How to Overcome the Barriers Behind Writing Case Reports for Beginners and Young General Physicians

Introduction

Case reports, which have existed since ancient Egypt and prior to Hippocrates, are the basis of clinical medicine.^1,2 Case reports contribute to the development of academic fields and innovative clinical research.^3–5 In particular, case reports can highlight scientific findings previously overlooked in clinical research.⁵ However, only 3.8% of the cases presented at an annual meeting for Japanese generalists were later published in peer-reviewed journals.⁶ This may be attributed to various challenges physicians encounter when writing case reports.⁶ Therefore, it is crucial to seek out mentors early on to address any obstacles experienced during writing. Moreover, writing case reports can be difficult without guidance from mentors.^7–9 Therefore, this paper aimed to provide practical tips on how to overcome the barriers behind writing case reports.

Methods

The authors, seven academic generalists with a median of 8 years of practice after graduation, are board members of the Japanese Society of Hospital General Medicine (JSHGM) – Junior Doctors Association and have extensive experience in publishing case reports in international peer-reviewed journals. We conducted a narrative review and discussed ways to help beginners and young general physicians write case reports. Based on the outcomes, we provided three tips to overcome the barriers behind writing case reports for beginners and young general physicians. In addition, although a list of journals suitable for case reports and clinical image reports in the field of general medicine has been reported,^9,10 we propose a revised version in this article, which focuses solely on case reports and adds several important items for beginners or young general physicians.

Results

Tip 1: Recognize the Types of Suitable Cases for Case Reports: Novelty or Lessons-Learned Cases

There are two main categories of cases appropriate for case reports: “novelty cases” and “lessons-learned cases”. Novelty cases are those that have not been reported previously or have been reported very rarely as well as cases with novel findings. They are suitable for case reports. Contrarily, lessons-learned cases include those of common diseases with an atypical history or findings, or a complicated diagnostic process. They are also suitable for case reports. Understanding the category to which the case belongs is important because the way that the discussion is written differs depending on whether it is a novelty case or a lessons-learned case. Deciding whether to write a full case report or a clinical image report is sometimes difficult; therefore, it is important to understand the characteristics of both. Clinical image reports generally have short word limits and focused discussion points. Additionally, for clinical image reports, the images would be better to be striking and have good quality. However, even if the images are not striking, an instructive case can be accepted as clinical image report.⁹ Based on the word limits, full case reports are more suitable for cases with multiple discussion points, although the inclusion of images is not always allowed.

Tip 2: Select a Journal for Submission Using a List of Candidate Journals for General Physicians

Selecting a journal for submission can be challenging for beginners and young general physicians. General physicians work with a variety of patients and in different practice settings, leading to a wide range of journals that publish reports in their field.¹⁰ Currently, information available to aid in journal submission is limited, leaving authors to rely on information from colleagues or unreliable internet sources.¹⁰ Search engines like PubMed are not suitable for selecting journals for case reports.¹⁰ While web services that search for journals based on abstracts or titles in English can be helpful, the process can still be time-consuming due to the many options available.¹⁰ Gathering information from experienced physicians who have had case reports accepted or published is valuable in creating a list of potential journals.¹⁰ Table 1 provides a list of journals that specifically focus on case reports, along with important pointers for beginners and young general physicians. This list can assist authors in the field of general medicine in choosing appropriate journals for submission.

Table 1 The Target Journals for Case Reports Written by Japanese Generalists

Tip 3: Organize the Discussion Section with One Theme per Paragraph

The basic premise of writing a discussion in a case report is that each paragraph should comprise one theme (one discussion point), with multiple discussion points and paragraphs. As mentioned in Tip 1, case reports can fall into two main categories: novelty cases and lessons-learned cases. In novelty cases, the discussion section is organized in the order of a summary, novelty, lesson learned, and conclusion. Conversely, in lessons-learned cases, the discussion consists of a summary, lesson learned-1, lesson learned-2, and conclusion. The number of paragraphs is adjusted based on the number of novelties and lessons learned. In the summary paragraph, the background of the disease and the significance of the report should be briefly described. In novelty case reports, it is important to emphasize the rarity and novelty of the case. In lessons-learned case reports, it is important to emphasize the differences between the present case and the known information as well as the diagnostic process. If the case involves a common disease with an uncommon presentation or onset, emphasize the symptoms and course of the disease as a lesson learned. Additionally, if the disease is likely to become endemic in the country due to an influx of refugees or immigrants from an endemic area, it is useful to discuss the epidemiology of the disease as a lesson learned. In the concluding paragraph, it is important to emphasize the message as it applies to future cases. It is also important to describe the limitations, if any, and to show that you have objectively considered the weaknesses of the case report and reflected on its clinical significance. By presenting the limitations honestly, it is possible to provide a convincing case report based on sincere effort.

Discussion

We discussed strategies for overcoming these barriers and provided three tips for beginners and young general physicians as follows: Tip 1: Recognize the types of suitable cases for case reports: novelty or lessons-learned cases, Tip 2: Select a journal for submission using a list of candidate journals for general physicians, and Tip 3: Organize the discussion section with one theme per paragraph. In addition, we provide a list of journals that specifically focus on case reports, along with important pointers for beginners and young general physicians. It is very important to consider whether the journal is listed in search engines, such as PubMed, the journal’s impact factor, article publication charges, the word limit of the abstract, the word limit of the main text, and the maximum number of authors and references.

Some barriers for Japanese generalists in preparing case reports involved the process of preparing articles, literature search/article acquisition, the time required to prepare articles, disinclination to write articles in English, and the selection of a journal for publication.⁶ Shikino et al reported that there are five key points that largely determine whether a case report will be accepted by an academic journal, namely the uncovering of the novelty and clinical lessons of the case report, the inclusion of background reports, consulting a native English speaker, showing a blueprint detailing the writing process, and thinking about what to do if your paper was accepted by a journal.⁸ In addition, following five tips were proposed as important processes for writing clinical image reports: select a suitable case for the clinical image report, take appropriate images, select a journal for submission, prepare models of clinical image reports, and create templates for structuring clinical image reports in advance. These points are important when writing case reports and clinical image reports.⁹ This paper particularly emphasizes the following important points for writing case reports: (1) considering two main categories of cases (“novelty cases” and “lessons-learned cases) appropriate for case reports”; (2) using the latest version of a list of journals specifically focused on case reports, along with important pointers for beginners and young general physicians; and (3) each paragraph should comprise one theme (one discussion point), with multiple discussion points and paragraphs.

Limitations

This paper has some limitations. The opinion is based on the experience of a specific group of academic generalists within the JSHGM, which may limit its generalizability to other settings or specialties. It is important to acknowledge that this text reflects the experiences and views of clinicians within the Japanese healthcare system;⁵ therefore, it may not be applicable in medical contexts with different clinical practices, resources, and cultural backgrounds.⁵ In addition, establishing merits and criteria for evaluating the effectiveness of proposed tips is critical. However, this paper does not provide clear metrics and criteria. Internal and external validation will be necessary to reach a conclusion.

Conclusion

We hope that understanding and applying the tips provided in this paper will aid beginners and young general physicians in writing case reports, particularly the consideration of two main categories of cases (“novelty cases” and “lessons-learned cases”), the use of the version of a list of journals specifically focused on case reports, along with important pointers for beginners and young general physicians, and having each paragraph comprise one theme (one discussion point), with multiple discussion points and paragraphs.