dissertation topics for anaesthesia

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Introduction

The Top 25 Up-To-Date Dissertation Topics In Anaesthesiology

A comparative study into the effectiveness of using variable dosage of intravenous fluid used during a transurethral resection of the prostrate to prevent hyponatremia.
A study into the results of the performance of Nurse anaesthetists in National Board Certification Exams.
The development of a model of Anaesthesiology Care (during and post operative) that can be provided by Physicians and Nurses.
Research into the effect of the use of PCA (patient controlled analgesia) with young patients (under 15) who have undergone hip replacement.
The impact of using an early tracheotomy (in comparison to a late one) on patients who have suffered a severe head injury.
The effect of using a lighter state of anaesthetic (with a spinal block) as opposed to a full general anaesthetic on the recovery and immediate mobility after hip replacement.
Quality of care and patient satisfaction after anaesthesia has been delivered within an office-based surgery.
Research in the effect of bio-feedback prior to surgery and its correlation to the reported post-opt recovery.
The effectiveness of a rectally administered pre-medication in comparison to an orally administered pre-medication in young children.
The positive effect of music-therapy as a tool to reduce sedation and cortisol levels in patients undergoing lower limb arthroscopic procedure under spinal anaesthesia.
An evaluation into the use and effectiveness of a bacteriostatic heat and moisture exchanger in comparison to a non- bacteriostatic exchanger.
A study in to the factors that influence parental anxiety and satisfaction if they are allowed to be present during administration of anaesthesia to their child.
Study into the effectiveness of the percutaneous nerve stimulation for the performance and education of the peripheral nerve block administration.
A comparative study on the prevention of pain by the use of propofol injection of Novocaine; pethidine; dexamethasone and placebo.
A study based on the 2002 paper “Maternal hypo-tension and epidural anaesthesia for Caesarean section”.
Research into the possible current need for anaesthesia during and MRI scan and the possibility of designing and monitoring its protocols.
A study to determine the selection criteria and academic progression for doctors who express an interest in becoming anaesthetists.
A Comparative study in to the use of epidural anaesthesia for caesarean patients with pregnancy induced hypertension.
An evaluation of the use of epidural tramadol and its effects on the duration of the need for postoperative analgesia in urological surgical patients.
A study into the prevention of postoperative nausea and vomiting in patients undergoing a laproscopic cholecystectomy (a randomised, double-blind placebo-controlled study).
A comparative study into the effects of the use of pre-operative low dose ketamine infusion on postoperative males and females.
A comparative study into the efficiency of graisetron as opposed to droperidsol as a preventative of postoperative nausea and vomiting.
Research into the advantages of using tramadol as a wound filtration in children comparison to bupivacaine.
An evaluation into the use of sedation monitors that are used during conscious sedation procedures during a colonoscopy.
The effectiveness of bi-spectral monitoring as a tool for predicting the recovery time following a procedure that was performed under conscious sedation.
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High-impact papers in the field of anesthesiology: a 10-year cross-sectional study

Affiliations.

1 Department of Anesthesiology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University and The Research Units of West China, Chinese Academy of Medical Sciences, Chengdu, China.
2 Department of Medical Administration, West China Hospital, Sichuan University, Chengdu, China.
3 Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China. [email protected].
4 Department of Periodical Press and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China. [email protected].
5 Department of Periodical Press and National Clinical Research Center for Geriatrics & Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China. [email protected].
PMID: 36418743
PMCID: PMC9684867
DOI: 10.1007/s12630-022-02363-5

Abstract in English, French

Purpose: This study was performed to evaluate trends in and provide future direction for anesthesiology education, research, and clinical practice.

Methods: We collected high-impact papers, ranking in the top 10% in the field of anesthesiology and published from 2011 to 2020, by the InCites tool based on the Web of Science Core Collection. We analyzed the trends, locations, distribution of subject categories, research organizations, collaborative networks, and subject terms of these papers.

Results: A total of 4,685 high-impact papers were included for analysis. The number of high-impact papers increased from 462 in 2011 to 520 in 2020. The paper with the highest value of category normalized citation impact (115.95) was published in Anesthesia and Analgesia in 2018. High-impact papers were mainly distributed in the subject categories of "Anesthesiology," "Clinical Neurology," "Neurosciences," and "Medicine General Internal." They were primarily cited in "Anesthesiology," "Clinical Neurology," "Neurosciences," "Medicine General Internal," and "Surgery." Most of these high-impact papers came from the USA, UK, Canada, Germany, and Australia. The most productive institutions were the League of European Research Universities, Harvard University, University of Toronto, University of London, University of California System, and University Health Network Toronto. Research collaboration circles have been formed in the USA, UK, and Canada. Subject-term analysis indicated postoperative analgesia, chronic pain, and perioperative complications were high-interest topics, and COVID-19 became a new hot topic in 2020.

Conclusions: The current study provides a historical view of high-impact papers in anesthesiology in the past ten years. High-impact papers were mostly from the USA. Postoperative analgesia, chronic pain, and perioperative complications have been hot topics, and COVID-19 became a new topic in 2020. These findings provide references for education, research, and clinical practice in the field of anesthesiology.

RéSUMé: OBJECTIF: Cette étude a été réalisée pour évaluer les tendances et fournir une orientation future à l’enseignement, la recherche et la pratique clinique en anesthésiologie. MéTHODE: Nous avons colligé des articles à fort impact, classés dans le top 10 % dans le domaine de l’anesthésiologie et publiés de 2011 à 2020, par l’outil InCites basé sur la Web of Science Core Collection. Nous avons analysé les tendances, les emplacements, la répartition des catégories de sujets, les organismes de recherche, les réseaux de collaboration et les termes des sujets de ces articles. RéSULTATS: Au total, 4685 articles à fort impact ont été inclus pour analyse. Le nombre de manuscrits à fort impact est passé de 462 en 2011 à 520 en 2020. L’article ayant la valeur la plus élevée de l’impact normalisé des citations de catégorie (CNCI) (115,95) a été publié dans la revue Anesthesia and Analgesia en 2018. Les articles à fort impact ont été principalement distribués dans les catégories de thèmes « Anesthésiologie », « Neurologie clinique », « Neurosciences » et « Médecine générale interne ». Ils ont été principalement cités dans les catégories « Anesthésiologie », « Neurologie clinique », « Neurosciences », « Médecine générale interne » et « Chirurgie ». La plupart de ces articles à fort impact provenaient des États-Unis, du Royaume-Uni, du Canada, d’Allemagne et d’Australie. Les établissements les plus productifs étaient la League of European Research Universities, l’Université Harvard, l’Université de Toronto, l’Université de Londres, l’Université de Californie System et le University Health Network de Toronto. Des cercles de collaboration en recherche ont été formés aux États-Unis, au Royaume-Uni et au Canada. L’analyse des termes indiquait que l’analgésie postopératoire, la douleur chronique et les complications périopératoires étaient des sujets suscitant un fort intérêt, et la COVID-19 est devenue un nouveau sujet brûlant en 2020. CONCLUSION: La présente étude propose une vue historique des articles à fort impact en anesthésiologie au cours des dix dernières années. Les manuscrits à fort impact provenaient principalement des États-Unis. L’analgésie postopératoire, la douleur chronique et les complications périopératoires ont été des sujets d’actualité, et la COVID-19 est devenue un nouveau sujet en 2020. Ces résultats fournissent des références pour la formation, la recherche et la pratique clinique dans le domaine de l’anesthésiologie.

Keywords: InCites; anesthesiology; education; high-impact papers; research; visual analysis.

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Landmark Papers in Anaesthesia

Michael J. Avram, Ph.D., served as Handling Editor for this book review.

Accepted for publication October 3, 2014.

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Ronald D. Miller; Landmark Papers in Anaesthesia. Anesthesiology 2015; 122:475–476 doi: https://doi.org/10.1097/ALN.0000000000000503

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The Landmark Papers series by Oxford University Press is designed to identify “key” articles in the literature of a particular clinical specialty. The assumption is that fundamental articles represent the basis of every specialty in medicine. Landmark Papers in Anaesthesia summarizes 10 key articles in each of 19 chapters. Twelve of the chapters present fundamental articles on specific anesthesia specialties ( e.g. , neuroanesthesia); the remaining seven chapters are about specific anesthetic techniques ( e.g. , total intravenous anesthesia). The purpose of this book was to create a convenient and well-organized compendium of “classic” articles that would provide an overview of the core principles of anesthesia and also facilitate their review by practicing anesthesiologists.

Editors Webster and Galley began by identifying recognized experts for each of the specialties and techniques to be covered in this text. These experts then selected the 10 most important articles in their field of expertise. Each chapter was organized and managed by one or two experts. The appendix includes four tables listing the top 25 cited articles for Anaesthesia , Anesthesia and Analgesia , A nesthesiology , and British Journal of Anaesthesia . Interestingly, the experts for this text did not select most of the articles listed in the appendix citation tables.

In all, 29 experts were chosen, with 19 from the United Kingdom. The number of articles cited was understandably dominated by anesthesia journals ( e.g. , A nesthesiology [36] and British Journal of Anaesthesia [37]). The editors acknowledged that articles published by anesthetists in nonspecialist and basic science journals could not be easily identified, especially by using the citation index methodology. Yet, the editors did include these and are to be congratulated for citing articles from the Lancet (12 articles), JAMA (3 articles), New England Journal of Medicine (4 articles), Nature (3 articles), and the Royal Society of Medicine (1 article). Without a doubt, research, developments, and techniques published in the world’s leading general medical journals hasten their dissemination and impact on society overall. That the authors have cited anesthesia articles in these leading journals in science and medicine is a major strength of the book.

Depending on one’s definition of our specialty, there are omissions. Specifically, most anesthetic departments now have additional responsibilities that are not covered in this volume. Most obvious are critical care medicine, acute and chronic pain management, separate preoperative evaluation clinics, and transplant anesthesia overall ( i.e. , this text only considers liver transplantation). Also, anesthesia for ophthalmologic and ear, nose, and throat surgery is not considered.

Each review follows a consistent format that includes a summary of the findings, citation count, related references, principal message, strengths and weaknesses, and relevance. This format is superb and provides an excellent, organized approach for the reader to rapidly analyze each article. Perhaps a brief discussion of the role of the citation tables in the appendix would have been helpful to the clinician who does not have experience in the evaluation of the literature.

It was a surprising choice to have one component of anesthesia, “Neuromuscular Blockade,” appear as the first chapter in the book. Nevertheless, this reviewer especially enjoyed the chapter because it reminded me of the extensive debates in the 1980s regarding the virtues of atracurium versus vecuronium. These muscle relaxants generated a tremendous amount of clinical research and facilitated the careers of many young anesthesiologists including this reviewer’s as well as that of the senior author of this chapter. Unfortunately, this chapter’s introduction is not current. For example, the authors stated that “recurarization” and “prolonged block” have been largely confined to history. Examination of the recent literature does not support this conclusion; prolonged neuromuscular blockade is still a significant clinical problem. 1 , 2

Does this book provide us with a complete understanding of the past and future of anesthesiology? The answer is a qualified yes, with two notable reservations. First, as previously indicated, this book does not address the entire spectrum of anesthesiology. Second, the editors neglected to include in their analysis journals with some acknowledged “classic articles”; for example, Severinghaus and Bradley’s blood gases, 3 Gasser and Erlanger’s article on the importance of nerve size for regional anesthesia, 4 and Melzack and Wall’s pain mechanisms. 5 Nor can anesthesiologists avoid the content of these journals: Cousins and Mather’s article on intrathecal and epidural administration of opioids 6 and Lindenbaum and Leifer’s article on the hepatic necrosis associated with halothane anesthesia. 7

The text stimulated this reviewer to examine the influence of the past on the present state of anesthesiology. The selection of specific journals requires judgment and an understanding of the history of anesthesiology. In the preface, the editors even state that the choice of landmark articles was not precisely based on citation counts, but was subjective and based on their expert contributors’ judgments and personal likes and dislikes. This reviewer was intrigued by the editors’ parting suggestion to think about “which articles you would have chosen.” This book is an absolute delight to read. The format is excellent. Hopefully, more such publications will follow. Certainly, understanding the past may facilitate the design of the future.

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Hot topics in anaesthesia: a bibliometric analysis of five high-impact journals from 2010–2019

Published: 22 August 2021
Volume 126 , pages 8749–8759, ( 2021 )

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S. G. Grace ORCID: orcid.org/0000-0001-7583-717X 1 ,
F. S. S. Wiepking ORCID: orcid.org/0000-0002-3509-7549 1 &
A. A. J. van Zundert ORCID: orcid.org/0000-0002-1836-6831 1

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Publication of research in anaesthesia is increasingly competitive. Understanding what topics of research are more likely to be published and where, is clearly valuable for authors seeking to optimise reach and impact of their work. This study aimed to identify the relative proportion of anaesthesia articles by topic for five anaesthesia journals over a 10-year period from 2010 to 2019, including any differences between journals and regions. We chose five anaesthesia journals based on current impact factor. All journal issues published between 2010–2019 were checked for total number of articles with only original research articles being further categorised by topic, country of research, funding status and citation count. Of 5782 original research articles analysed, the most frequent article topics published were translational studies (16%) and clinical practice (16%). Obstetric anaesthesia was the least frequent published (4%). Translational studies were the most frequently funded (84%) while articles on paediatric anaesthesia were least frequently funded (29%). The average number of citations per funded article was 37 versus 28 for non-funded articles. Translational studies were the most frequently published topic of research conducted in North America (25%) and Asia (25%), but of only average frequency in Europe (9%). Studies in obstetric and paediatric anaesthesia are less well-represented in anaesthesia literature and researchers may experience greater difficulty publishing these topics and obtaining funding accordingly. Authors should be aware of the diverse publishing tendencies of the different journals in anaesthesia in order to save time and effort when submitting research for publication.

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Worldwide scientific production in obstetrics: a bibliometric analysis

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Publications from university-affiliated anaesthesiology departments: a look at Belgium, France and the Netherlands from 2001 to 2015

Abbreviations.

British Journal of Anaesthesia

European Journal of Anaesthesiology

Regional Anesthesia and Pain Medicine

High-income country

Low/middle-income country

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Acknowledgements

Many thanks to Rachel Ling and Aakanksha Sahu for their assistance with the original data collection.

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Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women’s Hospital, Brisbane and the University of Queensland, NHB, Butterfield St, Herston, Brisbane, QLD, 4006, Australia

S. G. Grace, F. S. S. Wiepking & A. A. J. van Zundert

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Samuel Grace: concept, design, literature search, data acquisition, original draft and critical revision of draft, approval final draft; Floris Wiepking: concept, design, literature search, data acquisition, original draft and critical revision of draft, approval final draft; André Van Zundert: concept, design, literature search, data acquisition, original draft and critical revision of draft, approval final draft.

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Grace, S.G., Wiepking, F.S.S. & van Zundert, A.A.J. Hot topics in anaesthesia: a bibliometric analysis of five high-impact journals from 2010–2019. Scientometrics 126 , 8749–8759 (2021). https://doi.org/10.1007/s11192-021-04129-0

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DOI : https://doi.org/10.1007/s11192-021-04129-0

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A List Of Unexplored Dissertation Topics In Anaesthesia

Anaesthesia is a medical term which means “loss of sensation”. The medications and their related catalysts are called anaesthetics. These anaesthetics are very useful and crucial in performing the medical tests and the surgical operations in order to induce sleep. It is necessary to put the patient to sleep because this prevents the person from feeling any kind of discomfort and pain and it also enables the surgeons to perform a very wide range of medical procedures that regularly need to be performed for various reasons.

Here we have a number of dissertation topics for your inspiration and needs. These topics are perfect and very suitable for your purpose of starting a good thesis based on a strong but unexplored research in field of anaesthesia. One can do their homework on any of these terms of interest. These dissertation topics are also a good choice for writing an essay for your medical speeches and exhibitions.

Here is a list of some interesting dissertation topics in the field of anaesthesia that have not been appropriately explored yet are:

The comparatively exhaustive relation between fentanyl, hyperbaric lignocaine and intrathecal hyperbaric lignocaine during spinal blockade.
Pain relief via intramuscular route post operation with comparison of inhibitors NSAID and COX-2
The effect of intrathecal tramadol for surgery of hernia on the behavior of subarachnoid blocks.
The overall influence and effect of intrathecal midazolam on the block of subarachnoid for the caesarean section.
Comparatively vigorous study of pre operated bilateral infraorbital block of nerve along with the peri incisional infiltration for the need of post-operative pain relief in the cleft lip surgery in the matters of pediatric cases.
Comparison of intra venous esmolol and oral clonidine for attenuation of the stress response to intubation and laryngoscopy in the middle ear surgery procedures.
Effects of low dose dexmedetomidine upper infusion on the perioperative hemodynamic response and the post-operative analgesia requirements in the patients that are undergoing laparoscopic cholecystectomy.
Dexmedetomidine acting as an adjuvant to the intrathecal hyperbaric bupivacaine for the spinal block characteristics and the post-operative analgesia for the lower limb orthopedic surgeries.
Air way management in the field of pediatric anaesthesia (the Pro seal laryngeal mask airway v/s the endtracheal intubation).
The efficiency and effectiveness of dexamethasone while getting added as an adjuvant to the combination of local anaesthetics in the brachial plexus block for the post-operative analgesia.
The placental morphology and mechanism in the pregnancy induced hyper tension along with its clinical significance.

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Page 1 of 63

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Dissertation writing in post graduate medical education

SS, Harsoor; Panditrao, Mridul M 1 ; Rao, Sumesh 2 ; Bajwa, Sukhminder Jit Singh 3 ; Sahay, Nishant 4 ; Tantry, Thrivikrama Padur 5

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

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

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

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

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

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

Address for correspondence: Dr. Nishant Sahay, AIIMS Patna, Room 503, B5A, New OT Complex (5 th floor), IPD Building, Phulwarisharif, Patna - 801 507, Bihar, India. E-mail: [email protected]

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 4.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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

INTRODUCTION

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

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

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

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

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

Framing the research question (RQ)

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

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

Review of literature

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

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

Aim and the objectives

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

Inclusion and exclusions

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

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

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

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

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

Ethical considerations

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

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

Clinical trial registration

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

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

Randomisation

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

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

Allocation concealment

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

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

Commonly used terms for blinding are

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

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

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

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

Statistical analysis

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

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

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

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

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

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

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

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

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

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

Role of a statistician in dissertation and data analysis

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

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

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

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

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

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

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

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

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

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

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

Graphical images

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

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

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

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

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

What to do when we get a negative result?

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

Publishing the dissertation work

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

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

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

Abstract and Summary

These two are the essential sections of a dissertation.

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

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

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

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

References/bibliography

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

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

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

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

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

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

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

Assessment of dissertations

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

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

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

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

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There are no conflicts of interest.

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Dissertations
M.B.B.S Phase III – Part-II

M.S General Surgery Dissertation

Dissertation Topics Completed (KLE Academic of Higher Education and Research, Belagavi):


Dr. Kannikanti Nageswararao	Dr. A. S. Gogate		Comparison of self retaining freedom proflor mesh repair versus Lichtenstein mesh repair for reduction of postoperative pain in inguinal hernia: a one year randomized controlled trial at KLES Dr. Prabhakar Kore Hospital	2014 to 2017
Dr. Prasanna Ram	Dr. A. S. Godhi	Dr. Rajesh Powar	A one year randomized control trial comparing the efficacy of topical sucralfate vs silver sulfadiazine in the management of burns	2014 to 2017
Dr. Shruti G. Raikar	Dr. S. M. Uppin	Dr. S. I. Neeli	Assessment of plasma homocysteine as a marker of acute renal injury in patients undergoing extracorporeal shock wave lithotripsy (ESWL) for renal stone disease – one year cross sectional study	2014 to 2017
Dr. Hima Bindu Kakarla	Dr. M. S. Sangolli		Randomized control trial of steri-strips versus subcuticular suturing in skin closure of open inguinal hernia	2014 to 2017
Dr. Sonam Tyagi	Dr. S. S. Shimikore		To evaluate the analgesic efficacy of intraperitoneal instillation of tramadol versus bupivacaine for post operative pain relief following laparoscopic appendectomy, a double blind randomized control trial, hospital based study	2014 to 2017
Dr. Ankur Kishore Agarwal	Dr. S. C. Metgud		To evaluate post-operative shoulder tip pain in low pressure (10MMHG Co ) versus standard pressure (14MMHG Co ) pneumoperitoneum in laparoscopic cholecystectomy, a one year randomized controlled trial hospital based study	2014 to 2017
Dr. Amrit Pal Singh Chawla	Dr. V. M. Uppin		A randomized controlled trial to compare papain- urea based preparation vs superoxidised solution in the management of grade 2 diabetic foot ulcer	2014 to 2017
Dr. Rahul Pradhan	Dr. A. C. Pangi		A comparative study of infection rates in the use of mosquito-net mesh versus commercially available prolene mesh in elective Lichtenstein’s tension free inguinal hernia mesh repair at KLES Dr. Prabhakar Kore Hospital & Medical Research Centre: a one year randomized controlled trial	2014 to 2017
Dr. Rampurwala Jakiyuddin Zoeb	Dr. B. M. Kajagar		A randomized control trial to determine the need for post-operative antibiotics after laparoscopic appendicectomy in non-perforated appendicitis	2014 to 2017
Dr. Katkar Aakash Pratap	Dr. A. P. Bellad		A prospective randomized control trial comparing tissue adhesive to conventional suturing in the closure of inguinal hernia skin incisions	2014 to 2017
Dr. Kanyadhara Lihita Krishna	Dr. V. M. Pattanshetti		Conventional laparoscopic appendectomy versus double incision three port appendectomy: a one year randomized controlled trial at KLES Dr Prabhakar Kore Hospital & MRC, Belagavi	2014 to 2017
Dr. Nikhil Sunil Tadwalkar	Dr. Ramesh S. Koujalagi		A one year randomized controlled trial to compare laparoscopic repair vs open repair for the treatment of hollow viscus perforation at KLES Dr. Prabhakar Kore Hospital, Belagavi	2014 to 2017
Dr. Achyuth A. Shivapur	Dr. A. S. Godhi		To Compare The Efficacy Of Topical Timolol Versus Normal Saline Dressing In The Treatment Of Diabetic Foot Ulcers – A Randomized Controlled Trial	2015-2018
Dr. Amar Ashok Murgod	Dr. A. P. Bellad		Role of Diagnostic Laparoscopy In Chronic Abdominal Pain With Uncertain Diagnosis – A One Year Cross Sectional Study at KLES Dr. Prabhakar Kore Hospital and MRC, Belagavi	2015-2018
Dr. Gajjala Bharathkumarreddy	Dr. S. C. Metgud		Comparison Of Skin Incision With Electro Surgical Cautery Vs Scalpel In Elective Inguinal Hernia Surgery: A Randomised Control Study	2015-2018
Dr. Guttikonda Varun	Dr. A. S. Gogate		Comparison Between Hand Suturing Versus Carter- Thomason Needle Closure Of Port Sites In Laparoscopic Surgeries. A One Year Randomised Controlled Study in KLE Dr. Prabhakar Kore Charitable Hospital, Belagavi, Karnataka	2015-2018
Dr. Kumar Nikhil	Dr. M. S. Sangolli		A Cross Sectional Study To Determine Predictive Factors For Difficult Laparoscopic Cholecystectomy Using Ultra-sonographic Criteria	2015-2018
Dr. Ladani Setu Nathalal	Dr. S. S. Shimikore		A One Year Randomized Control Trial Study To Compare Low Molecular Weight Heparin And Unfractionated Heparin In The Rate Of Reduction Of Lower Limb Girth In A Case Of Deep Vein Thrombosis	2015-2018
Dr. Mihir Shankar	Dr. V. M. Pattanshetti		A comparison of post-operative port site pain when gall bladder is retrieved from umbilical port vs epigastric port following laparoscopic cholecystectomy. A prospective one year randomized control trial: single centric hospital based study	2015-2018
Dr. Narra Naga Venkatesh	Dr. M. S. Sangolli		Comparison Of Postoperative Pain In Elective Division Versus Preservation Of Ilioinguinal Nerve In Lichtenstein Inguinal Hernia Repair: A One Year Single Blinded Randomised Controlled Trial At A Tertiary Care Hospital	2015-2018
Dr. Vaibhav Avinash Patil	Dr. V. M. Uppin		Randomized Control Trial To Study The Efficacy Of Tumescent Technique Over Non Tumescent Technique By Using Adrenaline In Healing Of Split Thickness Skin Graft (STSG) Donor Site	2015-2018
Dr. Rishikesh Mallikarjun Hanji	Dr. B. M. Kajagar		Comparison Of Sutures Versus N-Butyl 2- Cyanoacrylate Glue For Mesh Fixation During Primary Inguinal Hernia Repair- A One Year Randomized Control Trial	2015-2018
Dr. V. Geethika	Dr. R. S. Koujalagi		A One Year Randomized Control Trial To Compare The Outcome Of Primary Repair Of Hypospadias With Vascular Cover Using Tunica Vaginalis Flap With Those Using Preputial Dartos Fascia	2015-2018
Dr. Veerendra Patil	Dr. S. C. Metgud		Comparison Of Feasibility And Safety Of Laparoscopic Appendicectomy Under Spinal Anaesthesia VS General Anaesthesia, One Year Randomised Controlled Trial At A Tertiary Care Hospital	2015-2018
Dr. Shetty Vivek Raghuram	Dr. S. S. Shimikore		Subcutaneous wound drainage vs conventional closure in reducing surgical site infection after laparotomy for peritonitis- A randomised control trial	2016-2019
Dr. Patravale Tanmay Bharat	Dr. S. S. Shimikore		Assessment of blood c-reactive protein levels as a predictor of difficult laparoscopic cholecystectomy- a hospital based cross sectional study	2016-2019
Dr. Shah Soham Jineshkumar	Dr. V. M. Uppin		A one year randomized control trial to compare the effectiveness of honey dressing vs povidone iodine dressing for diabetic foot ulcer at Dr. Prabhakar Kore Hospital & MRC,	2016-2019
Dr. Shah Tanay Neelang	Dr. M. S. Sangolli		A one year randomized controlled trial to compare the effect of early versus late Post-operative showering on laparoscopic port site wound infection rates at KLES Dr. Prabhakar Kore Hospital & MRC, Belagavi	2016-2019
Dr. Shruthi S.	Dr. S. C. Metgud		Knotless barbed sutures vs subcuticular monofilament sutures for skin closure in inguinal hernia repair- a randomized controlled trial over 1 year duration at KLES Dr. Prabhakar Kore Hospital & MRC, Belagavi	2016-2019
Dr. Raghavendra G. Pattar	Dr. A. S. Gogate		A study of single Hem-o-lok clips v/s roeder’s knot in laparoscopic appendiceal stump closure: a one year randomized controlled trial study in KLES Dr. Prabhakar Kore	2016-2019
Dr. Priyanka R. Hegde	Dr. B. M. Kajagar		Glycosylated hemoglobin levels and wound healing in diabetic foot ulcers in type 2 diabetes- 1 year prospective study at KLES Dr. Prabhakar Kore Hospital & MRC, Belagavi	2016-2019
Dr. Manish C. A	Dr. A. P. Bellad		Role of pre-operative upper gastro-intestinal endoscopy in patients undergoing elective laparoscopic cholecystectomy for ultrasonographically proven gall bladder stone disease: a one year Hospital based cross sectional study	2016-2019
Dr. Nitin Oommen Ninan	Dr. V. M. Pattanshetti		A one year randomized control study to compare the outcomes of two incision three ports and four ports laparoscopic cholecystectomy at KLES Dr. Prabhakar Kore Hospital & MRC, Belagavi	2016-2019
Dr. Darshan. H. R	Dr. Ramesh S. Koujalagi		Randomized control trial to compare the efficiency of continuous versus interrupted abdominal fascia closure in patients undergoing laparotomy using polydioxanone suture in KLES Dr. Prabhakar Kore Hospital & MRC, Belagavi	2016-2019
Dr. Naresh Veeranki	Dr. Manoj D. Togale		To validate a scoring system to predict difficult laparoscopic cholecystectomy : a one year cross sectional study at KLES Dr. Prabhakar Kore Hospital & MRC, Belagavi	2016-2019
Dr. Kothapalli Sushmitha	Dr. Rahul Kenawadekar		Efficacy of powder free surgical glove bag vs no glove bag for retrieval of the gallbladder during laparoscopic cholecystectomy, a one year randomized controlled study	2016-2019
Dr. Pronoti Rajagonda Patil	Dr. Abhijit S. Gogate		A ONE YEAR RANDOMISED CONTROL TRIAL TO COMPARE APPENDICEAL STUMP CLOSURE TECHNIQUE IN LAPAROSCOPIC APPENDECTOMY WITH LIGA CLIPS V/S HEM-O-LOK IN KLE’S DR PRABHAKAR KORE HOSPITAL, BELGAUM	2017-2020
Dr. Anil Bilagi	Dr. Ashok S. Godhi	Dr. S. G. Alegaon	AN ANALYTICAL STUD OF GALL STONES BY FOURIER TRANSFORM INFRA –RED SPECTROSCOPY TECHNIQUE	2017-2020
Dr. Drishti Patil	Dr. Sidramappa S. Shimikore		MINILAPAROSCOPIC APPENDECTOMY VERSUS LAPAROSCOPIC APPROACH TO APPENDECTOMY : ONE EAR RCT AT KLES DR. PRABHAKAR KORE HOSPITAL AND MEDICAL RESEARCH CENTRE, BELAGAVI	2017-2020
Dr. Saipriya Natarajan	Dr. Veerendra M. Uppin	Dr. Manjunath C. Patil	SPINAL ANESTHESIA VERSUS INGUINAL FIELD BLOCK IN ASSESSING INTRAOPERATIVE EFFECTIVENESS & POST OPERATIVE PAIN USING VISUAL ANALOGUE SCALE FOR INGUINAL HERNIA REPAIR – A ONE YEAR COMPARATIVE STUDY	2017-2020
Dr. Amey M Khanolkar	Dr. Veerendra M. Uppin		ACUTE ABSCESS MANAGEMENT – A PROSPECTIVE 1 YEAR SINGLE – CENTRIC RANDOMIZED CONTROL TRIAL FRO COMPARISON BETWEEN PRIMARY CLOSURE OF ABSCESS VS HEALING BY SECONDARY INTENTION	2017-2020
Dr. Vishranka S Aithal	Dr. Shrishail C. Metgud		COMPARISON OF POST OPERATIVE PAIN AFTER PORT CLOSURE USING SPINAL NEEDLE AND PORT CLOSURE NEEDLE IN PATIENTS UNDERGOING LAPAROSCOPIC APPENDECTOMY – A HOSPITAL BASED RANDOMIZED CONTROLLED TRIAL	2017-2020
Dr. G Sreenivasa Reddy	Dr. Basavaraj M. Kajagar		COMPARISON OF OCTENIDINE WOUND GEL DRESSING VERSUS POVIDONE –IODINE DRESSING IN HEALING OF CHRONIC DIABETIC FOOT ULCERS – A RANDOMISED CONTROLLED TRIAL FOR PERIOD OF ONE YEAR , AT KLE’S DR. PRABHAKAR KORE CHARITABLE HOSPITAL AND MEDICAL RESEARCH CENTRE, BELAGAVI-590010	2017-2020
Dr. Kartik Sahu	Dr. Anilkumar P. Bellad		DIAGNOSTIC EFFICACY OF FENYO-LINDBERG SCORING SYSTEM IN PATIENTS OF ACUTE APPENDICITIS A ONE YEAR CROSS SECTIONAL STUDY IN KLE DR PRABHAKAR KORE HOSPITAL	2017-2020
Dr. M Shashidhar Reddy	Dr. Vishwanath M. Pattanshetti		A ONE YEAR RANDOMIZED CONTROL TRIAL TO COMPARE POST OPERATIVE MORBIDITY IN LAPAROSCOPIC INGUINAL HERNIA REPAIR VERSUS LICHTENSTEIN TENSION FREE HERNIA REPAIR – A SINGLE CENTRIC HOSPITAL BASED STUDY	2017-2020
Dr. Drona Sharma	Dr. Ramesh S. Koujalagi		A COMPARATIVE STUDY TO ACCESS EFFICACY OF TZANAKIS SCORE AND ALVARADO SCORE FOR EFFECTIVE DIAGNOSIS OF PATIENTS WITH ACUTE APPENDICITIS AT KLE DR. PRABHAKAR KORE HOSPITAL AND MEDICAL RESEARCH CENTRE, BELAGAVI – A ONE YEAR PROSPECTIVE ANALYTICAL STUDY	2017-2020
Dr. Pulkit Gupta	Dr. Manoj D. Togale		TO DETERMINE WELLS CRITERIA AS A RELIABLE CLINICAL TOOL IN DIAGNOSIS OF DEEP VEIN THROMBOSIS A ONE YEAR CROSS SECTIONAL SINGLE CENTRIC HOSPITAL BASED STUDY	2017-2020
Dr. Shashank Sunil Kari	Dr. Abhijit S. Gogate		CONVENTIONAL DRESSING VERSUS USE OF MANDAKINI DEVICE IN TREATING DIABETIC FOOT ULCERS : A RANDOMISED CONTROL TRIAL	2017-2020
Dr. Nikhil M	Dr. Abhijit S. Gogate		COMPARISON OF PROLENE VERSUS POLYGLACTIN SUTURES (VICRYL) FOR MESH FIXATION IN ASSESSING POSTOPERATIVE CHRONIC PAIN USING VISUAL ANOLOGUE SCALE IN INGUINAL HERNIA REPAIR – A ONE YEAR RANDOMISED CONTROL TRIAL”	2018-2021
Dr. Naren Mandalapu	Dr. Abhijit S. Gogate		“COMPARISON OF ABSORBABLE MULTIFILAMENT SUTURE (VICRYL ) AND NON-ABSORBABLE MONOFILAMENT SUTURE (PROLENE ) IN LAPAROSCOPIC PORT SITE CLOSURE USING SPINAL NEEDLE – A HOSPITAL BASED RANDOMIZED CONTROLLED TRIAL”	2018-2021
Dr. Mulakala Sravya Keerthi	Dr. Sidramappa S. Shimikore		“A COMPARISON OF COSMETIC OUTCOME OF PERIUMBILICAL VERSUS INTRAUMBILICAL INCISION IN LAPAROSCOPIC APPENDECTOMY AND CHOLECYSTECTOMY – A ONE YEAR RANDOMISED CONTROLLED TRIAL”.	2018-2021
Dr. B. Vipin Reddy	Dr. Veerendra M. Uppin		“TOPICAL PHENYTOIN SODIUM DRESSING IN DIABETIC ULCER – A COMPARATIVE STUDY WITH POVIDONE IODINE DRESSING: A 1 YEAR RANDOMIZED CONTROLLED TRAIL”	2018-2021
Dr. Azam Ali Shaik	Dr. Shrishail C. Metgud		“COMPARISON OF HYALURONATE-IODINE AND ORNIDAZOLE COMPLEX WOUND GEL DRESSING VERSUS POVIDONE-IODINE DRESSING IN HEALING OF CHRONIC DIABETIC FOOT ULCERS: A RANDOMISED CONTROLLED TRIAL FOR PERIOD OF ONE YEAR, AT KLE’S DR. PRABHAKAR KORE HOSPITAL AND MEDICAL RESEARCH CENTRE, BELAGAVI-590010”.	2018-2021
Dr. Janani M. N.	Dr. Shrishail C. Metgud		“TREATMENT OF VENOUS ULCER OF THE LOWER LEG BY ENDOVENOUS LASER ABLATION: ONE YEAR LONGITUDINAL STUDY”,	2018-2021
Dr. Ahana Bandyopadhyay	Dr. Basavaraj M. Kajagar		“EFFICACY OF TOPICAL ATORVASTATIN MEDICATION ON DIABETIC FOOT ULCER WOUND HEALING DYNAMICS – A RANDOMIZED CONTROLLED TRIAL FOR PERIOD OF ONE YEAR, AT KAHER;S DR. PRABHAKAR KORE HOSPITAL AND MEDICAL RESEARCH CENTRE, BELAGAVI-590010”.	2018-2021
Dr. Aarushi Mishra	Dr. Anilkumar P. Bellad		“ASSESSMENT OF SEVERITY OF DIABETIC FOOT ULCERS USING DIABETIC ULCER SEVERITY SCORE IN PATIENTS ADMITTED AT KLES DR. PRABHAKAR KORE HOSPITAL AND MEDICAL RESEARCH CENTRE, BELAGAVI – A ONE YEAR LONGITUDINAL STUDY”.	2018-2021
Dr. Prashant Sharma	Dr. Vishwanath M. Pattanshetti		“A ONE YEAR RANDOMIZED CONTROL STUDY TO COMPARE THE OUTCOMES OF PERIANAL SURGERY WOUNDS WHEN USING SILVER COLLOIDAL SOLUTION SPRAY VS. POVIDONE IODINE SITZ-BATH AT KLES DR. PRABHAKAR KORE HOSPITAL”.	2018-2021
Dr. Athira C	Dr. Ramesh S. Koujalagi		“ONE YEAR STUDY OF PREVALENCE OF HYPOTHYROIDISM IN PATIENTS WITH GALL BLADDER STONES AT KLE’S DR PRABHAKAR KORE HOSPITAL AND MRC, BELAGAVI”.	2018-2021
Dr. Kaushika Hubballi	Dr. Manoj D. Togale		“ANALYSIS OF LAPAROSCOPIC PORT SITE COMPLICATIONS – A ONE YEAR DESCRIPTIVE STUDY IN KLE’S DR PRABHAKAR KORE HOSPITAL BELAGAVI, A SINGLE CENTRIC STUDY”.	2018-2021
Dr. Kukreja Barkha Kailashkumar	Dr. Rahul Kenawadekar		“OPEN ANATOMICAL REPAIR V/S LAPAROSCOPIC REPAIR OF UMBILICAL HERNIA USING NO. 1 POLYDIOXANONE SUTURE (PDS), RANDOMIZED CONTROL TRIAL”	2018-2021

Dissertation Topics Ongoing (KLE Academic of Higher Education and Research, Belagavi):


Dr. Saoji Kaivalya Rajendra	Dr. Abhijit S. Gogate	A comparison of polypropylene versus polydioxanone (PDS) for mesh fixation in assessing postoperative pain using visual anologue scale in inguinal hernia repair- a one year randomised control trial	2019-2022
Dr. Puntambekar Aishwarya Shailesh	Dr. Abhijit S. Gogate	Comparison between octyle-2 cyanoacrylate glue versus 3-0 poliglecaprone 25 sutures for port site skin closure in assessing cosmetic outcome using modified hollander cosmesis scale in elective laparoscopic cholecystectomy and laparoscopic appedicectomy- a one year hospital based randomized controlled trial	2019-2022
Dr. Prithiviraj M.	Dr. Sidramappa S. Shimikore	Endoscopic versus open subfacial ligation in the treatment of perforator incompetence of varicose vein in terms of postoperative pain and cosmetic outcome- one year observational study.	2019-2022
Dr. Ghei Prem Sanjay	Dr. Shrishail C. Metgud	A prospective study to evaluate diagnostic efficacy of serum CRP levels in clinically diagnosed cases of acute appendicitis confirmed by HPR	2019-2022
Dr. Erbin J. E	Dr. Shrishail C. Metgud	Post-operative pulmonary complications in emergency laparotomy for acute abdominal condition- a one year observational study	2019-2022
Dr. Muzumdar Ameya Saiprasad	Dr. Basavaraj M. Kajagar	Gall bladder wall thickness at preoperative sonography and its impact on operative outcome of laparoscopic cholecystectomy, a one year prospective study at KAHER’s Dr. Prabhakar Kore Hospital.	2019-2022
Dr. Rahul Rai	Dr. Anilkumar. P. Bellad	A study for assessment of risk factors and incidence of surgical site infection in cases operated for peritonitis in KLE Dr. Prabhakar Kore Hospital & MRC, Belgaum.	2019-2022
Dr. M. Shubhashree	Dr. Vishwanath. M. Pattanshetti	Accidental gallbladder perforation durging laparoscopic cholecystectomy: incidence and effect on the patients admitted at a tertiary care centre: a one year prospective study	2019-2022
Dr. Ritika	Dr. Ramesh S. Koujalagi	Comparative study to access efficacy of modified alvarado scoring system versus ripasa scoring system in effective diagnosis of patients with acute appendicitis in a tertiary case hospital. A one year prospective analytical study	2019-2022
Dr. Dhinesh Ram C.	Dr. Manoj D. Togale	Evaluation of acute pancreatitis and its correlation with clinical outcome using modified computed tomography severity index in a tertiary care hospital- an observational study	2019-2022
Dr. Salil Aggarwal	Dr. Rahul Kenawadekar	Comparison of platelet rich plasma injection with normal saline dressing in rate of chronic ulcer healing, a one year randomised control trial	2019-2022
Dr. Adil Anwar Bagwan	Dr. Vishwanath M. Pattanshetti	A comparative study of appendicitis inflammatory response score and tzanakis score for diagnosis of patients with acute appendicitis at KLE Dr. Prabhakar Kore Hospital and Medical research Center, Belgaum-A one year prospective study	2020-2023
Dr. Amol Agarwal	Dr. Ramesh S. Koujalagi	Use of trocars and port dipped in 10% povidone iodine solution versus conventional technique to prevent port site infection in laparoscopic surgeries: A Hospital based randomized control trial study	2020-2023
Dr. Andra Ravikiran	Dr. Rahul Kenawadekar	Intra-Abdominal adhesions: A prospective observational study of the incidence, peritoneal adhesion index (PAI) based distribution & severity in a tertiary care hospital.	2020-2023
Dr. B. Sushanth Kumar	Dr. Basavaraj M. Kajagar	Prospective evaluation of platelet parameters in diagnosis of acute appendicitis-One year observational study, at KAHER’s Prabhakar Kore Charitable Hospital and Medical Research Center, Belagavi-590010.	2020-2023
Dr. Bishal Saha	Dr. Anilkumar P. Bellad	A comparative study to assess the post-operative morbidity parameters in patients undergoing uncomplicated laparoscopic cholecystectomy with placement of sub-hepatic drain-one year randomized controlled trial in KLE’s Dr. Prabhakar Kore Hospital and Medical Research Center Belagavi.	2020-2023
Dr. Kartikeya Atrey	Dr. Shrishail C. Metgud	Pre-Operative serum albumin and body mass index as predictors of surgical site infection in patients ungergoing open mesh repairs for incisional hernias-A longitudinal study.	2020-2023
Dr. Kashetty Kranthi Kiran	Dr. Shrishail C. Metgud	Ultrasound and computerized tomography guided therapeutic drainage of intra-abdominal abscess, a cross sectional observation study for a period of one year at KAHERA, Dr.Prabhakar Kore Hospital and Research Centre, Belagavi	2020-2023
Dr. Kolli Pravallika	Dr. Vishwanath M. Pattanshetti	longitudinal study to determine the application of site, ischemia, neuropathy, bacterial infection, area and depth[Sinbad]scoring in the outcome and management of diabetic foot ulcer- At KLE’s Dr. Prabhakar Kore Hospital	2020-2023
Dr. Nishi Gupta	Dr. Veerendra M. Uppin	Comparison on intra incisional instilliation of bupivacaine with normal saline into the wound for post operative analgesia. A 1 year hospital based RCT study at KLES Dr. Prabhakar Kore Hospital and MRC.	2020-2023
Dr. Prabhu Tanvi Pravinkumar	Dr. Manoj D. Togale	A prospective study to evaluate use of neutrophil to lymphocyte ratio (NLR) as a marker for severe acute cholecystitis	2020-2023
Dr. R. Bharathasena	Dr. Prashant Hombal	Prospective evaluation of correlation between the signs and symptoms of acute appendicitis with their respective intra operative positions of appendix- A One year observational study, At KAHER’s Dr. Prabhakar Kore Charitable Hospital and Medical research Center, Belagavi-590010	2020-2023
Dr. Rhea Pirojshaw Sarkari	Dr. Abhijit S. Gogate	Assessment and evaluation of peripheral neuropathy, vascular changes and plantar foot pressures in patients diagnosed with type II diabetes within the last 1 year- a cross sectional study	2020-2023
Dr. Rohit Gulgullia	Dr. Veerendra M. Uppin	A comparative study between ransons criteria and modified computed tomography severity index to determine which is more accurate in predicting prognosis in a patient diagnosed with acute pancreatitis, a cross sectional study	2020-2023
Dr. Shubham Yadav	Dr. Basavaraj M. Kajagar	Hypocholesterolemia (<151mg/dl) & Hypoalbuminemia (<3.5g/dl) As predictors of surgical site infections in elective general surgical procedures: A prospective observational study for period of 1 year at KAHER’s Dr. Prabhakar Kore Hospital and Medical Research Center, Belagavi.	2020-2023
Dr. Siddharth Reddy	Dr. Abhijit S. Gogate	Comparison of all three 5MM ports laparoscopic appendectomy with conventional laparoscopic appendectomy-hospital based randomized controlled trial.	2020-2023
Dr. Urbee Gupta	Dr. Anilkumar P. Bellad	Autologous platelet rich plasma v/s conventional sutures-A randomized control trial to compare their efficacy in anchoring split skin graft on wounds	2020-2023
Dr. V. Chidambara Krishnan	Dr. Anilkumar P. Bellad	Association of serum lipid profile with severity of acute pancreatitis, an one year prospective observational study.	2020-2023
Dr. Yakkaluri Ganesh Kumar Reddy	Dr. Abhijit S. Gogate	Quality of life of patients with hirschsprung’s disease and anorectal malformation after pull through surgery: observational study for period of 1 year at KAHER’s Dr. Prabhakar Kore Charitable Hospital and Medical Research Centre	2020-2023


Dr. Adil Anwar Bagwan	Dr. Vishwanath M. Pattanshetti	A comparative study of appendicitis inflammatory response score and tzanakis score for diagnosis of patients with acute appendicitis at KLE Dr. Prabhakar Kore Hospital and Medical research Center, Belgaum-A one year prospective study	2020-2023
Dr. Amol Agarwal	Dr. Ramesh S. Koujalagi	Use of trocars and port dipped in 10% povidone iodine solution versus conventional technique to prevent port site infection in laparoscopic surgeries: A Hospital based randomized control trial study	2020-2023
Dr. Andra Ravikiran	Dr. Rahul Kenawadekar	Intra-Abdominal adhesions: A prospective observational study of the incidence, peritoneal adhesion index (PAI) based distribution & severity in a tertiary care hospital.	2020-2023
Dr. B. Sushanth Kumar	Dr. Basavaraj M. Kajagar	Prospective evaluation of platelet parameters in diagnosis of acute appendicitis-One year observational study, at KAHER’s Prabhakar Kore Charitable Hospital and Medical Research Center, Belagavi-590010.	2020-2023
Dr. Bishal Saha	Dr. Anilkumar P. Bellad	A comparative study to assess the post-operative morbidity parameters in patients undergoing uncomplicated laparoscopic cholecystectomy with placement of sub-hepatic drain-one year randomized controlled trial in KLE’s Dr. Prabhakar Kore Hospital and Medical Research Center Belagavi.	2020-2023
Dr. Kartikeya Atrey	Dr. Shrishail C. Metgud	Pre-Operative serum albumin and body mass index as predictors of surgical site infection in patients ungergoing open mesh repairs for incisional hernias-A longitudinal study.	2020-2023
Dr. Kashetty Kranthi Kiran	Dr. Shrishail C. Metgud	Ultrasound and computerized tomography guided therapeutic drainage of intra-abdominal abscess, a cross sectional observation study for a period of one year at KAHERA, Dr.Prabhakar Kore Hospital and Research Centre, Belagavi	2020-2023
Dr. Kolli Pravallika	Dr. Vishwanath M. Pattanshetti	longitudinal study to determine the application of site, ischemia, neuropathy, bacterial infection, area and depth[Sinbad]scoring in the outcome and management of diabetic foot ulcer- At KLE’s Dr. Prabhakar Kore Hospital	2020-2023
Dr. Nishi Gupta	Dr. Veerendra M. Uppin	Comparison on intra incisional instilliation of bupivacaine with normal saline into the wound for post operative analgesia. A 1 year hospital based RCT study at KLES Dr. Prabhakar Kore Hospital and MRC.	2020-2023
Dr. Prabhu Tanvi Pravinkumar	Dr. Manoj D. Togale	A prospective study to evaluate use of neutrophil to lymphocyte ratio (NLR) as a marker for severe acute cholecystitis	2020-2023
Dr. R. Bharathasena	Dr. Prashant Hombal	Prospective evaluation of correlation between the signs and symptoms of acute appendicitis with their respective intra operative positions of appendix- A One year observational study, At KAHER’s Dr. Prabhakar Kore Charitable Hospital and Medical research Center, Belagavi-590010	2020-2023
Dr. Rhea Pirojshaw Sarkari	Dr. Abhijit S. Gogate	Assessment and evaluation of peripheral neuropathy, vascular changes and plantar foot pressures in patients diagnosed with type II diabetes within the last 1 year- a cross sectional study	2020-2023
Dr. Rohit Gulgullia	Dr. Veerendra M. Uppin	A comparative study between ransons criteria and modified computed tomography severity index to determine which is more accurate in predicting prognosis in a patient diagnosed with acute pancreatitis, a cross sectional study	2020-2023
Dr. Shubham Yadav	Dr. Basavaraj M. Kajagar	Hypocholesterolemia (<151mg/dl) & Hypoalbuminemia (<3.5g/dl) As predictors of surgical site infections in elective general surgical procedures: A prospective observational study for period of 1 year at KAHER’s Dr. Prabhakar Kore Hospital and Medical Research Center, Belagavi.	2020-2023
Dr. Siddharth Reddy	Dr. Abhijit S. Gogate	Comparison of all three 5MM ports laparoscopic appendectomy with conventional laparoscopic appendectomy-hospital based randomized controlled trial.	2020-2023
Dr. Urbee Gupta	Dr. Anilkumar P. Bellad	Autologous platelet rich plasma v/s conventional sutures-A randomized control trial to compare their efficacy in anchoring split skin graft on wounds	2020-2023
Dr. V. Chidambara Krishnan	Dr. Anilkumar P. Bellad	Association of serum lipid profile with severity of acute pancreatitis, an one year prospective observational study.	2020-2023
Dr. Yakkaluri Ganesh Kumar Reddy	Dr. Abhijit S. Gogate	Quality of life of patients with hirschsprung’s disease and anorectal malformation after pull through surgery: observational study for period of 1 year at KAHER’s Dr. Prabhakar Kore Charitable Hospital and Medical Research Centre	2020-2023

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

Comparing postgraduate anaesthesia education in India and abroad: Strengths and scope

Lalit mehdiratta.

Department of Anaesthesiology, Critical Care and Emergency Medicine, Narmada Trauma Centre, Bhopal, Madhya Pradesh, India

Nandini M. Dave

1 Department of Anaesthesiology, NH-SRCC Children's Hospital, Keshavrao Khadye Marg, Mahalakshmi, Mumbai, Maharashtra, India

Neeru Sahni

2 Department of Anesthesia and Intensive Care, PGIMER, Chandigarh, India

Edward Johnson

3 Department of Anaesthesiology, Kanyakumari Government Medical College, Asaripallam, Kanyakumari, Tamil Nadu, India

Prasanna U Bidkar

4 Department of Anaesthesiology and Critical Care, Division of Neuroanaesthesiology, JIPMER, Puducherry, India

Anju Grewal

5 Department of Anaesthesiology, DMCH, Ludhiana, Punjab, India

The quality of training is a major contributor to workforce proficiency in healthcare, and there is a definite need to achieve a uniform level of knowledge and skill in medical education programmes. There is a paucity of literature comparing postgraduate anaesthesia medical education training structure and requirements across the globe. In a zeal to achieve uniform competencies and technical skills, the strengths and scope of training programmes need to be identified. In this article, we describe the core elements of postgraduate training in various countries while proposing an amalgamation of strengths of each programme and providing a roadmap to evolve further the competency-based comprehensive curriculum proposed by the National Medical Commission of India.

INTRODUCTION

The raging pandemic has made it crucial for nations to upgrade their healthcare infrastructure and workforce for effective health care delivery within their own country and across borders. One of the major contributors to workforce proficiency is the quality of training received during the postgraduate (PG) training programme. Anaesthesiologists have been catapulted to the forefront of all medical specialities in recent times, thus making it imperative for us to enhance the quality and uniformity of knowledge and skill development in medical education programmes.

Scientific literature comparing PG anaesthesia medical education training structure and requirements across the globe is scant, and it is indeed time to define the strengths and scope of PG training programmes to move towards uniform competencies and technical skills acquisition. Apart from core anaesthesiology technical skills, a lot of emphasis has been given to the inclusion of non-technical skills like team-work and communication into the curriculum.[ 1 ] The objective of writing this article is to compare various aspects of anaesthesiology PG education training structure between India as proposed by the National Medical Commission (NMC) of India and other major countries, so as to assist policymakers in adopting the strengths of anaesthesia training programmes across the globe, thereby empowering the Indian anaesthesia PG to deliver services efficiently anywhere across the world.

PG TRAINING CURRICULUM AND TEACHING METHODOLOGY

The latest guiding principles from NMC focus on a competency-based PG training programme in Anaesthesiology with specific learning objectives in theoretical knowledge, skill and attitude development.[ 2 ] NMC mandates that the training is well planned, supervised and delivered by well-trained teachers. The PG student learns the basic principles of safe and effective anaesthesia, to prevent and treat pain as well as the overall care of the surgical patient during a period of three years in which the first six months are for training in the management of uncomplicated cases and the selection of thesis topic with submission of the requisite protocol. During the next 18 months, the clinical experience broadens as the student learns the skills of performing and maintaining general as well as regional anaesthesia for the American Society of Anesthesiologists (ASA) grade I to V patients. In the last 12 months, thesis submission is mandatory at least six months before the final examination. Super speciality postings like cardiothoracic and vascular surgery, etc., should be covered, and there should be at least four months of intensive care unit (ICU) posting. Our PG training should expand to include extensive training in ICU and trauma triage units. The trainees also need to grasp management and organisation during pandemics.[ 3 ] Apart from the description of clinical rotations and goals of learning year-wise, a detailed syllabus covering the three domains has been proposed.

Cognitive domain: It pertains to the ability to demonstrate the knowledge of relevant anatomy, physiology, biochemistry, principles of physics, gas laws, pre-anaesthetic assessment, anaesthesia techniques, basic and advanced life support, neonatal resuscitation and trauma life support as per the latest guidelines. The student must learn about the history of anaesthesia; management of an unconscious patient; and understand the principles of ventilation, shock management, oxygen therapy, etc. Post-operative care, acute and chronic pain management, research methodology and basics of statistics, arterial blood gas analysis, rational use of blood and its components, tenets of sterilisation and infection control are also included. Principles and techniques of various anaesthetic procedures; care of terminally ill; the concept of auditing; reporting of critical incidents along with clinical trial and ethics; design of operation theatre (OT), ICU and hospital, etc., are also to be imparted.

Affective domain: The trainee needs to learn methods of effective communication with colleagues, patients, their families and other health personnel.

Psychomotor domain: This includes skill development in broad areas and the competence of the student to demonstrate the abilities of a perioperative physician, including pre-operative equipment check, monitoring, failed intubation drills, etc. Proficiency in most performed anaesthesia procedures is expected, along with skills in emergency anaesthesia, trauma and resuscitation. At this point, the student can demonstrate the practice of regional anaesthesia, thoracic and cardiovascular anaesthesia, paediatric anaesthesia, transplant anaesthesia, neuro anaesthesia apart from anaesthetic considerations in surgical procedures like rhinootolaryngological, orthopaedic, obstetrics and gynaecology, replacement surgeries, urosurgery, vascular, plastic, dental, non-operating room location anaesthesia, etc.

There are a variety of teaching methods [ Table 1 ]. Emphasis is given to safety, communication skills, behaviour, attitude, ethics, audit and management. Students acquire hands-on training in performing various procedures, including exposure to newer modalities.[ 2 ] A logbook pertaining to these activities is required to be maintained.

Post Graduate (PG) anaesthesiology curriculum, teaching and assessment methodology: A comparison across countries

Country	PG curriculum	Teaching Methods	Assessment
INDIA	National Medical Commission focus on competency-based PG training programme Duration: Three years (MD); Two years (DA); Two-three years (DNB) At least four months ICU rotation Research (Thesis) mandatory Domains: cognitive, affective, psychomotor	Tutorials, case discussions, seminars, symposia, journal clubs, clinical demonstrations, grand rounds and research presentations Hands-on training on models and performance under supervision Simulators for events of high importance	Formative assessment (Quarterly) Summative assessment at the end of the training Logbook of activities The final examination consists of three parts: 1) Thesis 2) Theory evaluation 3) Practical/Clinical and viva voce
EUROPE	European Training Requirement (ETR) Five years, at least one year ICU Competencies: Expert clinician, Professional leader, Academic scholar, Inspired humanitarian Domains: General and Specific core competencies	Workplace-based, supervised experiential learning Independent, self-directed learning Small group sessions with peers Formal education sessions, including case presentations, journal clubs, audit and quality improvement projects, joint speciality meetings Simulation training	Formative assessments throughout based on the Mini-CEX or direct observations and simulation-based In-training evaluations [Multiple-choice questions (MCQs) or viva] Logbook of activities A “tutor” or “mentor” for follow-up and feedback Nine European countries have officially adopted the EDAIC as National examination. In some, EDAIC is the official exit examination.
CANADA	Competency-based medical education (CBME) Five years Four stages with milestones Stage 1: Transition to Discipline, two months Stage 2: 16 Entrustable Professional Activities (EPA), 22 months Stage 3: Core, 30 months Stage 4: Transition to Practice, 6-12 months	Clinical rounds, resident educational retreats, simulation training, journal club POCUS Boot camps, block rotations, longitudinal educational sessions, portfolio sessions, research training, senior revision tutorial	EPA to be attained at the end of the stage Assessment strategies to be linked to each EPA for assessments and feedback Each EPA comprises milestones that outline the progression and span the seven CanMeds domains
UK	14 domains Seven years Three stages Stage 1: 3 years, low to moderate risk patients Stage 2: 2 years, specialist areas of anaesthetic practice Stage 3: 2 years, Bridge from training to consultant practice	Lectures, tutorials, e-learning Scenario-based immersive simulation training Outcome-based learning Focus on excellence than competence alone	Initial Assessment of Competence Primary FRCA in Stage 1: Summative assessment Objective Structure Clinical Examination (OSCE): summative assessment of a candidate’s clinical communication skills and applied technical knowledge. Structured Oral Examination (SOE): Summative assessment of basic sciences Final FRCA: Written examination, gateway to the Final FRCA SOE Final FRCA SOE: the last component of the FRCA examination
USA	Accreditation Council for Graduate Medical Education (ACGME) curriculum 36 or 48 months Six core competencies: Professionalism, Patient care and procedural skills, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, systems-based practice	Didactic teaching, grand rounds, case discussions, courses, conferences, simulations and drills, critical appraisal of evidence	Formative assessment Summative assessment. Written Examinations. (MCQs) OSCE

EDAIC: European Diploma in Anaesthesiology and Intensive Care; FRCA: Fellowship of the Royal College of Anaesthesiologists; ICU: Intensive care unit; MD: Doctor of Medicine; DNB: Diplomate of National Board; PG: Postgraduate; POCUS: Point of Care Ultrasound; UK: United Kingdom; USA: United States of America

The competency-based medical education in India has also incorporated self-directed learning (SDL), which is a process in which the onus of learning is with the trainees as they themselves decide their goals of learning, take initiatives to diagnose their needs, look for resources and also, evaluate the outcomes.[ 4 ] A PG student must read one paper at a national/state conference, present one poster and one research paper. The research paper should be published or be sent for publication during the period of training, which then makes them eligible to appear for the PG degree examination.[ 5 ] Good quality research can be encouraged by promoting research methodology and scientific paper writing workshops.[ 6 ]

Apart from Doctor of Medicine (MD) Anaesthesia (3 years) and Diploma in Anaesthesia (2 years), the Diplomate of National Board (DNB) offers PG anaesthesiology courses (2–3 years) in India. The completion of training prepares the trainee to work as a specialist in the community and as a medical teacher and researcher in the field.[ 7 ]

The European Training Requirement (ETR) in anaesthesiology guidelines emphasise competency-based specialist training over a minimum duration of five years, including one year of training at an intensive care unit (ICU). Four generic competencies and roles have been identified.[ 8 ]

Expert clinician: This includes the domain of perioperative medicine, intensive care medicine, resuscitation of critically ill patients and acute and chronic pain management.

Professional leader: The competencies in communication, and human interactions, must be developed, enabling the specialist in Anaesthesiology to effectively organise and manage tasks during professional activities.

Academic scholar: This role enables the specialist to be able to contribute to the development of new medical knowledge through research and implementation thereof. They also acquire basic tools for teaching and education presentations.

Inspired humanitarian: This aspect defines the role as a professional with high empathy, integrity, compassion and honesty. This also includes the ethical aspects in patient care and decision-making along with medico-legal concerns pertaining to the practice of Anaesthesiology.

To fulfil these four roles, there is a list of domains of competencies which have been divided as general core competencies (general anaesthesia, regional anaesthesia, airway management, perioperative care, acute pain management, intensive care and emergency medicine, patient safety, non-technical skills, ethics and professionalism, health economics, self-directed learning and research) and specific core competencies (obstetric, cardiothoracic, neuro and paediatric anaesthesiology, chronic pain management).

For each domain, the learning objectives have been categorised as knowledge, skills and attitudes to finally achieve the required level of competency, defined as:

Observer level
Performs, manages, demonstrates under direct supervision
Performs, manages, demonstrates under distant supervision
Performs, manages, demonstrates independently

Also included are various clinical guidelines, standards of quality care and medical simulation training.

There is a focus on competency-based medical education (CBME) and the duration of training is five years. Since July 2017, Anaesthesiology programmes have been structured according to the Competency by Design (CBD), an initiative by the Royal College of Physicians and Surgeons of Canada. Anaesthesia trainees are trained in four stages and each stage has a predetermined milestone to achieve.[ 9 ]

Stage 1, the introductory stage, named Transition to Discipline (TTD), is of two months duration which includes courses like Advanced Trauma Life Support (ATLS), Basic Life Support (BLS), Transthoracic Echocardiography and Ultrasound. During this stage, hands-on operating room experience is ensured along with didactic and simulation-based teaching.

Stage 2 is of 22 months duration, and it includes 16 Entrustable Professional Activities (EPA). The trainee is initially rotated in internal medicine, paediatrics, emergency medicine, cardiology and respiratory medicine before proceeding to advanced rotations in general anaesthesia and ICU.

In stage 3, which is the core and lasts for 30 months, the trainee is rotated in advanced sub-specialities in anaesthesia such as neuro-anaesthesia, cardiac, paediatrics and ICUs and near the end of the core, they write the written portion of the Royal College examination.

Stage 4 is the Transition to Practice with a duration of 6 to 12 months. The trainee is trained vigorously to be independent in delivering advanced consultant-level anaesthetic care.

United Kingdom (UK)

The goal of the curriculum for anaesthesia training in the UK is similar to that in Canada. They aim to achieve 14 domains of learning ranging from professional behaviour, communication, management, requirements (both professional and regulatory), teamwork, safety and quality improvement, education and training, perioperative medicine, general anaesthesia, regional anaesthesia, resuscitation and transfer, research and data management, procedural sedation, intensive care and pain management. The training has been divided into three stages over seven years.[ 10 ] Each stage has a specific critical point to enable the trainee to move on to the next stage and final recommendation for Certification of Completion of Training (CCT).[ 11 ]

Stage 1 (three years): Trainee anaesthetists are introduced to elective as well as emergency practices along with perioperative care. Duration of training is spent for gaining clinical experience in low to moderate risk patients. During this stage of training, anaesthetists will complete the primary Fellowship of the Royal College of Anaesthetists (FRCA) examination.

Stage 2 (two years): Trainees are introduced to broader areas of anaesthesia so that they consolidate skills gained in Stage 1 while learning specialist areas of anaesthetic practice. Thus, they get trained for generalist practice with more autonomy while learning management of high-risk patients. During this stage, they complete the final FRCA examination.

Stage 3 (two years): This level is a bridge from training to consultant practice where anaesthetists mature in their clinical skills for conducting safe practice. At the end of this stage, they will have the requisite expertise for complex clinical situations and also manage any organisational issues.

The anaesthetic training is more outcome-based than time-based. The four competencies defined are medical expert, leader, scholar and professional. As a medical expert, the anaesthetist should know anaesthetic and medical technology, principles of general medicine pertaining to methods in diagnosis and therapy based on a thorough knowledge of applied physiology, pharmacology, respiratory, circulatory and nervous systems.

As a leader, the important competence considered is effectiveness in communication. As a scholar, there should be professional competency as well as capability to promote development in Anaesthesiology. Lastly, as a professional, the anaesthesia specialist should have impeccable behaviour and be thorough about duties and responsibilities acceptable as a professional. To fulfil these four identified professional roles, there is a list of domains of expertise and their related competencies.[ 12 ]

United States of America (USA): Accreditation council for graduate medical education (ACGME) curriculum

The programme duration ranges from 36 months to 48 months; the 48 months programme includes additional 12 months of training in basic clinical skills in medicine. At least six months of fundamental training should incorporate family medicine, neurology, internal medicine, paediatrics, gynaecology and obstetrics, surgery or any surgical speciality. At least a month in critical care and emergency medicine is mandatory. The remaining 36 months of training is about perioperative medicine with the distribution of clinical experience in surgical anaesthesia, critical care medicine and pain medicine. Two weeks each for pre-operative medicine and post-anaesthesia care is a must. In critical care, at least four 1-month rotations should be there wherein the trainee participates as an integrated member of critical care teams. Further, two 1-month rotations are suggested for obstetric anaesthesia, paediatric anaesthesia, neuro anaesthesia and cardiothoracic anaesthesia. A minimum of 3 months in pain medicine and two weeks in anaesthesia for patients undergoing procedures outside operating rooms is planned. Certification in Advanced Cardiac Life Support (ACLS) is mandatory, at least once during residency, as is at least one simulated clinical experience each year.

Along with the educational curriculum, importance is given to the availability of basic facilities to the trainees, like food and refrigeration facilities, rest areas, availability of reference materials, etc. The roles of programme director, core faculty and programme coordinator are explicitly narrated. Also, the core didactic academic activities are defined for which the time is protected.

There are six core competencies of ACGME.[ 13 ]

Professionalism: It includes the demonstration of compassion, integrity and respectful behaviour. There should be responsiveness to patient needs, consideration for patient privacy as well as autonomy. The resident should be able to manage personal and professional well-being and disclose and address conflict of interest appropriately.
Patient Care and Procedural skills: The residents should provide appropriate, compassionate and effective patient care. Along with fundamental skills of medicine, they must be able to demonstrate competence in anaesthesia management. This includes objectively defined competency skills, like the care of 100 patients less than 12 years of age, including 20 children less than five years and five under three months of age; 20 patients for pain evaluation; anaesthesia care for 40 patients undergoing vaginal delivery, 20 undergoing caesarean section, 20 patients undergoing cardiac surgery, including 10 with the use of cardiopulmonary bypass and so on.
Medical knowledge: This includes knowledge of current and upcoming biomedical, clinical, epidemiological and social-behavioural science and their application in patient care.
Practice-based learning and improvement: They should be able to demonstrate investigation ability with which they can evaluate patients, and assimilate this knowledge and evidence to improve the care of patients.
Interpersonal and communication skills: There is a focus on the development of soft skills so that there is effective communication and good collaboration with all the patients and other health professionals.
Systems-based practice: The trainee must understand the system of health care, including social factors determining health and should develop the ability to use resources appropriately to provide the best possible health care.

Topics such as professional liability, billing arrangements, health care finance have also been given due importance. Competence in the identification of one's own deficiencies, strengths and expertise is emphasised. The importance of utilising feedback and evaluation into daily practice, concluding evidence from scientific literature and the use of information technology is encouraged. The structure of training must ensure sufficient length of rotations for optimal learning, relationship with faculty and assessment and feedback.[ 13 ]

A recent review compared similarities and differences in competencies in anaesthesiology residency for the European Union (ETR), United States (ACGME Milestones), and Canada (CBD). The authors found that about 93% of competencies were common, and the difference between the three repositories was in terms of emphasis. While ETR emphasised non-technical skills in anaesthesia, CBD highlighted finely detailed competencies within specific anaesthesiology situations, and ACGME Milestones emphasised behavioural practices and professionalism.[ 14 ]

South East (SE) Asia

Anaesthesia education in SE Asia is quite diverse. Singapore follows the American model with a 5-year residency program.[ 15 ] The training programme is an outcome-based modular training programme with structured objectives and goals stipulated in accordance with the requirements of the ACGME. The Philippines and Malaysia model is similar to India with a 3-year basic residency programme.

ASSESSMENT METHODOLOGY

The assessment methodologies followed across the globe are varied [ Table 1 ]. In India, according to PG Medical Education Regulations, 2000 of NMC, a combination of both formative and summative assessment is vital for the successful completion of the PG programme. Formative assessment should be done continuously to assess knowledge about anaesthesia, patient care and procedural skills. There should also be an ongoing assessment for professionalism, SDL and interpersonal skills. Frequent internal assessment should include all learning domains and provide feedback as well. The quarterly assessments should include recent advances, skill-based learning, SDL, interdepartmental learning activity and external activities.[ 2 ] The formative assessment is being carried out in many institutes in the form of exams at fixed intervals.[ 16 ]

To be eligible for the final assessment, the candidate has to submit a dissertation on a relevant topic under the direct supervision of the guide. As a part of the final assessment, candidates have to undergo theory and practical examinations. Theory examinations consist of four papers and detailed practical examinations include case-based discussions, assessment of knowledge in anaesthesia equipment, drugs, objective structured clinical examination (OSCE), and communication skills. The student has to score eligibility marks (above 50%) in both theory and practical examinations. OSCE, as a formative or summative examination, is being used increasingly for objectivity and reliability both by teachers and students. The preset standards of competence and checklists rule out any biases while covering a large number of topics.[ 17 ]

In addition to the above, the assessment of procedural skills should be made essential. Direct Observation of Procedural Skills (DOPS) is one such tool developed by the Royal College of Physicians in 2007.[ 18 ] Yet another tool, the Objective Structured Assessment of Technical Skill (OSATS) includes a global rating scale and a task-specific checklist. OSATS has been considered superior to other methods of assessing clinical competencies. However, a robust rating scale to improve performance using OSATS is still lacking.[ 19 ]

Anaesthesiologists desiring to practice overseas following completion of training in India need to appear for the licensing examination; United States Medical Licensing Examination (USMLE) (USA), Professional and Linguistic Assessments Board (PLAB) (UK) and European Diploma in Anaesthesiology and Intensive Care (EDAIC) (Europe).

Whilst enlisting and comparing the strengths and scope of various PG anaesthesia training programmes across the globe, we propose an amalgamation of the strengths of each programme, especially in regard to technical and non-technical competencies with an aim to be able to develop a critically thinking perioperative physician, compassionate professional leader, and a scholar with research capabilities. The programmes followed by Canada, the USA and perhaps European countries need to be adapted to our unique geographical needs and logistical conditions. We need to incorporate simulation technology not only in training but also as part of an ongoing formative and summative assessment. The aim should be to inculcate critical thinking in an empathetic, ethical and logical manner.

In summary, it is indeed time to upgrade our PG training programme and its duration uniformly across the country and across the globe. We also need to think about the feasibility of a uniform competency-based exit exam, akin to the final FRCA exam in the UK. Physician exchange programmes, not only for the student but also for teachers with the best across the globe, should aim at constant quality improvement initiatives. We should be ambassadors for a radical change in our systems to be able to produce lifelong empathetic, ethical learners equipped to adapt to varying clinical environments with an aim to enhance patient safety and quality of perioperative care across the length and breadth of our country.