To the Editor
Dr. Packer1 and his coauthors provide a thoughtful commentary as they make a case for case reports. Their article reminds us that case reports are a learning tool not only for dissemination of knowledge but also for thoughtful reflection, with many often-intangible benefits for our learners. They highlight that case reports offer opportunities to improve learner observation, hypothesis generation, patient-centered care, writing skills, and scholarship. We recognize these benefits for learners at our institution and integrate them into training programs with deliberate support.
We agree that choosing a case can be difficult and therefore ask our learners to consider other learning opportunities beyond “zebras.” For example, many cases teach clinical reasoning or patient safety and can be published in journal formats that specifically highlight these topics. Ultimately, we encourage our learners to emphasize what they learned from a case and consider how it can teach others.
At our institution, we have a competitive internal case report process for our residents that combines mentorship and support to present cases at regional meetings. Before regional conference deadlines, residents submit case reports, which are anonymously rated by faculty based on their relevance, teaching value, and overall quality. We then provide financial support for the highest rated to attend the conference, although the benefits extend to others, beyond those who are accepted. Through the process, all of our residents gain faculty mentorship, improve their writing and editing skills, and hone their clinical reasoning and presentation skills.
For those accepted to present, we organize practice sessions during which faculty volunteers coach residents following a systematic approach.2 One of the article’s authors, Rachel Katz, described the benefit of preparing emotionally to receive constructive criticism, which we have found through these sessions leads to a better final product and a well-prepared presenter. Throughout our 10-year experience with this process, learners have been enthusiastic and thankful for the experience. The benefits to learners and faculty are invaluable as both benefit from the mentoring process, camaraderie, and scholarship. Case reports are now an integral part of our culture and are celebrated and supported.
Starr Steinhilber, MD, MPH
Assistant professor, Department of Medicine, University of Alabama at Birmingham and Birmingham Veterans Affairs Medical Center, Birmingham, Alabama; ORCID: http://orcid.org/0000-0002-3858-9688.
Robert Smola, MD
Third-year resident, Tinsley Harrison Internal Medicine Residency Program, Birmingham, Alabama; ORCID: http://orcid.org/0000-0002-5339-9540.
Winter Williams, MD
Assistant professor, Department of Medicine, University of Alabama at Birmingham and Birmingham Veterans Affairs Medical Center, Birmingham, Alabama; firstname.lastname@example.org; ORCID: http://orcid.org/0000-0002-4015-9409.
1. Packer CD, Katz RB, Iacopetti CL, Krimmel JD, Singh MK. A case suspended in time: The educational value of case reports. Acad Med. 2017;92:152156.
2. Snyder ED, Salanitro AH, Estrada C, Centor RM, Castiglioni A. Preparing for oral scientific and clinical vignette presentations. J Grad Med Educ. 2011;3:554557.