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Korean J Med Educ > Volume 35(1); 2023 > Article
Sahoo, Mishra, Jain, Sahoo, and Ghoshal: Problems and solutions to conduct of thesis of postgraduate medical students during the COVID-19 pandemic: an insight into the students perspective



The coronavirus disease 2019 (COVID-19) pandemic has adversely impacted medical education worldwide. However, its impact on the postgraduate medical thesis and dissertation work is still not evaluated. Through this study, we planned to find out the problems brought by the pandemic and likely alternatives and possible solutions to thrust the academic competence of postgraduate students.


After obtaining institutional ethics committee approval, we sent a 13-item questionnaire to postgraduate medical students in India via various social media online platforms. Data on the impact of the COVID-19 pandemic on thesis work and alternatives/solutions to improve the research competence were collected on a Likert scale and analyzed.


We received a total of 398 responses out of which 377 entries were included for final analysis. The majority of participants (88%) reportedly had an adverse impact on the thesis work and out of 25% of the participants who recently submitted their around 45% had to do so without achieving the estimated sample size. The 6-month departmental review for thesis progress was seen in merely 28% of participants. Possible alternatives suggested were the maintenance of log books, task-based assessment of research methodology, departmental audits, and systematic reviews. Solutions suggested for improving the research competence of students were a compulsory research methodology curriculum, a biostatistics department in each institution, permission to conduct thesis work beyond submission time, exclusive time for research work, and financial incentives.


Modification in the research aspect of the current postgraduate medical education is the need of the hour and the pandemic has enlightened us regarding the current weaknesses.


During a pandemic, healthcare systems re-channelize all their resources including manpower to focus on managing the outbreak, limiting the spread of the disease, and preventing the healthcare system from collapsing. Such a shift during the coronavirus disease 2019 (COVID-19) pandemic however resulted in interruption of the medical education even in the most successful medical training programs [1,2].
Besides the clinical activities, teaching, and training, producing a research paper or thesis is an essential step for a student graduating from medical school [3]. A typical postgraduation training in India for specialties is usually 3 years for degrees and 2 years for diploma courses and the super specialty training further involves 3 years post-specialization. During the training period of 2 to 3 years, the student goes through clinical rotations including emergency duties, regular academics involving didactic lectures, seminars, group discussions, case presentations, and journal clubs. To potentiate academic competence and research-based critical analysis thinking skills, the National Medical Council (NMC; formerly Medical Council of India, MCI) mandates that each student is required to undertake a research topic with a faculty as the guide and or co-guide from the concerned specialty. However, dissertation research by Indian postgraduate students remains invisible in international literature, and conversion to publication is abysmally low due to various factors involving time constraints, poor mentorship, and lack of funding [4]. The COVID-19 pandemic with all its effects made this scenario further worse.
We, therefore, planned to conduct this survey to find out the problems in the conduct of thesis/dissertation work during the time of the ongoing pandemic. To the best of our knowledge, this is the first survey to evaluate the impact of the COVID-19 pandemic on the conduct of a thesis for postgraduate medical students across all specialties. This study aims to find the size ability of the problems associated with the conduct of thesis and dissertation work of postgraduate medical students and suggest tangible solutions for the same to improve academic productivity.


1. Methodology

After obtaining approval from the institutional ethics committee, we conducted an online questionnaire-based survey (Appendix 1) and sent it to all postgraduate medical students using various online and social media chat platforms. The questionnaire contained a series of a total of 13 questions which are either short answers or multiple-choice types and prepared on google forms. The questions were designed based on a literature search, personal experiences, and feedback from students. Open-ended questions are also included. The content validity of the questionnaire was performed before snowballing by experts (senior faculties and postgraduate medical students). They rated each question on a Likert scale based on simplicity, clarity, ambiguity, and relevance. The reliability of data was checked after the test-retest method on 21 students. After data collection, a descriptive analysis was conducted.

2. Statistical plan

1) Sample size calculation

The sample size was calculated with Sample Size Calculator (https://www.surveysystem.com/sscalc.htm). For deriving the sample size, we calculated the approximate number of postgraduates across India to be approximately around 35,000 as per the MCI and Diplomate of National Board websites [4]. Considering the reachability of at least 60% of students and assuming a minimum two-sided 95% confidence level, 5% margin of error, and standard deviation of 0.5, a minimum sample size of 376 was obtained.

2) Data analysis

Data was analyzed using multiple measures of dispersion, and cross-tabulations. Categorical data were presented as percentages or frequencies as appropriate. One sample chi-square test was used for comparing proportions with the expected count in all the cells of at least 5. GraphPad Prism ver. 8.0 (GraphPad Software, San Diego, USA) was used for the chi-square test.

3. Ethical approval

The study was approved by the Institutional Ethics Committee, All India Institute of Medical Sciences, Bhubaneswar as an exemption on July 15, 2021 (T/IM-NF/Anesth/21/50).


Data were collected from 398 participants and entries from 377 participants were included for final analysis. The demographics of the 377 participants are depicted in Fig. 1A and Table 1.

1. Effect of the pandemic on thesis

The thesis was affected due to the pandemic adversely by 88% of the participants and mildly by 10%. Only 5% of participants had a thesis that was related to COVID-19 patients. While assessing the participants on the current timeline around 98 (25%) of the participants had submitted their thesis recently; out of which around 48% had submitted without achieving the estimated sample size; however, there were no statistically significant differences in that group (χ2=0.163, p=0.68) (Table 2). Out of the rest, 280 participants (75%) who were yet to submit their thesis, around 80% reportedly did not achieve the anticipated sample size (χ2=102.36, p<0.0001).
Around 218 participants informed that their concerned institutes had provided relaxation in the time limit for submission of thesis/protocols whereas 159 suggested they did not receive any (χ2=102.63, p<0.006). However, there was no significant difference noted between the type of institutes (central/state/private/corporate) (Table 2).
The most common problems for the conduct of the thesis reportedly and the effect of the pandemic situation on the departmental thesis review meetings were as represented in Table 2.

2. Alternatives and suggestions

As per the participants, the best alternatives to pursuing a thesis during postgraduation could be systematic reviews/metanalysis (35%), departmental audits (46%), publication of case reports as first/corresponding author (44%), maintenance of portfolio/logbook (51%), task-based assessment of research methodology (44%), and publication of protocol/original idea (30%) (Table 3).
Survey participants suggested options for improving the current thesis program for completion of postgraduation which included research methodology must before protocol submission (65%), collaborative studies involving multiple departments with two or more students (submitting the same but good quality thesis) (57.5%), permission to conduct thesis study post-submission (58%), exclusive time separate from clinical and academic work (64%), a biostatistics department in each medical college (67%), and financial incentives for thesis completion (88%) (Table 4).
The time utilization of the pandemic with distribution in clinical work as a frontline worker, thesis work, attending webinars, and self-study was assessed on a Likert scale of 0–10, and data is presented in Fig. 1B.


To the best of our knowledge, this is the first survey to evaluate the impact of the covid pandemic on the conduct of a thesis for postgraduate medical students across all specialties.
Most of the participants in our survey were from government institutes as most of the latter have turned into nodal centers for the clinical management of COVID-19 patients during the pandemic. Also, the majority of the participants included postgraduates from anesthesiology possibly because two authors from this study are faculties in the department of anesthesiology and could reach more anesthesiologists via networking. Secondly, the postgraduates from the anesthesiology, critical care, and internal medicine were the core departments conferred with the primary care of COVID-19 positive patients as per the guidance by the Ministry of Health and Family Welfare, Government of India. Nonetheless, all other specialties have made a significant contribution to the clinical management of patients even outside the clinical purview because of the acute shortage of manpower during acute waves. In a recent survey done on orthopedic residents in northern India [5], more than 70% of the postgraduate trainees had a clear impact on their thesis work. As per our study, the numbers were still higher at 88% possibly because we included all specialties, and the sample size was larger.
Thesis and dissertation work has its challenges most commonly as its time-limited and can lead to exclusion of various research questions and thereby publication-oriented study designs. Time constraints in research work have always been highlighted as obstacles in academic research work in previous studies [6,7]. As per a survey done in India, a postgraduate medical student spends 60–100 hours per week on clinical rotation uniformly throughout the residency which leaves negligible time left for thesis work [8]. Excessive clinical workload during the pandemic, prolonged health issues of self and family including quarantine period, and loss to follow-up of cases because of patients turning covid positive in interventional studies further potentiated the time-bound challenge. Around 77% of participants in our survey spent less than 50% of their time on thesis work and around 40% spent less than 20% of their time on thesis work. Apart from that the physical and mental health also might have led to unnecessary fatigue and procrastination of the students. In our study close to 42% of the survey participants informed that there was no relaxation provided by the local ethics committee for submission of protocol/main manuscript at the time of doing the survey (July to August 2021 where the majority of participants responded to the survey). Although there was a notification from NMC in July 2021 regarding the relaxation of the sample size and timing of submission of the postgraduate thesis, clearly many students were already affected in the previous year. Secondly, the sample size is a huge limiting factor for meeting the publication criteria of high-impact journals. As per our survey, around 50% of the submitted thesis did not achieve the anticipated sample size and more than 75% of the ongoing projects did not achieve the anticipated sample size as per their planned timelines. This problem was highlighted in other studies too [5]. This would be a grave issue if not tackled appropriately: more and more thesis work either just lying in the libraries for the sake of degrees, loss of research motivation to the upcoming generation, and probable publication in predatory journals. To tackle this problem, rather than reducing the sample size which would yet again bring down the quality of the project for publication, an exclusive unhindered research time separate from clinical rotation could be allowed to the students, and the same was affirmed by 64% of our participants. Harvard Medical School in their MD (Doctor of Medicine) thesis requirements has mentioned a minimum commitment of full-time of at least 4 months for research purposes with an additional period of a complete 1 month for thesis writing [9]. Similarly, Yale School of Medicine also allows first-year medical students full-time research work with an additional 3 to 4 months in the 3rd and 4th year [10]. As per a study done on urology residents, research productivity doubles with an additional year of dedicated research time [11]. Similarly, till the pandemic is officially called off, the sample size criteria for submission to the institutional research section may be given a “relaxation” mainly for experimental studies where there are problems due to recruitment and loss of follow-up with permission to complete the due thesis post submission or after the exit examinations with an extension for research work without which the degree may not be conferred. The extension period may also be supported with financial remuneration for further motivation. Around 58% of the survey participants also suggested this method of continuing the thesis post-submission could be adapted for improving the thesis work in the pandemic era.
As per a survey done by Abhari et al. [12] on expert professors and postgraduate managers, the three most important steps which help in advancing dissertation work include time tracking the progress by the mentors, providing feedback on the student’s ideas and problems, and holding regular sessions with students expressing the expectations from the students explicitly. Accessibility of the supervisor was considered one of the major hurdles in the conduct of the thesis as per many studies. In our study, around 20% of participants felt that the accessibility of guides was reduced due to excessive COVID-19–related clinical duties. This was also reflected in the data which showed a gross plummeting of 6 monthly departmental meetings for thesis progress from 57% in the prepandemic to 28% in the pandemic period and pushing towards “no departmental meetings” at all in 33% of the participants versus 12% in the prepandemic period. The incorporation of information technology into academic research supervision like Google Meet, Zoom, and WhatsApp as suggested by many for medical education, and the use of teleand online-supervision systems would be helpful to achieve a higher level of supervision and motivate the students further [12].
Financial support for the conduct of the thesis with even paid research workdays can be an excellent initiative that could be taken up for motivation of students for research work as per 59% of the survey participants. Inadequate financial support has been cited as one of the reasons for the poor conduct of research by 41% of participants as per an analysis in India [13]. Uniform provision for financial incentives/stipends for full-hour research work as provided in many international universities in the United States, and Canada with the meeting of deadlines would motivate the better research output of students.
One of the many factors for good quality research projects in developed nations is a research-oriented curriculum with a structured research program that involves research rotation of varying duration from 1 month to 1 year [14,15]. This could be possible with a dedicated biostatistics department in each medical college to foster more research-based education in addition to the compulsory research methodology training for all postgraduate residents implemented by the NMC. Close to 65% of the students in our survey were in favor of conducting the research methodology training much before protocol submission and maybe even earlier in undergraduate levels would help in better orientation.
Another strategy to cope with the small sample size and problems in recruitment during the pandemic times was a suggestion of having a thesis as collaborative work in multiple departments which was supported by as many as 58% of participants. For example, a single intervention is done on a single group of patients; however, the outcomes of interest may be different. Here each of the students may write their protocols separately and involve guides from two separate departments. Similarly, a single study may be given to two students so that they can divide the sample size and work on it. This would not only reduce the stress level but also may induce good team-based research work.
Considering the alternatives to research studies like experimental and observational studies, one of the strongest suggestions was to maintain a logbook or portfolio as most of the time is spent in clinical or lab rotations, which also means the thesis to be made optional and not mandatory akin to countries like the United Kingdom and Europe [16]. Systematic reviews have long been argued in favor of PhD (Doctor of Philosophy) theses, although there are experts who argue against this but can be considered as an option in challenging times. Few other alternatives favored by the participants were case reports published in indexed journals, clinical audits, and publication of protocol or original ideas that can be left open for discussion to stakeholders; however, we as authors believe it would definitely help in building up the academic portfolio of the student to an extent but still may lack in the holistic development of a clinician with an ability to critically analyze literature evidence and put them into practice.
The strength of the study is that it provides practical solutions for improving the research education policies which would help not only help during crises like pandemics but also identify the existing loopholes and provide a tangible solution for the same. Secondly, the survey participants have been kept anonymous so that transparency of the collected data may be maintained.
The limitations of this study are that the survey findings represent the viewpoints of the students and not the policymakers, program directors, or faculties at large which is important while reframing and implementing new policies.
In conclusion, various transformational steps in the postgraduate medical research methodology curriculum should be sought which should focus on the research output of the medical students and thereby motivate them to embark on their journey toward becoming clinician-scientists.


The authors are thankful to the students who participated in this survey wholeheartedly.


Conflicts of interest: No potential conflict of interest relevant to this article was reported.
Author contributions: Conception or design of work: NM, AS, MJ; data collection: NM, AS, MJ, MS, PG; data analysis: AS, NM; drafting the article: AS, NM, MJ; critical revisoon of article: NM, AS, MJ, MS, PG; and final approval of the version to be pulblished: AS, NM, MJ, MS, PG.
Funding: No financial support was received for this study.

Fig. 1
Effect of the Pandemic on Postgraduate Thesis
(A) Departmental thesis review meetings before and after the pandemic. (B) Time utilization of the postgraduate students during the pandemic
Table 1
Demographics of the Survey Participants
Characteristic No. of participants (%)
Type of institutes/medical college and hospital
 Central government 257 (68)
 State government 65 (17)
 Private 46 (12)
 Corporate 9 (2)
Degrees pursued by the participants
 MD 212 (56)
 MS 79 (21)
 DM 35 (9)
 MCh 36 (9)
 FNB/DNB 15 (4)
Subjects in which students pursued specialization/super-specialization
 Anesthesiology and critical care 117 (31)
 Orthopedics 38 (10)
 General medicine 23 (6)
 General surgery 25 (6)
 Obstetrics and gynecology 27 (6)
 Pulmonary medicine and critical care 9 (2)
 Others 123
Type of study given as thesis topic
 Randomized clinical trial 150 (40)
 Prospective observational 179 (47)
 Retrospective study 14 (4)
 Descriptive studies 34 (9)
Was the thesis topic related to COVID-19 patients?
 Yes 21
 No 356

MD: Doctor of Medicine, MS: Master of Science, DM: Doctor of Management, MCh: Magister Chirurgiae, FNB: Fellowship of National Board, DNB: Diplomate of National Board, COVID-19: Coronavirus disease 2019.

Table 2
Effect of the Pandemic on the Thesis
Question No. of participants χ2 p-value
Q1. How badly was the thesis affected? 451.87 <0.0001
 Severely 220
 Moderately 113
 Mildly 36
 Not affected 4
 Benefitted 4
Q2. Have you achieved your sample size in the thesis submitted/done in the current year? 0.163 0.68
 Submitted and sample size achieved 51
 Submitted and sample size not achieved 47 102.36 <0.0001
 Not submitted, but anticipated sample size achieved 55
 Not submitted, but anticipated sample size not achieved 224
Q3. Provision of relaxation on timing for submission of thesis protocols/final manuscript 9.23 <0.0024
 Yes 218
 No 159
Table 3
Problems Faced in Conduct of Thesis
Q4. Problems faced in conduct of thesis No. of participants
Issues in recruitment (decrease footfall/change of inclusion or exclusion criteria, post-COVID-19 status) 231
Early fallout of cases from intervention/loss to follow-up 176
Posting to thesis unrelated to COVID-19 areas 173
Procedural limitation (risk of aerosol generation) 100
Prolonged illness/quarantine of self/family member 79
Less availability of mentor/guide due to excessive COVID-19-related clinical work 77

COVID-19: Coronavirus disease 2019.

Table 4
Alternatives and Suggestion to Improve Thesis Work in Postgraduation
Yes No Neutral χ2 p-value
Alternatives to thesis 39.19 <0.0002
 Systematic reviews and meta-analysis 131 132 114
 Departmental audits presented at national conferences 172 117 88
 Publication of case reports as first/corresponding author 166 126 58
 Maintenance of portfolio/log book 193 91 93
 Task-based assessment of research methodology 167 113 99
 Publication of protocol/original idea 160 115 102
Suggestions to improve the conduct of thesis work 23.41 <0.009
 Research methodology must be before protocol submission (65%) 247 70 61
 Collaborative studies involving multiple departments with two or more students (submitting the same but good quality thesis) (57.5%) 217 72 88
 Permission to conduct thesis study post-submission 220 96 61
 Exclusive time separate from clinical and academic work 242 72 63
 Biostatistics department in each medical college 254 67 56
 Financial incentives for thesis completion 222 80 75


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Appendix 1

Problems in Conduct of Thesis during COVID-19 Pandemic in India: A Nation-Wide Survey of Postgraduate Medical Students (PROCON THESIS)

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