In Reply to Steinhilber et al

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We thank Dr. Steinhilber and colleagues for their comments on our article and applaud their enthusiasm for case reports in medical education. The well-designed “competitive internal case report process” they have developed at the University of Alabama at Birmingham (UAB) shows the critical role of mentorship in writing and publishing case reports. In our medicine clerkship case reporting program, the scarcity of dedicated mentors may have lowered the student publication rate. At UAB, on the other hand, the authors state that “all of our residents gain faculty mentorship” (emphasis ours). We wonder how faculty are recruited and incentivized to participate in this rigorous teaching activity. Also, does the competitive nature of the program discourage the residents who are not accepted? Are they encouraged to revise and resubmit their case reports?
We also appreciate the point about teaching learners to look beyond “zebras” and focus on the educational value of the case. This gets to the historical roots of the case report. Hippocrates was not looking for novelty; he carefully described the cases that he encountered, considered what could be learned from them, and compiled his teaching points, or aphorisms. That same ancient process, when done well, can still lead to useful and often publishable case reports.
The successful case report educational program described by Dr. Steinhilber and colleagues is not an isolated phenomenon. Other similar programs are emerging,1,2 and editorial voices are beginning to call for expanded use of case reports in medical education.3,4 The next step, in our era of competencies and milestones, will be to define the specific educational objectives that can be met with case report curricula. The ability to select, prepare, and publish a case report may fulfill several of the Accreditation Council for Graduate Medical Education (ACGME) competencies, including medical knowledge, patient care, practice-based learning, and communication.4 In fact, we think this activity may provide a more robust and objective assessment in some areas than the methods proposed by ACGME. We recommend that the UAB case report program and others like it should be studied and put into broader practice.
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