MSc: CEHCR Program Details

Overview and Milestones

Introduction

The thesis is an original piece of scholarly research on a topic that has been selected by the student and approved by the supervisor and the student’s thesis committee. The thesis is a major undertaking that reflects the highest standards of scholarship and makes a significant contribution to knowledge and practice in the field of health services research.

Work on the thesis is conducted under the supervision of the supervisor in consultation with the thesis committee. The first step is the completion of the MSc thesis proposal. An MSc thesis is approved by the MSc Thesis Committee. The proposal is then presented at a hospital or research institute clinical epidemiology rounds. When the proposal is approved, the student can proceed with obtaining ethics approval and, once achieved, can begin their research. The student should meet with their supervisor and committee at regular intervals. It is important that the student keep both the supervisor and the committee informed of their progress. 

When the thesis is completed and has met with the approval of the thesis committee, the student proceeds to the Oral Examination. If at all possible, students are encouraged to present their research results on IHPME’s Research Day (in early May), or in another academic conference venue, prior to their final defence.

MSc Major Milestones

Supporting Activities

• Intake meeting (complete Annual Progress Report form)
• Use the Step 1 form for approval of the supervisor and thesis committee
• After the Step 1 form is approved by the program director, the student and supervisor should sign the Memorandum of Understanding
• Completion of the Annual Progress Report form each July/August
• Meeting with the committee at least 2 times annually [or equivalent communication about thesis progress] (complete Thesis Committee Meeting Report form)
• Publishing your work 

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Selecting a Suitable Thesis Topic

Purpose of Master’s Thesis

Although the courses are a key component of the MSc program, completing a master’s thesis will provide students with research training above that acquired in courses. Through the thesis, the student will learn the ‘nuts and bolts’ of carrying out ‘real world’ studies in a highly supported manner, which will prepare them for a career as an independent investigator.

Students are strongly encouraged to choose a thesis topic that is original and publishable. The study should involve methods that are appropriate for the type of study undertaken (epidemiologic, clinical trial, economic evaluation, etc.). It is expected that the student will gain experience in study design, data analysis as well as drafting a manuscript. All MSc students should have a publishable manuscript by the end of their studies.

Most students will elect to carry out studies that do not involve primary data collection (e.g., secondary analyses of administrative data). This represents a trade-off, in that the student finishes in a timely fashion but does not learn directly about study subject recruitment or retention, or how to collect and manage data. Primary data collection is permitted but must feasibility must be carefully considered when doing so, to ensure completion of the work within the timeframe allowable for the MSc degree.

Guidelines for Choice of Thesis Topic

The following are proposed guidelines for choice of thesis topic in the CEHCR program based on methodological approaches to data collection, not necessarily research design. Students who wish to pursue other topics should consult with their supervisor and the Program Director. As a rough guide, students should expect to spend five months FTE undertaking and writing their MSc thesis.

NOTE: Regardless of the thesis topic or design, ethics approval must be obtained for all thesis work prior to undertaking the research.

A. Primary Data Collection

1. Randomized Controlled Trials
   As it is difficult for a student to complete a RCT in a suitable time frame, these types of stuidies are not recommended for an MSc thesis. Instead, for MSc students interested in clinical trials, it may be possible for a student to undertake the design of a RCT and complete a pilot study. Alternatively, the student could start the RCT and provide an ‘interim’ analysis of the trial for the thesis.
2. Observational Studies
   1. Surveys
      Surveys (particularly mailed or self-administered in clinic or office setting) are usually appropriate for a master’s thesis. The circumstances should be that the sampling frame is large (e.g., physicians in Ontario), easily obtainable (sampling frame is available and accessible to students) and the sample size is manageable (e.g., one-time survey rather than longitudinal). Some examples include a survey of physicians’ attitudes towards prescribing a new drug; survey of patients’ satisfaction with a new intervention, etc.
   2. Assessing patients’ preferences
      Interviewing patients or using a self-administered questionnaire about their preferences for treatment choices, waiting times, etc., can usually be achieved with a manageable sample size. Again, the issue should be one where access to patients will be easily obtained and large numbers of participants can be anticipated (e.g., breast cancer, heart disease).
   3. Other types of observational studies
      If primary data collection is undertaken, generally a case-control study may be more suitable than a cohort study, as a case-control study can often be performed in a more timely fashion. Cohort studies may be considered as long as feasibility is carefully assessed. Methods might include mailed questionnaires to cases/controls and/or chart reviews or interviews with patients. The question should be one in which there are large numbers of cases and controls (e.g. cancer, heart disease, diabetes) who can be easily accessed (e.g. cases/controls identified by patient registry, hospital patients, etc).
      
3. Instrument development and testing
   The development of a new instrument from scratch would generally be too complex and take too long for a timely completion of a master’s thesis. However, portions of instrument development would be suitable, e.g. item generation, or reliability or validity studies.
4. Reliability/validity study of existing database
   An MSc student project may involve the ascertainment of the reliability/validity of an existing administrative or clinical database. This might involve primary data collection such as a comparison of computerized records and hospital or physician hospital charts.
5. Qualitative study
   This is an area of increasing interest among CEHCR students and faculty. Students should take the appropriate courses prior to undertaking this type of study and must have an experienced qualitative researcher as a member of their thesis committee. Qualitative studies can range from focus groups, key informant surveys or in-depth interviews with content analysis of interviews of patients or other groups.

B. No Primary Data Collection

1. Administrative data or clinical databases
   Administrative data studies (using existing databases such as those at ICES or other ‘purpose built’ clinical databases) are commonly undertaken by MSc students in the CEHCR program. If administrative data or clinical databases are to be used, then all the data analyses are typically performed by the student (help by a programmer can be given, but in principle, all the computer analyses should be carried out by the student). Linking external datasets may introduce feasibility concerns as this process may introduce delays and should be carefully considered by the student with the help of their supervisors.
2. Decision analysis
   A project using decision analysis is appropriate for an MSc thesis. The student and their supervisor should consider  some primary data collection (e.g., obtaining utilities from providers or patients) for a portion of the project. The scope and depth of the thesis topic will determine if it is suitable for an MSc.
3. Meta-analysis
   Meta-analysis may be suitable for a master’s thesis in some circumstances. There needs to be a reasonable number of trials (approximately 100 studies) available to be considered in the project and it should include at least 10 high quality studies . The quality of the studies should be assessed by at least 2 reviewers. Students should justify that the meta-analysis topic is of sufficient scope to warrant a master’s thesis.

Comparison of MSc/PhD Thesis Expectations

	MSc	PhD
Time needed to undertake the research	5 months FTE	1.5 years FTE
Primary data collection	Optional	Encouraged but not required
Originality	Preferred	Essential
Innovation potential	Preferred	Essential
Ownership	Preferred	Essential
Publishable project	Essential	Essential

Comparison of MSc/PhD Thesis Topics

	MSc	PhD
RCT	Exceptional	Suitable in select circumstances
Administrative data	Suitable	Suitable but with wide scope or as one of three papers
Reliability/validity of database	Suitable	Suitable as one of three papers
Observational study	Case-control preferred	Any design
Survey	Small survey suitable	Large scale survey
Decision analysis	Suitable in some circumstances	Suitable but with wide scope involving data collection or as one of three papers
Meta-analysis	Suitable in some circumstances	Suitable or if using advanced methods or as one of three papers
Instrument development	One or two aspects	Entire instrument development and testing

Review Past IHPME Thesis Topics

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Selecting a Supervisor / Role of the Supervisor

Selecting a Supervisor

All MSc (thesis-based) students are required to find a supervisor who will act as a mentor and guide as they proceed through their degree.

The choice of a faculty member who will supervise the thesis work required to fulfill degree requirements is one of the most critical decisions a graduate student will make and should not be taken lightly. A student will need not only a competent supervisor in a particular area but also willing to act as the student’s advocate when necessary. It is important that the student be able to work and communicate effectively with the supervisor and not feel overwhelmed or intimidated in the relationship. Each student requires the guidance of someone who will stimulate thoughts, who has sufficient interest in the student’s topic to produce insights jointly, and who will challenge the student to think in a novel manner about the research.

The following suggestions are included to help students find an appropriate supervisor:

1. Look through the list of IHPME Faculty (CEHCR or Non CEHCR) and Research and Initiatives on the IHPME website to find a professor that fits you by:
   • Content area (e.g., cardiology), and/or
   • Methodological area (e.g., health services research)
   • (You are NOT restricted to content – someone out of your area with a “method” match can be great!)
2. Ensure that your potential supervisor has the appropriate SGS appointment level and meets other requirements (both are required):
   • MSc students need a supervisor who is an Associate or Full SGS member 
   • See “IHPME Requirements to be a Supervisor” for additional requirements.
3. Students may get to know the potential supervisor whose research interests parallel their own. Consider doing a database (ProQuest, PubMed, Scopus) search to see what they’ve published – see if it sounds interesting to you.
4. If possible, talk to other trainees. They will tell you who is a good supervisor.Graduate students working with a specific supervisor are an invaluable source of information.
5. There are tradeoffs in picking a supervisor based onseniority/eminence. A very experienced supervisor may help “fast-track” your career. On the other hand, a senior person may have less time for you.
6. A supervisor is also a mentor, often for the first few years of your career. Someone who is a good mentor can be really helpful.
7. Do not be afraid to approach potential supervisors cold, i.e. without any personal connection or contact. They expect it. It’s their job (usually among many others) to teach and mentor students.
8. If you need advice regarding selecting a supervisor, contact the Associate Program Director of Clinical Epidemiology and they will help you to find an appropriate supervisor.

For more information visit:

Requirements for MSc Supervision

While other programs may have different guidance, CEHCR requires a single supervisor (i.e., two co-supervisors or co-supervision is not permitted).

Review the IHPME Requirements to be a Supervisor. 

Note authorship position on individual papers is not directly tied to the supervisor role.  Authorship should be discussed and decided among the student, supervisor and committee for each potential publication, in accordance with the ICMJE authorship recommendations. 

Role of the Thesis Supervisor

1. The supervisor provides advice on all aspects of the thesis project. Specifically, they are responsible for providing direction to the student, advice on data sources and potential avenues of approach, instructions on the proper content and form of the thesis, as well as reviewing the student’s progress, and serving as the first reader of the thesis. It is the responsibility of the supervisor to help the student think through methodologic issues and to raise questions about possible methodologic decisions faced/taken by the student.
2. The supervisor and student are expected to read and sign a Statement of Agreement (Student-Supervisor MOU) – [PDF] before undertaking thesis work.
3. The supervisor and student are expected to meet on a regular basis at a mutually agreed schedule (many supervisors meet with their students on a bi-weekly basis)
4. Additionally, the supervisor is expected to help the student complete annual progress reports. Annual Progress Report Student Study Plans are signed by the supervisor and the student. These reports are due by August 1 of each year the student is enrolled in the Program and should be returned to the CEHCR office. 

For more information visit:

What to Do if You Have Challenges Working With Your Supervisor

• First, try to discuss it openly with your supervisor. Share your concerns and try to reach a mutual agreement.
• If that does not work, you may contact the Program Director, the Associate Program Director or Graduate Coordinator for their advice.
• Contact the Centre for Graduate Mentorship and Supervision (CGMS) for expert advice

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Selection of the Thesis Committee  

Purpose of the Thesis Committee  

The thesis committee gives meaningful input into the thesis proposal and supports you through the research.

MSc Thesis Committee

The thesis committee should have a minimum of three members (including the supervisor). In consultation with the supervisor, the student selects two or more additional members for their committee. Students and supervisors are encouraged to form a committee that can properly support the student, both methodologically and in content expertise. It is important that the committee be balanced in terms of background/expertise including content experts.

• The supervisor, who functions as the Chair of the thesis committee, must have a full or associate membership to the School of Graduate Studies (SGS) and an appointment through IHPME. See “IHPME Requirements to be a Supervisor” for additional requirements.
• Committee members are chosen on the basis of their expertise in the student’s area of research and must have a graduate faculty membership (GFM).
  • For the CEHCR MSc committee, in addition to the supervisor, one other committee member must also have an IHPME appointment AND a graduate faculty membership (full or associate membership with SGS).
  • Committee members who have a graduate faculty membership (full or associate membership with SGS) elsewhere within the University of Toronto do not have to apply for an appointment with IHPME.
  • Clinical faculty with appointments elsewhere in the university that do not have a GFM need to apply for it through IHPME. They can send their CV to ihpme.appointments@utoronto.ca and will receive the details and a link for the application submission.
  • It is possible to appoint a committee member from outside the university. In this instance, the supervisor must obtain a copy of the outside member’s CV and forward it to the IHPME Appointments Officer ihpme.appointments@utoronto.ca who will explain the application process to obtain the GFM.

When all committee members have been selected and have agreed to serve, the Step I (Committee Confirmation) form should be completed by the student, signed by the student and supervisor, and submitted to the Graduate Assistant. 

After the Step 1 form is approved by the program director, the student and supervisor should sign the MOU.

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Thesis Proposal Approval Process

Bound copies of theses by Clinical Epidemiology graduates are available in the CEHCR Program office for reference only and are also available online through the University of Toronto library system. There are two steps in the thesis proposal approval process:

Proposal Approval Step I: Approval of the thesis question and the composition of the thesis committee

By the end of the first academic year of enrollment in the CEHCR program, the student is expected to have:

1. Confirmed supervisor (supervisor ideally identified at the time of application to the Program);
2. Confirmed thesis topic; and
3. Confirmed thesis committee membership. This information should be submitted for approval to the CEHCR office by the end of May in the first year of enrollment.

Note: the main purpose of Step I is to approve your topic, the composition of the committee and its relevance to your selected topic.

Proposal Approval Step II: Development of Full Thesis Proposal

Once the thesis topic and composition of the thesis committee (Step I) have been approved by the CEHCR Program Director (or Associate Program Director), students should work with their thesis committee to develop a more detailed proposal including the research design and procedures for data collection and data analysis.

The supervisor (and student) must ensure that all members of the thesis committee are thoroughly familiar with the research proposal at an early stage of development and fully participate in all phases of the research. This is to avoid potential disagreements at a later stage.

The thesis supervisor should arrange for the proposal to be presented at one of the hospital or research institute based Clinical Epidemiology Rounds. The supervisor and members of the thesis committee should be present for this preliminary presentation.

The supervisor must inform the CEHCR Office of the time and date of the presentation at least 30 days in advance in order to adequately notify fellow students and clinical epidemiology faculty.

In addition, at the same time, the Thesis Supervisor and student should submit a 3-5 page outline of an MSc-quality thesis proposal including:

• The research question(s)
• Background and a brief literature review indicating the importance of the research
• A preliminary research design, including the likely methods to be used
• The data source(s), and
• A preliminary analysis plan.

At least three additional IHPME faculty members are required to be present at the Step IIpresentation. It is the responsibility of the supervisor to ensure that these committee members are present prior to the start of the presentation. If three additional IHPME faculty members are not present, the defence must be cancelled and rescheduled. 

Students considering an MSc to PhD Transfer must find an external reviewer for the Step II Transfer Proposal Defence, see transfer steps.   

The proposal defence should consist of:

• A 20 minute presentation
• 20 minutes for questions and answers
• 20 minutes for the committee and additional IHPME faculty to meet

Following this presentation, the student is excused and faculty who hold an IHPME faculty appointment and the thesis committee members will meet briefly to discuss and vote on the suitability of the thesis proposal.  Other faculty members should not attend this discussion.  The thesis supervisor will provide feedback to the student based on recommendations by the group.

After the Step II presentation, the student must submit a revised proposal, incorporating feedback received at the proposal defence, to the CEHCR office for final approval. The proposal cannot exceed 5 pages in length, must be single-spaced and in 12-point Times New Roman font with 1-inch page margins.  The proposal should follow the format outlined in Section F.

The full proposal must be accompanied by a letter from the supervisor (email correspondence is acceptable) including the following:

• The date and location of the thesis proposal
• The committee members who were present
• The IHPME faculty members outside the committee who were present
• A statement that the proposal has been approved by the thesis committee and that it incorporates feedback received at the presentation

The student cannot proceed with the study until this documentation has been received by the CEHCR office.

Format of Full Thesis Proposal for Submission to CEHCR Office

Note: SGS guidelines for formatting a thesis that is ready for defence can be found at the end of this Section.

• Objective: The exact question(s) to be addressed by the thesis proposal.
• Rationale/Relevance: The deficit in current knowledge to be addressed and the importance of the question.
• Research Design: The nature of the study architecture (descriptive or analytic; retrospective or prospective; experimental or observational; randomized or non-randomized; cross-sectional or longitudinal; etc.)
• Setting: The location of the study and the nature of the patient population.
• Patients/Participants: The clinical disorder and key sociodemographics, the number and selection of participants.
• Research Procedure: The intervention, exposure or investigational manoeuvre and proposed monitoring.
• Main Outcome Measures: The primary and secondary outcome measures(s), their frequency and measurement characteristics (particularly in settings and populations similar to those proposed in the study)
• Sample Size/Analysis: The number of subjects needed for the key outcome measures and the proposed plan of analysis.
• Feasibility: The availability of data or subjects and the expected participation rate; resources available for the completion of the research.
• Ethics Approval: Proposal should indicate that it will be submitted for ethics approval.

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Submission of Thesis Project for Ethics Review

All students must obtain University of Toronto research ethics approval for their research in addition to any approvals required by other institutions such as those of research sites or the home institutions of their supervisors. Note that depending on the research site, risk level and other factors, ethics approval may take several months.

Note: for research based at Toronto Academic Health Science Network (TAHSN) hospitals, students need to obtain Research Ethics Board (REB) approval from the hospital first, and then submit the REB approval letter, approved application form, Research protocol, and appendices for administrative review by the University of Toronto REB.  Administrative reviews are normally approved within two weeks.

Applications for approval can only be submitted after the proposal has been approved by the CEHCR program. Students must be listed as a researcher or investigator with the relevant Research Ethics Boards. While the University of Toronto sometimes exempts student research from full ethics review, students must apply for such exemptions and supply the appropriate documentation to the IHPME graduate office. Students must never assume that their research is exempt from ethics approval. Students who do not have documented University of Toronto ethics approval will not be allowed to proceed to their defence.

IHPME students are required to take the online tutorial TCPS 2: CORE (Course on Research Ethics), an introduction to the 2nd edition of the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (TCPS 2). Upon completion, you will be able to print or email a Certificate of Completion to be submitted to the IHPME graduate office.

Guidelines for Studies Using Data Held by ICES

ICES is a prescribed entity under section 45 of Ontario’s Personal Health Information Protection Act. Section 45 is the provision that enables ICES to conduct analysis related to the management, evaluation and monitoring of the health system. Section 45 authorizes health information custodians – like physicians, hospitals and long-term care homes – to disclose personal health information to a prescribed entity, like ICES, without consent for such purposes. Studies conducted wholly under section 45, by definition, do not require approval of a research ethics board (REB).

When students at UofT conduct studies (in connection with supervised undergraduate or graduate course work or supervised thesis or non-thesis based graduate analysis) within ICES they do so under the auspices, and as “agents”, of ICES. As such, their studies are legally exempt from REB approval so long as the studies use only personal health information and include specific and substantive objectives to conduct analysis related to the management, evaluation and monitoring of the health system. This also means that the UofT REB does not need to review and approve the study.

In some cases – infrequently – REB approval may be legally required. This is the case if a study’s objectives fall outside section 45 parameters or use ICES data holdings governed by different laws or by data sharing agreements that specifically require REB approval.

All studies carried out within ICES are subject to a privacy impact assessment and approval from ICES’ Privacy & Legal Office prior to launch. The privacy impact assessment is the mechanism that ICES uses to confirm the legal authority for use of the data. Only studies conducted wholly under section 45 are exempt from REB review. If a study requires REB approval, ICES will identify and communicate this requirement. The student is then responsible for obtaining approval of the UofT REB in accordance with its guidelines: REB Guidelines. If REB review is not required, please submit documentation from ICES that indicates to support this – email confirmation from the Privacy office confirming that the PIA is approved will suffice.

For questions, please contact the UofT REB at ethics.review@utoronto.ca or 416 946 3273

UofT REB Application

The office of Research Ethics at the University of Toronto has launched an online application process. Here is the landing page to submit an application: My Research 

Please consult the Research Involving Human Subjects resource and Federal Guidelines (TCPS2)

For more information on Research Ethics, or if you have questions about submission, please contact:  ethics.review@utoronto.ca or 416 946 3273.

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Research and Writing

Once the research proposal is approved by the CEHCR program and ethics approval obtained, the student may begin working on their research including participants’ recruitment, data collection, data analysis and writing. Some parts of the research such as scoping or systematic reviews may begin before REB approval is obtained.; however, it is not advisable to begin before the proposal is approved because the committee may have some comments and suggestions to improve the study.

Research and writing are conducted under the guidance of the supervisor in consultation with the thesis committee. The committee should meet as a whole at least twice a year and submit a meeting report to the graduate assistant after each meeting.

Writing support

The Writing Centre of the Graduate Centre for Academic Communications (GCAC) and the Health Sciences Writing Centre both offer support for graduate students including one-on-one consultation support.

Financial Support for Research and Publication 

Ideally, your supervisor will have some grants to cover some research-related expenses you may incur, such as compensation to study participants, transcription of interviews, travel for data collection, presentation at conferences, or publication in open access journals.

• Many conferences offer travel fellowships for students to present their work. 
• SGS also offers  a conference grant for students to present at conferences
• The University of Toronto has signed agreements with a number of publishers to support open access publication of research

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Committee Approval of the Thesis

Committee members must read the thesis and each member must conclude that it is an acceptable piece of work. Typically, a student will provide each reader with a completed first draft, and the readers will make whatever recommendations they feel are necessary for revision so that a final draft will be acceptable. It is the responsibility of the supervisor to get committee members and the student together to obtain a common understanding of what changes in the first draft are necessary for an acceptable subsequent document. If the recommendations for change are at all contentious or detailed, the student is entitled to a written statement from the committee outlining exactly what has to be done.

Important! – The thesis supervisor must ascertain the written agreement from all the thesis committee members that the thesis is ready for final and formal defence. The thesis committee will need a minimum of two weeks for final approval before beginning the thesis defence process.

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MSc Thesis Defence

When the supervisor and thesis committee agree that the thesis is complete and ready for defence, they may proceed with setting up the final oral exam (FOE). The process of setting up the FOE takes approximately 6 weeks as outlined below; thus, you will need to plan ahead.

Please consider the SGS deadlines and recommended dates and timeline below:

Deadline Request for Defence (recommended dates)	Last Scheduled Defence (recommended dates)	Deadline for Submission of Completed Thesis to SGS	Expected Convocation
PhD: June 24, 2024 MSc: July 8, 2024	August 19, 2024	PhD: September 16, 2024 MSc: September 30, 2024	November
PhD: October 16, 2024 MSc: October 30, 2024	mid-December 2024	PhD: January 15, 2025 MSc: January 24, 2025	March (in absentia*) or June
PhD: January 20, 2025 MSc: February 3, 2025	March 17, 2025	PhD & MSc: April 11, 2025	June

The Examination Committee

The Committee consists of those members approved by the Graduate Coordinator and will normally include four (or more) members.

• External Examiner
• Internal Examiner
• Supervisor
• Member(s) of Thesis Committee

A quorum is four appointed Members, with at least two individuals with no prior involvement in preparation of the thesis.

In rare cases, when it is proven difficult to find an external or internal examiner who meets the above criteria, the Graduate Coordinator may approve an internal examiner who meets the SGS criteria but not the stricter IHPME ones.

What to Expect at the Defence

• A quorum of the Defence Committee must be present.
• The chair appointed by the Graduate Department follows clearly established examination procedures.
  • CEHCR:  Examination Committee for MSc Degree: Guidelines and Procedures
• The student is asked to leave the room while the committee discusses procedure and order of questioning
• The student is recalled and presents their thesis (maximum 20 minutes, uninterrupted).
• One or two rounds of questions are posed to the student. (*Note: Questions can be asked about both the oral presentation and written thesis.)
• Student is asked leave the room.
• The defence Committee votes on the acceptability of both the thesis and the oral defence.
• The supervisor informs the student if modifications are required.

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After the Defence

1. The student makes modifications to the thesis as required. These are reviewed by the faculty member(s) designated at the end of the oral defence (usually the supervisor).
2. Supervisor informs the Graduate Department in writing that the student has made revisions/corrections.
3. As of September 1, 2009, the School of Graduate Studies will ONLY accept the submission of theses in electronic format. Please view SGS – Producing your Thesis webpage for information on electronically submitting your thesis.
4. The Graduate Department prepares the Degree Recommendation for the School of Graduate Studies for MSc students. Note: To be put forth, students must have registered (ie. paid fees) up to and including the session in which they are graduating. 
5. Students failing to complete all steps by the SGS deadlines will be required to register and pay fees for another term.
6. The School of Graduate Studies notifies students about convocation arrangements 4 – 6 weeks in advance.