 16 Therefore a continuous record of variables should be preferred and sought to reveal the secrets hidden in the kinetics.
• Finally, the discussion should conclude how far the study was successful in answering the questions being posed at the end of the introduction part. Usually a doctoral thesis raises more questions than it answers. In this way research does not come to a standstill and does become a life time engagement for a committed scientist. Also it is important to note that all scientific theses should be quantifiable and falsifiable, otherwise they lose the spirit and fragrance of a scientific research.
• The author’s claim of original work is finally decided by the critical review of his research work by the literature and the number of times being cited. It can be easily read by a high rate of a citation index of a publication and invitation. When a methodological research clicks, one becomes a star overnight.

Type-II: CUMULATIVE DOCTORAL THESES

Another way of writing a doctoral work is a cumulative type of thesis. 11 It consists of a few original publications in refereed journals of repute. It is supplemented by a concise summary about the research work. This type of thesis is usually practiced in Sweden, Germany and other countries. It has the advantage of being doubly refereed by the journals and the faculty of health sciences. Additionally, papers are published during a doctoral work. A declaration has to be given to the faculty of science about the sharing of research work in publications, provided there are co-authors. The weightage should be in favour of the PhD candidate, so that the thesis can ethically be better defended before the team of august research faculty.

ACKNOWLEDGEMENTS

A critical review of this manuscript by Dr. Roger Sutton, Dr. Khalid Khan, Dr. Bukhtiar Shah and Dr. Satwat Hashmi is gratefully acknowledged.

Dedicated to the memory of Mr. Azim Kidwai for his exemplary academic commitment and devotion to the science journalism in Pakistan.

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