thesis meaning in medicine

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Biomedical Sciences: Theses and Dissertations

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Introduction

Theses and dissertations are documents that present an author's research findings, which are submitted to the University in support of their academic degree. They are very useful to consult when carrying out your own research because they:

• provide a springboard to scope existing literature
• provide inspiration for the finished product
• show you the evolution of an author's ideas over time
• provide relevant and up-to-date research (for recent theses and dissertations)

On this page you will find guidance on how to search for and access theses and dissertations in the Bodleian Libraries and beyond.

Definitions

Terms you may encounter in your research.

Thesis: In the UK, a thesis is normally a document that presents an author's research findings as part of a doctoral or research programme.

Dissertation: In the UK, a dissertation is normally a document that presents an author's research findings as part of an undergraduate or master's programme.

DPhil: An abbreviation for Doctor of Philosophy, which is an advanced research qualification. You may also see it referred to as PhD.

ORA: The Oxford University Research Archive , an institutional repository for the University of Oxford's research output including digital theses.

Theses and dissertations

• Reading theses and dissertations in the Bodleian Libraries

The Bodleian Libraries collection holds DPhil, MLitt and MPhil theses deposited at the University of Oxford, which you can consult. You may also be interested to read theses and dissertations beyond the University of Oxford, some of which can be read online, or you can request an inter-library loan.

Help with theses and dissertations

To find out more about how to find and access theses and dissertations in the Bodleian Libraries and beyond, we recommend the following:

• Bodleian Libraries theses and dissertations Links to information on accessing the Bodleian Libraries collections of Oxford, UK, US and other international theses.
• Oxford University Research Archive guide
• Help & guidance for digital theses Information on copyright, how to deposit your thesis in ORA and other important matters
• Guide to copyright The Bodleian Libraries' Quick guide to copyright and digital sources.

Plagiarism checking tools

Read the University academic good practice page.

Seek your Supervisor or Tutor's guidance. In addition, your Supervisor or Tutor may decide to submit your work to Turnitin, accessible to teaching staff only. Visit the Turnitin website for product information.

Consult books - suggested reading:

• Cite Them Right An online referencing tools which gives examples and generates citations from a choice of 7 referencing systems for print and electronic formats. The citations can be copied into your work or emailed. The referencing systems are Harvard (author-date), APA, MLA, MHRA, OSCOLA, Vancouver and Chicago. Citations can be created for a very diverse range of sources, including books, journals, digital resources and websites, audiovisual material, unpublished material (theses, manuscripts, etc.), financial & scientific reports, genealogical sources (wills, censuses, etc.), legal material, government and other official publications, and other forms of communication sources (email, Twitter, graffiti, etc.). more... less... Alternative name: Cite Them Right Online An online referencing tools which gives examples and generates citations from a choice of 7 referencing systems for print and electronic formats. The citations can be copied into your work or emailed. The referencing systems are Harvard (author-date), APA, MLA, MHRA, OSCOLA, Vancouver and Chicago. Citations can be created for a very diverse range of sources, including books, journals, digital resources and websites, audiovisual material, unpublished material (theses, manuscripts, etc.), financial & scientific reports, genealogical sources (wills, censuses, etc.), legal material, government and other official publications, and other forms of communication sources (email, Twitter, graffiti, etc.). Note that “Manuscripts” are located in Book > More books.

Depositing your thesis

It is mandatory for students completing a research degree at the University of Oxford (registered to a programme of study on or after 1st October 2007) to deposit an electronic copy of their theses with the Oxford University Research Archive (ORA) in order to meet the requirements of their award. To find out more, visit the Oxford University Research Archive guide.

Quick access to research & writing guides

• Research integrity and ethics The University of Oxford regards research integrity as a core value and has a longstanding commitment to ensuring that it is embedded in its research culture and activity
• Academic good practice Advice on academic good practice including avoiding plagiarism, managing your time, reading, note taking, referencing and revision.
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• Last Updated: Jul 11, 2024 10:51 AM
• URL: https://libguides.bodleian.ox.ac.uk/biomedical-sciences

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Melbourne Medical School

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Writing a thesis

A thesis is a written report of your research, and generally contains the following chapters: introduction, methods, results, discussion and conclusion. It will also have a list of references and appendices. Check with your faculty/department/school for degree-specific thesis requirements. You may also find it helpful to look at published theses (in your department) to see how they are structured. (Internationally, the ‘thesis’ may be referred to as a ‘dissertation’).

• Gruba, P., & Zobel, J. (2014). How to write a better minor thesis . Melbourne, Australia: Melbourne University Publishing.
• Stoddart, K. (1991) Writing Sociologically: A Note on Teaching the Construction of a Qualitative Report. Teaching Sociology (2), 243-248.
• Mullins, G. and M. Kiley (2002). It’s a PhD, not a Nobel Prize: how experienced examiners assess research theses. Studies in Higher Education . 27(2): 369-386 .
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• > Introduction to Research Methodology for Specialists and Trainees
• > How to Write a Medical Thesis

Book contents

• Introduction to Research Methodology for Specialists and Trainees
• Copyright page
• Contributors
• Chapter 1 Research During Specialist Medical Training
• Chapter 2 Time Management When Planning and Conducting Medical Research
• Chapter 3 Computer Skills Required for Medical Research
• Chapter 4 Computer Skills Required for Medical Research: Social Media
• Chapter 5 Finding and Using Information in Your Research
• Chapter 6 Critical Appraisal of the Medical Literature
• Chapter 7 Evidence-based Medicine and Translating Research into Practice
• Chapter 8 Clinical Audit for Quality Improvement
• Chapter 9 A Journey of Exploration
• Chapter 10 Randomised Clinical Trials
• Chapter 11 Animal Research and Alternatives
• Chapter 12 Genetic and Epigenetic Research
• Chapter 13 ‘Omic’ Research
• Chapter 14 Data Management in Medical Research
• Chapter 15 Statistics in Medical Research
• Chapter 16 Epidemiological Research
• Chapter 17 Informing Patients, Consent, Governance and Good Clinical Practice
• Chapter 18 Patient Involvement in Medical Research
• Chapter 19 Research in the National Health Service
• Chapter 20 Supervising Medical Research and Being Supervised
• Chapter 21 Funding Medical Research
• Chapter 22 The Purpose and Practice of Medical Research Meetings
• Chapter 23 How to Present a Medical Research Paper
• Chapter 24 How to Write a Medical Research Paper and Get It Accepted for Publication
• Chapter 25 How to Write a Medical Thesis
• Obstetrics and Gynaecology Supplement
• B Research in Fetal Medicine
• C Research in Maternal Medicine
• D Research in Benign Gynaecology
• E Research in Gynaecological Oncology

Chapter 25 - How to Write a Medical Thesis

Published online by Cambridge University Press:  04 August 2017

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• How to Write a Medical Thesis
• By Jennifer Byrom , David Lissauer
• Edited by P. M. Shaughn O'Brien , Fiona Broughton Pipkin , University of Nottingham
• Book: Introduction to Research Methodology for Specialists and Trainees
• Online publication: 04 August 2017
• Chapter DOI: https://doi.org/10.1017/9781107585775.026

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Internal Medicine: Thesis & Dissertations

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National & International Thesis and Dissertations

• Current & Completed Research This link opens in a new window Contains current and completed research projects (in economics, science and humanities), and includes (the master’s and doctoral theses and dissertations) theses and dissertations from South African universities, Technikons, and Universities of Technology, as well as the research works from the government, non-government and private sectors. Some records include links to the full text. The database is maintained by the National Research Foundation (1919- ).

• ProQuest Dissertations & Theses Global This link opens in a new window ProQuest Dissertations & Theses (PQDT) Global is the world's most comprehensive collection of dissertations and theses from around the world, offering millions of works from thousands of universities. Each year hundreds of thousands of works are added. Full-text coverage spans from 1743 to the present, with citation coverage dating back to 1637.

Self-submission of Thesis & Dissertations

• Uploading Thesis and dissertations Quick guide to submitting your thesis/dissertation
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Writing a medical thesis: tips for post-graduate students.

What is a medical thesis?

A medical thesis is the written work resulting from an original research in the field of Medicine, Nursing, Pharmacy, and other health and life sciences. It is submitted by the students in order to obtain a higher degree from the University.

However, keep this in mind! The purpose of submitting a medical thesis is not limited to the achievement of a doctoral or post-graduate degree. It is a medium to organize the scientific knowledge in a way to make further progress in the field.

That’s the reason why the experts in  medical thesis writing  stress on the importance of choosing the right topic for your thesis. You must be able to address a genuine problem or series of problems through your medical thesis. Choose a topic that aligns with your interest and where you can offer a fresh perspective through your research study.

Writing your medical thesis

After choosing the topic for your research study, collaborate with your supervisor to design your research study and its goal. Collect all the information and data pertaining to your research before proceeding with your clinical trials.

Now, you are ready with your research data and clinical findings. You just need to pen down your findings in your medical thesis.

That sounds easy, isn’t it?

In reality, it’s not so. But, you need not worry!  Writing a medical thesis  becomes easy and fun if you follow the given steps with competence:

1.Outline the structure of medical thesis

Prepare an outline of the thesis in accordance with the following sections:

• Introduction: Why did you start your study?
• Methods Used
• Results of the study
• Discussion of results

List the major sections and chapters in each. Do a section at a time. Assemble all the figures and tables and organise them into a logical sequence.

2.Writing a title of the thesis

The title reflects the content of your thesis. For writing a perfect thesis title:

• Be concise and accurate. The title must neither be too long nor too short
• Avoid unnecessary words and phrases like “Observation of” or “A study of”
• Do not use abbreviations
• Avoid grammatical mistakes

3.Writing an Introduction

The purpose of writing an Introduction is to provide the reader with sufficient background information on the topic and help him understand and evaluate the results of the present study, without needing to refer to the previous publications on the topic.

• Give this background information in brief in the first paragraph
• Include the importance of the problem and what is unknown about it in the second paragraph
• State the purpose, hypothesis, and objective of your study in the last paragraph

Cite the research papers written on your research topic

• Include unnecessary information other than the problem being examined
• Include the research design, data or conclusion of your study
• Cite well-known facts
• Include information found in any textbook in the field

4.Writing the section of “Methods Used”

This section must be so written that the reader is able to repeat the study and validate its findings.

Write a detailed exposition about the participants in the study, what materials you used and how you analyzed the results

• Give references but no description for established methods
• Give a brief description and references for published but lesser known methods
• Give detailed description of new methods citing the reasons for using them and any limitations if present
• Include background information and results of the study
• Refer to animals and patients as material
• Use trade name of the drugs; instead, use their generic names
• Use non-technical language for technical statistical terms

5.Writing your Results

Keep in mind the objective of your research while writing the “Results” section. The findings of the research can be documented in the form of:

• Illustrative graphs

Use text to summarize small amounts of data. Do not over-use tables, figures, and graphs in your paper. Moreover, do not repeat information presented in the table or figure in the text format. Text must be a summary or highlight of the information presented in tables or figures.

6.Discussing your Results

Good medical theses have a targeted discussion keeping it focused on the topic of the research. Include:

• Statement of the principal findings. Make it clear to show that your thesis includes new information
• Strengths and weaknesses of your study
• Strengths and weaknesses in relation to the other studies
• A take-home message from your study for clinicians and policymakers
• Any questions that are left unanswered in your study to propose new research

How to conclude your medical thesis?

The conclusion of your research study must comprise of:

• The most important statement or remark from the observations
• Summary of new observations, interpretations, and insights from the present study
• How your study fills the knowledge gap in its respected field?
• The broader implications of your work
• How can your work be improved by future research?

However, avoid any statement that does not support your data.

With these tips, write your thesis like a pro and don’t let it delay your doctoral award!

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• Dissertations & Theses
• Collections

EliScholar > Medicine > Medicine Thesis Digital Library

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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Definition of thesis

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In high school, college, or graduate school, students often have to write a thesis on a topic in their major field of study. In many fields, a final thesis is the biggest challenge involved in getting a master's degree, and the same is true for students studying for a Ph.D. (a Ph.D. thesis is often called a dissertation ). But a thesis may also be an idea; so in the course of the paper the student may put forth several theses (notice the plural form) and attempt to prove them.

Examples of thesis in a Sentence

These examples are programmatically compiled from various online sources to illustrate current usage of the word 'thesis.' Any opinions expressed in the examples do not represent those of Merriam-Webster or its editors. Send us feedback about these examples.

Word History

in sense 3, Middle English, lowering of the voice, from Late Latin & Greek; Late Latin, from Greek, downbeat, more important part of a foot, literally, act of laying down; in other senses, Latin, from Greek, literally, act of laying down, from tithenai to put, lay down — more at do

14th century, in the meaning defined at sense 3a(1)

Dictionary Entries Near thesis

the sins of the fathers are visited upon the children

thesis novel

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“Thesis.” Merriam-Webster.com Dictionary , Merriam-Webster, https://www.merriam-webster.com/dictionary/thesis. Accessed 25 Jul. 2024.

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What is medicine? Why it’s so important to answer this question

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Alex Broadbent receives funding from the National Research Foundation of South Africa.

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What is medicine? We recognise it in all societies past and present. But the nature of medicine differs so greatly from place to place and time to time that it’s difficult to offer a single answer. So what is it that we see in common between a traditional healer’s throwing of bones and the cardiologist’s incisions?

One of the answers that often seems to be implicit in what we say and think about medicine is a curative thesis : medicine’s goal is to cure the sick. Curing the sick is the core medical competence, whose exercise is medicine’s core business.

But if the curative thesis is true, then most medicine throughout history – as well as much contemporary medicine – isn’t medicine at all. Much medicine was and is ineffective, or at best partially effective. The curative thesis leads to a dismissive attitude towards the past efforts upon which any current medicine is built, as well as failing to promote profitable collaboration between traditions.

A second idea is an inquiry thesis about medicine: although the goal of medicine is to cure, its core business is something quite different. It’s this thesis I explore in my latest article .

That “something” has to do with inquiring into the nature and causes of health and disease. The idea is that we don’t necessarily expect someone to be able to cure us. We will accept that they are a medical expert if they can show an understanding of our ailment, often by issuing an accurate prognosis. Perhaps they won’t have a complete understanding, but they should somehow be engaged with the larger project of inquiry into the nature and causes of health and disease.

The inquiry thesis offers a way to understand the history of medicine that makes it more than a tale of quackery and gullibility. It also provides a way to understand medical traditions that practised outside the West, or in the West in defiance of the mainstream. They may offer or at least engage with a project of obtaining; a kind of understanding that Western medicine cannot.

The inquiry model of medicine lays the ground for fruitful and respectful discussions between medical traditions that doesn’t descend into an untenable relativism about what works.

Towards understanding

The curative thesis faces a difficulty that I believe it cannot overcome.

We do not define an activity by its goal alone, unless it has at least some success in that respect. A blacksmith cannot be defined as one who makes horseshoes if he simply throws lumps of hot metal onto his anvil and hammers them randomly – occasionally producing something horseshoe-like, but more often producing a mess.

Yet, taking a historical perspective, something of this kind has been true of medicine for much of its history, before it developed a serious curative arsenal. Historian of medicine Roy Porter has remarked that

the prominence of medicine has lain only in small measure in its ability to make the sick well. This was always true, and remains so today.

What, then, could be the business of medicine – the thing in which we recognise expertise, even when we accept that there is no cure to be had?

This is where the inquiry model enters the picture. I propose that the business of medicine is understanding the nature and causes of health and disease, for the purpose of cure.

The core of the argument is simple: what could medical persons be good at doing, that relates to the goal of cure without achieving it? The most likely candidate is understanding. Understanding is something that we can gain without corresponding curative success.

Tackling objections

As with the curative thesis, there are several objections to the inquiry model. First, it is obvious that many doctors either don’t (fully) understand what they treat or, if they do, don’t (successfully) communicate this understanding to the patient. Who, then, understands? In what sense is the doctor’s competence understanding?

The answer is that understanding isn’t a binary. You can partially understand something. You can be one the road to understanding it better, by inquiring into it. Hence the inquiry model of medicine. The idea is not that medicine is a sack full of answers, but rather that it is an ongoing effort to find answers.

Another objection is that so-called understanding is often bogus, and that medicine is as unsuccessful in this regard as in cure. This fails to account for the historical record, which – at least for Western medicine –- is precisely a case of understanding without curative success.

And, just as false scientific theories have contributed to developing scientific understanding , so false medical theories have provided a foundation for what we now accept.

Medicine is an ancient and complex social phenomenon, variously seen as art, science and witchcraft. These visions share the goal of curing disease. But it is too crude to think medicine as only the business of curing, since in that case, few doctors would be in business.

The distinctive feature of medicine is that it tries to cure by obtaining some understanding of the nature and causes of health and disease: by inquiry, in short. This understanding of medicine permits a much healthier dialogue between proponents of different traditions, and enables a non-defensive perspective on areas where we remain sadly lacking in curative ability.

This is an edited, shortened version of an article that first appeared in the Canadian Medical Association Journal, ‘The inquiry model of medicine’ , accompanied by a podcast available on the article’s page and also here .

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Immersive virtual reality for interdisciplinary trauma management – initial evaluation of a training tool prototype

• Laura Isabel Hanke 1 ,
• Lukas Vradelis 1 ,
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BMC Medical Education volume  24 , Article number:  769 ( 2024 ) Cite this article

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Introduction

Emergency care of critically ill patients in the trauma room is an integral part of interdisciplinary work in hospitals. Live threatening injuries require swift diagnosis, prioritization, and treatment; thus, different medical specialties need to work together closely for optimal patient care. Training is essential to facilitate smooth performance. This study presents a training tool for familiarization with trauma room algorithms in immersive virtual reality (VR), and a first qualitative assessment.

Materials and methods

An interdisciplinary team conceptualized two scenarios and filmed these in the trauma room of the University Medical Center Mainz, Germany in 3D-360°. This video content was used to create an immersive VR experience. Participants of the Department of Anesthesiology were included in the study, questionnaires were obtained and eye movement was recorded.

31 volunteers participated in the study, of which 10 (32,2%) had completed specialist training in anesthesiology. Participants reported a high rate of immersion (immersion(mean) = 6 out of 7) and low Visually Induced Motion Sickness (VIMS(mean) = 1,74 out of 20). Participants agreed that VR is a useful tool for medical education (mean = 1,26; 1 very useful, 7 not useful at all). Residents felt significantly more secure in the matter after training ( p  < 0,05), specialist showed no significant difference.

This study presents a novel tool for familiarization with trauma room procedures, which is especially helpful for less experienced residents. Training in VR was well accepted and may be a solution to enhance training in times of low resources for in person training.

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Emergency care of trauma patients is an integral part of in-hospital work. Trauma care in Germany is administered into different hospitals by their competency level and available specialties [ 1 ]. The University Medical Center Mainz, Germany is a level 1 trauma center and thus provides care for all types of injuries, amounting to about 1000 patients treated in the trauma room per year. The trauma room team consists of a core team including anesthesiology, radiology and orthopedic and trauma surgery and is extended depending on the patient’s needs. Every member of the team has specific tasks to fulfill in order to facilitate a swift and smooth execution of procedures in the trauma room [ 2 ]. Patients in the trauma room require fast diagnostics, interprofessional decisions and procedures because of their critical state. Figure  1 depicts the trauma team with their technical and nontechnical skills and tasks. The emergency trauma room resembles a well running machine or clockwork at its best. To accomplish this goal, regular training is essential [ 3 , 4 , 5 , 6 ]. Physicians are required to be proficient in their field and to be able to make life saving decisions and initiate and perform emergency procedures, which usually applies to physicians with completed specialist training or at the end of residency. It is recommended that each specialty and profession not only train on their own, but also as an interprofessional teams [ 7 ]. A recent international survey by Bento et al. has found potential for improvement on training opportunities [ 8 ]. Interprofessional trainings organized on a regular basis in the University Medical Center Mainz and is a precious resource in times of personnel shortages, thus only a handful of employees can train at a time. These trainings are elaborate and require regular hospital work to be reduced since the premises must be blocked off, and physicians, who would be needed in the OR need to be set free for the day to train. It has been common practice for younger residents to shadow during emergency trauma room procedures and to take on smaller parts of the procedure, such as assisting in documentation or patient transfer. Younger colleagues have mostly not taken part in an interdisciplinary trauma room training, since their availability is limited and usually reserved for advanced residents or early specialists. There is a written protocol to reference the procedure. Detecting a need for more training opportunities especially for younger residents, our group aimed to create a temporally and spatially flexible training resource to familiarize younger residents with the emergency trauma room setting and procedures. To be applicable for different specialties, novices and students we opted for a sole observer of an emergency trauma room procedure, without teaching of specific medical knowledge in the first prototype. To achieve our goal of a temporally and spatially flexible tool which is independent of trained instructors, and thus creating a resource-saving widely available tool, we chose immersive virtual reality (VR). Training in VR has been shown to be processed like autobiographical memories, which is thought to be beneficial for learning, in contrast to reading a text [ 9 ]. It has also been shown that training in VR is well received by different professions and age groups, making the learning experience more enjoyable [ 10 , 11 ]. Therefore, we opted to evaluate subjective measures, such as self-perceived confidence in the topic as well as eye tracking as an objective measure. Eye tracking can indicate interaction with and perception of information from different sources in the virtual world [ 12 ]. Furthermore, this setting makes training times flexible and accessible for young residents as well as students, as no additional instructors or specific time slots or rooms are needed.

depiction of all members of the trauma team with their respective key roles. It should be noted that most team members are able to supplement or switch to different roles, however those are not their main duties. In the center of all is the patient

Previously, more realistic scenarios using real-life video material were preferred for training by participants over animated videos [ 13 ]. Similar projects have been described especially for military medical education [ 14 , 15 , 16 ] using simulated VR. This exploratory study aims to evaluate the first prototype of a fully immersive 360° VR trauma room training among anesthetists of different experience levels.

Conceptualization of scenarios and video shoot

An interdisciplinary team of persons responsible for the trauma team training in the different departments conceived and scripted two scenarios. In both scenarios, the trauma leader explains his work and the processes of the trauma room to a medical student. When the patient arrives, clear communication between all team members is key and is depicted, enabling the viewer to perceive each action. The general goal of the VR application was to supplement trauma room experience to medical professionals. The aim of this first evaluation described was acceptance of VR training methods and differences among the users depending on their prior experience and personal characteristics.

A young man riding a bicycle was involved in a traffic accident and brought to the trauma team by an emergency physician. The patient is awake and cardiorespiratory stable on arrival, he has no visible wounds and claims to have abdominal pain. In the trauma diagnostics No injuries were found in the trauma diagnostics.

An elderly patient is brought in by an emergency doctor with reduced vigilance and compromised blood pressure but no known trauma. In the focused assessment with sonography for trauma (FAST), large amounts of free intra-abdominal fluid are found. A CT scan shows a ruptured spleen, and the patient is brought to angiography for further treatment.

A detailed script of the scenarios is provided as a supplement (Supplement 3 ).

In both scenarios, the role of each team member is clearly depicted and their tasks are emphasized. A total of ten physicians, three nurses and one medical student are involved in both scenarios, an actor portrays the patient. The videos were filmed using a 3D 360° camera in 8k (Insta360 Pro 2; Insta360, Guangdong, China) with the support of a company specialized in 360° video shooting (Visual-Impressions GmbH, Magdeburg, Germany). Filming took place in the actual trauma room and the Department of Radiology and included real medical equipment. Each scenario is about 35 min long.

Creation of the 360° immersive virtual reality environment

The 360° videos obtained were edited and stitched based on the scenarios using Shotcut video editing tool (Meltytech, LLC, United States). We utilized the cross-platform game engine Unity (version 2019.2.18f1) as an environment for VR development. A Virtual Reality Toolkit (VRTK) was used to develop basic VR interactions. The VR environment with 360° videos was developed in a manner similar to the that described in [ 18 ]. We used the VIVE Media Decoder, a high-performance video decoding plugin, to implement video streaming in VR. For eye tracking, VIVE SRanipal and Tobii XR SDKs were used to access the eye tracking capabilities of HTC Vive Pro Eye VR headset in Unity. This VR headset provides 110° trackable field of view with 120 Hz tracking gaze data output frequency and 0.5°–1.1° accuracy for eye tracking performance. A heat map was generated using tracked gate data that visualizes the points of interest during the session. A mapping layer with the heat map texture was developed to track the gaze data and generate the heat map in real time. Additionally, recorded gaze data and timestamps can be applied to create a replay video with real-time gaze and heat-map visualizations. We used FB Capture SDK (version 2.25) and its metadata injection to record the replay 360° video while the user is performing in VR. This allows post-hoc assessment and scoring. Patel et al. [ 19 ] described their process of creating an immersive 360° VR environment, which differs from our set-up, but may be helpful for other centers seeking to create their own applications.

Recruiting and data collection

The study collective is comprised of volunteering physicians working in the Department of Anesthesiology of the University Medical Center Mainz. Informed consent was obtained from all participants. Potential participants were informed about the study via regularly repeated e-mails as well as on a personal basis. The subjects watched both videos wearing a VR headmounted-display (HTC Vive Pro Eye, Taoyuan, Taiwan). Before starting the application, a short introduction into the study and VR equipment as well as the possibility of motion sickness, was provided. The head mounted display was calibrated for the subject before use, utilizing the Eye Tracking Calibration of the Steam VR dashboard. Eye Tracking was recorded as a separate data file as well as video file. The results are displayed as colored heat maps. A brief look only turns the track blue, a longer observation will turn the heat map yellow, and finally red. An example of this is shown in Fig.  2 . Subjects were instructed to follow the video attentively and were blinded to the use of eye tracking. Following the scenarios, each subject completed a short questionnaire that consisted of personalized data, the Visual Induced Motion Sickness Scale (VIMS Scale) [ 17 ], the Immersion Scale by Nichols [ 18 ] and questions to subjective knowledge regarding trauma care and perception of beneficing of VR equipment in medical education and training using a 7 point Likert scale.

a shows a scene of the training scenario in immersive virtual reality, the patient has been transferred to the CT, different medical professionals are working on the patient, while the trauma leader on the right supervises them. In b regions of interest ( ROIs) are defined by yellow squares, in this part of the scenario ROIs are the patient, the second anesthesiologist and the monitor. c shows the heat map of an experienced anesthetist (13 years of work experience) and d the heatmap of an anesthetist in his first months of his first year. While the experienced anesthetist watches the patient, the monitor and the examiner, the young colleague appears to mainly watch the examiner. This may be due to the inexperienced anesthetist trying to learn from the actions of the examiner. This effect, while interesting did not show a significant difference in eye tracking overall

Subjective knowledge of procedures in the emergency trauma room were assessed using a 7-point Likert scale and compared between physicians who had completed specialist training in anesthesiology and residents using ANOVA. Subjects were asked to assess their knowledge prior to VR training and past VR training.

Statistical analysis

The participants’ characteristics were analyzed using descriptive parameters. Further questionnaire items were analyzed using Chi-square and ANOVA test and grouping for different parameters. Statistical analysis was performed using SPSS 23 (SPSS, IBM, Armon, NY, USA). Eye Tracking was only analyzed in video 1. For analysis, regions of interest (ROIs) were defined, and two physicians of the study group (LH and LV) rated if participants looked at ROIs briefly [ 1 ], extensively [ 2 ], or not at all (0) by assessing the colors. Both raters were blinded to the identity and experience of participants and only worked by identification numbers. Raters scores were added and analyzed using Mann-Whitney-U test. An example of an eye tracking heat map and ROIs is depicted in Fig.  2 .

A total of 31 volunteers of the Department of Anesthesiology of the University Medical Center Mainz were included. Ten (32.2%) participants had already completed specialist training in anesthesiology, 14 (45.2%) had finished emergency medical training and were working as emergency physicians. The other participants had not finished 3 years of specialist training, yet. The University Medical Center Mainz organizes emergency trauma room trainings on a regular basis. Of the participants 13 (41.9%) had attended this training or a similar one in the past. Detailed participants’ characteristics are displayed in Table  1 . Participants were further analyzed by their experience with VR equipment (see also supplement 4). While mean age did not differ significantly between groups, there was a significant difference in gender distribution with more male participants with VR experience ( p  = 0.032).

Mean VIMS was 1.74 with a standard deviation of 3.098 and a minimum of 0 and maximum of 13. None of the participants had to interrupt or discontinue the training because of VIMS or any other reason.

Specialists felt very secure about the procedures prior and after VR training. Residents reported to feel unsure prior to VR training and rather secure after. Both prior and after VR training there was a significant difference in subjective knowledge between specialists and residents (p prior < 0.05; p post = 0.002). Specialists showed no significant change in subjective knowledge ( p  = 0.168), while residents felt significantly more secure in the matter after VR training ( p  < 0.05). Figure  3 depicts the details of these results.

Participants were asked how secure they felt concerning emergency trauma room procedures prior and after training, 1 was “very secure” while 7 was “very insecure”. Specialists felt very secure before and after training, which is likely to be attributed to their long-term work experience. Residents were significantly less secure than specialists (p(prior) < 0.05; p(post) < 0.05) and felt significantly more secure after training ( p  < 0.05)

Participants reported to feel like they were present in the emergency trauma room, reaching a mean of 6 out of 7 (1 - not at all to 7 - very much). Furthermore, they were asked if they felt VR to be a useful tool in medical education on a 7-point Likert scale (1 - very useful to 7 - not useful at all). Subjects regarded the use of VR in medical education as very useful (mean 1.26), specialists and residents agreed on this matter ( p  = 0.724).

Eye Tracking was evaluated in 25 of 31 participants due to technical difficulties in recording of eye movements in 6 participants. Participants were divided by “specialist training in anesthesiology completed (yes / no)”. There was a significant difference in the observation of the emergency physician during patient hand-over, with residents watching the emergency doctor for a longer time ( p  = 0.008). For all other ROIs there was no significant difference between residents and specialists. To further explore the different groups Mann-Whitney-U Test was also performed using “emergency medicine qualification obtained (yes / no)” and “participated in an emergency trauma room training in the past (yes / no)” as grouping variables. There were no significant differences in the observed ROIs in these tests ( P  = 0.695 and P  = 0.734, respectively). Interobserver reliability was high (Cronbach’s Alpha = 0.95).

We introduce an innovative tool for familiarization and training in emergency trauma rooms, which received positive feedback from participants. This novel training method was feasible even during the COVID-19 pandemic, which acted as a catalyst for the project’s initiation. Additionally, other groups demonstrated that virtual reality (VR) could supplement existing training programs and courses, effectively substituting certain components even during periods of social distancing [ 19 , 20 ]. Furthermore, training sessions can be conducted at flexible hours and on short notice, such as during extended lunch breaks or at the end of regular shifts. Participants reported gaining a more comprehensive understanding of emergency trauma room procedures. While typically focused on their specific tasks within the trauma team, they gained greater insight into the overall process and the responsibilities of other team members. This was particularly beneficial for PGY1 residents, who were eager to train before their first night shifts. Eye-tracking data indicated a tendency for younger residents to observe the second anesthetist working on the patient, likely due to their future role in the trauma team (see Fig.  2 ). However, this finding was not statistically significant. The only significant difference observed in eye tracking was during patient handover, where younger residents focused on the emergency physician. This behavior suggests that more experienced anesthetists, accustomed to the trauma leader role, listen to the handover while monitoring the overall situation, whereas younger residents focus on the emergency physician to avoid missing any information. This is consistent with previous studies showing that experienced surgeons can engage in multitasking, such as taking phone calls, without impairing their surgical performance, unlike their less experienced counterparts. [ 21 ].

The immersive VR training was met with curiosity and high interest, with overwhelmingly positive feedback from participants. However, there are several limitations to the current program. The application is tailored specifically to the procedures and facilities of the University Medical Center Mainz, making it difficult to adapt for use in other institutions. Currently, the application simulates the role of an independent observer in the emergency trauma room and does not support interactive capabilities. Consequently, while it is suitable for familiarizing all medical specialties and professions with emergency trauma room procedures, it does not provide in-depth training on specific knowledge or medical procedures in its initial prototype. Future developments will include flow charts of responsibilities and educational slides within the VR application. Additionally, training in decision-making and task simulations will be incorporated to benefit more advanced physicians. Similar applications using animated simulations have been described previously and are partially available commercially [ 14 , 16 ]. We agree with Couperus et al., who have presented a prototype of a military application for trauma training in simulated VR, that these types of simulations can create systems comparable to fight simulation training [ 14 ]. However, these advanced applications may not be as suitable for first-time employees or medical students, as they are more specialized for different medical fields. Currently, there is an educational gap in procedural knowledge and organizational understanding among novice physicians that we aim to address. The current program was well received and provides a foundation for future expansions tailored to various specialties and experience levels.

Optimal trauma room care requires training not only in medical knowledge and procedures but also in communication and leadership skills. For this reason, our hospital incorporates real-life training that includes serious games conducted in larger groups. Prior studies [ 3 , 22 ] have underscored the importance of such training methods, independent of VR usage. The current program allows users to observe optimal communication practices, as noted by several participants, but it does not provide direct instruction or training in communication skills. Effective communication training requires group participation to enable practical exercises. While VR can enhance communication team training, our focus was on its capability to provide flexible, individual training without the need for training partners and instructors.

This study presents an initial user evaluation of a prototype for a new custom educational tool in immersive VR, and thus, the number of participants is limited. Future goals include implementing this tool for new and first-time employees, as well as further evaluating and developing interactive solutions.

Data availability

Data are available from the corresponding author upon reasonable request.

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Acknowledgements

We thank the company Visual-Impressions GmbH (Magdeburg, Germany) for the support during the acquisition of 360° Video materials.

The application for this study was developed during the research project “AVATAR” funded by the Federal Ministry of Education and Research, Germany (FKZ: 16SV0857).

Open Access funding enabled and organized by Projekt DEAL.

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Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Johannes Gutenberg-University, Mainz Langenbeckstraße 1, 55131, Mainz, Germany

Laura Isabel Hanke, Lukas Vradelis, Christian Boedecker, Florentine Huettl, Nicolas Wachter, Hauke Lang & Tobias Huber

Department of Anesthesiology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany

Jan Griesinger, Tim Demare & Nicola Raphaele Lindemann

Virtual and Augmented Reality Group, Faculty of Computer Science, Otto-von-Guericke-University, Magdeburg, Germany

Vuthea Chheang, Patrick Saalfeld & Christian Hansen

Department of Orthopedics and Trauma Surgery, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany

Jochen Wollstädter

Department of Diagnostic and Interventional Radiology, University Medical Center Johannes Gutenberg-University, Mainz, Germany

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Contributions

LH and TH prepared the questionnaires, LH, CB, LV, FH and TH structured the course of the study, LH conducted the study, collected and evaluated the data and prepared the manuscript, LH and LV evaluated eye tracking, VC, PS and CH programmed the VR-application, CB, JG, TD, NRL, NW, JW, MS and TH concepted and filmed the video material, HL and TH supervised the study. All authors have read and approved the manuscript.

Corresponding author

Correspondence to Tobias Huber .

Ethics declarations

Ethics approval and consent to participate.

This study’s participants were volunteering physicians from the Department of Anesthesiology; all participants gave written informed consent. It was a voluntary addition to their education, which could be interrupted or terminated at any time. Participation was not reported to the heads of the department and all results were handled anonymously. According to local guidelines evaluation of educational content, does not require ethical approval.

Consent for publication

All authors approved the manuscript in its current form and consented to publication. All individuals seen in any images consented to publication in an open access journal. There are no participants or identifying information depicted in any images.

Competing interests

The authors declare no competing interests.

Summary statement

Interdisciplinary training is key for care of critically ill trauma patients. We present a prototype of a trainings tool in immersive virtual reality with high acceptance and significant subjective knowledge improvement.

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Prior presentation: Preliminary results were presented at the Viszeralmedizin Conference 2022 in Hamburg (16.09.2022), the abstract of these preliminary results was published in the conference journal, as well as at the DCK 2023 (18.04.2023, online).

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Hanke, L.I., Vradelis, L., Boedecker, C. et al. Immersive virtual reality for interdisciplinary trauma management – initial evaluation of a training tool prototype. BMC Med Educ 24 , 769 (2024). https://doi.org/10.1186/s12909-024-05764-w

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By Sara Moniuszko

Edited By Allison Elyse Gualtieri

July 24, 2024 / 3:13 PM EDT / CBS News

It's not just President Biden who recently tested positive for COVID — cases of the virus are spiking across the country.

Nearly 40 states are reporting high COVID activity levels, according to data from the Centers for Disease Control and Prevention, and emergency room visits are at their highest for the virus since February.

Why the seemingly sudden summer surge? There are a couple of factors at play, Dr. Céline Gounder, CBS News medical contributor and editor-at-large for public health at KFF Health News, told  "CBS Mornings" Wednesday .

"One, the virus continues to evolve to stay ahead of our immune systems. That's what we can talk about when we're talking about variants," she said. "Two, your immunity to infection only lasts about three months. Your immunity to severe disease, hospitalization and death, that lasts much longer, which is why people are not getting sick the way they were early in the pandemic. But it is to be expected that every few months, maybe twice a year or so, we'll see a big wave of COVID across the country."

More reasons for increased numbers? People are traveling and spending more time indoors and not masking as much, Gounder added . 

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• v.21(5); 2020 Sep

Resident Research in Emergency Medicine: An Introduction and Primer

James h. paxton.

* Wayne State University, Department of Emergency Medicine, Detroit, Michigan

Anne M. Messman

Nicholas e. harrison, adrienne n. malik.

† Kansas University Medical Center, Department of Emergency Medicine, Kansas City, Kansas

Raina J. Burke

‡ Wheeling Hospital, Department of Emergency Medicine, Wheeling, West Virginia

Phillip D. Levy

Training in research methodology represents an important aspect of emergency medicine (EM) resident education, but best methods for design, implementation, and dissemination of resident research remain elusive. Here we describe recommendations and best practices from the existing literature on EM resident research, including helpful tips on how to best implement a resident research program.

INTRODUCTION

When René Laënnec, a French physician in 1816, failed to adequately percuss the thorax of a young woman with heart disease, he improvised. Laënnec wrote, “I rolled a quire of paper into a sort of cylinder and applied one end of it to the region of the heart and the other to my ear.” 1 After numerous revisions, his invention was revealed to the medical community, and quickly caught on. Within a few years, primitive stethoscopes could be found in medical shops throughout Paris. Had Laënnec stopped with that rolled-up piece of paper, his one-time improvisation would have been lost to the annals of history. Fortunately, he chose to build upon his initial discovery and, crucially, to share his breakthrough with the world. Laënnec’s journey charts an enduring and fundamental trajectory of medical innovation: from observation, through inspiration, refinement and testing, to dissemination.

Development of a research project can be especially daunting to physicians already engaged in an emergency medicine (EM) residency training program. But execution of a research project during residency remains a worthwhile experience, allowing participants to meaningfully contribute to medical knowledge and develop an investigative spirit. 2 Residents participating in research appear to attain greater job satisfaction, 3 and can objectively frame everyday questions and methodically seek answers 3 to problems including (among others) staffing issues, wait times, and communication barriers. 4 – 5

The Accreditation Council for Graduate Medical Education Residency Review Committee for EM recognizes the importance of these efforts, mandating resident completion of a “scholarly project” prior to graduation. Their requirement cites the following as examples of qualifying activities: “…the preparation of a scholarly paper such as a collective review or case report, active participation in a research project or formulation and implementation of an original research project.” 6 These activities should include problem identification, data collection, analysis, and conclusion. 7 Performance and documentation of these projects are vital to the acceptance of a scholarly project, whether a case report, community project, development of medical software, or traditional research project. 7 Recent reports from within the EM community have emphasized the importance of scholarly activity to EM resident education. 8 – 9

Advancing the state of scientific knowledge is not a requirement for success in resident research, but it is a potential benefit of this exercise. It is the responsibility and privilege of those involved in residency administration to facilitate the training of EM resident researchers in the development and execution of research projects that support not only the professional careers of residents but also the advancement of our specialty. 8 – 9

What is Resident Research?

It has been suggested that “resident research” is, “research where a resident has a principal role in the implementation and completion of the project.” 10 We suggest that the resident research experience be defined by the engagement of the resident learner in the research process, focusing upon the educational value of the project rather than the resident’s official role or involvement in the design and execution of the project. Research studies are intended to create new generalizable knowledge that can be applied to other populations and settings. 11 Consequently, we propose that “resident research” be defined as any systematic investigation designed to yield new information that actively engages the resident-learner and facilitates the acquisition of a greater understanding of the scientific method. This is in distinction to quality improvement projects, which seek to apply existing knowledge to improve healthcare outcomes within a local healthcare institution or setting. 12

Setting Realistic Expectations

One purpose of resident research is to expose residents to the methods by which research is conducted, creating “educated consumers” of the medical literature. However, residencies hoping to establish a resident research program de novo must recognize the additional workload that resident research projects impose upon faculty. Mentors should be primarily responsible for guiding and supervising resident research, but should be adequately vetted to ensure that the research experience yields a positive result for all involved. Research directors should provide guidance relating to funding opportunities, deadlines for abstract submission to key research conferences, important institutional and federal regulations, and departmental resources. 13 Departmental leadership should create an environment in which research is actively promoted, providing appropriate funding and protected time for mentors and other research faculty. 13

Getting Started

Clinical experiences, journal club articles, or experiences with different teaching modalities may generate an appropriate resident research topic including relevant clinical or educational questions. 2 , 14 – 15 Additional ideas may come from the resident’s personal interests or experiences.

Learning Research Methodology

Most programs will offer training through didactic presentations, journal clubs or evidence-based literature discussions. However, a focused educational effort specifically targeting research methodologies has been shown to correlate with improved resident skills, knowledge, and research productivity. 16 Nearly one in four EM training programs offers a fixed rotation in research. 5 , 17 A more feasible format for the busy trainee might be the Advanced Research Methodology Evaluation and Design video series available from the Society of Academic Emergency Medicine (SAEM), including “how-to” webinars and podcasts produced by senior researchers. 18

The Research Question

A general research question must be formulated, which will generate a testable hypothesis. 3 , 19 All possible outcomes should be considered, and at least one of them must be worthwhile. 20 The FINER criteria may be used to assess the relative merits of the proposal: 14 – 15 , 21

Can the project be completed within the time allotted using the given resources? Can the proposed investigation enroll enough patients to demonstrate a difference in the proposed outcome measures?

Is the topic engaging enough to be worth the effort?

Is the proposed investigation different enough from what has been done before to add knowledge on the subject?

Does the proposed investigation respect the morals of the community, the patient, and the profession?

Are the results likely to be applicable to many patients? Will the results be useful and contribute to the greater good?

Formulating a Hypothesis

A suitably refined and meaningful research question will help in generating a hypothesis, providing a clear delineation of what the investigation will attempt to prove. Investigation of a well-designed hypothesis will be interesting even if a negative result is found.

A mentor experienced in the resident’s area of research interest can be an invaluable resource by offering hints at project scope, helping with setbacks, and tailoring the learning experience to the resident’s needs. 22 Most often, the mentor is an established researcher within the department but could include a specialist in another field, or even a non-physician investigator. 5 , 23 – 24 Goals and expectations should be discussed early on, to avoid frustration for both parties. 5 Terregino has shown that, in general, EM residents are relatively unfamiliar with what resources are available to them, which can lead to significant amounts of time wasted. 25 Most hospitals provide research support that is invisible to the outside observer, including project coordinators, departmental research directors, and biostatisticians. 25 The mentor should be aware of all available institutional resources.

The Literature Search

A valid research project must be informed by past work. Most literature reviews will begin with a search of PubMed.gov , the database of the National Library of Medicine, or OVID.org , which includes textbooks as well as journals. 26 Search terms used must be carefully selected, and the proper Boolean operators assigned. One study has shown physicians to be especially inept at crafting effective search strings. 27 Any doubts about the literature search process or its results should be referred to a librarian.

Each paper identified from the literature review should be thoroughly read. Investigators should avoid citing abstracts alone, as they are often incomplete in their data presentation. This process is labor-intensive but necessary to form a strong foundation for the research project. All references cited within each article should be assessed for relevance. The selected literature should be reviewed to better understand the subject matter and to develop context for the proposed work. If adequate data from existing sources are uncovered, one may consider a retrospective evaluation of prior results including a meta-analysis. 2 , 28 – 29

Research Design

The novice researcher should look to the existing medical literature for guidance in how to properly design a new study. Selection of the proper research methodology will depend upon multiple factors, including the research question, hypothesis, and predetermined outcome measures. A timeline should be implemented to ensure that all tasks are achievable within the allotted time. Resident physicians should develop a team approach, incorporating input from the faulty mentor as well as a staff epidemiologist or biostatistician. The required sample size will depend upon a variety of factors, including the acceptable level of significance, power of the study, expected effect size, underlying event rate in the population, and standard deviation in the population. 30 – 31 Efforts should be made to collect an inclusive and truly random sampling, to avoid convenience selection bias. 32 Early consultation with the biostatistician will also inform the researcher’s decisions on the most appropriate methods for the statistical analysis of data derived from the study. For further information about study design specifics, the reader is referred to several existing publications. 2 , 4 , 13 , 33 – 34

The Institutional Review Board

Any research project that involves human participants or their data requires submission to the local institutional review board (IRB). Research protocols submitted to the IRB can fall into one of three categories: full submission; expedited; or exempt. Research involving greater than minimal risk to human subjects will require a thorough review by the IRB and development of an informed consent document. Prospective projects involving only minimal risk may be approved via the expedited process, where a single reviewer may approve the work in lieu of the convened board. Studies that include only retrospective data from the electronic health record may be exempt from IRB review, but this determination should be made by the IRB, rather than by the investigator. Investigators should confer with their local IRB to confirm what level of IRB review is required before beginning data collection.

Conducting the Study

After the research protocol has been IRB-approved or exempted, data collection can commence. Prior development of a data collection tool will greatly enhance the efficiency of this process, facilitating both IRB approval and the subsequent data analysis. Subject enrollment can also be improved with use of a trained research assistant. This problem may be circumvented through creation of an “academic associate program,” which integrates EM research with undergraduate education. 35

Research Funding

Resident research projects usually require little external funding. On occasion, additional costs may be incurred to help pay for statistical analysis, or the purchase of required equipment. 36 Internal sources, as well as the Emergency Medicine Foundation 37 and the SAEM Foundation 38 represent potential sources for funding.

Presentation and Publication

Once the data have been collected and analyzed, the researcher should consider how the results will be disseminated. The annual meeting of SAEM, the Research Forum at the American College of Emergency Physicians’ annual scientific assembly, and the Annual Assembly of the Council of Residency Directors in Emergency Medicine (CORD) represent the premier locales for presentation of EM research. 39

Ideally, the resident research experience should lead to a manuscript, although the lack of immediate publication must not be interpreted as failure. Only 40% of EM abstracts go on to become full article publications. 15 , 40 Most manuscripts are published 1–2 years after initial presentation. 17 Appropriate journal selection for submission enhances the likelihood of success, as does a thorough understanding of manuscript preparation techniques and review criteria. 41 – 43

While any research resultant from a resident’s scholarly project is unlikely to have the impact of Laënnec’s stethoscope, EM residents may still gain much from engaging in clinical research. For some, it will light an investigative fire that will burn for an entire career. At the least, resident research projects can provide an opportunity to explore issues central to the practice of EM, helping the resident to become a more well-rounded physician.

Section Editor: Whitney Johnson, MS, MD

Full text available through open access at http://escholarship.org/uc/uciem_westjem

Conflicts of Interest : By the West JEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.