August 2006, Volume 56, Issue 8

Short Essay

Case presentation - first echelon for the young researcher

Recent years have witnessed an increasing trend towards research work amongst the undergraduates. Evidenced by increasing number of student medical journals and incorporation of student sections in established international journals, the inspiration enhances students' aptitude towards medicine and boosts their future career prospects as competition toughens for postgraduate posts in residency training programs of reputed health care institutions globally.

However, as lack of experience and resources dictate that they are unable to initiate major trials or scholarly reviews, students often remain somewhat disadvantaged to accredit a research paper to themselves. While some remain content with the mundane task of data collection and inclusion as junior author in an original article, most young research enthusiasts discover that the primary step into research paper writing is often through case reports. Even still, with busy schedules and relative medical writing, naïveté students frequently find themselves unable to encompass all aspects of case presentation, from patient profile to the right decisions about submission. This article, on a point wise basis aims to elucidate the important concepts surrounding the above, coming from an author who has had experience in case report publications as a student.

* First step is selection of an appropriate case for reporting. Even as some degree of contrast exists towards understanding of the above in global medical community today, one singular fact about a worthwhile case report is that it should carry a message - either through its rarity in features or educational content in nature. Be on the lookout in ward rounds as you enter your clinical years and read up on anything that you find unusual or out of ordinary, since a good probability exists that you may not encounter such cases regularly. Do express your interest in front of your supervising consultant. Many senior physicians have record of exceptional cases and are often waiting for some interested researcher to report them.

* Before you delve into your patient's file, it pays to read up the topic from a standard text. Next go through PubMed, MEDLINE, (even Google!) and any other standard medical database that you have access to obtain a comprehensive literature review. Read up all previous reports on the topic. Be thorough and don't miss out on some landmark work on the relevant subject, no matter how recent or archaic!

* Now go through the medical record of your patient. Don't be selective here - copy down everything from initial presentation to the last follow-up. Even the most minor detail may prove to be a critical piece of information when you sit down to write.

* You may now feel that you are ready for the write up!
You should possess complete understanding and literature review of the topic plus knowledge of the whole clinical course of your patient. Before you begin though, have a final discussion with the supervising clinician as to what features should you highlight in your report and what message you are trying to convey through this article. This will aid you in directing your paper purposefully.

* Most journals require case reports to be formatted as a brief introduction followed by the case history and then the discussion, plus, if at all, a short unstructured abstract.

* Start the introduction section with a brief overview of your patient's disease process - its prevalence, morbidity and impact on health prospects globally. Cap it up with a mention of your case, what makes it unique and/or instructional and what message are you trying to
convey by presenting it to medical professionals of the particular specialty.

* In the case history provide a succinct summary of the clinical course of your patient - his or her presenting features, important findings on history, examination, laboratory and imaging assessment. Try and include radiological and microscopic illustrations as part of your final draft - they add to the validity/interest of your work. Mention the management and the outcome.
Don't forget to include the follow-up/current status of the person.

* Begin the discussion section with an outline regarding the pathology highlighted in your report, in a manner that is comprehensible for the general reader. Detail on the usual clinical picture and laboratory and imaging findings plus the disease course and management alternatives, at the same time highlighting on the pertinent features that make your case exceptional.
Address any controversies surrounding the issue in literature. Conclude with the significance and the educational value of your report.

* Keep the references limited, relevant and recent.

* Congratulations, your preliminary draft is now ready.
Have it reviewed by your senior faculty author. Remember revision = 're-vision' - the more time you spend in reviewing your article, the more polished and presentable it is going to appear in the end.

* Finally you have now prepared your case report! It is now time for the most critical decision - which journal you wish to submit your article to? Biomedical journals today often have stark variations in their publication policy towards case reports - from encouraging
educational or instructional reports to inclusion only of the very rare presentations, from including case reports only as letters/correspondence to sometimes not having a provision for case reports at all. Understandably therefore it is a good idea to take time to assess the
prospective impact of your article:

- Is it the report of a unique occurrence or a teaching concept?
- Is it more pertinent for the local literature, and thus publishable in a local journal, or is it of sufficient relevance for an international audience?
- Which journals have published related articles in the past?
- What is the processing speed and impact factor of the journal you have decided upon?

Be objective and reasonable in reviewing the significance of your work - this will often save you time and disappointment in getting your article published.

In the end, always remember that your 'case' is an actual person and you are bound by ethics to maintain confidentiality and accuracy in your writing, obtaining consent when required in accordance with most good journal guidelines.
Good Luck!

Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: