Thesis Topic Recommendations for Postgraduate Internal Medicine
I recommend focusing your thesis on quality improvement in morbidity and mortality conferences (M&M) or acute-on-chronic liver failure (ACLF) management, as these represent high-impact areas with significant knowledge gaps, established frameworks for research, and direct relevance to patient outcomes in internal medicine.
Priority Topic Areas
1. Quality Improvement in Morbidity and Mortality Conferences
This represents an ideal thesis topic because M&M conferences are universal in internal medicine training yet suffer from poorly defined goals and inconsistent educational outcomes. 1, 2
Specific Research Questions You Could Address:
Implementation of patient safety frameworks: Evaluate whether restructuring M&M conferences to emphasize systems-based analysis rather than individual blame improves identification of actionable quality improvements 3, 2
Educational outcome measurement: The literature reveals a marked disconnect between what faculty believe they are teaching (process improvement, systems thinking) and what residents value learning (medical content knowledge) 1
Just culture integration: Examine how incorporating psychological safety principles and peer-review protection affects adverse event reporting rates and quality of case discussions 2
Concrete metrics: You could measure system improvements implemented (one study achieved 59% implementation of 121 suggested improvements), resident attendance rates, and attitudinal changes using validated surveys 3
Why This Works as a Thesis:
Established methodology exists: The SCARE guidelines provide a standardized framework for case presentation and outcome assessment 4, 5
Measurable outcomes: You can track both educational outcomes (resident attitudes, knowledge acquisition) and clinical outcomes (system improvements implemented, patient safety metrics) 3
Institutional support likely: Every internal medicine program conducts M&M conferences, making this immediately relevant and implementable 1, 2
Addresses ACGME competencies: Directly targets systems-based practice and practice-based learning and improvement milestones 6
2. Acute-on-Chronic Liver Failure Management in General ICU Settings
ACLF carries 30-50% 28-day mortality yet lacks standardized management protocols in general intensive care units, making this a high-impact research area. 4, 7
Specific Research Questions You Could Address:
Prognostic score validation: Compare NACSELD-ACLF scores versus traditional MELD scores in predicting mortality in your institution's patient population, as MELD markedly underestimates mortality in ACLF 7
Early palliative care integration: Measure whether incorporating palliative care consultation within 48 hours of ACLF diagnosis improves quality of life metrics and family satisfaction 7
Infection screening protocols: Develop and test an aggressive infection screening algorithm, since infection precipitates 48% of ACLF cases but traditional sepsis markers (lactate, fever, blood pressure) are unreliable in cirrhosis 7
Norepinephrine versus terlipressin: Conduct a comparative effectiveness study for hepatorenal syndrome-AKI treatment in your ICU setting 7
Why This Works as a Thesis:
Clear clinical guidelines exist: The French Society of Anesthesiology and Critical Care Medicine (SFAR) and French Association for the Study of the Liver (AFEF) produced 18 consensus statements providing a framework for your research 4
High mortality justifies research: With 30-50% mortality at 28 days, even modest improvements in management could significantly impact patient outcomes 7
Knowledge gaps are explicit: The guidelines specifically identify areas needing further research, including optimal timing for transplant referral and futility criteria 7
Multidisciplinary collaboration: This topic naturally involves hepatology, critical care, transplant surgery, and palliative care, enriching your training experience 4
3. Multi-Morbidity Management in Internal Medicine
Internal medicine residents struggle with managing patients with multiple chronic conditions, yet this represents the dominant clinical scenario in modern practice. 6
Specific Research Questions You Could Address:
Prioritization algorithms: Develop decision-support tools for prioritizing competing treatment goals in patients with 3+ chronic conditions (e.g., diabetes + heart failure + chronic kidney disease) 8, 6
Polypharmacy reduction: Test deprescribing protocols in hospitalized patients with multi-morbidity, measuring 30-day readmission rates and adverse drug events 6
Geriatrics-internal medicine collaboration: Implement and evaluate a curriculum combining internal medicine and geriatrics competencies for managing complex patients 6
Why This Works as a Thesis:
Addresses identified educational gaps: SGIM specifically identified this as a priority area for collaboration and curriculum development 6
Practical clinical relevance: Every internal medicine resident encounters these patients daily, making your findings immediately applicable 6
Assessment tools available: Geriatrics competencies can be mapped to internal medicine milestones, providing validated assessment frameworks 6
Methodological Considerations for Your Thesis
Study Design Options:
Quality improvement project: Use Plan-Do-Study-Act (PDSA) cycles to implement and refine interventions, which 11 studies in guideline implementation research successfully employed 4
Pre-post intervention study: Measure outcomes before and after implementing your intervention, as demonstrated in the M&M conference redesign study that showed significant improvements 3
Cohort study: Compare outcomes between patients managed with different protocols, particularly relevant for ACLF prognostic score validation 7
Critical Success Factors:
Use established frameworks: The GRADE methodology provides rigorous evidence evaluation for guideline development 4
Engage stakeholders early: 50% of successful guideline implementation studies identified barriers and tailored interventions accordingly 4
Define outcomes clearly: Prioritize patient-centered outcomes (mortality, morbidity, quality of life) over surrogate endpoints 5
Plan for sustainability: Document how improvements will be maintained after your thesis is complete, as this determines real-world impact 4
Common Pitfalls to Avoid:
Inadequate sample size: Calculate required sample size before starting data collection to ensure sufficient power for detecting meaningful differences 4
Incomplete follow-up: Establish multiple assessment timepoints (baseline, immediate post-intervention, mid-term, long-term) rather than single-point measurement 5
Ignoring implementation barriers: Identify and address local barriers (staffing, resources, culture) that could prevent successful intervention adoption 4
Poorly defined outcomes: Avoid vague endpoints like "improved care quality" in favor of specific, measurable outcomes like "30-day mortality" or "number of system improvements implemented" 3