HOW TO WRITE A DISSERTATION

What is Dissertation ?

A formal, often lengthy treatise or discourse, especially one written by a candidate for a doctoral degree It is an exercise to train a PG student to plan, execute, evaluate, write and report a scientific project. It is an in depth study of a particular topic which contributes new information and knowledge in the field Words Thesis and Dissertation are used interchangebly Thesis is much shorter than Dissertation. (1 year versus 3-4 years) Masters s Thesis and Doctoral Dissertation have different objectives. Objective of Thesis is to teach and train a PG student in Research Methodology and in Thesis process is more important than outcome. Whereas in Doctoral Dissertation (PhD) there is bound to be a new outcome and it reflects the critical thinking of the candidate on the research topic .

Why to do a Dissertation.?

As per the guidelines of MCI, many universities in India including KLE Academy have made Dissertation a mandatory part of PG degree curriculum, because the Dissertation.

1. teaches the fundamentals of Research Methodology & stimulates an interest in research, 2. helps to develop scientific attitude 3. teaches to probe in depth of a topic. 4. teaches the critical appraisal of the medical literature. 5. encourages to develop special technical skills. 6. encourages the students to use library and electronic medical data bases. 7. contributes new knowledge 8. teaches publishing of a scientific data 9. satisfies the academic /scientific instincts of PG students. 10. brings about a behavioural change in a student

Role of Postgraduate Students __Wrong notion amongst the students & inability to relate the need of dissertation with their clinical goal leads to malpractice like cooking the data, statistics, & copying from other sources. ____ They must realise its importance, get truly involved in their projects, work sincerely and honestly to make use of this best opportunity of learning. Role of Guides --- Supervision & guidance of the candidate at all stages of the dissertation. --- Helping from all angles to conduct a proper study. Role of University To set a standard for dissertation Interim (Midterm) assessment To give a proper weightage for dissertation by alloting marks ( to be counted in final examination ). Where and How to Start? Selection of the topic 1). Idea: Invariably comes from the guide, since the guide is an experienced person with the knowledge of the research and the limitations of the facilities available in the institution and moreover it is a maiden experience for the PG student. Suppose an anesthesiologist ( guide) who has a special interest in post operative pain relief reads an article in a journal about the description of various receptors present in the spinal cord and effective pain relief that can be achieved by blocking them. This information is relatively new to the field to him and so he does a literature search with cross references, books and electronic data bases and gets a better understanding of this subject. He wonders whether, Ketamine, a time tested, widely used, anaesthetic agent that has powerful analgesic properties can be used epidurally in subanaesthetic doses to provide effective post operative pain relief following upper abdominal surgeries. This is only a broad idea and many issues need to be sorted out. He will give this idea to a PG student and ask him to work on it. 2) Formulation of Hypothesis: -Hypothesis is nothing but an idea, which is yet to be proved. From the above example a Research hypothesis can be formulated. Epidural Ketamine in subanaesthetic doses provides effective post operative pain relief following upper abdominal surgeries. Null Hypothesis: also known as stastical hypothesis states exactly opposite of the research hypothesis.

eg: Epidural Ketamine in subanaestheic doses does not provide postoperative pain relief following upper abdominal surgeries. Null hypothesis is the one that will be tested by the statistical significance tests and is either rejected or not rejected. This hypothesis if not rejected concludes that the observed post operative pain relief with Ketamine could be due to chance alone and not due to systematic course. On the other hand its rejection signifies that the observed post operative pain relief is statistically significant indeed. Useful hints for the selection of a topic: 1) Avoid topics on which dissertation has already been carried out in the previous 5 years, in the same institution. 2) As far as possible select a topic, which requires minimal help from other departments (equipments or personnel). If unavoidable official appointment of a co-guide from the collaborating department will be useful. Defining an objective At this stage only vague objective can be formed. To define a clear objective more information may be needed. Next thing is to search for available literature on the topic. A thorough reading of Anaesthesia/Pharmacology textbooks on Ketamine will be helpful. The cross reference from the original articles should be gathered. One should also find out whether similar studies have been conducted or published elsewhere, to avoid duplication. Now the objective can be defined with precision. If the literature search reveals that the idea has already been tested by many, one has to drop that idea and go for another one. If it is found that the other studies have missed an important aspect, your study can be modified to explore that aspect. The objectives have to be simple, clear, precise and should be only one or two . Please keep in mind the limitation of available time. In our example the objective will be To study the analgesic efficacy of subanaesthetic doses of epidural ketamine for post operative pain relief in patients under going upper abdominal surgeries. Difference between Aims and Objectives. There is no real difference between an Aim (Goal) and an Objective. Aims point out the general purpose of the study, whereas Objectives spell out specifically what one intends to do in the study. eg: Aim is to study the analgesic efficacy of epidural ketamine. Objective is to compare the duration of pain relief, pain score (VAS ) in Ketamine group Vs. Saline ( Placebo ) group. In any study objectives must be justifiable and the PG student must be able to defend them

Review of Literature (ROL ) Sources: Books: * Textbooks & Reference books * Journals Index Medicus. * Electronic Database: Medline. Advantages: ROL reveals 1. Those aspects of topics on which research has not been carried out 2) Strength and weaknesses of other studies which will serve as guide for the proposed study. 3. Requirements and difficulties for the proposed study. 4. Information about dose of the drug, animal model, sample size, statistical methods used, which is very much useful to design the study properly. 5. The knowhow or the technical details for the proposed study. Requirements for a PG dissertation 1. Competent guide and a determined student 2. Adequate time 3. Instrument, Equipments, Consumable & Drugs with technical know-how to use them. PROTOCOL --- PROFORMA A Proforma consisting of the details of the patient, details of the methodology, technical details, observations (in the convenient format for recording), complications and all the relevant details needed for the study have to be prepared by the students with, of course the help of guide/co-guide. Approval of: 1) Dissertation committee 2) Ethical committee: - Any scientific study epidemiological microbiological, pharmacological, pathological, clinical, nonclinical which involves human subjects, requires clearance from ethical committee. There is no clear line to demarcate what is ethical and what is non-ethical. A self-test such as asking oneself Would I conduct this study on myself or my child (or parent). is one way of solving this dilemma. If the answer is yes, go ahead and plan the study. 3)Consent from all Patients enrolled in the study is very essential. The proformas are to be xeroxed and kept ready in the place of work and one copy is to be utilized for one patient. The details of the study, results procured, are to be entered in the proforma then and there itself. A separate logbook for all the cases of the dissertation has to be maintained by the students. A logbook is the only document, which can bailout a student if the credibility of his dissertation is challenged. PILOT STUDY. Registration of the Dissertation: Once all the requirements for the study are satisfied, perform the pilot study always in the physical presence of the guide. Some or many of the unanticipated difficulties / problems/ complications may be encountered. At times, it may be necessary to modify/ alter some of the material and methods to achieve the goals of the dissertation, after the pilot study. Relevant changes may have to be made in the proforma.

Once about five (n/10) cases are conducted in each of the groups in the study a synopsis has to be prepared as per the format provided by the university, containing every detail of the study and the dissertation has to be registered with the university within 6 months of joining the post graduate course. EXECUTION Useful hints: * Be meticulous in recording the data. * Interact with the guide/co guide as frequently as possible (at least once a month ) * The dissertation team (candidate, guide and co-guide) should meet at least once in 3 months and quarterly report should be submitted to the Departmental Dissertation Committee. * Collection of data should be complete in one year. * Consult a statistician for scientific analysis of the study including for calculation of sample size at the beginning of the study itself. * Six months would sufficient for writing the dissertation, * Dissertation should be submitted six months prior to the examination as per University stipulations. Details to be worked out before execution. 1) 2) 3) 4) 5) 6) 7) Study design and methods of elimination of errors, in the study. Sample size & number of groups. Inclusion/Exclusion criteria. Technical details. Parameters to be measured. Data collection, organization and analysis Statistical methods.

Strategies to Eliminate Errors: ____ Errors may creep into a study at any time, even during interpretation of results. They can be: * Random or Systematic * Due to bias or oversight. Error elimination can be done by: * Controls * Randomization * Cross over designs * Placebo * Blinding

STUDY DESIGNS A study may be: i) Prospective: - Data collected from the follow up of patients/ volunteers over a period of time. Look forward after the exposure (drug /intervention) to observe the outcome. ii) Retrospective: Data collected from past records. Look back with the aim of finding a cause. A study may be : i) Descriptive: - Describe the characteristics of a disease in relation to a person, place or time. They are mainly epidemiological studies necessary for planning of preventive/ control /eradication programs Three sub types viz. Correlational, Case studies, Cross sectional surveys. ii) Analytical: - A hypothesis is tested Two sub types i) Observational (Case Control & Cohort) ii) Interventional (Experimental) Clinical trials. SAMPLE SIZE ( SS) Denotes the number of subjects to be used in the study A correct sample/size is the real strength of a study, the results of which can be applied to a population. Incorrect sample size will lead to: i) Wrong Conclusion ii) Poor quality research iii) Wastage of resources and invite iv) Ethical problem. Factors affecting sample size : 1) Prevalence rate of the factor. 2) Degree of difference expected. 3) Degree of variation among subjects 4) Desired level of significances. 5) Power of the study 6) Drop out cases. 7) Non compliance to treatment 8) Resources available. The correct method to calculate the sample size of a study is to use one of formulae depending upon type of a study and study design. One of the commonest formula often used. n= 4pq/ d {n= Sample size, p= Prevalence of a factor in the population, q= (1-p) / (100-p) , d= error allowed } ANATOMY OF A DISSERTATION * * * * * * Title Introduction including aims and objectives. Review of the literature Material and methods. Results. Discussion

* Summary & conclusion * References. _________ * Acknowledgement * Certificate. The Title It should be concise, but informative, short, active, & brisk. No abbreviations are to be used. The title must indicate in fewest possible words the i) objective of the study ii) the type of study iii) the place where the study was conducted and the duration of the study. Introduction. Avoid Long preambles in the introduction. Should answer why did you start? The introduction should include (in 200-500 words) the purpose of the study, the hypothesis being tested and the methods employed for the study. Need for the study has to funneled down from- What is known of a topic through Whats not known to identify the unexplored aspect of a topic. Review Of Literature Strictly pertinent references are to be written. Critical approach to the reliability of previous work has to be performed. A retrospective ramble is boring and so use your discrimination in including various studies. Evolve a consistent theme in the narration. Avoid data / conclusion from the work being reported, in the review. Material & Methods It should contain that much information (and no more) for a competent worker to repeat your work. It should contain sample size, sampling procedure. selection criteria, randomization, blinding if any, data collection procedure, instrument, and investigation . Results This is usually the shortest part of the dissertation and should precisely state your findings, analysis plan, statistical measures employed, confidence interval. level of significance etc. Present the data wherever possible in the form of a) Graphics histogram, bar diagram, pie chart, frequency polygon. b) Illustrations. c) Photographs.

Discussion The discussion should contain ( in the sequence given ) i) Present principles, relationships and generalizations shown by the results. ii) Point out exceptions or lack of correction. iii) Indicate agreement or contrast with previously published work. iv) State the implications of your results ( dont be shy ) v) Give reasons for your conclusions. vi).Mention limitation of your work vii).Indicate the scope for further work.

The Summary & conclusion: The summary should concisely describe, ( with in 150-200 words ).i) The problem. ii) the solution and iii). the principle conclusion. In the summary, avoid all experimental details and references to previous work. References: Two commonly used styles are 1) Vancouver Style : References are numbered according to their appearance in the text. The first author cited in the text is reference number 1 the second author cited is reference number 2 and so on. These numbers are written as Superscripts in the text at their relevant places and enlisted at the end serially 2) Harward Style : References are written in alphabetical order. It is obligatory that you meticulously check each and every reference, spellings of names, page numbers, volume numbers one by one. The standard format for writing references is given in BRITISH MEDICAL JOURNAL 1988; 296; 40-405. (Uniform requirements for manuscripts submitted to the biomedical journals ). This article is a MUST for any one attempting to write a dissertation or scientific paper. Certificate Certificate from 1) Self ( declaration ) 2) Guide and Co-guide, 3) Head of the department must be included in the dissertation. The head of the institution must countersign the dissertation. Acknowledgement Acknowledge without fail 1) all persons who have helped directly or indirectly 2) source of funds if any. ____________________

Time management PhaseI ( 0-6 Months) Problem identification Review of Literature Proforma Pilot study

Synopsis Phase II --- ( 7-18 Months ) Data Collection Phase III ( 19-24 Months ) Analysis Discussion Publication. Books for Further Readings:

1) A practical approach to PG dissertation by R. Raveendran. Jay pee Publishers, 1997. 2) WHO Health Research Methodology ; A guide for training in Research Methods. Oxford University press 1993. 3) International committee of Medical Journal Editors. Uniform requirements for manuscripts submitted to biomedical journals. N.Eng. J Med; 324: 424-8 3) An Epidemiologic Approach to Reproductive Health. CDC Atlanta, Georgia, USA World Health Organization Geneva, Switawrland. Editor Phyllis. A Wingo & others. 1994.