thesis examination outcomes

• University News
• Academic Departments A-Z
• Map & Directions
• Careers at HKUST
• Faculty Profiles
• About HKUST
• HKUST Fok Ying Tung Graduate School
• Administration
• PG Facts and Figures
• Publications
• Postgrad Channel
• Sharing by Postgraduate Students and Graduates

About FYTGS

• Program Types
• Areas of Studies
• PG Prospectus and Booklets
• Continuing and Professional Education
• Programs and Courses
• HKUST College of LifeLong Learning
• Useful Links
• How to Apply
• Admission Requirements
• Admission Timeline
• Documents Required
• Scholarships & Fees
• Online Application
• Accepting an Offer
• Submitting Official Documents
• Applying for Student Visa
• Handy Resources for Preparing Your Studies
• Moving to Hong Kong (for Non-Local Students)
• PG Visiting Internship Students (Research Only)
• Visiting PG Students (Coursework Only)
• PG Exchange Students
• Associate Postgraduate Students
• Preparing your Short-Term Study @HKUST

• Aims and Objectives of Research Postgraduate Education
• Strategic Framework for Taught Postgraduate Education
• Programs & Courses
• Academic Standards
• Code of Practice for RPg Thesis Supervision
• Academic Requirements for RPg Students

Handbook for Research Postgraduate Studies

• Handbook for Taught Postgraduate Studies
• Scholarships for Admission
• Hong Kong PhD Fellowship Scheme
• Targeted Taught Postgraduate Programmes Fellowships Scheme
• Other Funding & Scholarships

Scholarship

• Guidelines & Forms
• Online Systems
• Program/Course Guidelines and Proposals
• Introduction
• Meeting Schedules
• Meeting Documents
• Circulation
• Annual Reports
• Annual Reporting of Self-financing Programs
• Working Schedule
• Student Surveys and Statistics
• Training Series for HKUST(GZ)
• PG Outreach and Admissions
• Quick Access
• Download Prospectus
• University Governance
• Student Conduct and Academic Integrity
• Policies and Practices Governing Research Activities
• Scholarships, Awards and Financial Assistance
• Registration in Programs
• Study Commitment
• Curriculum Requirements (with guidelines on thesis research)
• Course Registration
• Course Substitution and Credit Transfer
• Course Grading
• Progression and Academic Standing
• Appeals and Grievance Channels
• Glossary of Terms

Guidelines on Conducting MPhil and PhD Thesis Examinations

A. introduction.

• The thesis examination is mandatory for those enrolled in research postgraduate programs. It is conducted by a Thesis Examination Committee (TEC).
• An MPhil TEC normally consists of at least three faculty members. One is the thesis supervisor; if there are two thesis supervisors, they will both be on the committee, which will then comprise four members. Of the other two members, one is appointed as Chairperson. All three (or four) are voting members.
• A PhD TEC normally consists of a Chairperson and at least five voting examiners. The examiners include the thesis supervisor(s), two faculty members from the candidate’s major Department, one faculty member from outside the Department, and one faculty external to the University who has expertise in the field being examined.

B. Protocol

• A thesis examination takes place in a single session, comprising four parts. The first two parts are open to all members of the University and to departmental guests. The third part is closed to all but the candidate and the TEC, and the fourth is a closed session of the TEC in the absence of the candidate.
• The first part is an oral presentation by the candidate, emphasizing the major elements of the research and the results obtained. The candidate is expected to apportion no more than 60 minutes for the presentation.
• The second part is an open questioning session, involving the TEC members, and others in attendance. During this part of the examination, all questions are addressed through the Chairperson, and any dialogue is limited to the candidate and the individual questioner.
• The third part is a closed session involving a less formal discussion between the candidate and the TEC. Other than the candidate and the TEC, other persons are not ordinarily allowed to attend this part. However, in exceptional circumstances, with the prior agreement of the candidate, the thesis supervisor and the TEC Chairperson, other persons may be allowed to attend as observers. It should be noted that observers are not permitted to participate in the examination or attempt to influence the examiners in their assessment of the thesis examination. At the end of this part of the examination, the candidate and any observers must leave the examination venue.
• The fourth and final part is a closed session involving only the TEC, who then assess the quality of the thesis, and the performance of the candidate during the examination. In arriving at a decision, the votes of members of the TEC carry equal weight.
• The TEC will convey the outcome of the thesis examination to the student immediately after the thesis examination. The outcome will be recorded in a proforma report, the “ Report on Thesis Examination Results for Research Postgraduate Degrees ”, as described below.

The examination result will be reported in a proforma entitled “ Report on Thesis Examination Results for Research Postgraduate Degrees ” and submitted by the TEC Chairperson.

• This Report comprises several parts, to be completed by the examiners. Some parts need to be completed before the examination.
• The TEC Chairperson shall collect Part 2 of the report from all the examiners and complete Part 3 and Part 4.1 of the report.
• The report must include all comments that the TEC or the Chairperson wishes to make on the conducting of the examination, the quality of the thesis, the contribution of the thesis to the field of study, the performance and competency of the candidate in the thesis examination, and any other remarks relating to the thesis and the examination.
• All TEC members must sign the report.
• The TEC Chairperson shall return the completed form to Department for further follow up, as described below.

The Chairperson is also required to submit an online “ Chairperson’s Report on Thesis Examination ” to the HKUST Fok Ying Tung Graduate School (FYTGS)  within one week from the date of the thesis examination, reporting any irregularities observed during the conduct of the thesis examination.

D. Outcomes

A thesis examination, whether MPhil or PhD, will have one of the following results:

• Passed subject to minor corrections;
• Passed subject to major corrections;
• Failed but may be resubmitted; or

The protocols for handling each outcome are described below.

• Procedure. The Chairperson will forward the completed “ Report on Thesis Examination Results for Research Postgraduate Degrees ”, together with the final thesis, to the head of the candidate’s Department. After signing the report, the Department Head/Program Director will forward it to the Dean or the Dean’s designee for endorsement. Finally, the Department will forward it to the Academic Registry for action and record.
• Thesis submission deadline. If a thesis has been graded “Passed”, the candidate must, within one week of the date of the thesis examination, submit an electronic copy of the final thesis, together with the electronic copy of the authorization page containing the student’s signature, and a signature page containing signatures of the thesis supervisor(s) and Department Head/Program Director, to the University’s Thesis Submission System.
• Procedure. In this case, the Chairperson should pass the entire set of documents to the thesis supervisor(s) who should keep the report until the candidate has submitted a revised thesis to his/her satisfaction before the deadline as described below. The full set of documents, with the final thesis, should then be forwarded to the Department Head/Program Director and the Dean or the Dean’s designee for endorsement before passing to the Academic Registry for action and record.

Thesis submission deadline. In this case, the final thesis and the iThenticate report must be submitted within three months from the date of the thesis examination, or a date specified by the TEC, whichever is earlier. The iThenticate report should be handed in to the supervisor(s), via the Department for review and endorsement.

• The thesis supervisor will record whether the corrections are satisfactory in the “ Report on Thesis Examination Results for Research Postgraduate Degrees ”.
• Upon approving the thesis, the supervisor will forward the signed report, together with the final thesis, to the Department to obtain signatures of Department Head/Program Director.
• Candidates should allow sufficient time for the above approval processes.
• Finally, the candidate must submit an electronic copy of the final thesis, with the electronic copy of the authorization page containing the student’s signature and the appropriate signatures of approval, to the University’s Thesis Submission System.
• Procedure. In this case, the Chairperson should pass the entire set of documents to the thesis supervisor(s) who should keep the report until the candidate has submitted a revised thesis approved by the TEC before the deadline as described below. The full set of documents, with the final thesis, should then be forwarded to the Department Head/Program Director and the Dean or the Dean’s designee for endorsement before passing to the Academic Registry for action and record.

Thesis submission deadline. In this case, the final thesis and the iThenticate report must be submitted within 12 months from the date of the thesis examination, or a date specified by the TEC, whichever is earlier. The iThenticate report should be handed in to the TEC via the Department for review and endorsement.

• The revised thesis requires the approval of the full TEC.
• The TEC may recommend that a re-examination be held before a final assessment is arrived at. If a re-examination is required, the TEC membership should be the same as that for the first examination, unless otherwise recommended by the Department or FYTGS. In this case, the protocol is repeated, as for the first examination.
• The TEC will need to indicate whether the major corrections are satisfactory by completing the “ Report on Thesis Examination Results for Research Postgraduate Degrees ”. If the members are satisfied with the revised thesis, the final thesis must be submitted, with the electronic copy of the authorization page containing the student’s signature and the appropriate signatures of approval, to the University’s Thesis Submission System.
• In this case, the Chairperson should forward the duly completed “ Report on Thesis Examination Results for Research Postgraduate Degrees ” to the head of the candidate’s Department. After signing the report, the Department Head/Program Director will forward it to the Dean or the Dean’s designee for endorsement.
• The TEC membership may or may not be the same as that for the first examination.
• Failure in the second attempt of thesis examination will result in the automatic withdrawal of the candidate from the program of study and termination of registration at the University.
• Timeline. At least six months should pass before the second thesis examination. The protocol is repeated, as for the first examination.

E. Submission of Final Thesis

Thesis copy. On successful completion of the thesis examination, and after any required corrections, a candidate must submit a copy of the thesis (either hard or electronic) to the Department.

For final theses which have been graded “Passed subject to minor corrections” or “Passed subject to major corrections”, students are required to submit the thesis for originality check via iThenticate. The iThenticate report should be handed in to their thesis supervisor(s), and the Thesis Examination Committee if applicable, for review and endorsement via their Department.

The Department will arrange for the appropriate signatures of approval to be obtained, and then return the signed copy to the candidate. The candidate will upload and submit the Signature Page and the Authorization Page as a PDF file and the final thesis as another PDF file to the University’s Thesis Submission System. The candidate does not need to replace the two unsigned pages in the thesis PDF with the scanned signature pages. The candidate will receive email acknowledgement of successful upload. The final thesis will be forwarded to the thesis supervisor(s) for approval via the Thesis Submission System. 

Note: Candidates should allow sufficient time for the thesis supervisor(s) to check and verify their final version of the thesis, and for the Department to obtain signatures of approval before the submission deadline.

• The “ Report on Thesis Examination Results for Research Postgraduate Degrees ” will be submitted by the Department to the Academic Registry.
• Other documents. Candidates are also required to submit other documents to the Department together with the final thesis. Details are available on the FYTGS website.
• Failure to meet submission deadline. If a candidate fails to submit the final thesis before his/her specific deadline, the candidate will be deemed to have failed to meet the thesis examination requirements of the University and to have failed the requirements of the degree program being pursued. If the candidate fails to meet the deadline in submitting the final thesis, and the delay is through no fault of the candidate, the candidate may appeal for an exception to the above rules in a written letter. The appeal must be supported by the thesis supervisor(s) and PG Coordinator of the Department, and endorsed by the relevant School. It should then be submitted to FYTGS for further arrangements.

Examination of Doctoral Theses: Research About the Process and Proposed Procedures

• Reference work entry
• First Online: 12 June 2018
• Cite this reference work entry

• Ronel Erwee 7 &
• Chad Perry 7 , 8  

Part of the book series: University Development and Administration ((UDAA))

1501 Accesses

3 Citations

Despite some standard thesis examination guidelines having been established by institutions, examination of theses by individual examiners was known in the 1990s and early 2000s to be an irregular and idiosyncratic process that could delay completion of candidature. This chapter reviews research that established this disappointing position about issues in the examination process and what happened a decade after this initial situation. It then proposes some standard procedures to make sound thesis examination procedures for institutions and examiners. These procedures cover many issues that affect the thesis examination process like the definition of a degree, selection of examiners, criteria to evaluate the contribution of the research, and proposals for future policies and practices.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

• Available as PDF
• Read on any device
• Instant download
• Own it forever
• Available as EPUB and PDF
• Durable hardcover edition
• Dispatched in 3 to 5 business days
• Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Albertyn, R.M., C.A. Kapp, and B.L. Frick. 2007. Taking the sting out of evaluation: Rating scales for thesis examinations. South African Journal of Higher Education 21 (8): 1207–1221.

Google Scholar  

American Psychological Association. 2015. Publication manual of the American psychological association . 6th ed. http://www.apastyle.org/manual/index.aspx . Accessed 7 Apr 2015.

Australian Qualifications Framework. 2013. Australian qualifications framework .. http://www.aqf.edu.au/wp-content/uploads/2013/05/AQF-2nd-Edition-January-2013.pdf . Accessed 18 Apr 2016.

Blass, E., S. Bertone, J. Luca, C. Standing, R. Adams, H. Borland, R. Erwee, A. Jasman, K. Tickle, and Q. Han. 2013. Developing a toolkit and framework to support new postgraduate research supervisors in emerging areas . Sydney: Report to the Office of Teaching and Learning, Department of Industry, Innovation, Science, Research and Tertiary Education.

Department of Finance and Administration. 2002. Style manual for authors, editors and printers . 6th ed. Brisbane: Wiley.

Edith Cowan University. 2016. Research assessments – guidelines for examination of PhD theses. https://intranet.ecu.edu.au/data/assets/pdf_file/0010/418726/PhD_exam_guidelines.pdf ; http://intranet.ecu.edu.au/research/for-research-students/research-journey/thesis-examination/information-for-examiners and http://intranet.ecu.edu.au/research/for-research-students/research-journey/thesis-examination/appeals . Accessed 9 May 2016.

Holbrook, A., and S. Bourke. 2008. Consistency and inconsistency in PhD thesis examination. Australian Journal of Education 52 (1): 36–48.

Article   Google Scholar  

Holbrook, A., S. Bourke, H. Fairbairn, and T. Lovat. 2014. The focus and substance of formative comment provided by PhD examiners. Studies in Higher Education 39 (6): 983–1000.

Johnston, S. 1997. Examining the examiners: An analysis of examiners’ reports on doctoral theses. Studies in Higher Education 22 (3): 333–347.

Kiley, M. 2009a. Rethinking the Australian doctoral examination process. Australian Universities Review 51 (2): 32–41.

Kiley, M. 2009b. ‘You don’t want a smart Alec’: Selecting examiners to assess doctoral dissertations. Studies in Higher Education 34 (8): 889–903.

Lawson, A., H. Marsh, and T. Tansley. 2003. Examining the examiners. Australian Universities Review 46 (1): 32–36.

Luca, J., and T. Wolski. 2013. Higher degree research training excellence: A good practice framework. Presentation of Final Report to Council of Deans and Directors of Graduate Students for Office for Learning and Teaching. www.ddogs.edu.au or [email protected].

Mullins, G., and M. Kiley. 2002. “It’s a PhD, not a Nobel Prize”: How experienced examiners assess research theses. Studies in Higher Education 27 (4): 369–386.

Nelson, H. 1991. The gatekeepers: Examining the examiners. Australian Historical Association Bulletin 68: 12–27.

Nightingale, P. 1992. Initiation into research through writing. In Starting research – Supervision and training , ed. O. Zuber-Skerritt. Brisbane: Tertiary Education Institute, University of Queensland.

Office of Teaching and Learning. 2013. Supervision of higher degree by research students: Supervisor resource book . Canberra: Department of Education. http://researchsupervisiontoolkit.com/page/rst-ebook . Accessed 3 Apr 2016.

Perry, C. 1998. A structured approach for presenting theses. Australasian Marketing Journal 6 (1): 63–85.

Perry, C. 2013. Efficient and effective research . Adelaide: ABE Publications.

Perry, C., and A. Cavaye. 2004. Australian universities’ examination criteria for DBA dissertations. International Journal of Organisational Behaviour 7 (5): 411–421. http://pandora.nla.gov.au/pan/10282/20040713-0000/www.usq.edu.au/resources/perrycavaye.pdf . Accessed 28 Apr 2016.

Perry, C., J.L. McPhail, and L. Brown. 1998. How are marketing theses examined? Proceedings , Australia and New Zealand Marketing Academy Conference (ANZMAC98), University of Otago, Dunedin, Dec 1998.

Phillips, E. 1992. The PhD: Assessing quality at different stages of its development. In Starting research – Supervision and training , 119–136. Brisbane: Tertiary Education Institute, University of Queensland.

Pitkethly, A., and M. Prosser. 1995. Examiner’s comments on the international context of PhD theses. In Research into higher education: Dilemmas, direction and diversions , ed. C. McNaught and K. Beatte, 129–136. Melbourne: Higher Education and Research and Development Society Australasia Victoria.

Starfield, S., B. Paltridge, R. McMurtrie, A. Holbrook, S. Bourke, H. Fairbairn, M. Kiley, and T. Lovat. 2015. Understanding the language of evaluation in examiners’ reports on doctoral theses. Linguistics and Education 31: 130–144. https://doi.org/10.1016/j.linged.2015.06.004 .

Tewari, D.D. 2012. Examination of doctoral theses/dissertations: Models practices, and guidelines. African Journal of Business Management 6 (9): 3438–3448. https://doi.org/10.5897/AJBM11.652 . http://www.academicjournals.org/AJBM . Accessed 24 Apr 2016.

University of Newcastle. 2016a. Research into the PhD examination. Study of Research training and Impact (SORTI) https://www.newcastle.edu.au/research-and-innovation/centre/sorti/publications/research-into-phd-examination . Accessed 9 May 2016.

University of Newcastle. 2016b. Thesis examination guidelines. http://www.newcastle.edu.au/__data/assets/pdf_file/0020/72470/Thesis-Examination-Guidelines-Nov-2015.pdf . Accessed 11 May 2016.

University of Southern Queensland. 2016. Examination process. http://www.usq.edu.au/research/research-students/current-research-students/examination . And ‘PhD by publication procedure’ http://policy.usq.edu.au/documents/13383PL . Accessed 20 May 2016.

Download references

Author information

Authors and affiliations.

School of Management and Enterprise, University of Southern Queensland, Toowoomba, QLD, Australia

Ronel Erwee & Chad Perry

Australian Institute of Business, Adelaide, SA, Australia

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Chad Perry .

Editor information

Editors and affiliations.

School of Management and Enterprise, University of Southern Queensland, Toowoomba, Queensland, Australia

Ronel Erwee

Open Access College, University of Southern Queensland, Toowoomba, Queensland, Australia

Meredith A. Harmes

Marcus K. Harmes

School of Linguistics, Adult and Specialist Education, University of Southern Queensland, Toowoomba, Queensland, Australia

Patrick Alan Danaher

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer Nature Singapore Pte Ltd.

About this entry

Cite this entry.

Erwee, R., Perry, C. (2018). Examination of Doctoral Theses: Research About the Process and Proposed Procedures. In: Erwee, R., Harmes, M., Harmes, M., Danaher, P. (eds) Postgraduate Education in Higher Education. University Development and Administration. Springer, Singapore. https://doi.org/10.1007/978-981-10-5249-1_4

Download citation

DOI : https://doi.org/10.1007/978-981-10-5249-1_4

Published : 12 June 2018

Publisher Name : Springer, Singapore

Print ISBN : 978-981-10-5247-7

Online ISBN : 978-981-10-5249-1

eBook Packages : Education Reference Module Humanities and Social Sciences Reference Module Education

Share this entry

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Publish with us

Policies and ethics

• Find a journal
• Track your research

• Thesis submission and examination

Thesis examination and outcomes

Postgraduate Advocacy Service

Our caseworkers are experts on Uni policy, and advocate on behalf of Usyd postgrads to improve your rights and research conditions. 

SUPRA Legal Service

Our solicitors can assist with a wide range of legal issues, from intellectual property to contracts, as well as visas and migration law.

Stay in touch with us

Current students

• Staff intranet
• Find an event

Thesis submission

• Notice of intent to submit
• Submit your thesis
• What happens next
• Your thesis in the University Library

Each examiner will provide a detailed report and summary recommendation for the award of your degree. Typical outcomes are:

• award with corrections.

If the examiners’ recommendations vary, the University will consider the reports and make a recommendation. This is done by an academic committee in consultation with your supervisor. We will advise you of the outcome and provide you with copies of the examiners’ reports.

An examiner can also provide the following recommendations:

• revise and resubmit for a second examination
• not to be awarded a doctoral degree but be awarded another eligible degree
• do not award.

If this occurs, the faculty will consider the reports and provide a recommendation. In the case of doctoral examinations, the faculty recommendation and examiners’ reports will then be reviewed by the Higher Degree Research Examination Sub-Committee. Additionally, masters by research examinations in the Faculty of Arts and Social Sciences and Faculty of Medicine and Health will be reviewed by this committee.

All other master's examinations will be decided by review at the relevant faculty committee.

If you need to substantially revise your thesis to resubmit for a second examination, we will advise you in writing. We’ll also provide advice about re-enrolling in your course for two or more research periods.

Related links

• Prepare your thesis
• Academic dishonesty and plagiarism
• Research progress

Higher Degree by Research Administration Centre

• +61 2 8627 4343

Find your discipline contact

Opening hours: 9am to 5pm, Monday to Friday.

• Website feedback

Your feedback has been sent.

Sorry there was a problem sending your feedback. Please try again

You should only use this form to send feedback about the content on this webpage – we will not respond to other enquiries made through this form. If you have an enquiry or need help with something else such as your enrolment, course etc you can contact the Student Centre.

• Find an expert
• Media contacts

Student links

• How to log in to University systems
• Class timetables
• Our rankings
• Faculties and schools
• Research centres
• Campus locations
• Find a staff member
• Careers at Sydney
• Emergencies and personal safety

• Accessibility

• Research, Partnerships and Innovation
• Postgraduate Research Hub
• Thesis and Examination: The Code of Practice

Examination outcomes and reports

An overview of the potential recommendations concerning the award or non-award of a doctoral degree.

After the oral examination, the examiners must complete a report that is sent to Research, Partnerships and Innovation for faculty approval. This is a joint report, to which the preliminary reports completed by each examiner prior to the examination must also be appended.  If the examiners are unable to agree on a recommendation, a third examiner, external to the University, is normally appointed. Research, Partnerships and Innovation must be informed immediately so that arrangements for this can be made.

Examiners must clearly indicate on the report form their recommendation concerning the award or non-award of the degree. The recommendations open to the examiners following first submission and oral examination are set out on the joint report form, as follows:

• that the degree be awarded without the need for any corrections to the thesis
• that the degree be awarded once specified minor corrections have been completed to the satisfaction of the examiners
• that the degree be awarded once specified major corrections have been completed to the satisfaction of the examiners
• that the degree be not now awarded, but that the candidate be allowed to undergo a further oral examination without modification of the form or content of the thesis
• that the degree be not now awarded, but that the candidate be allowed to submit a revised thesis after such modification of form or content as the examiners may prescribe, with/without oral re-examination
• that the degree be not awarded

In addition, examiners for the degree of PhD may also make either of the following recommendations:

• that the degree of PhD be not awarded, but that the degree of Master of Philosophy (MPhil) be awarded (subject only to the necessary changes to the cover and title page of the thesis)
• that the degree of PhD be not awarded, but that the candidate be allowed to submit a revised thesis for the degree of MPhil after such modification of form or content as the examiners may prescribe, with/without oral re-examination

Recommendations for resubmissions and for other degrees may vary and are specified in the Guidance Notes for Examiners  and on the appropriate examiners’ joint report form. Recommendations other than those specified for a particular degree are not permitted.

Once completed and signed, the joint report form should be returned to Research, Partnerships and Innovation within two weeks of the date of the oral examination. Where minor or major corrections are required, the separate minor/major corrections sheet should be detached and retained until the corrections have been completed to the examiners' satisfaction. One of the examiners will be required to approve the corrections once they have been completed. This is normally undertaken by the internal examiner. The examiner should then sign and date the separate minor or major corrections sheet and return it immediately to Research, Partnerships and Innovation.

Pass with minor corrections

This option may be chosen if the examiners are satisfied that the thesis meets the requirements for the award of the degree, but contains deficiencies that are genuinely minor in nature, such as typographical or presentational errors.  The nature and extent of the required corrections should be such that they can reasonably be completed and submitted to the examiner within a period of three calendar months from the date the examiners notify the student of the corrections.

If more substantial corrections are required before the award of the degree can be recommended, or if the examiners remain in some doubt that the thesis is likely to meet the required standard for the degree after minor corrections, then the examiners should make a different recommendation.

Where minor corrections are required, it is the examiners' responsibility to provide the student with details of the required changes as soon as possible following the viva.

The examiners should also advise the student of the three-month timescale for completion of the corrections.  Students who are undertaking minor corrections to their thesis will have their time limit extended by three months and can request that their UCard is extended by SSiD in line with the new time limit on their student record.

Exceptionally, the time-limit for completion of minor corrections may be extended by the faculty for a further period; however, lengthy, or repeated extensions are unlikely to be approved, as three months should be adequate time to complete minor corrections. Students who need to request an extension should complete the Time Limit Extension form available from Research, Partnerships and Innovation and, if the extension is granted, will be required to pay the standard extension fee for the duration of the extension period.

Examiners must confirm that they are satisfied with the corrections undertaken by the student before the degree can be awarded. If not, they may ask the student to undertake further work to bring the thesis up to the required standard, which may require an extension to the time limit.  If a student is still unable to complete the required corrections to the examiners' satisfaction, and their time limit has passed, then they may be withdrawn.

When the student has completed the required minor corrections, they should send a copy of the revised thesis directly to the examiner who is going to check the corrections (normally this is the internal examiner). It is acceptable for the candidate to email a copy of the thesis directly to the examiner for checking. This is the only circumstance where it is acceptable for candidates to send a copy of the thesis directly to the examiners.

Once the thesis corrections have been approved by the examiner, students must provide a final electronic Library copy of their thesis - see the section on final library copies .

Pass with major corrections

Examiners may choose the recommendation of pass with major corrections if they are satisfied that the thesis has the potential to merit the award of the degree for which it has been submitted, but does not yet satisfy the requirements for award and contains deficiencies that are more than editorial or presentational corrections. This may involve re-writing sections, correcting calculations or clarifying arguments, but should not require the candidate to undertake any further original research.

The candidate will be granted six months to complete the required corrections from the date they receive the list of required corrections. Where major corrections are required, it is the examiners' responsibility to provide the candidate with the details of the required corrections as soon as possible following the viva.

The examiners should also advise the student of the six-month timescale for completion of the corrections. Students who are undertaking minor corrections to their thesis will have their time limit extended by six months and can request that their UCard is extended by SSiD in line with the new time limit on their student record.

Exceptionally, the time limit for completion of major corrections may be extended by the faculty for a further period; however, lengthy or repeated extensions are unlikely to be approved, as six months should be adequate time to complete major corrections. Students who need to request an extension should complete the Time Limit Extension form available from Research, Partnerships and Innovation and, if the extension is granted, will be required to pay the standard extension fee for the duration of the extension period.

When the student has completed the required major corrections, they should send a copy of the revised thesis directly to the examiner who is going to check the corrections (normally this is the internal examiner). It is acceptable for the candidate to email a copy of the thesis directly to the examiner for checking. This is the only circumstance where it is acceptable for candidates to send a copy of the thesis directly to the examiners.

Once the thesis corrections have been approved by the examiner, students must provide a final electronic Library copy of their thesis - see the section on final library copy .

Resubmission of a thesis

Where the examiners' recommendation is for a full resubmission, the joint report should contain detailed advice to the student on the required corrections and improvements and must indicate whether the resubmission is with or without a further oral examination. The joint and preliminary reports should be completed and returned to Research, Partnerships and Innovation within two weeks of the date of the oral examination.  

Research, Partnerships and Innovation will formally notify the student of the requirement to resubmit by letter and will also send the student a copy of the examiners’ report containing the details of the corrections.

Students required to resubmit their thesis will have their time limit amended to 12 months from the date of formal notification from Research, Partnerships and Innovation and can request that their UCard is extended by SSiD in line with the new time limit on their student record.  

A resubmission fee is charged for all resubmissions. For 2023-24 this will be £355 for a resubmission without oral examination and £430 for resubmission with oral examination.

Exceptionally, the time limit for resubmission may be extended by the faculty for a further period; however, lengthy or repeated extensions are unlikely to be approved, as twelve months should be adequate time to resubmit. Students who need to request an extension should complete the Time Limit Extension form available from Research, Partnerships and Innovation and, if the extension is granted, will be required to pay the standard extension fee for the duration of the extension period.

At the end of the resubmission period, the revised thesis must be resubmitted directly to Research, Partnerships and Innovation, following the same procedures as apply to a first submission (see Submitting your thesis ). The resubmitted thesis should also be uploaded to Turnitin at the same time.  The resubmitted thesis must not be sent to either of the examiners prior to formal resubmission.

Research, Partnerships and Innovation can only accept a resubmitted thesis once the student has been formally notified in writing of the examiners' decision on the first submission.

For resubmissions, the title page and front cover should be changed to show the date of the resubmission only, however it is not necessary for the thesis to state 'Resubmission'.  It is recommended that a detailed list of the corrections that have been made following the first submission is included with the resubmitted thesis.

If a resubmission with a further oral re-examination is required, this should normally take place within 10 weeks of receipt of the thesis by the examiners.

If a resubmission without a further oral examination is required, the examiners should aim to complete the re-examination of the thesis within approximately 6-8 weeks of their receipt of the revised thesis.

The same reporting requirements apply to resubmissions as to first submissions, i.e. the examiners must each complete an independent written preliminary report and a joint report.  There are fewer recommendations available to the examiners following a resubmission and, crucially, there is no option for a student to make a further resubmission at this stage. Consequently, the examiners must be confident that the thesis meets the criteria for the award of the degree, or will do so after a period of minor or major corrections, in order to recommend the award of the degree.

Following the viva, the examiners' report forms should be returned to Research, Partnerships and Innovation within two weeks of the date of oral examination (or the date of re-examination in the case of a resubmission without oral). If additional minor or major corrections are required, the examiners should retain the minor/major corrections sheet and return it to Research, Partnerships and Innovation once all corrections have been satisfactorily completed.  

Following completion of the resubmission and re-examination, students must provide a final electronic Library copy of their thesis - see the section on final library copy .

Related information

Contact the Research Degree Support Team

The oral examination (viva voce)

Thesis submission

• 3. Thesis examination
• Information and services
• Higher Degree by Research

If you have submitted your thesis for examination via UQ eSpace please read this document for information on how your examination will progress.

You can track the progress of your examination via the HDR Thesis examination request in my.UQ.

• Receiving examiner reports
• Oral examinations (viva voce)
• Examination outcomes
• After the examination process
• Thesis completion

3. Examination outcomes

You will receive your examination reports and outcome once the Dean of the Graduate School has made a decision. This will be emailed to your UQ student account.

Possible examination outcomes include:

• Degree awarded with no further changes to the thesis.
• Degree awarded with changes to the thesis. You will have up to 3 months to complete the changes
• Repeat oral examination based on the recommendation of the oral exam panel.
• Revise and resubmit the thesis based on examiners’ reports. You will have up to 12 months to revise and resubmit.
• Fail , but only after re-examination of your revised and resubmitted thesis.

If you need a letter for your employer or sponsor to show that your thesis is being corrected following feedback from your examiners, you can submit a request through the Student Centre .

No further changes

If the recommendation is that no further changes are required, all you need to do is upload your final thesis to UQRDM.

Read more about final thesis upload .

Most candidates are required to make some changes – or corrections – to their thesis.

Any changes you make should be recorded in a separate document to the thesis. This ‘response’ document should clearly explain your response to each change request.

You don’t have to make every change your examiners suggest, but you need to address the point and explain why you have decided not to make that change.

Most candidates use the following format:

Once your list of changes has been reviewed by your advisors, you will need to upload your corrected thesis and the list of changes to UQRDM.

For more information,  read the UQRDM guide – corrections (PDF, 120.8 KB) .

Revise and resubmit

If your examination outcome was revise and resubmit, you will have to upload the following three files in PDF format to UQRDM:

• your revised thesis
• your, iThenticate report
• your list of corrections

The changes you make should be recorded in a separate document to the thesis. This ‘response’ document should clearly explain your response to each change request.

You don’t have to make every change your examiners suggest but you need to address the point and explain why you have decided not to make that change.

Wherever possible, your original examiners will re-examine your thesis.

Once your list of changes has been endorsed by your advisors, you can upload your revised thesis, and the list of corrections to UQRDM

For more information, read the UQRDM guide – resubmission (PDF, 128.2 KB) .

Repeat oral examination

If you are asked to repeat your oral examination, you

To prepare, make sure you’ve read our advice about oral examinations . There are also learning workshops that could help you prepare.

A thesis can fail if:

• the first examination outcome is revise and resubmit , and
• the revised thesis is deemed not to be of an appropriate standard for any higher degree by research.

This outcome is only issued after a second examination and if the thesis is not of the appropriate standard for the award of any research higher degree.

Award of MPhil if PhD attainment is unsuccessful

This outcome is only issued after a second examination and if the thesis is not of an appropriate standard for a PhD but fulfils the criteria for an MPhil

More information is in the Higher Degree by Research Examination (with Oral Examination) Procedure  and Higher Degree by Research Examination (without Oral Examination) Procedure .

---------------------------

If your examiners disagree

If your examiners’ reports are radically divergent, the Dean of the Graduate School will seek advice from the Chair of Examiners. In some cases, a third examiner may be appointed.

For more information about examination outcomes, read the:

• Higher Degree by Research Examination Policy
• Higher Degree by Research Examination (with Oral Examination) Procedure  
• Higher Degree by Research Examination (without Oral Examination) Procedure .
• 1. Thesis preparation
• 2. Thesis submission
• 4. Award of degree
• Thesis submission date and scholarship extension

Need assistance?

Chat to the Graduate School Team

Adelaide Graduate Research School

Thesis Examination

After you submit your thesis, please make sure you are across the examination process below and complete the final steps to finishing your degree.

The examination

Detailed information on how the examination will be conducted is in the  ’Examination’ section of the   Research Student Handbook (please see the examination chapter). Your thesis will be sent electronically to 2 examiners who will be asked to submit their reports within 8 weeks.

How long will my thesis examination take?

We ask examiners to complete the examination and provide their reports to the Adelaide Graduate Research School within eight weeks from their receipt of the thesis.  To expedite the examination process, the Adelaide Graduate Research School reminds examiners if their reports have not been received by the due date and follows up with additional reminders where necessary. In practice, it takes an average of three months before you will receive notification of the outcome of your examination.

Why may my thesis take longer than 3 months to examine?

There are a couple of key reasons why an examination can take longer than usual.

Firstly, examiners are busy people and sometimes they have commitments or circumstances which necessitate them requesting an extension of time to complete their assessment. On rare occasions, an examiner may even need to withdraw from an examination due to ill health or other personal circumstances.  Where a situation like this arises, the Adelaide Graduate Research School will consult with your supervisor to agree on the most expedient way to move the examination forward (e.g. agree to the extension request or appoint a new examiner).

Secondly, time can be added to the examination process where the examiners make discrepant recommendations on the outcome of a thesis examination, e.g. one examiner recommends that the degree be awarded (with or without amendments), whilst the second examiner recommends that the thesis is revised and resubmitted, or failed. In such cases, the University will normally appoint a third independent examiner. Where this happens, the length of the examination process may be significantly increased.

Please be aware that while the Adelaide Graduate Research School works to ensure that examinations are completed as quickly as possible, some things are outside of our control and so we cannot guarantee that you will receive an outcome by a specified date.  We do appreciate that waiting for an examination result can be a nerve-wracking and frustrating time for students. We look forward to hearing about your successful outcomes too!

Your examination outcome

If you are not completing an oral examination.

You will receive an email advising of the outcome of your examination along with copies of the reports from your examiners. The email contains advice on the examiners’ recommendation and what steps you need to take to complete the requirements and be qualified for your degree.

Descriptions of the recommendations that examiners can make and how an outcome is determined can be found in the  ’Examination’ section of the   Research Student Handbook .

If you are completing an oral examination

You will receive an email with copies of the reports from the examiners and advice on when your oral examination will occur and who the Chair will be.  Further information on the oral examination and how that will proceed can be found on the oral examination webpage .

After you receive your outcome email

Your outcome email will detail what you need to do. You will need to submit the following to the Adelaide Graduate Research School:

The Australian Higher Education Graduate Statement (AHEGS) is a formal document describing the University of Adelaide and your degree requirements.  A 100 word description of your research must be submitted on a special template for inclusion in the AHEGS. Once you have completed your 100 words on the template you should email it to your principal supervisor and request their approval by return email.  Once you have your principal supervisor’s approval send that email, along with the approved AHEGS template to the Adelaide Graduate Research School.  This should be done at the time of your thesis submission, or at the latest, before your final thesis is submitted after it has been examined. Your AHEGS statement is required before you can be qualified and be eligible for the conferral of your degree.

Download the AHEGS template

Exit survey

The Adelaide Graduate Research School is interested to learn of your experiences during your candidature with a view to improving the experiences of current and future students. Answers to the questions in the exit survey are anonymised and aggregated so that your answers cannot be attributed to you. Please complete the exit survey, preferably just before submitting your thesis for examination, or at the latest, before your final thesis is submitted after it has been examined.  A completed exit survey is required before you can be qualified and be eligible for the conferral of your degree.

Complete the exit survey

Your final thesis

You will need to consult with your supervisors regarding the content of the examiners’ reports and make any required changes. The final approved version of your thesis should then be submitted to the Adelaide Graduate Research School along with a Final Thesis Lodgement form.

Download the final thesis lodgement form

When you submit your thesis you will be advised of several important deadlines for conferral of your degree and graduating. It is important that you check MyAdelaide to ensure that you have applied to graduate by the dates indicated on the Graduations website . Information is available in the ‘Graduation’ section of the Research Students Handbook . All queries regarding graduation ceremonies and academic transcripts should be directed to the Graduations Office , not the Adelaide Graduate Research School.

Graduate Research Hub

• Examination

Examination overview

What examiners look for.

Examiners evaluate your work for understanding of the relevant literature, the methods and techniques used, the results and conclusions obtained. The full criteria used are included in the Graduate Research Training Policy .

The Thesis Examination System (TES)

The Thesis Examination System (TES) , allows you to register your intention to submit and to submit your thesis electronically. It also allows for the examination to be managed online by the Graduate Research Examinations Office.

You can also view the progress status of your examination when you logon. Further information regarding the different types of TES statuses can be found here.

Need more information? Please refer to some of the Frequently Asked Questions regarding TES that may help.

Examination process

The exam process, from submitting your thesis to being notified of your examiners’ recommendations, will usually take a minimum of four months. The process and length of time will vary for each examination as examiners who are external to the University are involved. Some examiners need more time due to their other responsibilities and commitments. Regular follow-ups with supervisors and examiners are an integral part of the exam process to minimise delays. You will receive a result only when the Chair of Examiners has received and considered all reports.  Once you receive your examination outcome, you will have a clearer idea of when you are likely to complete all degree requirements. The identity of your examiners will remain anonymous until you have been awarded a final 'pass’ grade. See below for a flow chart of the exam process.

Intention to submit is registered

Supervisor contacts potential external examiners

Thesis submitted (along with iThenticate report of submitted thesis)

Thesis sent to approved examiners who have accepted a formal invitation

Examiners assess thesis and provide a report with their recommendations

For Joint PhDs, your partner institution will usually arrange your oral examination after the required written reports are received (if an oral examination is outlined in the Joint Award Agreement)

Reports sent to Chair of Examiners for consideration

Examination outcome sent with recommendations for any required amendment (and/or resubmission)

50-word citation submitted by supervisor to be approved by Associate Dean (Graduate Research)

Final copy of thesis submitted to Chair of Examiners

Once approved, electronic copy of final thesis is submitted to the Thesis Examination System

Final examination outcome advised

Identities of your examiners may be revealed, if they agree

Once all requirements have been fulfilled, you will receive a notification stating that you have successfully completed your degree. You will be considered eligible to pass once the final thesis is certified by the Chair of Examiners and an approved citation has been received by the Examinations Office. If you have completed a Masters by Research, you will be informed of your final percentage mark.

Information about graduation will be included in your completion of degree notification email.  Once you have graduated, either by attending a ceremony or by graduating in absentia, you can add post-nominals, for example, PhDMelb.  Doctoral degree graduates can use the title Dr.

If you require an official statement of your completion, including the official date of completion, you will be able to download a free Evidence of Qualification statement from my.unimelb . The University will issue an  Australian Higher Education Graduation Statement (AHEGS) , which will include your citation, after your degree is conferred at a graduation ceremony. You can learn more about the documents you will receive once you complete, such as academic statements and transcripts as well as other documents you can order.

The rules governing examination are contained in the Graduate Research Training Policy .

If you have any issues with your examiner go to: Resolving Issues .

Examination of jointly awarded PhD

Your examination will be carried out in a manner that meets the requirements of both universities. These requirements should be stated in the agreement governing your program and you should consult with your supervisors for more detail.

You must meet both institutions’ requirements, as the examinations will be run independently.  You will therefore need to register your intention to submit and submit your thesis to both institutions.

Most jointly awarded degree programs require an oral examination in addition to the examination of the thesis. The oral examination is usually arranged by your partner institution as outlined in the signed Joint Award Agreement. Where the oral examination is held at the University of Melbourne, your Chair of Examiners will oversee the arrangements.

Unless otherwise stated in your agreement, the oral examination should be conducted as described in the University of Melbourne Graduate Research Training Policy .

Examination criteria and marking

The examination criteria and processes are described in detail in the  Graduate Research Training Policy .

Due to the impacts of the COVID-19 pandemic, it may have been necessary for you to alter your research plan, leading to a project that is different to the one you had originally intended.  In some cases, this may mean that the thesis you submit is not typical for your discipline. Your discussion in the thesis of COVID-19 impacts will guide the examiners’ understanding of the reported work and the environment in which it was undertaken.

All examiners will be asked to recommend that the thesis should:

• Pass with Revisions (Chair of Examiners)
• Revise, Resubmit and Regrade (Examiners), or

Masters theses also receive a numerical mark and a letter grade according to the  Grading Scale for Masters Degrees (Research) . A mark of 65% is required to pass.

The tables in the  Graduate Research Training Policy describe how examiners reports work.

Responding to examiners

Upon receiving the examiners' recommendations you are required to consider their feedback and discuss them with your supervisor and Chair of Examiners.

If you have been asked to resubmit your thesis for a second examination, you will be invited to write a response to the examiners' reports, which they will receive along with the revised thesis.

For theses requiring minor changes or revision, written responses to the examiners are not required.

Changes to the thesis

The majority of theses require some amendment before the degree is awarded. You will be informed of the changes required and supplied with copies of the examiners' reports, which will be edited for confidentiality. Note that you should only make changes to your thesis based on the recommendations of your examiners. The only other permitted change is if the publication status of a publication incorporated into your thesis has changed and you update that material to reflect the latest version (usually up to the author accepted version).

The corrections to your thesis should be incorporated in the body of the text.  If your examiner has provided an enumerated list of requested changes, you will also be required to supply a similarly enumerated list to address how you have responded to those requests.

• Pass with minor edits are required if the examiners recommend that you be awarded your degree, but minor corrections (such as typographical errors or formatting issues) are requested to the Chair of Examiner's satisfaction. You are usually given six weeks to complete minor amendments.
• Revision s entails minor revisions to content. These revisions will be reviewed and verified by your Chair of Examiners who may consult your Examiner to verify the changes.  You will be given two months to complete any revisions.
• Revise, resubmit and regrade (Examiner) occurs when serious shortcomings in the content of the thesis are present but can be resolved with major revision. Your revised thesis is returned to the Examiner to consider, and the Examiner regrades the thesis accordingly. Doctoral candidates are given 12 months to revise and resubmit the thesis; Masters candidates are given 6 months .  Your revision should address and respond to any concerns raised by the examiners, as well as make other changes to improve the thesis. Your revised thesis will be re-examined in its entirety.  This is a final opportunity to ensure your thesis meets the requirements of your degree.

If you need more time to finish the corrections, you can apply for an extension by completing an Application for an Extension to Submit Revisions.

For more information, view the Graduate Research Training Policy .

Citation for Completion

A citation is a completion requirement that is prepared by your supervisor. The citation will be read out at the graduation ceremonies for PhD and Doctorate students. The citation will also be included in the University's Evidence of Qualification and in the Australian Higher Education Graduation Statement (AHEGS).

The citation will summarise the nature of the independent research, the contribution to knowledge made, and the intellectual and/or practical value of the work. It is important that a lay person, without specialist knowledge of the field or its technical terms, is able to comprehend the nature of the research and appreciate its contribution to society.  Where technical terms or technical descriptors cannot be avoided they should either be expressed in plain language or include a plain language explanation so that the meaning is easily understood. Citation examples are provided below, including an example where technical terms are used.

Citation format

The citation should:

• be restricted to 50 words to prevent delays in the conferring ceremony (Please note citations that exceed the 50-word limit will be returned for revision to the appropriate length)
• commence with either of the words:  who investigated.../ who studied.../ who examined.../ who found.../ who argues.../ whose work will benefit...  (the name of the candidate will be automatically added once the citation has been submitted)
• contain a brief description about what the research achieved or 'found'
• give an indication about the impact of the research or its potential application
• be grammatically correct and  written in language which can be understood by a lay audience at the conferring ceremony
• use present or future tense to describe the findings, impact or potential application
• only use those technical or specialised terms which are in general use; otherwise a plain language explanation should be added
• refer back to the candidate by using 'their findings' (the candidate's name should not be used within the text of the citation).

Citation examples

Technical terms

who investigated biofilms of the hospital 'superbug' Klebsiella. Biofilms are resistant to standard disinfection and treatment regimes.  He discovered that biofilm formation was mediated by Mrk, a bacterial attachment structure, regulated by a protein, MrkH. The identification of MrkH presents opportunities for creating biofilm-resistant plastics and drug inhibitors of biofilms.

who investigated the invasion process of cancer cells. A protein known as Tks5 was implicated in the formation of membrane structures on the cell surface known as invadopodia. His study gives unique insight as to how cancer cells utilise Tks5 within invadopodia to facilitate invasion throughout the body.

Discipline-specific examples

"who completed a study of Victoria's celebrated initiatives in community consultation in the 1970s and 80s. She showed how governments and key mediating agencies marginalised radical and politically turbulent values and interests to achieve forms of consultation consistent with conservative interest accommodation practices traditional to Victorian politics."

Business & Economics

"who studied how leaders use performance evaluations and rewards to influence employee behaviours. He finds that while lenient evaluations have negative organizational consequences, the opposite is true for lenient rewards. He also finds that being somewhat lenient with rewards helps leaders more clearly communicate their priorities and build their credibility."

Psychological Sciences

"who studied parents of adolescents with emerging psychosis. She found that certain coping styles and beliefs about mental illness were associated with parents' distress and grief, and with problematic interactions with their children. Her study has important implications for psychological interventions with mentally ill young people and their caregivers."

Earth Sciences

"who investigated the origins of diamond-bearing magmas from India. He established a new analytical technique and used this to reveal subtle differences in the mantle source characteristics between provinces. This technique has attracted international interest and is currently being applied to the kimberlites of South Africa."

"who investigated the impact of learning on the political literacy of young activists. He developed our understanding of political knowledge, skills and values and how these influenced participation.  His study gives unique insight to a new generation of activists and poses challenges for researchers, policy makers and education practitioners."

Engineering

"who studied the structural behaviour of concrete walls, composite steel-concrete columns and industrial buildings when subjected to fire. The study improved our understanding of appropriate levels of building safety and now forms the basis of structural design requirements for building elements and buildings in situations involving fire."

"who examined the problem of human trafficking for forced labour in the fishing industries of Thailand, Cambodia and Indonesia. He demonstrates the failure of these countries to harmonise their responses under norms of ‘transnational criminal law’. His findings expose legal and policy ‘fault-lines’ for the benefit of future industry regulation."

"who investigated the role of chromosome breaks in the development of leukaemia in mice. A new tumour suppressor gene was unequivocally implicated, and its position refined to a degree which will allow cloning of the gene, and examination of the role of the equivalent gene in human cancer."

"who developed a system for analysing tonal implications in fifteenth-century European Music. He found that many Renaissance works, unlike later Classical music, project two tonal centres. His study opens the way for a richer understanding of the links between Early Music and the music of today."

"who investigated the relationship between fire, vegetation and climate in western Tasmania, Australia, over the last 12,000 years. She identified climate as the dominant control over fire activity, and produced Australia’s first ever pollen-based estimates of vegetation change, reconciling a long-standing debate over the evolution of this landscape."

Veterinary and Agricultural Sciences

"who studied key pork supply chain factors that influence eating quality to develop cuts-based predictive eating quality models for pork. Her studies focussed on reducing eating quality variability of Australian pork, informed by quantitative consumer analyses, to improve consumer acceptability and support its differentiation as a consistently high quality product."

• Resources for candidates
• Orientation and induction
• Mapping my degree
• Principles for infrastructure support
• Peer activities
• Change my commencement date
• Meeting expectations
• Working with my supervisors
• Responsible Research & Research Integrity
• Guidelines for external supervisors
• Pre-confirmation
• Confirmation
• At risk of unsatisfactory progress
• Unsatisfactory progress
• Add or drop coursework subjects
• Apply for leave
• Return from leave
• Apply for Study Away
• Return from Study Away
• Change my study rate
• Check my candidature status
• Change my current supervisors
• Request an evidence of enrolment or evidence of qualification statement
• Change my project details
• Change department
• Transfer to another graduate research degree
• Late submission
• Withdraw from my research degree
• Check the status of a request
• Re-enrolment
• Advice on requesting changes
• Extension of candidature
• Lapse candidature
• How to cancel a form in my.unimelb
• Resolving issues
• Taking leave
• About Study Away
• Finishing on time
• Accepting an offer for a joint PhD online
• Tenured Study Spaces (TSS) Usage Guidelines
• Tenured Study Spaces Procedures
• Research skills
• Academic writing and communication skills
• Building professional and academic networks
• Research internships
• Commercialising my research
• Supplementary PhD Programs
• Writing my thesis
• Examples of thesis and chapter formats when including publications
• Thesis with creative works
• Research Integrity in my Thesis
• Graduate researchers and digital assistance tools
• TES Statuses
• Submitting my thesis
• Depositing multiple components for your final thesis record
• The Chancellor's Prize
• TES Graduate Researcher FAQs
• Career planning
• Publishing my research
• Getting support
• Key graduate research contacts
• Melbourne Research Experience Survey
• Quality Indicators for Learning and Teaching (QILT)
• Current Students

• Policy Library Home
• Bulletin Board
• Current Version
• Status and Details
• Associated Information
• Historic Versions
• Future Versions

Higher Degree by Research Examination Outcomes Procedure

Section 1 - purpose, section 2 - scope, section 3 - policy, section 4 - procedure, receipt of examiners’ reports, recommendations, notification of recommendation, section 5 - guidelines.

(1) This Procedure has been developed to guide stakeholders in the processes relating to Higher Degree by Research (HDR) thesis examination outcomes.

(2) This Procedure applies to candidates who have submitted a HDR thesis for examination at the University of Canberra (University), and to the staff involved in thesis examination process at the University.

(3) Refer to Examination of Higher Degree by Research Theses Policy . 

(4) If all examiners have recommended the award of the degree and this is not subject to amendments to the thesis (Recommendation A), then the reports are forwarded immediately to the Associate Dean, Research by the HDR Services team.

(5) If any examiner has provided a recommendation that is not Recommendation A, the candidate will consult with the Primary Supervisor to prepare responses. Responses must be submitted to the HDR Services team no later than three weeks from the candidate’s receipt of the reports.

(6) Delays in the completion of the examination process due to a late response to the examiners’ reports are the responsibility of the candidate and Primary Supervisor.

(7) In all cases, examination results will be submitted to the faculty HDR Committee. Examiner recommendations of A, B or C will be included on the agenda for noting.

(8) Where an examination has resulted in D or E recommendations, an Examination Outcomes Committee will, in consultation with the relevant student’s supervisory panel, review the results and report the outcome to the faculty HDR Committee (see below).

Award the Degree

(9) If all examiners recommend the award of the degree, and this is not subject to amendments to the thesis (Recommendation A), the Associate Dean, Research should also recommend the award of the degree.

Minor or Editorial Amendments

(10) If the Associate Dean, Research recommends the award of the degree subject to the completion of editorial amendments only to the thesis (Recommendation B), the following applies:

• the time limit for editorial amendments is two months from the date the candidate and Primary Supervisor are advised of the Faculty recommendation and specific amendments to be made; and
• the Primary Supervisor will advise HDR Services team when amendments have been completed.

Revisions as Specified by Examiners

(11) If the Associate Dean, Research recommends the award of the degree subject to revisions to the thesis as specified in the report/s (Recommendation C), the following applies:

• the time limit for revisions to the thesis as specified by the Associate Dean, Research is six months from the date the candidate and Primary Supervisor are advised of the Faculty recommendation;
• the Primary Supervisor will advise HDR Services team when revisions have been completed and provide a copy of the revised thesis; and
• the Associate Dean, Research will ensure that appropriate revisions have been made and, if so, recommend the award of the degree.

Revise and Resubmit

(12) If one or more examiners have recommended that the candidate be required to revise and resubmit the thesis for examination (Recommendation D), an Examination Outcomes Committee will be formed to determine the outcome of the examination. The Examination Outcomes Committee will comprise the Chair of the faculty HDR Committee and the Dean, Graduate Research.

(13) In determining an outcome, the Examination Outcomes Committee will review the thesis, all examiners’ reports and the candidate’s and Primary Supervisor's responses and will consult with members of the supervisory panel.

(14) Any of the examination outcomes outlined in these Procedures may be recommended. The appointment of another external examiner to examine the thesis may be recommended.

(15) If the final recommendation is that the candidate revise and resubmit the thesis for examination, the following guidelines apply:

• the time limit to revise and resubmit the thesis is twelve months from the date the candidate and Primary Supervisor are advised of the Committee’s recommendation;
• a candidate who undertakes to revise and resubmit is normally required to re-enrol for the expected duration of the revision process;
• a statement from the candidate outlining substantive changes made; and
• if applicable, an explanation of why recommendations for change have not been accepted;
• every reasonable effort will be made to ensure that a resubmitted thesis is examined by the original examiners;
• each examiner will receive a copy of all the original reports, a statement from the candidate outlining substantive changes made and, if applicable, an explanation of why recommendations for change that have not been accepted; and
• when the thesis is resubmitted, the procedures for its examination will be in accordance with the  Examination of Higher Degree by Research Theses Policy  (with the exception being the option to revise and resubmit for a second time).

Not Award the Degree

(16) If one or more examiners have recommended that the candidate not be awarded the degree (Recommendation E), an Examination Outcomes Committee will be formed to determine the outcome of the examination. The Examination Outcomes Committee will comprise the Chair of the faculty HDR Committee and the Dean, Graduate Research.

(17) In determining an outcome, the Examination Outcomes Committee will review the thesis, all examiners’ reports and the candidate’s and Primary Supervisor's responses and will consult with members of the supervisory panel.

(18) Any of the examination outcomes outlined in these Procedures may be recommended.

(19) The appointment of another external examiner to examine the thesis may be recommended.

(20) If the Committee determines that the degree not be awarded and/or that the candidate should not be allowed to present for the degree again, a recommendation to Academic Board to that effect will be made.

(21) In all cases, the Associate Dean, Research will make a final recommendation on the examination outcome to HDR Services team.

(22) Refer to the Higher Degree by Research Submission and Examination Guidelines .

• Skip to content
• Skip to navigation

• Thesis submission

Examination and completion

• Graduate research
• Current Students
• My Examination

Examination can take anywhere from 6-9 months to complete from thesis submission depending on your examination outcome. There are three key steps in the examination process:

Examiners report

Examination outcome, course completion.

Examiners will have eight (8) weeks to complete their examination report.

• Graduate Research will redact any confidential examiner information and email the completed reports to the Candidate (UC student Email) and their Primary Supervisor.
• You and your Primary Supervisor must provide responses to examiners report in the provided template within three (3) weeks of receipt of the reports.
• The Associate Dean Research will consider the examiners feedback and your responses and make a recommendation on the outcome including any revisions that may be required.
• You must provide the revised thesis with track changes enabled within the timeframe outlined for your examination outcome as per the Examination Outcomes Procedure .
• Once all requirements have been satisfied the Associate Dean Research or Supervisor (in some cases) will recommend course completion.

Examination Outcomes Procedure

There are several things you need to prepare in order to be course completed and be eligible to graduate. You must complete all requirements for course completion at least 3 months prior to next graduation ceremony to be eligible to be invited to attend.

• You are required to arrange printing for hardcopy thesis for the library.
• Graduate Research will confirm that you have met all other academic requirements of the course of study and will notify the Student Centre.

Read the quick guide Preparing for Course Completion (PDF, 211.55 KB) for detailed information.

Download preparing for course completion

What happens next?

Normally, it can take 3 – 9 months from recommendation of course completion to graduate depending on the dates of the upcoming graduation ceremonies.

You are not confirmed to participate in graduation ceremony until you have been invited by the Student Centre and have purchased your tickets.

Find out about graduation

The HDR Examination team provides central administration of thesis examination for Higher Degree by Research candidates from thesis submission to course completion. Contact Us

The Essex website uses cookies. By continuing to browse the site you are consenting to their use. Please visit our cookie policy to find out which cookies we use and why. View cookie policy.

Examination outcome recommendations

Examination outcomes.

Both examiners MUST complete the appropriate sections of the Joint Report (RD4) form. Examiners may recommend one of the following examination outcomes on academic grounds.

• Pass subject to no corrections
• Pass subject to typographical/presentational corrections . The candidate makes any corrections prior to submission of the final version of the thesis, usually within four weeks of being notified of the outcome.
• Pass subject to minor corrections to be made within three months . The examiners must provide a separated typed list of corrections that they wish to see made. Minor corrections should not require the candidate to conduct further research or undertake substantial further work. These include typographical errors, clarifying points, rephrasing, editing/adding paragraphs, correcting references, etc. The internal examiner must confirm in writing that these have been made satisfactorily. Corrections must be made and the thesis submitted within three months.
• Pass subject to major corrections to be made within six months . The examiners must provide a separate typed list of corrections that they wish to see made. Major corrections require the candidate to undertake substantial further work but the corrected thesis should not require re-examination. Such major corrections include more extensive editorial revisions, the addition of substantial new material, re-writing of substantial parts of the thesis, re-analysis of existing data, etc. The internal examiner must confirm in writing that these have been made satisfactorily. Corrections must be made and the thesis submitted within six months.
• Referral for re-examination in up to 12 months . The candidate has not met the requirements for the degree examined but may resubmit, on one occasion only, a revised thesis for re-examination within 12 months. The examiners must provide a separate statement describing the shortcomings of the thesis and the changes required. These may include, amongst other things, editorial corrections and revisions, rewriting a part, parts or the whole of the thesis, the carrying out of further research and/or experimental work. They must also specify the referral period, which should not normally be less than six months or exceed 12 months. For viva outcomes (f) to (j) (below) the candidate is awarded a degree at a lower level from the qualification for which they were initially assessed (for example awarding an MPhil to a PhD candidate). In such cases, the examiners must clearly provide in their statement how the candidate has met the criteria for the lower award in addition to the reasons for not meeting the criteria for the higher award.
• Award of a (lower award) subject to no corrections .
• Award of a (lower award) subject to minor typographical/presentational corrections . The candidate makes any corrections prior to submission of the final version of the thesis, usually within four weeks of being notified of the outcome.
• Award of a (lower award) subject to minor corrections to be made within three months. The candidate has not met the requirements for the degree examined but has met the requirements for the (lower award) subject to the approval of minor corrections. The examiners must provide a list of the corrections that they wish to see made. Minor corrections should not require the candidate to conduct further research or undertake substantial further work. These include typographical errors, clarifying points, rephrasing, editing/adding paragraphs, correcting references, etc. The internal examiner must confirm in writing these have been made satisfactorily. Corrections must be made and the thesis submitted within three months.
• Award of a (lower award) subject to major corrections to be made within six months . The candidate has not met the requirements for the degree examined but has met the requirements for the (lower award) subject to the approval of major corrections. The examiners must provide a list of the corrections that they wish to see made. Major corrections require the candidate to undertake substantial further work but the corrected thesis should not require re-examination. Such major corrections include more extensive editorial revisions, the addition of substantial new material, re-writing of substantial parts of the thesis, re-analysis of existing data, etc. and the internal examiner must confirm in writing that these have been made satisfactorily. Revisions must be made and thesis submitted within six months.
• Referral for a (lower award) . The candidate has not met the requirements for the degree examined but may resubmit a revised thesis for re-examination for a (lower award). The examiners must provide a statement describing the shortcomings of the thesis and the changes required. These may include, amongst other things, editorial corrections and revisions, rewriting a part, parts or the whole of the thesis, the carrying out of further research and/or experimental work. They must also specify the referral period, which should not normally be less than six months or exceed 12 months.
• Fail . The examiners must provide a clear statement describing the shortcomings of the thesis.

Thesis by published works

The examiners for a submission by published work shall declare the result of an examination for:

• the degree of Doctor of Philosophy as 'pass', ‘minor corrections to the summary’ ‘resubmission of published work on one further occasion only’, ‘award of Master of Philosophy’ or 'fail'
• the degree of Master of Philosophy as 'pass', ‘minor corrections to the summary’ ‘resubmission of published work on one further occasion only’, ‘award of Masters by Dissertation’ or 'fail'
• the degree of Masters by Dissertation as 'pass', ‘minor corrections to the summary’ ‘resubmission of published work on one further occasion only’ or ‘fail’.

The examiners for a submission by publication may recommend any result that is available for the degree examined (see Regulations 4.55, 4.60 or 4.71).

• University of Essex
• Wivenhoe Park
• Colchester CO4 3SQ
• Accessibility
• Privacy and Cookie Policy

• Scholarships

Arts Graduate Research Publication Support Grant

University of Melbourne

Application is required. Check eligibility

Key scholarship details

Application status

Not open yet

Applications open

Applications close

31 Dec 2023

Benefit amount

Up to $5,000

Eligible study level

Graduate research

Eligible student type

Domestic and international students

Eligible study stage

Current study

Benefit duration

This grant supports eligible Graduate Researchers in the Faculty of Arts after submission of the thesis for examination. The grant supports them to prepare scholarly publications such as journal articles, book chapters, books and non-traditional research outputs while awaiting the outcome of their examination.

A one-off payment up to $5000 for PhD candidates and $2500 for MA by Research candidates.

Approximately 100

Eligibility and selection criteria

Eligibility.

To be eligilbe for this scholarship you:

• must be enrolled in a graduate research degree in the Faculty of Arts at the time of application
• may not have been lapsed, reinstated or approved for late submission)
• must have registered an ‘Intention to submit’ the thesis for examination and submitted the thesis in 2024
• must be within the maximum candidature for the degree
• must have the written support of your supervisor.

Selection criteria

Applicants who meets the eligibility criteria and provides the required supporting documents will receive the grant

Payment is conditional on thesis submission. If an awardee does not submit their thesis for examination in 2024, they are considered to have not met the eligibility criteria and the offer of a scholarship will lapse. The scholarship may not be deferred. For Joint PhD candidates, Melbourne must be the Home institution. The work plan should commence immediately after thesis submission and is expected to take approximately three months to complete. Awardees whose thesis is already under examination, must accept the award and commence workplan immediately. Awardees will be responsible to the Head of School and their Principal Supervisor for the work undertaken during the award period. It is expected that awardees must maintain regular contact with the principal supervisor during the tenure of the award. Awardees are required to submit an online report within three months of the award period, on the work undertaken, manuscripts submitted for publication, and/or evidence that the manuscript has been submitted. If the work has not been satisfactorily completed, the report must include a detailed explanation and a revised timeline. Only one award is permitted per candidate. The number of awards issued is subject to available funds within the Faculty’s annual budget. Awardees who are no longer enrolled in their graduate research course may be required to declare the award income for tax purposes and are advised to consult with an accountant for tax advice. In the case of co-authored outputs, awardees need to explain their own contribution and this must be more than 50% of the work towards the output. A signed co-author authorisation form will be required at the 3-month reporting stage.

In addition to the above you must:

• you agree to the University sharing your name and the name of your course with the donor of this scholarship
• you must provide a brief report on the benefits of the scholarship and give permission for the University to provide the report, your name and course details to the donor

Study level:

Student type:

Study stage type:

Study area:

Arts, humanities and social sciences

Need help understanding the process?

Application, how to apply.

To apply for this grant, please submit an application form

Applications open:

Applications close:

The information listed here is subject to change without notice. Where we have listed information about jointly run scholarships programs, please also see our partners' websites. Information describing the number and value of scholarships awarded is indicative.

Looking for more study options?

Courses and career pathways.

Browse all undergraduate and graduate courses, study areas and career pathways on the Study website. Explore courses

Whatever your passion, you'll discover stimulating research opportunities at Australia's #1 ranked university. Research at Melbourne

International students

Find support, advice and what to expect living and studying as an international student at the University of Melbourne. Learn more

How can we help?

ORIGINAL RESEARCH article

Sex differences in the combined influence of inflammation and nutrition status on depressive symptoms: insights from nhanes provisionally accepted.

• 1 Jiangxi University of Chinese Medicine, China
• 2 Affiliated Hospital of Jiangxi University of Chinese Medicine, China

The final, formatted version of the article will be published soon.

Background: Both nutrition and inflammation are associated with depression, but previous studies have focused on individual factors. Here, we assessed the association between composite indices of nutrition and inflammation and depression. Method: Adult participants selected from the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2018 were chosen. The exposure variable was the Advanced Lung Cancer Inflammation Index (ALI) integrating nutrition and inflammation, categorized into low, medium, and high groups. The outcome variable was depression assessed using the Patient Health Questionnaire-9 (PHQ-9). A multivariable logistic regression model was employed to evaluate the relationship between ALI and the risk of depression. Results: After extensive adjustment for covariates, in the overall population, participants with moderate and high levels of ALI had a decreased prevalence of depression compared to those with low ALI levels, with reductions of 17% (OR, 0.83; 95% CI: 0.72-0.97) and 23% (OR, 0.77; 95% CI: 0.66-0.91), respectively. Among females, participants with moderate and high ALI levels had a decreased prevalence of depression by 27% (OR, 0.73; 95% CI: 0.60-0.88) and 21% (OR, 0.79; 95% CI: 0.64-0.98), respectively, compared to those with low ALI levels, whereas no significant association was observed among males. Subgroup analyses based on females and males yielded consistent results. Conclusions: In this study, we observed a negative correlation between moderate to high levels of ALI and the prevalence of depression, along with gender differences. Specifically, in females, greater attention should be given to the nutritional and inflammatory status.

Keywords: sex differences, Advanced lung cancer inflammation index, Depression, National Health and Nutrition Examination Survey, a cross-sectional study

Received: 02 Apr 2024; Accepted: 13 May 2024.

Copyright: © 2024 Xu, Yan and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Mx. Yifeng Xu, Jiangxi University of Chinese Medicine, Nanchang, China

People also looked at

• Open access
• Published: 10 May 2024

Implementation of a clinical breast exam and referral program in a rural district of Pakistan

• Russell Seth Martins 1 ,
• Aiman Arif 2   na1   na2 ,
• Sahar Yameen 2 ,
• Shanila Noordin 2 ,
• Taleaa Masroor 3 ,
• Shah Muhammad 2 ,
• Mukhtiar Channa 2 ,
• Sajid Bashir Soofi 2 &
• Abida K. Sattar 2 , 4  

BMC Health Services Research volume  24 , Article number:  616 ( 2024 ) Cite this article

43 Accesses

Metrics details

The role of clinical breast examination (CBE) for early detection of breast cancer is extremely important in lower-middle-income countries (LMICs) where access to breast imaging is limited. Our study aimed to describe the outcomes of a community outreach breast education, home CBE and referral program for early recognition of breast abnormalities and improvement of breast cancer awareness in a rural district of Pakistan.

Eight health care workers (HCW) and a gynecologist were educated on basic breast cancer knowledge and trained to create breast cancer awareness and conduct CBE in the community. They were then deployed in the Dadu district of Pakistan where they carried out home visits to perform CBE in the community. Breast cancer awareness was assessed in the community using a standardized questionnaire and standard educational intervention was performed. Clinically detectable breast lesions were identified during home CBE and women were referred to the study gynecologist to confirm the presence of clinical abnormalities. Those confirmed to have clinical abnormalities were referred for imaging. Follow-up home visits were carried out to assess reasons for non-compliance in patients who did not follow-through with the gynecologist appointment or prescribed imaging and re-enforce the need for follow-up.

Basic breast cancer knowledge of HCWs and study gynecologist improved post-intervention. HCWs conducted home CBE in 8757 women. Of these, 149 were warranted a CBE by a physician (to avoid missing an abnormality), while 20 were found to have a definitive lump by HCWs, all were referred to the study gynecologist (CBE checkpoint). Only 50% (10/20) of those with a suspected lump complied with the referral to the gynecologist, where 90% concordance was found between their CBEs. Follow-up home visits were conducted in 119/169 non-compliant patients. Major reasons for non-compliance were a lack of understanding of the risks and financial constraints. A significant improvement was observed in the community’s breast cancer knowledge at the follow-up visits using the standardized post-test.

Conclusions

Basic and focused education of HCWs can increase their knowledge and dispel myths. Hand-on structured training can enable HCWs to perform CBE. Community awareness is essential for patient compliance and for early-detection, diagnosis, and treatment.

Peer Review reports

Introduction

Breast cancer is the most frequently diagnosed malignancy (barring skin cancers) and the fifth leading cause of cancer-related deaths worldwide [ 1 , 2 ]. According to GLOBOCAN 2022, 2.3 million new cases of breast cancer were diagnosed in 2022, with 666,103 patients dying from the disease [ 3 ]. Moreover, the incidence and mortality of breast cancer is expected to increase by 40% and 50% respectively by 2040 [ 3 ]. The rise in incidence is particularly steep in Asia, with these countries also seeing a significantly younger age of onset compared to the Western world [ 4 , 5 ]. In Pakistan, one in every nine women suffers from breast cancer, with the country having one of the highest incidence rates in the region (around 2.5 times higher than neighboring countries such as Iran and India) [ 6 , 7 ]. Breast cancer accounts for more than 20% of all malignancies in Pakistan, and almost half of all cancers in women [ 8 ].

The World Health Organization (WHO) has emphasized the role of early diagnosis of symptomatic breast cancer as a more feasible and economical strategy as compared to screening in resource-constrained countries [ 9 , 10 ]. Screening for breast cancer allows for detection of breast cancer at an earlier stage (especially when small enough to remain undetectable on clinical examination) and leads to significantly better management outcomes and less treatment expenditure [ 1 , 9 ]. While screening aims to identify lesions in asymptomatic and healthy individuals who have yet to develop clinical manifestations of disease, early detection of symptomatic breast cancer seeks to recognize individuals at an earlier stage than when they would otherwise present, allowing for more timely management and potentially better oncologic outcomes [ 9 ].

Early diagnosis and treatment are a cornerstone of efforts to reduce cancer-associated mortality in developed countries. In the United States (US), fewer than 20% of cancers present with advanced disease [ 11 ]. Data from Pakistan presents a stark contrast, with more than half of patients presenting with locally advanced or metastatic disease [ 11 ]. Mammography is the most effective screening modality for breast cancer in high-income countries. Multiple breast cancer screening trials have reported a reduction breast cancer-related mortality up to 25% among women undergoing mammography screening [ 12 ]. However, it remains under-utilized as a screening tool, both in developing and developed countries. Reasons for this range from misconceptions regarding screening methods, techniques, and radiation to lack of insurance or a care provider and fear of recall imaging, overdiagnosis leading to unnecessary biopsies and treatment and side effects [ 13 , 14 ]. In the US, more than 75% of eligible women are screened for breast cancer via mammography [ 15 ]. In a lower-middle-income country (LMIC) like Pakistan, access to investigations such as mammogram, breast ultrasound and needle biopsy is limited due to lack of availability of machines and trained personnel, lack of awareness and financial limitations (75% of healthcare financing in Pakistan is out-of-pocket and over one-third of the population lives below the poverty line) [ 16 , 17 ]. In addition, conservative sociocultural norms and religious factors also prevent women from seeking routine healthcare [ 18 ]. Given the lack of healthcare access coupled with a largely conservative culture, community outreach programs with home visits may be the ideal system for bringing initial breast cancer recognition home to the rural communities, enabling early confirmation of disease and initiation of treatment. Similar outreach programs have met with considerable success in other aspects of healthcare. These include programs improving screening and prevention of malaria, tuberculosis, and HIV and those targeting improvement maternal and neonatal mortality [ 19 , 20 ]. Thus, screening, and early detection interventions implemented in LMICs like Pakistan must take into account the local healthcare systems and social structures.

Clinical breast examination (CBE) is recommended as the preferred approach for early detection of symptomatic and clinically detectable breast cancer in LMICs such as Pakistan. It consists of inspection and palpation of the breasts and regional (axillary, supraclavicular, infraclavicular and cervical) lymph nodes of the patient in a sitting and supine position [ 21 ]. It can be readily performed by a primary care physician to identify abnormal breast findings and determine the need for further evaluation.[ 22 ], [ 23 ] In fact, while mammography is expected to miss over 20% of breast cancers, CBE is able to detect 3–45% of these false negative cases [ 24 , 25 , 26 ].

Due to the aforementioned sociocultural barriers towards mammographic breast screening in Pakistan, it is vital that early detection interventions employ more feasible methods such as CBE. Thus, the objective of this study was to describe the outcomes of a community outreach breast education, home CBE and referral program for early recognition of breast abnormalities and improvement of breast cancer awareness in a rural district of Pakistan. We conducted a community outreach and referral program where home CBE visits were conducted by trained healthcare workers (HCWs) for early detection of breast signs and symptoms, in a rural district of Pakistan. Women who had clinical abnormalities detected upon examination were then referred for further evaluation. During these visits, the women were also educated regarding breast cancer management. In this study, we report our results and experiences with this program. We believe that it is important to reinforce that early detection interventions for breast cancer may be implemented in LMICs like Pakistan using CBE as the preferred approach. Given that most patients with breast cancer present with advanced disease, CBE may be able to identify characteristic breast changes earlier and allow for timely treatment of the tumor at earlier stages [ 27 ].

Materials and methods

Study design and setting.

A quasi-experimental study was carried out over September 2021 - September 2022 in Sindh, Pakistan. The study team was primarily based at Aga Khan University (AKU) in Karachi, Sindh, while the field location where the community outreach program was implemented was situated in the Dadu district of Sindh, Pakistan. The Aga Khan University is an academic tertiary care private hospital and a health services agency of the Aga Khan Development Network (AKDN) in Pakistan. This study featured a collaboration between the Departments of Surgery and Maternal and Child Health at AKU. Ethical approval was obtained from the ethical review committee at AKU.

The Dadu district covers 19,070 km 2 in interior Sindh and is divided into four sub-divisions which are further divided into Union Councils (UC). The UC is the smallest administrative unit of Pakistan. The field location of our study consisted of five UCs within the Johi subdivision of the Dadu district. Some census data of the five included UCs, as collected by the AKU for local projects, are shown in Table  1 . Approximately 48.7% of the population is female. As of 2021, it has 47 Basic Health Units (BHU) and 5 Rural Health Centers (RHC) with a total of 503 beds (BHUs and RHCs are first-level primary healthcare facilities that serve rural populations). The doctor -to-patient ratio is 1:6,030, nurse-to-patient ratio is 1:39,629, and bed-to-patient ratio is 1:3,309 [ 28 ].

Study population and sample size calculation

The total population within the five target UCs was 64,023. Our target sub-population consisted of all adult women ≥ 18 years of age. Using an estimated 20% prevalence of abnormal CBE according to a similar study conducted in Tajikistan [ 29 ], 80% power, 95% confidence level, and design effect of 2, we calculated the minimum required sample size to be 547 individuals. This was inflated by 100% to mitigate against extreme rates of individuals being lost to follow-up, which we anticipated to be a significant real-world challenge, yielding a final minimum required sample size of 1,094. Cluster convenience sampling was used to identify women in the community.

Training workshop and outreach program

The study schema consisted of the following interventions in sequence as described:

Training of Health Care Workers (HCWs) : Non-physician HCWs received training at AKU, Karachi in September – October 2021. This specialized training program was designed to enhance HCWs’ skills in identifying suspicious breast problems, making appropriate and timely referrals, and improving general knowledge regarding breast cancer. This training was conducted and overseen by an attending breast surgeon at AKU. HCWs were taught how to perform clinical breast examinations (CBEs) and engaged in hands-on practice sessions with simulated breast disease models and real patients in clinics. In addition, the HCWs were educated regarding general knowledge regarding breast cancer, with special emphasis on treatment, evaluation and commonly held misconceptions among the public. Pre and post-intervention surveys were administered to evaluate improvement in knowledge.

Community outreach program with home visits : The HCWs were deployed into the community in the Johi subdivision in October 2021. The initial series of home visits took place between October 2021 to February 2022, with the HCWs performing home visits in groups of two. Each visit began with an introductory and informed consent-seeking debriefing, followed by CBE of all consenting adult women belonging to a household, an assessment of baseline breast cancer-related knowledge, and lastly, a brief, standardized educational intervention delivered verbally (Supplement). For each CBE performed, a checklist of examination findings was completed. In the event of any abnormal finding, a referral to a local gynecologist within Johi was made. All interactions during the home visits were conducted in the Sindhi language, which is the native language of the region.

Visit to the local gynecologist : Patients who complied with their referral (for a palpable breast concern) were evaluated by a gynecologist at the local District Health Quarter. The gynecologist repeated a CBE on all referred patients in order to validate the HCWs’ examination findings. All eligible patients were then referred for breast imaging, either mammography or ultrasound, to the nearest facility within Johi.

Follow-up home visits : The HCWs attempted to conduct follow-up home visits for all women who were non-compliant with initial referral to a gynecologist. These follow-up visits took place six months after the initial series of home visits. Patients were questioned as to the reasons for their non-compliance with referral using a self-designed structured questionnaire (Supplement: Sect.  4 ). In addition, the breast cancer-related knowledge survey was re-administered to the women to gauge improvement in knowledge since the educational intervention delivered at the initial home visits. Finally, the importance of complying with referral for future evaluation, diagnosis and management was re-emphasized to all patients.

Validation of Data Collection Tools :

CBE checklist : This was a self-designed checklist (Supplement: Sect.  3 ) that included all the important components of a CBE, including a brief history of relevant symptoms (pain, discharge), breast inspection (skin changes, or changes in breast size, shape, or symmetry, and nipple changes), and breast palpation (presence of lumps in the axilla or breast).

Breast cancer-related knowledge survey : Separate surveys were administered to the HCWs and the women within the general community (Supplement: Sects.  2 and 3 ). Both surveys were designed by faculty within the Section of Breast Surgery at AKU. Prior to its use, the survey for women within the community was pretested amongst 30 local women for content, comprehensibility, and language. Minor adjustments were made on the basis of this pilot procedure.

Statistical analysis

All analyses were performed using SPSS (Statistical Package for Social Sciences) version 23.0 (IBM Corporation, Armonk, New York). Descriptive analysis was performed whereby categorical values were reported using frequencies and percentages. McNemar’s test was used to compare changes in knowledge across the multiple administrations of the breast cancer-related knowledge surveys. A p-value less than 0.05 was considered significant for all the analysis.

Education and training of the HCWs

A total of 8 HCWs were trained. Tables  2 and 3 show the changes in breast cancer-related knowledge after the educational and training intervention for the HCWs. The absolute percentage increase in HCWs who correctly believed that breast cancer can occur in men, and in women despite breast feeding their children, was 50%. In addition, the percentage of respondents who believed that women with a painless lump should visit a healthcare professional increased from 87.5 to 100%. The absolute percentage of HCWs who correctly identified painless lump and bloody nipple discharge as a symptom suspicious of breast cancer increased by 12.5% and those that identified dimpling of skin as a suspicious symptom increased by 25%. The percentage of HCWs who correctly believed that a tissue biopsy could be used to diagnose breast cancer increased from 62.5 to 87.5%.

Implementation of the outreach program

A total of 8,757 women were screened by the HCWs in the field during initial series of home visits. A palpable breast lump was identified in 20/8,757 women, while other palpable or visible breast concerns warranting further evaluation were identified in 98/8,757 women. In addition, HCWs were unsure about the presence of a lump in 51/8,757 women. Keeping a low threshold for seeking a physician’s evaluation and prompt referrals, these 169/8,757 patients were all referred to a gynecologist for further examination. However, only 38/169 patients (ten with a palpable breast lump and 28 for which the HCWs exercised caution-either noted other breast concerns or were unsure) complied with initial referral to the gynecologist. Out of the 28 patients (where HCWs noted breast concerns or were unsure about a lump), none were found to have a lump on the gynecologist’s CBE examination. Out of the ten patients in which the HCWs had positively identified the breast lumps, nine patients (90% concordance) were confirmed to have a breast lump on the gynecologist’s CBE. However, all these ten patients were referred for imaging with only 4 of them complying. Amongst these 4 patients who had breast imaging, one patient had BI-RADS (Breast Imaging Reporting and Data System) category I finding (i.e. negative imaging) and 3 patients had BI-RADS category III findings (Lump with extremely low probability of malignancy). The outcomes of the CBE and referral program are illustrated in Fig.  1 .

Outcomes of community outreach Breast referral program. HCW: Health Care Workers; CBE: Clinical Breast Examination; FNAC: Fine Needle Aspiration Cytology

At the follow-up home visits to the 131 patients who had been non-compliant with initial referral, the most common reasons for non-compliance were assessed by the HCWs ( Table  4 ). The most common reasons for non-compliance were a belief that follow-up was not important (42.0%), lack of money to visit the gynecologist (24.4%), not having anyone to accompany them (9.2%), long distance to travel for the appointment (7.6%).

Increase in community awareness regarding breast cancer

A comparison of the women’s knowledge regarding breast cancer at the time of initial visit and later at follow-up is shown in Table  5 . The percentage of women who had heard of breast cancer increased from 54.6 to 100%, the percentage of women who were aware that breast cancer was treatable increased from 32.8 to 61.3%. The percentage of women understood the need to consult a healthcare professional upon finding a lump increased from 50.4 to 94.1%.

The purpose of this study was to evaluate the feasibility of the real-world implementation of a large-scale clinical breast examination and referral community outreach program in a rural district of Pakistan. Secondarily, we also explored the feasibility of delivering basic breast cancer-related knowledge to the community via non-physician HCWs. This program was the first of its kind for breast cancer detection in the country. The key positive takeaways from our experience were that it is: (i) possible to train non-physician HCWs to perform a comprehensive CBE and identify examination findings warranting referral and further evaluation, (ii) practically feasible to implement a large-scale community outreach program with home-visits for mass detection of breast cancer, (iii) possible to increase community knowledge and awareness for breast cancer by imparting education at the home-visits when CBE was performed. However, we encountered several real-world challenges that precluded the full realization of this outreach program’s impact. Only 50% of women initially identified by the HCWs as having a breast lump followed through with referral to the gynecologist, and only 40% of women followed up with subsequent referral for imaging. None of the patients eventually referred for histopathological evaluation ended up complying with the referral. However, prior experience with a similar program by the AKDN in Tajikistan demonstrated that with appropriate follow-ups, breast cancer may be detected in up to 0.2% of the women in the community [ 29 ]. Although this rate is slightly lower than the reported incidences of mammographic screening-detected breast cancers in the literature (0.5–0.8%), it underscores the potential for success of CBE-based programs as an early detection strategy in low-resource communities [ 30 , 31 ].

Accuracy of CBE by non-physician HCWs and effectiveness of educational interventions

Overall, the theoretical frameworks and foundations of this large-scale clinical breast examination and referral community outreach program were observed to be largely successful. We were able to achieve a high degree of concordance (90%) between the CBE findings of the HCWs and the gynecologist, indicating that it is possible and feasible to leverage HCWs for the early detection of symptomatic breast cancer. Another study carried out in Malawi to train community laywomen to conduct CBE in the community showed 88% concordance between CBE performed by the HCWs and those performed by the physicians [ 32 ]. This is exceedingly important in a LMIC like Pakistan, where the ratio of physicians to population is a major impediment to healthcare access. In Pakistan, there are only 170,000 general practitioners to serve a population of over 230 million individuals. Thus, a major bottleneck for the delivery of high quality breast cancer-related healthcare is the timely initial identification of these patients from the community. Utilizing existing community outreach frameworks, such as the Lady Health Worker (LHW) Program, cite which was in Pakistan in 1994 [ 33 , 34 ]. While the LHW Program was initially developed for promoting family planning and maternal health, the model has been adapted for other major public health interventions such as immunizations and basic preventative healthcare. These LHWs are salaried and recognized as part of the healthcare workforce. Since LHWs are recruited from within the community itself, one of the major strengths of such a program is their ability to deliver culturally appropriate healthcare to populations with limited access to healthcare facilities. Thus, based on the successful training of HCWs in our study, we believe that the LHW Program model can be effectively adapted for the early recognition of breast abnormalities in women who would otherwise go undetected. However, it is important to know that the training of the HCWs in our study was performed by a fellowship-trained breast surgeon at a tertiary care hospital in one of the major cities of Pakistan. To ensure the feasibility, uptake, and growth of our model throughout the underserved regions of the country, it is important that a certain degree of sustainability is achieved. In future iterations of this model, we plan to assess the effectiveness of cascade learning with peer-to-peer teaching. In such a model, HCWs initially trained by a breast surgeon will subsequently assume the role of trainers themselves and teach other HCWs/LHWs how to perform a CBE. Interestingly, the study conducted in Malawi trained non-HCWs to serve as “Breast Health Workers”, highlighting the potential to leverage non-HCW professionals to perform a health-related role in communities with low HCW-to-patient ratios [ 32 ].

Community education and awareness

Despite the successful and rigorous implementation of the CBE and referral community outreach program, the Achilles’ heel of this project was the pervasive lack of community awareness regarding the importance of following up with referrals. This was compounded by other sociocultural barriers such as financial constraints, transportation issues, and a lack of family support to visit the healthcare facility. Thus, it is important that future iterations of similar public health interventions be cognizant of these challenges and seek to mitigate them to the best of their ability. Indeed, the most modifiable of these obstacles is the lack of awareness which can be countered by greater community education during home visits, with a particular focus on emphasizing the potential consequences of non-compliance with diagnostic evaluations. Our results demonstrated the feasibility of educating HCWs to subsequently serve as teachers for the community, and that the newly gained knowledge remained reasonably intact even at a follow-up of six months. A study in Vietnam showed that repeated breast cancer-related educational interventions were successful in increasing compliance with referrals for breast cancer evaluation. [ 35 ] In addition, a more robust follow-up system including frequent interaction and monitoring of patients could help boost compliance with referrals and better continuity of care. For example, routinely scheduled phone calls could be made to the patient as a reminder to follow-up with their referrals. Moreover, for women who are not able to comply with their referrals because of the absence of a family member to accompany them, arrangements may be made whereby LHWs could accompany them as their attendants.

The other challenges, however, harken to well-known and longstanding problems with the healthcare system in Pakistan, where most of the population is unable to afford even basic healthcare. In such a setting, Universal Healthcare Coverage (UHC) emerges as the only viable solution to the masses. An attempt at such a system, the Sehat Sahulat Program (SSP; translates to Health Facility Program) was introduced in 2016 by the provincial government of Khyber Pakhtunkhwa, one of the five provinces of Pakistan [ 36 ]. The SSP was designed to cover a broad range of health conditions and services, including breast cancer diagnosis and evaluation. While the program was met with success in its initial years, and even expanded into some of the other provinces, instability in the political and economic infrastructures of Pakistan have limited its growth, uptake, and effectiveness. Ideally, mass community interventions for early breast cancer detection such as ours could be integrated with UHC programs such as SSP to ensure patient compliance, continuity of care, and maximization of invested resources most effectively.

Limitations

Our study has several limitations that we would like to acknowledge. Firstly, we were unable to calculate a study participation rate as the HCWs did not record the number of informed refusals that they received from women in the community. Secondly, as mentioned earlier, compliance with referrals was exceedingly poor and limited the realization of the true impact of the program. Thirdly, given the limited number of HCWs included, we were unable to perform statistical comparisons to evaluate the improvement in HCWs knowledge. Lastly, the evaluation of the long-term impact and sustainability of the program was limited, presumably due to the influence of sociocultural barriers on the health-seeking behaviors of the women.

This study describes the real-world implementation of a large-scale clinical breast examination and referral community outreach program in a rural district of Pakistan. Our study highlights the importance of CBE programs in early recognition of breast abnormalities/lumps, in regions where mammography is not feasible. Such training programs may lay the foundation for improved provider and community awareness, and examination at the patient’s doorstep and initiate referrals. However, for such programs to ultimately lead to earlier detection of breast cancer/downstaging of disease, community awareness and political buy-in from governmental stakeholders would be critical. Lastly, for such a program to have a truly national impact and be sustainable, more widespread training of HCWs using cascade learning and peer-to-peer teaching models would be necessary.

Data availability

The datasets generated and/or analysed during the current study are not publicly available since the Ethical Review Committee guidelines does not allow institutional data to be dispersed. However, the data is available on reasonable request to the corresponding author.

Abbreviations

Global Cancer Observatory

United States

Lower-Middle-Income Country

World Health Organization

Clinical Breast Examination

Aga Khan University

Union Council

Healthcare Workers

Breast Imaging Reporting and Data System

Lady Health Worker

Universal Health Coverage

Wilkinson L, Gathani T. Understanding breast cancer as a global health concern. Br J Radiol. 2022;95(1130):20211033.

Article   PubMed   Google Scholar  

2022 G. Cancer Today: World Health Organization; 2022 https://gco.iarc.who.int/today/en/dataviz/tables?mode=population&cancers=20&types=1

Arnold M, Morgan E, Rumgay H, Mafra A, Singh D, Laversanne M, et al. Current and future burden of breast cancer: global statistics for 2020 and 2040. Breast. 2022;66:15–23.

Article   PubMed   PubMed Central   Google Scholar  

Ali A, Manzoor MF, Ahmad N, Aadil RM, Qin H, Siddique R, et al. The Burden of Cancer, Government Strategic policies, and challenges in Pakistan: a Comprehensive Review. Front Nutr. 2022;9:940514.

Lin CH, Chuang PY, Chiang CJ, Lu YS, Cheng AL, Kuo WH, et al. Distinct clinicopathological features and prognosis of emerging young-female breast cancer in an east Asian country: a nationwide cancer registry-based study. Oncologist. 2014;19(6):583–91.

Moore MA, Ariyaratne Y, Badar F, Bhurgri Y, Datta K, Mathew A, et al. Cancer epidemiology in South Asia - Past, present and future. Asian Pac J Cancer Prev. 2010;11(Suppl 2):49–66.

PubMed   Google Scholar  

Raza S, Sajun SZ, Selhorst CC. Breast Cancer in Pakistan: identifying local beliefs and knowledge. J Am Coll Radiol. 2012;9(8):571–7.

Badar F, Faruqui ZS, Uddin N, Trevan EA. Management of breast lesions by breast physicians in a heavily populated South Asian developing country. Asian Pac J Cancer Prev. 2011;12(3):827–32.

CAS   PubMed   Google Scholar  

Management-Screening NCD. D.a.T. Guide to cancer early diagnosis 2017 https://www.who.int/publications/i/item/guide-to-cancer-early-diagnosis . [Accessed June 20, 2023].

Organisation. W.H. WHO position paper on mammography screening. 2014.

Zeeshan S, Ali B, Ahmad K, Chagpar AB, Sattar AK. Clinicopathological features of Young Versus older patients with breast Cancer at a single Pakistani Institution and a comparison with a National US database. J Glob Oncol. 2019;5:1–6.

Løberg M, Lousdal ML, Bretthauer M, Kalager M. Benefits and harms of mammography screening. Breast Cancer Res. 2015;17(1):63.

Jones TP, Katapodi MC, Lockhart JS. Factors influencing breast cancer screening and risk assessment among young African American women: an integrative review of the literature. J Am Association Nurse Practitioners. 2015;27(9):521–9.

Article   Google Scholar  

Mascara M, Constantinou C. Global perceptions of women on breast Cancer and barriers to Screening. Curr Oncol Rep. 2021;23(7):74.

Services, U.S.D.o.H.a.H. Increase the proportion of females who get screened for breast cancer 2021 https://health.gov/healthypeople/objectives-and-data/browse-objectives/cancer/increase-proportion-females-who-get-screened-breast-cancer-c-05/data . [Accessed 28-06-2023].

Bank W. Out-of-Pocket Expenditure (% of current health expenditure) - Pakistan 2023 https://data.worldbank.org/indicator/SH.XPD.OOPC.CH.ZS . [Accessed 28-06-2023].

Bank W. Poverty & Equity Brief Pakistan. 2023 April 2023.

Gutnik LA, Matanje-Mwagomba B, Msosa V, Mzumara S, Khondowe B, Moses A, et al. Breast Cancer screening in low- and Middle-Income countries: a perspective from Malawi. J Glob Oncol. 2016;2(1):4–8.

Metwally AM, Abdel-Latif GA, Mohsen A, El Etreby L, Elmosalami DM, Saleh RM, et al. Strengths of community and health facilities based interventions in improving women and adolescents’ care seeking behaviors as approaches for reducing maternal mortality and improving birth outcome among low income communities of Egypt. BMC Health Serv Res. 2020;20(1):592.

Moh DR, Bangali M, Coffie P, Badjé A, Paul AA, Msellati P. Community Health Workers. Reinforcement of an Outreach Strategy in Rural areas aimed at improving the integration of HIV, Tuberculosis and Malaria Prevention, Screening and Care into the Health Systems. Proxy-Santé Study. Front Public Health. 2022;10:801762.

Lynn S, Bickley PGS, Richard M, Hoffman, Rainier P. Soriano. Bates’ Guide to physical examination and history taking Thirteenth Edition. Philadelphia: Wolters Kluwer; 2024.

Google Scholar  

Kearney AJ, Murray M. Breast Cancer screening recommendations: is Mammography the only answer? J Midwifery Women’s Health. 2009;54(5):393–400.

McDonald S, Saslow D, Alciati MH. Performance and reporting of clinical breast examination: a review of the literature. CA Cancer J Clin. 2004;54(6):345–61.

Barton MB, Harris R, Fletcher SW. The rational clinical examination. Does this patient have breast cancer? The screening clinical breast examination: should it be done? How? Jama. 1999;282(13):1270–80.

Article   CAS   PubMed   Google Scholar  

Klein S. Evaluation of palpable breast masses. Am Fam Physician. 2005;71(9):1731–8.

Cady B, Steele GD Jr., Morrow M, Gardner B, Smith BL, Lee NC, et al. Evaluation of common breast problems: guidance for primary care providers. CA Cancer J Clin. 1998;48(1):49–63.

Miller AB, Baines CJ. The role of clinical breast examination and breast self-examination. Prev Med. 2011;53(3):118–20.

Bureau Of Statistics Pdd. Government of Sindh. Health Profile Of Sindh; 2021.

Buribekova R, Shukurbekova I, Ilnazarova S, Jamshevov N, Sadonshoeva G, Sayani S, et al. Promoting clinical breast evaluations in a Lower Middle-Income Country setting: an Approach toward achieving a sustainable breast Health Program. J Glob Oncol. 2018;4:1–8.

Grabler P, Sighoko D, Wang L, Allgood K, Ansell D. Recall and Cancer Detection Rates for Screening Mammography: finding the Sweet Spot. AJR Am J Roentgenol. 2017;208(1):208–13.

Service NCRaA. Screen-Detected Breast Cancer 2009 [ http://www.ncin.org.uk/publications/data_briefings/screen_detected_breast_cancer#:~:text=17%2C045%20cancers%20were%20detected%20 .

Gutnik L, Moses A, Stanley C, Tembo T, Lee C, Gopal S. From community laywomen to breast Health workers: a pilot training model to implement clinical breast exam screening in Malawi. PLoS ONE. 2016;11(3):e0151389.

Hafeez A, Mohamud BK, Shiekh MR, Shah SA, Jooma R. Lady health workers programme in Pakistan: challenges, achievements and the way forward. J Pak Med Assoc. 2011;61(3):210–5.

Jalal S. The lady health worker program in Pakistan—a commentary. Eur J Pub Health. 2011;21(2):143–4.

Ngan TT, Jenkins C, Minh HV, Donnelly M, O’Neill C. Breast cancer screening practices among Vietnamese women and factors associated with clinical breast examination uptake. PLoS ONE. 2022;17(5):e0269228.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Forman R, Ambreen F, Shah SSA, Mossialos E, Nasir K. Sehat sahulat: a social health justice policy leaving no one behind. Lancet Reg Health - Southeast Asia. 2022;7.

Download references

Acknowledgements

Not applicable.

No funding was received for this study.

Author information

Russell Seth Martins and Aiman Arif contributed equally to this work.

Sahar Yameen and Shanila Noordin contributed equally to this work.

Authors and Affiliations

Division of Thoracic Surgery, Department of Surgery, Hackensack Meridian School of Medicine, Hackensack Meridian Health Network, Nutley, NJ, 08820, USA

Russell Seth Martins

Aga Khan University, Karachi, 74800, Pakistan

Aiman Arif, Sahar Yameen, Shanila Noordin, Shah Muhammad, Mukhtiar Channa, Sajid Bashir Soofi & Abida K. Sattar

Department of Surgery, John Hopkins University, Baltimore, MD, 21218, USA

Taleaa Masroor

Department of Surgery, Link Building The Aga Khan University, Karachi, 74800, Pakistan

Abida K. Sattar

You can also search for this author in PubMed   Google Scholar

Contributions

AKS was responsible for study conceptualization, design of the study. Project administration was overseen by AKS and SBS. Development of the curriculum and training of healthcare workers was conducted by AKS. Implementation of the study protocols and the acquisition of data was performed by SY, SN, SM, and MC. TM and RSM were responsible for formal analysis and data curation. AA was responsible for writing the original draft of the manuscript. Critical review and editing of the manuscript were conducted by RSM, AKS and AA. SM and MC were responsible for the supervision of the project on the field and AKS and SBS were responsible for the supervision of the entire project. AKS was involved in all aspects from conception and design, through implementation, monitoring, internal audits, study coordination, data analysis, manuscript concept, and critical review. All authors approved the final version to be published and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Abida K. Sattar .

Ethics declarations

Ethics approval and consent to participate.

The study was approved by the Institutional Ethical Review Committee at Aga Khan University Hospital, Karachi. Informed consent was taken from all study participants after debriefing them regarding the study. The reference number for the study was 2020-2047-14276.

Consent for publication

Written informed consent for publication was taken from all study participants as part of the informed consent.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Rights and permissions.

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Martins, R.S., Arif, A., Yameen, S. et al. Implementation of a clinical breast exam and referral program in a rural district of Pakistan. BMC Health Serv Res 24 , 616 (2024). https://doi.org/10.1186/s12913-024-11051-7

Download citation

Received : 13 February 2024

Accepted : 26 April 2024

Published : 10 May 2024

DOI : https://doi.org/10.1186/s12913-024-11051-7

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Breast cancer
• Clinical breast exam
• Healthcare workers
• Community outreach program

BMC Health Services Research

ISSN: 1472-6963

• General enquiries: [email protected]

Stormy Daniels' testimony at Donald Trump's trial: Five takeaways

• Medium Text

Sign up here.

Reporting by Luc Cohen in New York; Additional reporting by Jack Queen in New York; Editing by Noeleen Walder and Stephen Coates

Our Standards: The Thomson Reuters Trust Principles. New Tab , opens new tab

Thomson Reuters

Reports on the New York federal courts. Previously worked as a correspondent in Venezuela and Argentina.

World Chevron

Director Mohammad Rasoulof flees Iran ahead of Cannes premiere

Mohammad Rasoulof, a celebrated Iranian director whose latest film is competing in the Cannes Film Festival, has fled Iran after being sentenced to eight years in prison and flogging.

Advertisement

Stormy Daniels Delivers Intense Testimony in Trump’s Trial: 6 Takeaways

A long day on the stand put Ms. Daniels’s credibility to the test as defense lawyers challenged her motives.

• Share full article

By Kate Christobek and Jesse McKinley

• Published May 7, 2024 Updated May 13, 2024, 8:44 a.m. ET

Follow our live coverage of Trump’s hush-money trial in Manhattan.

“The people call Stormy Daniels.”

So began the intense and often uncomfortable testimony of Ms. Daniels, who spent almost five hours in a Manhattan courtroom on Tuesday recounting her story of a 2006 encounter with Donald J. Trump and the ensuing hush-money cover-up that has become the bedrock of the prosecution’s case.

Ms. Daniels spoke quickly and at length about her first meeting with Mr. Trump at a celebrity golf tournament near Lake Tahoe in Nevada.

After the lunch break, Mr. Trump’s lawyer Todd Blanche moved for a mistrial, arguing that the prosecution’s questions had been designed to embarrass Mr. Trump and prejudice the jury.

The judge, Justice Juan M. Merchan of State Supreme Court, agreed that some of Ms. Daniels’s testimony might have “been better left unsaid,” but he denied a mistrial.

The former president is accused of falsifying business records to cover up a $130,000 payment to Ms. Daniels just before the 2016 election. Mr. Trump, 77, has denied the charges and says he did not have sex with Ms. Daniels. If convicted, he could face prison time or probation.

Here are six takeaways from Mr. Trump’s 13th day on trial.

Prosecutors took a risk with their witness.

Jurors heard a vivid account of the Lake Tahoe encounter and met the woman who had received the hush-money payment. This could have presented a risk for prosecutors, depending on whether the jury viewed Ms. Daniels’s story as prurient or powerful.

Ms. Daniels described meeting Mr. Trump at the golf event and accepting his dinner invitation after her publicist said, “What could possibly go wrong?”

She recalled that Mr. Trump had been wearing pajamas when she met him at his hotel suite and that she asked him to change. They discussed the porn industry, and he asked about residuals, unions and testing for sexually transmitted diseases, she said.

She said they had talked about his family, including his daughter, whom he likened to Ms. Daniels — “People underestimate her as well,” Ms. Daniels recalled him as saying. They also discussed his wife; Mr. Trump said they did not “even sleep in the same room.” He suggested that Ms. Daniels might appear on “The Apprentice.”

When she later emerged from the bathroom, Ms. Daniels found Mr. Trump partially undressed, she said. The sex was consensual, she said, but there was a power “imbalance.”

The Links Between Trump and 3 Hush-Money Deals

Here’s how key figures involved in making hush-money payoffs on behalf of Donald J. Trump are connected.

Trump received another warning.

Justice Merchan has already held the former president in contempt 10 times, fined him $10,000 and twice threatened to send him to jail. On Tuesday, Mr. Trump again drew the judge’s ire after Justice Merchan said he had been “cursing audibly” and “shaking his head.”

The judge asked Mr. Trump’s lawyers privately to talk to their client, saying Mr. Trump’s actions might intimidate the witness, Ms. Daniels.

“You need to speak to him,” the judge said. “I won’t tolerate that.”

The motive for the payoff is a point of contention.

Prosecutors asked Ms. Daniels about a 2018 statement in which she denied the sexual encounter. Ms. Daniels said she had not wanted to sign it and that it was not true.

Defense lawyers, capitalizing on what they seem to perceive as Ms. Daniels’s shortcomings as a witness, came out blazing. One of them, Susan Necheles, implied in her cross-examination that Ms. Daniels was trying to “extort money” from Mr. Trump.

Ms. Daniels replied sharply, “False.”

Daniels’s story bothers Trump.

Before court even started Tuesday morning, Trump telegraphed his frustration with Ms. Daniels in an angry post on Truth Social, saying he had just learned about a coming witness and that his lawyers had “no time” to prepare. The post was removed shortly thereafter, possibly because of concerns over violating the gag order.

Mr. Trump, who has spent much of the trial with his eyes closed, remained attentive for part of the day, often with a sour expression on his face. He continually whispered to his lawyers and at one point mouthed an expletive.

But by the afternoon, he had returned to his habit of closing his eyes, even during a combative cross-examination.

Daniels’s credibility is a hurdle for prosecutors.

Ms. Daniels’s motivations are a major focus of the defense. In a sharp moment, Ms. Necheles confronted her about what Ms. Necheles described as her hatred of the former president and asked whether she wanted him to go to jail. Ms. Daniels responded, “I want him to be held accountable.”

Ms. Necheles also asked Ms. Daniels about making money by claiming to have had sex with Mr. Trump. Ms. Daniels responded, “I have been making money by telling my story,” and later added, “It has also cost me a lot of money.”

Who Are Key Players in the Trump Manhattan Criminal Trial?

The first criminal trial of former President Donald J. Trump is underway. Take a closer look at central figures related to the case.

Trump’s words haunt him.

Prosecutors have tried several times to use Mr. Trump’s prior statements against him.

Before Ms. Daniels testified Tuesday, a witness read aloud passages from books by Mr. Trump. Some spoke to his frugality. Others spoke to his penchant for revenge.

“For many years I’ve said that if someone screws you, screw them back,” the witness read. The passage continued, “When somebody hurts you, just go after them as viciously and as violently as you can.”

Not long after, one of his enemies — Ms. Daniels — took the stand. Her cross-examination resumes on Thursday.

Kate Christobek is a reporter covering the civil and criminal cases against former president Donald J. Trump for The Times. More about Kate Christobek

Jesse McKinley is a Times reporter covering upstate New York, courts and politics. More about Jesse McKinley

Our Coverage of the Trump Hush-Money Trial

News and Analysis

Michael Cohen was paid to fix Donald Trump’s problems. Now, as he prepares to take the stand in Trump’s criminal trial, he’s one of them .

Ahead of Cohen’s testimony, Justice Juan Merchan told prosecutors to keep Cohen from speaking about the case .

Witnesses have described Trump monitoring the minutiae of his business , a portrait prosecutors are drawing to help convince the jury that he couldn’t have helped but oversee the hush-money payment.

More on Trump’s Legal Troubles

Key Inquiries: Trump faces several investigations  at both the state and the federal levels, into matters related to his business and political careers.

Case Tracker:  Keep track of the developments in the criminal cases  involving the former president.

What if Trump Is Convicted?: Could he go to prison ? And will any of the proceedings hinder Trump’s presidential campaign? Here is what we know , and what we don’t know .

Trump on Trial Newsletter: Sign up here  to get the latest news and analysis  on the cases in New York, Florida, Georgia and Washington, D.C.