Letter to the Editor

Structured Didactic Education Program for Writing Case Reports Can Motivate Medical Students

Yosuke Kakisaka¹ ² , Mayu Fujikawa¹, Schuyler Gaillard³

doi: http://dx.doi.org/10.5195/ijms.2016.197

Volume 4, Number 3: 131-132
Received 18 10 2016: Accepted 26 10 2016

To the Editor,

Introduction

As we described in our editorial in this issue,¹ writing case reports is crucial in both building case writing skills and enhancing clinical diagnostic reasoning. Case reports have always been an integral part of medical history.^2,3 However, case reporting instruction has previously tended to be vague, whereas students may need more detailed support such as step-by-step guidance. To address this issue, we recently launched an educational program, entitled “How to write a case report: Visualizing the trajectory from nothing to submission.” The program consists of two parts: (1) a didactic lecture on the theoretical principles of case-writing, and (2) hands-on case report writing practice using a clinical case. The program is suitable for entry-level writers intending to make a submission to a journal. The present article introduces the contents of the didactic part of our program and evaluates the motivational level of medical students towards case writing. The feasibility of structured education in case writing will also be discussed.

Methods

Eighteen medical students at Tohoku University School of Medicine participated in the program. The didactic part of the program is a one-hour lecture consisting of nine parts. After the lecture, the students were anonymously asked to evaluate the level of understanding on a self-reporting questionnaire developed by the authors. The intelligibility questionnaire for the lecture covered nine items. Each item is rated on a 4-point Likert-type scale: not understandable at all, less understandable, understandable, and very understandable. In this study, we focused on three selected parts, which are essential to understand the practical skills of case writing: (1) to read related case reports in order to deepen knowledge of the patient’s condition; (2) to make a table to compare the current patient’s symptoms with those in previously published case reports; and (3) to deliberate critically whether the choice of a topic has reportable significance as a case report. As an example of the product of this methodology, a past publication of the authors is shown in Table 1. The participants provided comments for qualitative evaluation and also assessed their motivation for writing case reports after the lecture.

Table 1.

Clinical Profiles Comparison between Our Case and a Previous Case

	Column 1	Column 2	Column 3	Column 4
Row 0		Our case⁴	Previous case⁵	Comparison
Row 1	Observed phenomenon	Psychiatric symptom due to CSF leakage	Psychiatric symptom due to CSF leakage	Similar
Row 2	Period between CSF leakage and onset of psychiatric symptoms	4 days	40 days	Different
Row 3	Psychiatric symptoms	Visual hallucination	Behavioral dysfunction, Disinhibition, Impulsivity	Different
Row 4	Imaging study	No abnormalities	Downward brain displacement	Different
Row 5	Recovery time	One day	Several days	Different

The typical form of the comparison table consists of 4 columns and rows of various clinical factors (e.g., chief complaints, past and family history, present finding, laboratory data, imaging, clinical course, etc.). Each factor is compared between “our case” (the case being considered for a report) and “previous case(s).” Each clinical factor is marked as either “similar” or “different” in the last column. Clinical factors labeled as “different” are candidates for the main topic of the case report, and may represent a new finding, which is fundamental for significant scientific reports. This table compares our case⁴ and a previously published case⁵ with psychiatric symptoms due to cerebrospinal fluid (CSF) leakage after lumbar puncture. The similarity is that both cases are examples of psychiatric symptoms due to CSF leakage (row 1), by which reproducibility of this phenomenon is warranted. Differences are seen in multiple characteristics (rows 2–5), implying the clinical and radiological diversity of this phenomenon. Our conclusion is that “presence and diversity of this rare phenomenon, psychiatric symptoms due to CSF leakage, should be considered for better patient management.”

Results

All 18 medical students answered the survey on the intelligibility part of the lecture, and 14 answered the motivation part. Table 2 shows the level of understanding for each step of the lecture. Approximately 90% of students rated each step as understandable or very understandable. No major concerns were raised regarding the quality of the contents. Positive comments were also given, such as “the lecture gave me generalized methods to make case reports.” Several technical issues were raised, including “presentation speed is relatively fast,” and “slides can be formatted better.” Eleven of the 14 students responded “motivated” to the question of “are you motivated to write a case report?”

Table 2.

Result of Intelligibility for Each Step of the Lecture

Step	Not understandable at all	Less understandable	Understandable	Very understandable
1	0% (0)	6% (1)	11% (2)	83% (15)
2	0% (0)	0% (0)	17% (3)	83% (15)
3	0% (0)	11% (2)	22% (4)	67% (12)

Parenthesis indicates number of responses.

Discussion

This preliminary study suggests that structured education for medical students on writing a case report is efficacious for the following reasons. First, the quality of the didactic education program was helpful for approximately 90% of the participating students. Second, approximately 80% of the students were motivated to write case reports after the lecture. The study is limited by the small sample size. Future study should consider expanding the sample size and implementing objective markers as an outcome.

Acknowledgments:

None.

Conflict of Interest Statement & Funding:

The authors have no funding, financial relationships, or conflicts of interest to disclose.

Author Contributions:

Conceptualization: YK. Writing, Critical revision of the manuscript, Approval of the final version: YK, MF, SG.

References

1. Kakisaka Y, Fujikawa M, Gaillard S. Writing case reports: teaching and tuition techniques, and the improvement of clinical diagnostic reasoning. Int J Med Students. 2016 Sep-Dec;4(3):88–90.

2. Nield LS. Writing case reports for the clinical literature: practical approach for the novice author. J Grad Med Educ. 2011 Sep;3(3):445.

3. Juyal D, Thaledi S, Thawani V. Writing patient case reports for publication. Educ Health (Abingdon). 2013 May-Aug;26(2):126–9.

4. Kakisaka Y, Hino-Fukuyo N, Kobayashi T, Kubota Y, Kikuchi A, Endo W, et al. Hallucinations associated with cerebrospinal fluid leakage after a lumbar puncture. Br J Anaesth. 2012 Sep;109(3):465–6; author reply 466.

5. Loures V, Savoldelli GL, Alberque C, Haller G. Post-dural puncture cerebrospinal fluid leak presenting as an acute psychiatric illness. Br J Anaesth. 2012 Mar;108(3):529–30.

Yosuke Kakisaka, 1 Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
2 Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.

Mayu Fujikawa, 1 Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.

Schuyler Gaillard, 3 Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA.

About the Author: Yosuke Kakisaka is a pediatrician and epileptologist at Tohoku University Graduate School of Medicine in Sendai, Japan.

Correspondence Yosuke Kakisaka. Address: Department of Epileptology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan. Email: kakisuke@mui.biglobe.ne.jp

Cite as: Kakisaka Y, Fujikawa M, Gaillard S. Structured didactic education program for writing case reports can motivate medical students. Int J Med Students. 2016 Sep-Dec;4(3):131-2.

International Journal of Medical Students, VOLUME 4, NUMBER 3, December 2016