Model essay on undergraduate clinical medicine 1: "Reflections on medical microbiology teaching for eight-year clinical medicine majors"
Medical microbiology is an important part of basic medicine, and it is also a bridge course linking basic and clinical. It is closely related to the diagnosis, treatment and prevention of diseases. With the continuous development of life science, medical microbiology covers more and more contents and fields. This requires medical students to master the basic knowledge of this course and learn to use it flexibly. However, the course of medical microbiology itself has the characteristics of scattered knowledge points, difficult to remember and easy to be confused. The traditional teaching method with teaching materials as the main body and teachers as the center can not stimulate students' learning interest and creativity well, which is not conducive to realizing the goal of cultivating practical and innovative comprehensive medical talents in modern medical education [1]. What is the practice of cultivating eight-year students in clinical medicine in our school? 3+5 mode? (that is, 3 years of basic cultural education plus 5 years of medical education). As one of the basic medical courses, medical microbiology is arranged in the second semester of the second year of medical education. Prior to this, the students of this major have thoroughly and systematically studied basic medical courses such as biochemistry, cell biology, histology and embryology, and have some basic medical knowledge. Secondly, as far as students' own quality is concerned, eight-year students have a solid foundation, active thinking, strong curiosity and strong acceptance. Moreover, the number of eight-year classes in our school is generally around 20, which is small and meets the requirements of small classes [2]. Therefore, in view of the shortcomings of traditional teaching methods and the characteristics of eight-year students, this study reformed and explored the teaching of medical microbiology for eight-year students majoring in clinical medicine from the following aspects:
1 case-guided teaching method
The traditional teaching mode of medical microbiology is usually to teach the basic biological forms of microorganisms first, and then to talk about their pathogenicity, immunity and prevention principles.
This systematic and regular teaching method is convenient for students to compare and memorize various theoretical knowledge points horizontally, but it is relatively boring and boring, and can not stimulate students' interest and motivation in learning. Therefore, we can take advantage of the close combination of medical microbiology and clinic to lead out the teaching content with a clinical case. The selection of clinical cases is very important, which should be close to clinic and reality, and reflect the basic knowledge points. First of all, by giving a suitable clinical case and asking questions, students can learn with questions, stimulate students' interest and improve their attention to teaching content; Then the teacher systematically explains the basic principles and knowledge of microorganisms; Next, go back to the original clinical cases, organize students to discuss in groups, and ask students to propose diagnosis and treatment methods for the cases. Finally, the teacher summarizes the students' opinions, eliminates the false and keeps the true, checks the missing and fills the gaps, and puts forward the teaching focus and requirements of this lesson. For example, in the teaching of hepatitis B virus, you can give it to one person first? Two and a half hepatitis B? Inspection Report Q: Are the subjects healthy, virus carriers or infected? Let the students take this question to the next step of learning; Through the teacher's explanation of the basic knowledge points of hepatitis B virus, such as morphological structure, pathogenicity, etc., let students discuss the initial cases with what they have learned; Finally, the teacher summarized and emphasized several important knowledge points, such as the morphological structure of hepatitis B virus, the diagnosis and prevention of hepatitis B [3]. This kind of classroom organization can make students apply what they have learned and find a sense of accomplishment from it.
2 Literature Reading Seminar
The main research object of medical microbiology is pathogenic microorganisms related to medicine, which is closely related to human health. With the rapid development of life science and technology, new pathogenic microorganisms are constantly identified, and some pathogenic microorganisms that were basically controlled in the past are popular again, which constitutes a serious public health problem. Compared with the rapid development of science and technology and the rapid updating of knowledge, the knowledge in textbooks is relatively fixed, and the speed of textbook updating is far behind the speed of knowledge development [4]. Therefore, to understand the frontier progress of a subject, we must read the literature. Therefore, the literature reading seminar was set up in the teaching of clinical eight-year medical microbiology, and it was arranged in the last two classes of theoretical courses. At this time, students have mastered and understood the knowledge of microbiology to a certain extent, and have the basis for reading relevant literature. The development of the course includes the following aspects: 1. Preview. Before the course begins, the author will draw up a special topic, such as the infection and prevalence of avian influenza virus, and then list several related questions, such as (1) why does avian influenza cause human infection? (2) Under what circumstances may an avian influenza epidemic occur? (3) What are the effective prevention and control measures for avian influenza? (4) As a medical student, what can you do to deal with the public panic caused by bird flu? Then 1 ~ 2 Chinese and English classic documents are given, so that students can read the documents to find information according to the special topic and given topic after class. Next, it is the class discussion part. In view of the small number of students in the eight-year program, a group discussion was held. Divide 20 students into four groups: A, B, C and D4. Five students in each group correspond to the number 1 ~ 5, that is, A 1, A2, A3, A4, A5, etc. Each group will discuss a problem separately. After 5 ~ 8 minutes, each group will send a representative to make a summary statement on the issues discussed. Then the students with the same numbers in Group A, Group B, Group C and Group D4 regroup into a new group, namely, A 1, B 1, C 1, D 1, and so on, ***5 groups. Five groups of students have a 5-8 minute cross-discussion on four questions. Finally, the teacher summarized the whole literature discussion. The opening of literature reading seminar has expanded students' knowledge and cultivated their self-study ability and innovation ability. The grouping method of cross-discussion can stimulate students' interest and enthusiasm in learning, make students participate more thoroughly and understand the literature more comprehensively [5].
3 students' independent teaching methods
The traditional teaching model is usually a teacher? Teaching? , students? Study? Students' learning knowledge is a passive acceptance process. By choosing appropriate teaching chapters, the author exchanges roles in clinical eight-year classes, so that students can change from the past simple? Listen. Take the initiative? Talk? . This change caters to the psychological characteristics of teenagers to challenge themselves and show themselves. It not only stimulates students' learning, but also enlivens the classroom atmosphere, exercises students' language expression ability and cultivates students' self-confidence. The primary factor in developing students' autonomous teaching is to choose appropriate teaching content. Humanimmunodeficiencyvirus (HIV) is highly concerned by the society, and it is easy to stimulate students' interest and learning motivation. Therefore, this study takes HIV in retrovirus as the content of students' independent teaching. In order to prevent the repetition and singleness of the content, the author divided 20 students into four groups and gave four topics respectively, such as (1) the epidemic situation and development trend of AIDS; (2) The pathogenicity and clinical manifestations of HIV; (3) the route of transmission of AIDS and the principles of prevention; (4) Research status of HIV and whether there are effective treatment methods. Each group prepares lessons for a special topic and prepares PPT for about 15min. In class, each group randomly chooses a classmate to give a lecture on stage. After each student's lecture, the teacher makes a brief comment on the teaching content, PPT production form and language organization ability, and students can also put forward their own views and opinions on the lecturer's performance. Finally, the teacher refines and summarizes the contents of the four topics, so that students can grasp the teaching content as a whole. At the same time, due to time constraints, it is impossible for every student to give lectures on stage. In order to make all students have a sense of participation, the author requires students to print out their own PPT content and hand it in as a paper version, set a grading standard, and the teacher will correct the grading, which will be included in the final grade at the ratio of 10% [6-7]. Practice shows that this teaching mode of students' autonomous listening to lectures has aroused students' learning enthusiasm and initiative, exercised students' autonomous learning ability, improved students' comprehensive quality, and at the same time allowed teachers to find problems in teaching and correct them in time.
4 the second classroom activities
Medical microbiology is a basic clinical subject, and it is very important to offer experimental courses. The experimental course is helpful for students to verify and consolidate the basic theoretical knowledge of medical microbiology, master the basic operation technology of microbiology and exercise their practical ability. However, due to the limitation of class hours, the content of experimental courses is mostly simple experiments that simply verify the basic theory of the subject, which can not well stimulate students' ability to think, analyze and solve problems independently, and it is difficult to cultivate students' innovative consciousness. In addition, our school has certain scientific research tasks in the cultivation of clinical eight-year students. Therefore, in the teaching of clinical eight-year medical microbiology, the author has set up a second classroom activity for some spare students. The so-called second classroom is the scientific research counseling activities carried out by teachers for students in their spare time [8]. Between teachers and students? Two-way choice? When teachers choose students, students can choose their tutors according to their interested scientific research direction. General 1 teacher teaches 1 ~ 2 students. In the implementation of the second classroom activity, the author will first conduct centralized training for all students involved, including laboratory rules and safe use of instruments, basic operation of molecular cloning experimental technology and so on. Then the teacher will give one-on-one specific guidance to the students. The teacher will give 3-5 review documents in related research fields. After reading it, students will discuss with the teacher and put forward their own views and understanding. With the guidance and help of teachers, students will ask scientific research questions and complete the experimental design. At this stage, reading literature and designing experiments are helpful to cultivate students' scientific research thinking and innovative ability. After demonstrating the feasibility of the scheme, the next step is the experimental operation stage. Under the guidance of teachers, students use their spare time to carry out experiments. During this period, teachers can organize a weekly report and discussion on the progress of experiments to solve various problems encountered by students in the experiments in time. Finally, the second class activity is summarized in the form of student report and defense. Teachers should encourage students with smooth progress and ideal experimental results to write and publish research papers and give them some rewards [9]. The second classroom activities have improved the teaching quality of medical microbiology, enriched the experimental teaching content, opened a window for students to understand and contact with scientific research, and cultivated their ability to explore knowledge and think independently. To sum up, in view of some disadvantages and deficiencies in the traditional teaching of medical microbiology, the author tried a series of reforms and innovations in the teaching process of clinical eight-year students in our school. Case-guided teaching and students' autonomous teaching stimulate students' enthusiasm for learning, test teachers' classroom organization ability, give students the opportunity to show themselves and improve their comprehensive quality. The literature reading seminar and the second classroom activities have created a platform for students who love scientific research and cultivated their independent thinking and hands-on ability. Although the new teaching methods are generally welcomed by teachers and students, there is still room for improvement, which requires continuous exploration and practice in the future teaching work and unremitting efforts to promote the improvement of the teaching quality of medical microbiology.
refer to
Li Ming, Shen Xiaodong, Li Shu, et al. Teaching reform and thinking of medical microbiology [J]. Off-campus education in China, 2011(6):116.
[2], Chen, Analysis and reflection on the current situation of eight-year clinical medicine [J]. China Higher Medical Education, 2010 (4):117-118.
Chen Jing, Li Shuqing, Zhang Ying, et al. Application of PBL teaching method based on medical records in pathophysiology teaching [J]. chongqing medical, 2014,43 (20): 2677-2678.
[4] Hu Xiaomei, Wang Zhengqing, Hu Fuquan, et al. Practice and thinking of innovative education in medical microbiology [J]. China Journal of Medical Education Exploration, 20 12,1(11):/kloc-0.
[5], Xing,, et al. The influence of literature reading discussion teaching mode on critical thinking ability of nursing postgraduates [J]. Chongqing Medical, 2014,43 (11):1399-143
[6] Chen Xia. Practical research on students' autonomous teaching in clinical practice teaching [J]. chinese medicine guides, 2012,36 (36): 662-663.
[7],, Zhang,. On the teaching reform of pharmacology of traditional Chinese medicine? Reflections on college students' autonomous class attendance [J]. chinese medicine modern distance education of china, 20 13,11(15): 70-72.
[8] He Haiyang, Wu. Teaching practice and experience of the second class for medical undergraduates [J]. Modern Medicine and Health, 2014,30 (12):1885-1886.
[9] Wang Wen, Ren Hao, Zhao Ping. Practice and thinking on the second classroom teaching of medical microbiology [J]. Basic medical education, 20 13, 15 (5): 492-493.
Model essay 2 of undergraduate clinical medicine graduation thesis: "Reflections on the employment status of graduates from clinical medical colleges"
This paper analyzes the current situation and reasons of the employment of graduates majoring in clinical medicine, and puts forward some countermeasures to improve the employment of graduates from the perspective of specialty construction.
Key words: clinical medicine major; University graduates; work status
Introduction to 0
Notice of the General Office of the State Council on Strengthening the Employment of Graduates from Ordinary Colleges and Universities and Several Opinions of the Ministry of Education on Comprehensively Improving the Quality of Higher Vocational Education clearly require? Market-oriented, accelerate the teaching reform of higher vocational education, improve the quality of personnel training and promote the employment of graduates? . This paper analyzes the employment situation of clinical medical graduates in the 20th15th session of Heilongjiang College of Nursing, closely combines talent training with employment, adjusts the professional direction in time according to the change of post demand, and improves students' employability and adaptability by updating, adjusting and adding necessary professional technical courses and practical training projects.
1 survey results
Taking the graduates of clinical medicine in the 20th15th session of Heilongjiang Nursing College as the investigation object, the employment situation is as follows: there are 87 graduates of clinical medicine in the 20th15th session, and the statistical time is up to the end of September. The comprehensive employment rate is 59, the comprehensive employment rate is 67.8 1%, the flexible employment rate is 8%, and the actual employment rate is 59.8000.00000000805 Enter an undergraduate college. In the actual employment rate, the proportion of tertiary hospitals is 3.4%, the proportion of township and community hospitals is 28.73%, and the unemployment rate is 32. 18%. According to the above data, there are more graduates who have suspended their employment. Nearly one-third of the graduates choose to go to hospitals at or above the county level for further study for one year, waiting for the examination of practicing assistant doctors, hoping to get the qualification certificate of practicing assistant doctors before going to big city hospitals with good economic benefits. Nearly 8% students choose to continue their studies. Graduates majoring in clinical medicine have relatively narrow employment channels because of their unique professional characteristics; During their school years, they are under great pressure to study, have poor communication and information exchange skills with the society, and have insufficient understanding of employment information acquisition or employment trends, which further aggravates their employment dilemma.
2 Coping strategies
How to face the increasingly heavy employment pressure of graduates is a severe challenge for all colleges, especially higher vocational colleges. How to deal with the pressure and get out of the predicament is also a problem that every college teacher should think about.
First of all, strengthen the guidance and service of employment work, reverse the concept of graduates' job hunting, and open up broad space and important channels for grassroots employment. According to the analysis of the demand for medical and health talents in China, although the demand for basic talents in large and medium-sized cities represented by provincial capitals is basically saturated, the demand for basic talents in medical institutions still exists on the whole level, and the demand for clinical medical graduates in the vast number of new cities, communities and border areas is still huge. With the development of new rural cooperative medical care in China, grass-roots medical and health institutions are in urgent need of a large number of talents, and they have great potential to accept and absorb clinical medical graduates. Heilongjiang College of Nursing has made some useful attempts in promoting graduates' employment at the grass-roots level, and constructed a professional training model for grass-roots employment. As a medical college in higher vocational colleges, from the first employment guidance class for freshmen every year, we have established the idea of students' employment at the grassroots level, emphasizing the medical concept of serving the grassroots and serving the countryside. In view of the three-year clinical medical graduates' probation and internship, the original class structure is broken, and several clinical probation and internship bases are set up based on regional and students' independent registration, so that the student internship hospital is close to their own employment scene, which is beneficial for graduates to understand the service characteristics of medical institutions to be employed nearby. In the management of specialized courses in clinical medicine, a professional counselor is set as the person in charge, who is responsible for students' study supervision and employment guidance for three years from enrollment to graduation, and the employment guidance is implemented to every teaching teacher in the department, which subtly guides students to position themselves and establish a correct concept of career choice in the teaching process.
Secondly, help graduates to participate in and successfully pass the qualification examination of practicing assistant doctors, obtain the qualification of doctors, and take up their posts legally, so as to improve the enthusiasm of employers in using medical graduates. Comprehensively optimize the course structure, improve the training accuracy, provide students with special training for the qualification examination of practicing assistant doctors, and improve the pass rate of participating in the qualification examination of practicing assistant doctors. The school plans to offer pre-examination counseling courses for the qualification examination of licensed assistant doctors after graduation, to help students obtain the qualifications of assistant doctors and doctors, and to contribute to students' high-quality job hunting. At the same time, in the construction of the curriculum system, a three-year training program for clinical medical professionals is established based on the examination outline of medical practitioners. To cope with the practical skills test and comprehensive written test as the goal, organize the compilation of practical school-based teaching materials. Organize young teachers to participate in the qualification examination of practicing doctors in person, sum up experience from comprehensive review and on-site response, and integrate first-hand experience into the pre-test counseling teaching of the qualification examination of practicing assistant doctors; Then, the test sites and knowledge points summarized and refined in counseling teaching are integrated into routine teaching, and the cultivation of practical ability and clinical thinking ability is emphasized, so as to fundamentally improve the comprehensive ability of clinical graduates and have better adaptability in employment and future clinical work.
Third, clinical medical students are encouraged to minor in or participate in professional courses training, and courses such as pediatrics, maternal and child health care, first aid and first aid are offered to meet the talent demand of rural primary health care in this respect. With the continuous improvement of the market-oriented mechanism, we realize that products with characteristics and individuality will be more competitive in the market. Although the requirements of hospitals for graduates' academic qualifications are getting higher and higher, and the employment situation of junior college students is getting more and more severe, the demand for junior college talents in primary hospitals is always quite stable. In other words, in the direction of personnel training, it is necessary to cultivate high-quality general medical talents and make students have their own characteristics. Under the guidance of professional teachers, we should combine classroom learning, online learning and autonomous learning to form our own expertise and improve our employment competitiveness. At the same time, strengthen humanistic quality education and expand students' comprehensive quality. Improve the ability of communication and information exchange between graduates and society, so as to strengthen the acquisition of employment information or the grasp of employment dynamics.
3 Conclusion
To sum up, we should guide graduates to change their employment guidance ideas, combine the training objectives of three-year clinical medicine specialty with the employment position setting of primary medical institutions, establish an employment-oriented professional talent training model, solicit the opinions of primary medical experts through the feedback from employers and graduates, and adjust the professional talent training model to enhance the employment competitiveness of graduates and cultivate qualified professional medical and health talents for the society.
References:
[1] Li Hao, Xiao Aiping. Investigation and Reflection on the Employment of Clinical Medical Graduates [J]. Exploration of Medical Education, 2009,8 (6): 741-743.
[2] Niu Chunhong, Liu, et al. Investigation and analysis on the employment situation of medical graduates and countermeasures [J]. China Higher Medical Education, 20 1 1, (11):16-/kloc-0.
Fan Wensan, Graduation Thesis of Undergraduate Clinical Medicine: Improving the Quality of Orthopedic Practice of Clinical Medical Students under the New Situation
Clinical medicine is a practical and applied subject, which needs to train high-quality medical workers through a step-by-step education model [1]. During the internship, especially the study of orthopedic surgery, it is professional and involves a wide range, which requires higher teachers and teaching methods. This paper discusses how to improve the teaching quality of orthopedic practice for medical students.
1 Main factors affecting clinical practice teaching
1. 1 disharmony between doctors and patients
In the current social environment, with the continuous improvement of the legal awareness of patients and their families, the disharmony between doctors and patients and the lack of trust between doctors and patients have brought certain obstacles to the clinical practice teaching of medical students. For personal gain, patients can't understand the purpose of clinical teaching and refuse interns; Patients often question the clinical diagnosis and treatment qualifications of interns and refuse to let interns do some simple physical examinations [2]. However, patients and their families do not fully recognize these regulations, which leads doctors to be more and more cautious in carrying out medical work, which to a great extent restricts the teaching teachers from delegating the right of diagnosis and treatment to interns and acting as full agents for some diagnosis and treatment operations that could have been attended by interns. As a result, the clinical skills of interns can not be comprehensively improved, and the effectiveness of clinical practice teaching is greatly reduced.
1.2 postgraduate entrance examination and the conflict between employment and practice
With the large-scale expansion and popularization of university education, there are more and more students. This seven-year program should aim at training senior clinicians. However, looking at the national situation, we can see that there are nearly a thousand students enrolled in seven-year medical colleges every year. As a part of teaching and training, the problem of how to ensure the teaching quality is inevitable. The same employment problem cannot be avoided. Undergraduate students can hardly find suitable and ideal jobs. Faced with the pressure of survival, how can students prepare for the postgraduate entrance examination without skipping the internship, just to get a higher degree and find an ideal job?
1.3 Short internship time
It is impossible for a department to systematically master the diagnosis and treatment of common diseases in various majors in three weeks, especially for the seven-year program aimed at cultivating clinical graduate students. The preliminary courses should be appropriately compressed, and theoretical study should be completed at least before the senior year. Then arrange 1~2 years of rotation practice, so that a department can basically have 1~2 months, so as to participate in the whole process of diagnosis and treatment of a complete patient, so as not to appear the phenomenon that the patient has not left the hospital.
2 Measures to improve the quality of orthopedic practice
2. 1 Relieve the tense doctor-patient relationship
The contradiction between doctors and patients and their families has a long history, and the general public has distrust of doctors, whether it is medical skills or medical ethics; Doctors, on the other hand, think that patients are often unreasonable, so there is a lack of the most basic trust between doctors and patients, which is difficult to eliminate in the short term. Doctors and patients, hospitals and patients should put themselves in their shoes and understand each other. Doctors should patiently listen to patients' complaints, sincerely sympathize with and support patients, strive to eliminate or alleviate patients' illness, and sincerely care for every patient. This will help patients to better cooperate with clinical teaching and fully understand the situation of interns participating in diagnosis and treatment. At the same time, efforts should be made to improve the public's understanding of clinical practice, and all sectors of society should also increase their understanding of hospitals and doctors, establish a correct public opinion orientation, and establish a good atmosphere for the development of clinical teaching [3].
2.2 Strengthen the attendance assessment system for medical students.
Students' clinical practice is the work of both the school and the practice hospital, so it is necessary to cooperate with each other, strengthen communication with the practice hospital, find problems in time and put forward suggestions for improvement. Try to let students know about common orthopedic diseases in a limited time. For example, in the teaching process of bone tumor, teachers need to make full preparations, select enough patients with various key diseases, prepare distinctive image materials, pay attention to case explanation, comparison and questioning, and then mobilize students to actively think and understand [4]. In addition, in different stages of internship, a certain attendance and assessment mechanism is set up to urge students to practice better.
2.3 Strictly select teaching staff to ensure the quality of clinical teaching.
Teachers play the most important leading role in teaching, and the quality of teaching teachers is the key to improve the quality of clinical teaching. In the process of improving the teaching team, it is necessary to strengthen the training of teachers' teaching methods: PBL practice of problem-oriented teaching method [5]; Sally pickard adopts the method of simulating patients in the teaching process to promote the operation skills of interns [6]. At the same time, regularly organize peer and teacher-student teaching evaluation activities to promote teaching.
2.4 Pay attention to improving interns' ability to integrate theory with practice.
An important part of clinical practice ability is the cultivation of clinical thinking ability. Practical clinical practice ability can not be separated from solid professional theoretical knowledge and scientific thinking ability. Orthopedics should attach importance to the cultivation of students' clinical thinking ability and practical work ability. Inspire students to discuss relevant basic and clinical knowledge, and hold regular reading reports.
3 abstract
Internship is very important, especially when choosing workers immediately after graduation. Practice can apply theoretical knowledge to practice and broaden one's clinical horizons. Started the psychological role change from students to doctors. Therefore, interns are required to master the most basic medical routine, such as collecting medical history, physical examination, especially physical examination in various specialties, and mastering the routine examination and treatment of common diseases; Master the writing of basic medical documents, such as medical records, course of disease, laboratory sheets, etc. Master the most basic operation, preoperative preparation and minimum sterile culture principle. For teaching teachers, especially senior teachers, learning interpersonal communication methods and conversation skills is very important for the growth of doctors, especially how to gain the trust of patients in the shortest time. Interns should pay full attention to and clearly understand their own factors, and make maximum use of this precious time to improve their clinical practice ability.
[References]
[1] Liu Jianwen Subo. Higher medical education [M]. Beijing: People's Military Medical Publishing House, 2004.
[2] Yu, Hu Gang. Factors affecting the quality of clinical practice of medical students and countermeasures [J]. Shizhen Chinese Medicine, 2009,20 (7):1824-1825.
Gao Yongjun, Wei Xu, Liu Jing, et al. Peking University Hospital incident? Clinical practice teaching for medical students [J]. China Medical Ethics, 20 10/0,23 (6): 70-71.
Lu Ying. Experience in clinical teaching of bone tumor and osteopathy in orthopedics [J]. China Bone Tumor and Osteopathy, 2005,4 (3):175-176.
[5] Li Hongwei, Su Yanhe, Yang Xianhui, et al. Practice and experience of practical teaching for seven-year medical students [J]. Henan Journal of Surgery, 201,17 (2):109-1.
Li, Cui, et al. Discussion on improving the practice quality of seven-year clinical medical students [J]. Anhui Medicine, 2009, 13 (6): 693-694.
Guess you like:
1. Undergraduate medical graduation thesis mode
2. Model essay for undergraduate graduation thesis
3. Download the model essay of undergraduate graduation thesis
4. Model essay of RTVU undergraduate graduation thesis
5. Model essay template for undergraduate graduation thesis
6. Model essay of undergraduate nursing graduation thesis