As the residency match continues to become ever more competitive, most medical students will participate in research and complete multiple publications.
Opportunities to publish are available, but they can take some work to locate. A case report is one opportunity to be published, and it is considered an entry point into research and writing. Case reports are basically write-ups of a clinical "case", with an introduction, a description of the case, and a discussion of what makes this case important to the reader. Although a case report is considered the simplest type of publication, writing one can often be challenging.
In this post, we describe:
The two main types of case reports
How to locate opportunities to write up a case report
How to identify the "hook" in a case report
How to write the case report
Even as a medical student, you can be published in your field
In every academic medical center, there are ample opportunities to publish. However, locating these opportunities is often the hardest step, because there are no hard and fast rules. Different types of opportunities to publish exist at the medical school level, even if you’ve never been involved in formal basic science or clinical research. A few include:
The case report of a classic case
The case report of an interesting case
A case series
A review article
The case report is typically the entry point for medical students who lack experience in research. Even if you’ve researched and published extensively, it can be important to have additional scientific study in your chosen field. This confirms your interests in the specialty and your ongoing commitment to scientific pursuits.
How can a case report strengthen your application?
By seeking out the opportunity, you’ve demonstrated your drive and
enthusiasm.
You’ve confirmed your interest in the specialty.
You’ve confirmed your thirst for additional knowledge.
Just the act of seeking out the opportunity demonstrates commitment to the field.
Seeking out opportunities to publish provides a professional way in which to speak with or meet residents, faculty, and PDs (program directors) in the institution.
On a basic level, you’ve added to, or at least started, the publication section of your CV.
By writing the case report, you have become an expert in one specific area.
Your expertise becomes a potential topic of discussion in interviews.
Your publication may also act as a point of commonality in interviews that can build rapport. “I’m very pleased to meet you, Dr. Lo. I referenced your work on…when writing my review article on…”
Writing provides an ideal opportunity to showcase your work ethic, your drive, and your skills.
By writing the case report in record time and by producing outstanding results, you’ll be able to highlight your skills to your attending (an individual who can influence your acceptance to the residency program.)
Faculty members with concrete knowledge of your skills may use this specific example in their rotation evaluation and in their letters of recommendation.
Such faculty members can also act as vocal advocates for your candidacy for their own program.
Students who produce outstanding case reports in record time are also more likely to be considered for more substantial research projects or publications. More substantial projects are difficult to locate on the medical student level, but obviously are much more valuable in strengthening your application.
For example, an attending who’s been asked to write a book chapter for the new edition of a well-respected textbook will only collaborate with individuals of known merit. By showcasing your skills, you’ve increased your chances of being awarded such valuable opportunities.
The Two Main Types of Case Reports
In general, medical students can be involved in publishing two types of case reports.
The first type is what I term “classic” cases. These are typical examples of certain diagnoses and may be published in a variety of journals in sections entitled “diagnostic puzzles,” “clinical pearls,” “grand rounds,” or others.
The other type of case report describes rare or distinctive clinical findings. For example: “This represents the first described case of pseudoporphyria due to the medication sulindac.”
How can students locate clinical cases that would be appropriate material for a case report?
In some departments, students are frequently involved in publishing case reports, case series, review articles, and book chapters, even if they haven’t formally participated in basic science or clinical research. In such departments, students will find it easier to locate opportunities to publish, because the path to doing so is relatively clear-cut. You can often locate opportunities just by discussing your interest with your classmates or upperclassmen.
In other departments, it may be uncommon for students to be involved. Having said that, there are still ample cases of interest in any academic medical center.
Residents and faculty will be helpful in suggesting clinical material that would be appropriate for publication. If you're interested in writing a case report, let your residents and attendings know during your rotation. They can highlight appropriate clinical cases.
However, students can also take the lead. With both the case report of an interesting case and the discussion of a classic case, students can take the lead in suggesting a case report.
You may see an interesting case in clinic.
This may prompt you to perform a thorough literature search in order to learn more about the disease.
As you're reading about the subject, you may recognize that this case may represent a good subject for a case report.
You can then suggest the case and ask your resident and attending for their thoughts about its potential acceptance.
Who can you work with to publish a case report?
As we mentioned, there are no hard and fast rules, and you really need to exhibit the skills of a self-starter to even be given the opportunity to start writing.
Speak to other students, especially in the class ahead of you. They can relay their own experiences, and how they found their opportunities to publish.
Speak to the residents, and let them know your interest in strengthening your application. They can identify clinical material that is interesting and appropriate for the medical literature. They can also, most importantly, direct you to the appropriate faculty members.
Certain faculty members are prolific writers, and have an interest in adding to the medical literature. Such faculty may be willing to work with you on case reports. They may have clinical material in their files that is awaiting an eager medical student to perform a literature search and prepare it for publication. Alternately, they may ask you to keep an eye out for interesting clinical cases during your time on the elective. Such faculty members are often asked to collaborate with colleagues in their field. They may have been asked to write a book chapter, or a review article. Such opportunities are ideal for medical student collaboration, and many faculty welcome interest by medical students.
In some institutions, it would be appropriate to send an e-mail to the faculty in your department highlighting your interest in working on a paper. Depending on your circumstances, you may seek to work on a paper during your elective or at any time during your third year. Many motivated students complete papers during their time on other rotations. Some students arrange time for a research elective, and then search for a faculty member to work with. In these cases, it is also appropriate to schedule a meeting with the chairman or program director to seek their advice.
Another ideal way to locate opportunities to publish is by participating in an away elective. Certain programs are well-known to provide ample opportunities for student participation in such projects, and your away elective can be chosen with this goal in mind. As with much in research, there’s no single best method to locate such programs. You can speak to the residents, your faculty advisor, and the PD. You can participate in online forums, or even scan journals to note which programs publish work with student authors.
Locating an opportunity to write is an accomplishment in and of itself. Congratulations. Now do everything in your power to maximize this opportunity.
Finish what you start
The first and most important point about identifying opportunities to be published in your field is a simple one. Once you’ve identified an opportunity to write, you need to submit a finished product.
The reason we choose to discuss such an obvious rule is that students don’t always finish projects. We’ve sat in faculty meetings where the inability to complete a project is used as evidence of a student’s poor fit for a residency program.
It’s rare that students in this situation actually have a poor work ethic and lack commitment. In many cases, students become paralyzed by their own perfectionism. They’re not sure what they’re doing, are insecure about the results they’ve produced, and can’t bear to turn in a final product that’s not perfect. As a student, though, hardly anyone has experience with preparing cases for publication. You need to read extensively, plan to work hard, and move forward. We’ve outlined the process in more detail here.
Before you write, you need to read
A great deal of literature exists on designing and conducting medical research, but not so much when it comes to writing a straightforward case report or review of the literature. We’ve outlined the process in more detail below.
Learning how to write medical papers starts with reading medical papers. Read the articles in your targeted journal. If you’ll be writing a case report, pay close attention to that section. Get a feel for format, sentence structure, and word usage. Move on to articles written in prestigious medical journals. Review articles written in specialty-specific journals. This type of reading provides the foundation for your medical writing.
It may be one of the most important papers you’ve ever written, but it’s not easy to write an outstanding case report
Arrange to meet with your attending before you start. You need to obtain several key pieces of information.
With a case report, what makes your case unique and compelling to the readers? Can your attending provide more information on what makes the case worthwhile for publication?
To which journal will you be submitting the paper?
Which section in that journal?
What is the anticipated timeline for submission of the paper?
How would your attending prefer that you communicate with her?
Would an e-mailed first draft be acceptable?
These are all critical to the creation of a compelling, publishable report, and we review each of these points in further detail.
Your publication must include a “hook”
What important point are you trying to convey to your readers? What makes this case unique or compelling to the readers? What is the point of publishing this case?
If you’re submitting the case of a patient who presented with the classic features of Wegener’s granulomatosis, you are presenting the case for the further education of your readers, so that they can recognize such cases in the future. As we discussed, many journals have sections in which they present examples of classic cases to their readers.
If your case is the first reported case of pseudoporphyria due to sulindac, then your hook is this: “We present this case of pseudoporphyria due to sulindac. While pseudoporphyria often occurs due to NSAIDs, this is the first reported case due to the medication sulindac. Therefore, this medication must be added to the possible causes.”
If you’re presenting a syndrome or disease that is well-described in the medical literature, then you need to search more deeply for what makes your case either unique or worth publishing. This can be difficult. It may be a fascinating syndrome, but if there’s not a compelling point to make, then many journals won’t see what use the information will have for their readers.
The insight and extensive clinical experience of your advisor will be critical in this situation. Was the last reported case of this syndrome 20 years ago? Then a reminder of its features may be useful. Does this case demonstrate a new association? Did the patient respond to a previously undescribed therapeutic measure? Did you note an interesting clinical finding that may serve as a clue to the diagnosis? “This case illustrates a complication of systemic amyloidosis and emphasizes its utility in reaching a timely diagnosis.”
Your point is that this information has educational or clinical significance for the readers.
Another option is to write a case report and review of the literature. “We present a case of Dowling-Degos disease and review and summarize the medical literature, with an emphasis on clinical and histologic presentations.” What is the point of this type of publication? You describe an interesting case and summarize the medical literature to date, so that your readers will be fully educated on all aspects of this condition.
For extensive projects, you need to establish a timeline
“What timeline did you have in mind for this project?” If you’ll be working on an extensive project, this question becomes very important. In your mind, a review article with over 200 references may take at least eight weeks. Your advisor may expect it in four, especially if she herself was given a deadline for submission. If you have a prior commitment, such as Step 2 in four weeks, then it’s important to let your advisor know that you won’t be able to meet that deadline. Be specific about your reasons, offer an alternative timeline, and ask if that would be acceptable.
We’re going to emphasize an important point here. The date you’re given is NOT a deadline. Some students will delay, then work feverishly for the week before, and then turn in a first draft on that date. That represents a wasted opportunity. The date you’re given is actually an indication of your advisor’s expectations, and is really an opportunity to exceed those expectations. Once you’ve heard the expected timeline, plan to cut it significantly. Turning in an outstanding finished product that exceeds expectations in terms of both quality and timeliness is an impressive accomplishment.
As a final note, a lack of timeline is not an excuse to delay. Many attendings won’t have a timeline in mind. “Just do your best, and we’ll work with it.” Other attendings will say the same, but are in actuality judging your work ethic.
Note that we specified asking for an expected timeline in the case of extensive projects. Case reports are a different situation, because they should be completed and submitted promptly. Realistically, case reports of a classic case can be completed in one very lengthy weekend spent at your computer. Submitting a high-quality case report at that speed will get you talked about.
You cannot write a strong case report without becoming an expert on your topic
Perform a thorough literature search. You cannot write a strong case report without becoming an expert on the topic. You should begin by reading the textbooks, online sources such as emedicine (www.emedicine.com), and recent review articles that summarize the literature on the subject. You can then move on to prior case reports on the topic.
When performing a literature search, most authors start with PubMed. Try to maximize your knowledge of PubMed and the various search options available, whether through classes or online tutorials.
Some students, when first writing a case report, heavily reference the major textbooks. However, such references are not ideal. For general information on the topic, it would be better to reference a review article-- ideally one which is more recent, up to date, and in depth. Including such a review article is helpful to your readers, as they can use that reference to obtain more information on the topic. However, review articles should never be used as substitution for the primary source of a piece of information.
In other words, avoid just referencing the review article: “Pseudoporphyria has been described as occurring due to ibuprofen, naproxen, and diclofenac. [1]” While it would be easier to include one reference that summarizes this information, such as a review article, it would be more appropriate, and in some cases more helpful for your readers, to include examples of publications that described each of these cases.
This is a better approach: “Pseudoporphyria has been described as occurring due to ibuprofen [1] , naproxen [2] and diclofenac. [3] ”
Note, however, that if you are limited in the number of references you can cite, you may choose to simply reference the review article.
Write the case report
Once you pinpoint why your case would be compelling to readers, the work of writing the case report becomes more straightforward. For a case report, you’ll typically write an introduction, a description of the case, and a discussion. The introduction will be brief, but should capture the reader’s attention. Why would they care to read about your case?
In summarizing the clinical features of the case, make sure you review other cases previously published in your target journal. Your description of the clinical features of the case, including the depth of detail included, should be modeled after that type of case report.
In the discussion, just as in a typical college review paper, you will summarize and present the existing literature on this subject, with an emphasis on the important take home points learned from the case.
Learning the appropriate focus and level of detail in the report is a skill that can take years to develop. “Should I focus on the clinical features of pseudoporphyria in general, and how to make the diagnosis, or should I just limit myself to a discussion on the prior reports of the NSAIDs that have triggered pseudoporphyria? Do I need to go into the pharmacological details of the different NSAIDs?"
The level of detail included will depend, in large part, on the goals of your advisor and the limitations of the journal. The instructions to authors specify a range of word counts, and it’s very important to adhere to these guidelines. Hopefully, the meeting with your advisor will have clarified the focus of the report. If in writing the discussion, though, you sense that you can go in two directions with your focus, you should contact your advisor for further guidance.
What medical journal should I submit my case report to?
If an opportunity to publish has been presented to you by your attending, then they’ll typically advise you on journal selection. Certain types of clinical material are appropriate for different journals.
Peer-reviewed and indexed journals are preferred, as they signal a higher level of scientific scrutiny. This information will typically be found in the journal’s front pages, or online under the instructions for authors. Journals indexed in PubMed are preferred. If the journal is found when searching on www.pubmed.gov, it’s indexed on PubMed.
Many options are available within the category of peer-reviewed and indexed journals. However, on a medical student level, an opportunity to publish in any medical journal is significant. Publication in a non-peer reviewed, non-indexed medical journal is still an accomplishment, and will be regarded as such.
Your residents and faculty advisors are the best source of suggestions for appropriate sections of journals to which to submit. These may include specialty-specific or non-specialty specific journals. When choosing a journal, residents or faculty will usually base their choice on several criteria
Is the journal one that has a section for "classic" cases?
If you are describing an unusual case, is the journal likely to accept this case report?
Does the journal charge APCs (article processing charges)? While some journals do not charge a fee for publication, other journals charge a fee the authors to publish.
For example, in the field of dermatology alone, we can list a dozen journals that accept classic cases that are published for the education of the reader. These types of classic cases are often seen in a typical week at an academic dermatology outpatient clinic. A case of epidermolysis bullosa acquisita, for example, may not be all that interesting to the dermatology attending, but may prove to be an interesting case for submission to the Photo Quiz section of American Family Physician.
Even your first draft should conform to the journal’s exact specifications
The first draft that you turn in to your attending must be perfect. As always, every aspect of your performance is up for scrutiny, and you need to be sending a consistent message throughout the application process. And yes, without a doubt, writing a paper is part of that process. Your message is that you bring excellence to whatever task you perform, and that your attention to detail is impeccable.
Proof your paper for grammatical and spelling mistakes, especially with medical terms for which neither you nor your spell-checker are familiar.
Submit a title page that adheres to the journal’s specifications.
Ensure that the format of your paper adheres to these specifications as well.
If the journal requires an abstract for case reports, then submit an abstract of the specified length.
Instructions for clinical photos, radiologic or other images, tables, and graphs should all be studied closely.
Journals vary in their requirements for listing of references. Follow these requirements exactly.
Since this is a first draft, your content will be revised. Therefore, anticipate that your references will be modified and/or moved around in order. Despite that, in the draft submitted to your advisor, the references should be formatted according to the instructions of the journal. In many cases, this means that references would be numbered and superscripted as directed, and the references section would include the numbered references in order of their inclusion in the body of the report.
I use a free online tool called Zotero that allows me to easily switch between styles of references. This way, if your advisor suggests a change in the order of the content, the work required for significant renumbering of your references won’t be difficult. (Side note: Zotero is amazing, and I require all students working on publications with me to use it for managing our references.)
The follow through is just as important
Most students feel a tremendous sense of relief when they can finally turn in a paper and say they’re done. However, follow through is just as important. Always offer to make any necessary revisions. Provide explicit instructions on how to reach you in the months to come. “I’ll be doing an away elective in the month of February, but please feel free to contact me by e-mail, because I’d like to make whatever revisions are necessary without delay.”
Sometimes the revisions suggested by your advisor can be lengthy and painful. Your ability to complete suggested revisions, and to do so promptly, will be noted. If a paper is submitted and subsequently accepted, there are almost always required revisions to be completed before the paper will be published. Be available for these revisions as well.
While your revisions should be submitted promptly, the converse won’t always be true. Some attendings may take a great deal of time to respond to your first or second draft of an article. While you should have made it clear that you are available to work on any suggested changes, you cannot do much more than that to speed up the process. Some students, after working so hard on a paper, are understandably impatient for the paper to be submitted, accepted, and published in time to help their application. However, it’s easy to annoy an attending when you check in too often on the status of your paper.
Case reports may lead to more substantial opportunities, such as review articles or clinical research projects
Many faculty, including myself, are often approached by medical students seeking research opportunities. Case reports are often considered the "entry point" into research. In other words, deeper research opportunities are only offered to students who have demonstrated their interest in research and their ability to follow through via a successful completed case report.
Case series are more substantial publications, but will require a faculty member asking you to collaborate using their clinical material.
Reviews are articles which are also typically identified by the faculty member.
Clinical and basic science research projects require a more formal and in-depth commitment.
While there are some one-month clinical and basic science research electives, many research projects require much more of a commitment.
In order to participate in research of this type, you’ll typically need to identify a faculty mentor who can support and educate you about the process.
The material in some case reports can also be presented at a scientific meeting or conference
Note that we’ve only focused on opportunities to publish. Many of these opportunities, however, can also translate into opportunities to present a poster at a national meeting, or to make a presentation at a local, regional, or national meeting. Can this case be presented at the monthly meeting of the Atlanta Pediatric Society? Can it be submitted as a clinical vignette for the national American College of Physicians meeting? Your faculty advisor can advise you of any potential opportunities.
A Note of Encouragement
If you've never written a piece for a medical journal, the entire process can seem opaque and intimidating. Don't let that stop you from moving forward and creating a first draft. (If you're dealing with perfectionism, you may find this article that I wrote for the Harvard Business Review of interest: "Don't let perfectionism slow you down".)
Having worked with many medical students on publications, I can assure that writing for publication is a skill just like any other: you can and will get better as you continue to take action. I wish you all the best with your medical writing!
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Dr. Rajani Katta is the creator of The Residency Interview 101, the online course that helps applicants quickly and confidently prepare for their residency interviews. She is also the co-author of The Successful Match: Rules to Succeed in the Residency Match and served as Professor of Dermatology at the Baylor College of Medicine for over 17 years.
Dr. Samir Desai is a faculty member at the Baylor College of Medicine and the author of The Successful Match: Rules to Succeed in the Residency Match. He is the co-founder of MD2B Connect, the most trusted and highest-rated provider of hands-on clinical experiences for IMGs in the U.S.
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