Each Master of Public Health degree student must complete a capstone project as the final requirement for the M.P.H. degree. The capstone project represents the culmination of a major practice or research activity and consists of a written paper and a final examination. The paper must be a well-reasoned original contribution to knowledge in a discipline of public health, and should provide evidence of scholarly achievement. The final examination consists of a formal presentation of the capstone project followed by a question and answer session conducted by the student's faculty committee. The capstone project will be graded on a pass/fail basis by the faculty committee. See Appendix I for details.
Each Master of Public Health (M.P.H.) student must complete a culminating experience as the final requirement for the M.P.H. degree. The culminating M.P.H. experience is a Graduate School Plan B, non-thesis option “Capstone Project”. The capstone project represents the culmination of a major practice or research activity and consists of a formal written manuscript that will become part of the College of Public Health archives, a formal public presentation open to the College’s students and faculty, and an oral examination consisting of questions by the student’s committee. The Capstone project is an opportunity to integrate coursework and field experience into a singular applied project that demonstrates proficiency. The project must be a well-reasoned contribution to knowledge in a discipline of public health, and should provide evidence of scholarly achievement. The nature of the capstone project should be consistent with the career goals of the student, and it should be viewed as a culminating display of ability, demonstrating that the M.P.H. graduate is prepared to become a professional in the field of public health. The excellence in writing and oral presentation requirements reflects competencies that are essential to success in the field of public health. The “manuscript format” for the capstone project is intended to familiarize students with the rigors of preparing manuscripts for professional journals.
To be successful, in the M.P.H. degree program and the profession, students are expected to possess or obtain proficiency in writing before they begin the capstone project. Thus, at the discretion of the Department Chair or M.P.H. Director of Graduate Studies, additional coursework may be recommended to students with identified deficiencies in their writing ability. The University of Kentucky offers several writing improvement resources. Students are encouraged to use University resources, including the Writing Center to improve their communications skills.
Similarly, students are expected to acquire proficiency in oral presentation. The CPH strongly recommends that all M.P.H. students attend at least one professional conference (e.g., APHA, Academy Health, SOPHE, ACHE) to observe and learn about formal oral presentations on public health topics. The presentation/oral examination is intended to be a learning opportunity for all students in the College of Public Health. All fall and spring semester presentations are scheduled on a single day and are open to students and faculty to achieve this objective. Students are strongly encouraged to attend these oral examinations each semester of enrollment in the M.P.H.
The primary product of the capstone project is a written report (using a standardized format applying the Uniform Requirements for Manuscripts Submitted to Biomedical Journals: Writing and Editing for Biomedical Publication along with a standardized title and signature page (Appendix 1 A) as the default standard for the capstone project). The length of a capstone manuscript will vary with the topic and the expectation of the student’s committee. The maximum length will typically be a text of 4,000 words not including appendices, tables, and charts. With the approval of the student’s committee, an alternate format consistent with the guidelines for authors of a relevant journal to which the student is planning to submit the paper will be accepted. All projects must conform to University of Kentucky Office of Research Integrity policies concerning the protection of human subjects. All projects must complete Institutional Review Board (IRB) review or have confirmation that IRB review is not required.
The capstone process is initiated and driven by the student; however, explicit deadlines are established by the Graduate School and the College of Public Health. These deadlines are critical and a student’s failure to complete necessary tasks on schedule will result in a delay in graduation. Graduate School rules require that the oral examination occur a minimum of one week prior to the last day of classes in a semester. The day scheduled for MPH oral examinations will be 2-3 days earlier than the Graduate School deadline. All deadlines are established to assure that a high quality project is completed by that date. The Capstone project is not an activity that can be completed in one week, and students must plan accordingly to graduate on schedule.
The first steps in the capstone process are the selection of a project topic and a committee. If a student is uncertain of a topic, she/he may consult with faculty in her/his discipline. Most students identify a capstone topic based upon individual academic interests, field practicum, current employment, and career plans. Once a student has identified a topic, the next step is to identify a capstone committee. The student must identify a faculty member to serve as the committee chair.
The Graduate School specifies that the capstone committee must include a minimum of three university faculty members. At least one of the faculty members must be a “full member” of the Graduate Faculty. The second committee member must be either a “full member” or “associate member” of the Graduate Faculty, and the third member must hold a university faculty appointment but need not be a member of the Graduate Faculty. Graduate status of faculty may be determined at the web site: https://www.research.uky.edu/cfdocs/gs/dgsgradfac/ . The College of Public Health requires that at least two committee members including the chair must be from the student’s area of concentration. (A listing of eligible chairpersons will be available at the beginning of each College year). The third committee member may be from any CPH department, or elsewhere in the University. In consultation with the faculty member serving as chair, the student may invite additional faculty or practitioners to serve on the committee. However, the larger the committee, the more complex the process.
The committee chair will play an essential role in the capstone process and should offer expertise and mentorship that will contribute to the student’s efforts. Selecting a chair is an important process that should begin with the student’s identification of a narrowly defined set of research questions. The process of developing these research questions may involve consulting with multiple members of the CPH faculty. Ultimately, however, the student is expected to identify a faculty member who is eligible (and willing) to serve as chair for the committee that will provide oversight for the study designed to address the identified research questions. Once the selected chair has agreed to serve, the student and chair will discuss the composition of the remainder of the committee, and other committee members will be invited (given approval from the chair) by the student. Students may also decide to identify a faculty mentor to help guide “topic-specific” aspects of the capstone project. The mentor may be necessary if the chair is not well versed in the topic chosen by the student. Mentors (unlike chairs) can be any member of the UK faculty. Typically, the chair and other faculty members will wish to see a one to two page project proposal prior to agreeing to serve on the committee. After the student has assembled a committee, she/he will submit a form (Appendix 1 B) to the Office of Admissions and Student Affairs that indicates the tentative title of the project, stated purpose of the project, the reasons that this topic is relevant to public health and the signatures from each of the committee members. For spring semester graduation, this should occur before the 10th week of fall semester. Students planning to graduate in the fall will be expected to submit this document at the equivalent point in time, prior to planned graduation. Students who fail to meet this deadline (or any other deadline described in this document) should be aware that missing a deadline gives the Chair (or any committee member) the prerogative to withdraw from the capstone committee. The MPH Director of Graduate Studies will make final committee recommendations to the Dean of the Graduate School based upon this form.
Following submission of the form, the chair and the student will continue to meet (possibly several times) to agree upon the methodology, and its potential implications to public health practice. By the 12th week of the fall semester, the student will be able to present a draft of 13 slides outlining the capstone project to the satisfaction of his/her committee chair (see the note below). After approval of these plans by the chair, the student must initiate the appropriate communications (and the respective paperwork process) with the Office of Research Integrity. Other than projects that review existing literature, having an approval letter from the ORI is solely the responsibility of the student. All capstone projects are subject to this step; only ORI can determine that a project is exempt.
Note: A set of “template” PowerPoint slides for the oral examination will be provided to all students – each of these will represent one aspect of the study project and each will be used to organize that portion of the capstone presentation. Students’ use of additional slides is welcomed, but not required. Students are required to make a presentation that includes the content dictated by the 13 template slides. (See Appendix III) Exceptions are made at the discretion of the chair. Students may use PowerPoint slides, overhead projector slides, or 2” x 2” slides for delivery of the oral presentation.
Between the 12th week of the fall semester and the 6th week of the spring semester, students will consult with the committee chair as needed to carry out the project. Students may also consult with members of the committee at this time. Note, students using statistical tests are expected to conduct and interpret these tests on their own; however, statistical support services can be used to help select the appropriate test and possibly to help the student conduct an initial test of the data. No later than the 7th week of the spring semester the student will be responsible for providing a draft copy of the completed manuscript to the committee chair. Note: This deadline is particularly vital. Students failing to provide a hard copy of the draft manuscript by that date should be aware that their chair has the prerogative to terminate the project or to recommend delayed graduation. Within one week after receiving this document, the chair will provide the student with written feedback that will comprise the required changes before the draft can be sent to the other committee members.
No later than the 10th week of the spring semester, the student will be responsible for providing a hard copy of the final draft manuscript to the chair and each of the committee members.
One week prior to the capstone presentation date, the chair will consult with the other committee members to discuss the quality of the final draft. At this point, the chair may exercise the option of removing the student’s name from the agenda for capstone presentations. (Note: a capstone committee can be kept in place as long as the student is eligible to complete the capstone project and as long as the committee members are willing to serve). However, committees will normally be preserved for a period of two years after they have been formed. Requests for continuation beyond two years must be made in writing by the student, and accompanied by a projected time of completion.
Capstone presentations will occupy one to two days, contingent upon the number of students scheduled to present. One presentation will begin every hour. The capstone presentation will begin with a 20-minute student presentation of the project. Emphasis should be on placed on methods, findings, and implications for public health practice using the model of professional association meeting presentations. It is important to note that information presented must be carefully selected, as 20 minutes will not be sufficient time to address all written material. Subsequently, the chair will coordinate a 20-minute “oral examination” period that will begin with questions from the committee and, if time allows, the audience will be invited to ask questions. (Note: all MPH students will be strongly encouraged to attend these presentations). The final 20 minutes of the hour session will be reserved for private committee deliberation. The committee will evaluate the quality of the final written manuscript in the context of the oral presentation, and oral examination. However, the written project will become a permanent part of CHP archives and, as such, this manuscript will be the ultimate object of the discussion. Under no circumstances may a student present a paper and complete the oral examination if the paper is not approved by the committee.
Each member of the committee will assign a grade (high pass, pass, fail) that reflects: 1) the quality of the project in its final written form (2/3 of the grade), and 2) the success of the student in the delivery of the presentation and his/her responses to the oral examination (1/3 of the grade). Approval requires a passing grade from a majority of faculty members on the student’s committee. Students will receive copies of the faculty evaluation forms within 24 hours of the oral examination. Appendix I C contains the M.P.H. Capstone Project Evaluation Form. Students should review and understand these criteria to help in preparation of the capstone project paper and oral examination.
In the case of a pass, the student must successfully complete any remaining course requirements and will receive the Master of Public Health degree at the conclusion of the semester. If the judgment of the committee is that the student has not passed the examination, the student will be required to enroll the following semester to refine the project based upon comments in the evaluation form, and repeat the examination process. Students will be permitted to one repeat of the examination. If a passing grade is not received after the second attempt, the student will not receive the M.P.H. degree.
No later than the same day as the presentation, the chair will provide the student with changes required in the written project before the capstone is considered complete. All students should expect some degree of required revisions. If changes cannot be completed within the Graduate School time constraint of ten days, the student will not pass and the student will need to reschedule graduation to the subsequent semester. The fully revised document is to be submitted (in person) to the chair within one week after the presentation date.
The capstone project and oral examination are rigorous, but are not difficult tasks for a well prepared and organized student. It is essential that the student carefully plan the process, and work closely with committee members. Requirements for the final written document are described in Appendix I D.
The student will submit a copy of the final edited paper along with an abstract and two original signature pages, and an electronic copy on a 3.5’ floppy diskette or compact disk to the Office of Admissions and Student affairs. The Student will also submit a check for $10.00 (amount may vary, depending on cost to College) to cover the costs of binding and postage for the bound volume. Students may also arrange for binding of additional personal copies.
Failure to meet deadlines is a matter to be discussed by the student and her/his selected chair. It should be noted, however, that the deadlines are considered essential to a successful capstone presentation, oral examination, and (ultimately) the completion of an acceptable written product within ten days after the capstone presentation. Thus, after one or more missed deadlines, the chair will have the option of terminating his/her agreement with the student.
As the chair approves committee membership and approves the capstone title (reflecting the nature of the planned project), it is the responsibility of the chair to become familiar with CPH policies regarding committee membership and criteria that define a capstone project achieving the minimum standards of the CPH. Thus, at the beginning of each College year, the M.P.H. Director of Graduate Studies will hold an “orientation meeting” for all eligible chairs.
Institutional Review Board
The Office of Research Integrity, (phone: 859-257-3138), supports the institution in its efforts to promote ethical conduct of research and to comply with federal requirements for educating faculty and students about research misconduct regulations. In accordance with federal and institutional regulations, any undertaking in which a University faculty, staff or student investigates and/or collects data on human subjects for research purposes must be reviewed by either the Medical or Nonmedical Institutional Review Board (IRB). The IRBs are charged with the institutional responsibility for assurance of protection of human subjects involved in research or related activities. The Medical IRB reviews research emanating from the Medical Center and the affiliated VA Medical Center, including the College of Public Health. The Boards have the authority to review, approve, disapprove or require changes in research activities involving human subjects.
The College of Public Health requires completion of this training prior to initiation of capstone project research. IRB submissions should be directed to Office of Research Integrity.
Following is an account of the Tuskegee Syphilis Experiment, which emphasizes the need for the protection of human subjects in scientific experimentation.
The United States government did something that was wrong—deeply, profoundly, morally wrong. It was an outrage to our commitment to integrity and equality for all our citizens clearly racist. —President Clinton's apology for the Tuskegee Syphilis Experiment to the eight remaining survivors, May 16, 1997
For forty years between 1932 and 1972, the U.S. Public Health Service (PHS) conducted an experiment on 399 black men in the late stages of syphilis. These men, for the most part illiterate sharecroppers from one of the poorest counties in Alabama, were never told what disease they were suffering from or of its seriousness. Informed that they were being treated for “bad blood,” their doctors had no intention of curing them of syphilis at all. The data for the experiment was to be collected from autopsies of the men, and they were thus deliberately left to degenerate under the ravages of tertiary syphilis—which can include tumors, heart disease, paralysis, blindness, insanity, and death. “As I see it,” one of the doctors involved explained, “we have no further interest in these patients until they die.”
The true nature of the experiment had to be kept from the subjects to ensure their cooperation. The sharecroppers' grossly disadvantaged lot in life made them easy to manipulate. Pleased at the prospect of free medical care—almost none of them had ever seen a doctor before—these unsophisticated and trusting men became the pawns in what James Jones, author of the excellent history on the subject, Bad Blood, identified as “the longest nontherapeutic experiment on human beings in medical history.”
The study was meant to discover how syphilis affected blacks as opposed to whites—the theory being that whites experienced more neurological complications from syphilis whereas blacks were more susceptible to cardiovascular damage. How this knowledge would have changed clinical treatment of syphilis is uncertain. Although the PHS touted the study as one of great scientific merit, from the outset its actual benefits were hazy. It took almost forty years before someone involved in the study took a hard and honest look at the end results, reporting that “nothing learned will prevent, find, or cure a single case of infectious syphilis or bring us closer to our basic mission of controlling venereal disease in the United States.” When the experiment was brought to the attention of the media in 1972, news anchor Harry Reasoner described it as an experiment that “used human beings as laboratory animals in a long and inefficient study of how long it takes syphilis to kill someone.”
By the end of the experiment, 28 of the men had died directly of syphilis, 100 were dead of related complications, 40 of their wives had been infected, and 19 of their children had been born with congenital syphilis. How had these men been induced to endure a fatal disease in the name of science? To persuade the community to support the experiment, one of the original doctors admitted it “was necessary to carry on this study under the guise of a demonstration and provide treatment.” At first, the men were prescribed the syphilis remedies of the day—bismuth, neoarsphenamine, and mercury—but in such small amounts that only 3 percent showed any improvement. These token doses of medicine were good public relations and did not interfere with the true aims of the study. Eventually, all syphilis treatment was replaced with “pink medicine”—aspirin. To ensure that the men would show up for a painful and potentially dangerous spinal tap, the PHS doctors misled them with a letter full of promotional hype: “Last Chance for Special Free Treatment.” The fact that autopsies would eventually be required was also concealed. As a doctor explained, “If the colored population becomes aware that accepting free hospital care means a post-mortem, every darky will leave Macon County . . .” Even the Surgeon General of the United States participated in enticing the men to remain in the experiment, sending them certificates of appreciation after 25 years in the study.
It takes little imagination to ascribe racist attitudes to the white government officials who ran the experiment, but what can one make of the numerous African Americans who collaborated with them? The experiment's name comes from the Tuskegee Institute, the black university founded by Booker T. Washington. Its affiliated hospital lent the PHS its medical facilities for the study, and other predominantly black institutions as well as local black doctors also participated. A black nurse, Eunice Rivers, was a central figure in the experiment for most of its forty years. The promise of recognition by a prestigious government agency may have obscured the troubling aspects of the study for some. A Tuskegee doctor, for example, praised “the educational advantages offered our interns and nurses as well as the added standing it will give the hospital.” Nurse Rivers explained her role as one of passive obedience: “we were taught that we never diagnosed, we never prescribed; we followed the doctor's instructions!” It is clear that the men in the experiment trusted her and that she sincerely cared about their well-being, but her unquestioning submission to authority eclipsed her moral judgment. Even after the experiment was exposed to public scrutiny, she genuinely felt nothing ethical had been amiss.
One of the most chilling aspects of the experiment was how zealously the PHS kept these men from receiving treatment. When several nationwide campaigns to eradicate venereal disease came to Macon County, the men were prevented from participating. Even when penicillin was discovered in the 1940s—the first real cure for syphilis—the Tuskegee men were deliberately denied the medication. During World War II, 250 of the men registered for the draft and were consequently ordered to get treatment for syphilis, only to have the PHS exempt them. Pleased at their success, the PHS representative announced: “So far, we are keeping the known positive patients from getting treatment.” The experiment continued in spite of the Henderson Act (1943), a public health law requiring testing and treatment for venereal disease, and in spite of the World Health Organization's Declaration of Helsinki (1964), which specified that “informed consent” was needed for experiment involving human beings.
The story finally broke in the Washington Star on July 25, 1972, in an article by Jean Heller of the Associated Press. Her source was Peter Buxtun, a former PHS venereal disease interviewer and one of the few whistle blowers over the years. The PHS, however, remained unrepentant, claiming the men had been “volunteers” and “were always happy to see the doctors,” and an Alabama state health officer who had been involved claimed “somebody is trying to make a mountain out of a molehill.”
Under the glare of publicity, the government ended their experiment, and for the first time provided the men with effective medical treatment for syphilis. Fred Gray, a lawyer who had previously defended Rosa Parks and Martin Luther King, filed a class action suit that provided a $10 million out-of-court settlement for the men and their families. Gray, however, named only whites and white organizations in the suit, portraying Tuskegee as a black and white case when it was in fact more complex than that—black doctors and institutions had been involved from beginning to end.
The PHS did not accept the media's comparison of Tuskegee with the appalling experiments performed by Nazi doctors on their Jewish victims during World War II. Yet in addition to the medical and racist parallels, the PHS offered the same morally bankrupt defense offered at the Nuremberg trials: they claimed they were just carrying out orders, mere cogs in the wheel of the PHS bureaucracy, exempt from personal responsibility.
The study's other justification—for the greater good of science—is equally spurious. Scientific protocol had been shoddy from the start. Since the men had in fact received some medication for syphilis in the beginning of the study, however inadequate, it thereby corrupted the outcome of a study of “untreated syphilis.”
In 1990, a survey found that 10 percent of African Americans believed that the U.S. government created AIDS as a plot to exterminate blacks, and another 20 percent could not rule out the possibility that this might be true. As preposterous and paranoid as this may sound, at one time the Tuskegee experiment must have seemed equally farfetched. Who could imagine the government, all the way up to the Surgeon General of the United States, deliberately allowing a group of its citizens to die from a terrible disease for the sake of an ill-conceived experiment? In light of this and many other shameful episodes in our history, African Americans' widespread mistrust of the government and white society in general should not be a surprise to anyone. —BB
1. All quotations in the article are from Bad Blood: The Tuskegee Syphilis Experiment, James H. Jones, expanded edition (New York: Free Press, 1993).
A paper submitted in partial fulfillment of the
requirements for the degree of Master of Public Health in the
University of Kentucky College of Public Health
Sherrie Elaine Human
Lexington, Kentucky (Home town)
May 18, 2005 (Presentation date)
(Signature lines, List all committee members)
F. Douglas Scutchfield, M.D., Chair
Raymond Hill, Dr.P.H, M.H.A.
Richard R. Clayton, Ph.D.
The College of Public Health adheres to the criteria of the International Committee of Medical Journal Editors . Authors must certify that they will take public responsibility for the content and provide any relevant data upon request. The author must also certify that she/he has contributed substantially to conception, design or analysis, and interpretation of the data, drafting or revision of content, and approval of the final version. The Author also must confirm that the content has not been published elsewhere and does not overlap or duplicate their published work.
The first page will be a title page including the capstone project title (a concise title that engages and stimulates interest), the authors name including previously earned college degrees, the date of the Final Examination, and signature lines for each committee member including their names and academic degrees.
Good abstracts are paramount. Abstracts should be limited to 250 words under four heads: Objectives, Methods, Results, and Conclusions. Use complete sentences, and spell out acronyms at first mention. Number the abstract as page 1.
Type is double spaced (including each line of the references), and leave no spaces between sections. Add subheads for clearer presentation and informed reading (at least 1 subhead for every 2 pages).
Refer to the International Committee of Medical Journal Editors http://www.icmje.org.
Prepare the biographical sketch on a separate final page of text. The Sketch will be a brief one paragraph description of the author including: full name, previously earned academic degrees, relevant professional employment, professional association affiliations, and long term contact information including address, phone number, and e-mail address.
Use sparingly, if at all.
Arrange each table on a separate sheet, with a self contained title that is fully comprehensible without reference to the text. Figures should include keys and should be either professionally drawn or lasers printed from a computer. Keep lettering large enough to read once reduced to print.
Prepare acknowledgments on a separate page. Also required is disclosure of all financial and material support. If human participants are involved, approval by an institutional review board and their informed consent is required. CPH adheres to the Declaration of Helsinki of the World Medical Association.
The student will submit two copies of the final edited paper along with an abstract and two original signature pages, and an electronic copy on a 3.5’ floppy diskette or compact disk to the Office of Admissions and Student affairs. The Student will also submit a check for $20.00 (amount may vary, depending on cost to College) to cover the costs of binding and postage for the two bound volumes. One copy goes to the student and the other belongs to the College. Students may also arrange for binding of additional personal copies.
The paper on which the work is printed must meet the standards for durability and permanence suitable for a work that will reside in the Library and Archives. See American National Standards Institute (ANSI) /National Information Standards Organization (NISO) Z39.48-1992; Permanence of Paper for Publications and Documents in Libraries and Archives. The requirements for paper are: white, 8 x 11 inches, acid- and lignin-free, alkaline-buffered, and durable, at least 20 lb. bond weight. Paper that does not meet these requirements, such as erasable and recycled paper, should not be used. Acceptable paper may be purchased at campus bookstores or other local copy and office stores. Students are encouraged to bring the label or end-panel from the original paper package at the time of final submission in order to demonstrate that the paper used meets these standards. The following 8 x 11 papers meet the standards listed above: PermaLife Bond (FoxRiver Paper Co.), Perma/Dur Buffered Bond (DISTRIBUTOR: University Products), Cranes Thesis Paper (DISTRIBUTOR: Crane and Company), Xerox Image Elite (DISTRIBUTOR: Xerox Corporation), and Hollinger Alkaline Buffered Bond (DISTRIBUTOR: Hollinger Corporation).
A standard font is required and should be consistent throughout the paper. This includes all page numbers, preliminary pages, Table of Contents, list pages, and table/figure headings. The only exceptions are for tables/figures that are formatted using separate graphics. However, the table and figure headings must be formatted with the exact same font style and size as used in the main body of the paper. The minimum font size for the body of the paper is 12-point type. The font size must be kept consistent throughout the body (i.e. text) of the paper. A larger font size is acceptable for chapter titles and major subdivisions. Recommended fonts are Times New Roman, Arial, Helvetica, and Century Gothic.
The following margins are required: top - 1 inch; bottom - 1 inch; left - 1.5 inches; right - 1 inch. These requirements apply to all pages of the manuscript and any illustrative material to be bound into the paper (see section on oversize materials). Note: The photocopying process enlarges text size up to 2% with each reproduction. For the submission of paper pages that have been photocopied (once), it is recommended that the margins of the original document be increased to: 1.6 inches (left), and 1.1 inches (top, bottom, & right).
Double spacing should be used in the body of the paper; single line spacing is not acceptable. The spacing of footnotes, bibliographic entries, long quoted passages, etc., should conform to the guidelines of a style manual consistent with scholarly practice in the discipline.