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Crafting Your Case Study

By Don Harting, MA, ELS, CCMEP
November 24, 2013

For medical writers who work in continuing medical education (CME) — or who aspire to enter this field — the ability to craft a compelling case study can become a marketable skill. Tips on how to plan, organize, draft, and evaluate case studies were presented Saturday, November 9 during the AMWA annual conference in Columbus, OH. The presenters were Scott Kober, MBA, CCMEP, of the Institute for Continuing Healthcare Education in Philadelphia and Eve Wilson, PhD, CCMEP, ELS, of MORPHOS Medical Education in Bowie, Maryland.

Case studies have an important place in adult education because they can help learners focus on applying new knowledge and skills, rather than simply regurgitating facts. Case-based education allows adults to draw on rich reserves of previous experience, and it lends a sense of immediacy to the learning process. Many CME providers incorporate case studies in both face-to-face and online delivery formats.

But a good case study doesn’t simply write itself. Skill is required to make sure the learning exercise delivers the desired instructional message in a manner that is engaging, appropriate to the learner’s level of expertise, and factually accurate.

According to Kober and Wilson, the typical teaching case proceeds through a series of stages. The narrative begins with a patient presentation, followed by a decision point, often conveyed to the learner in the form of a multiple-choice question; the correct answer can serve as a point of further discussion and move the case to the next stage. The narrative then continues with the impact of the decision on the patient and subsequent events. These events bring the learner to the next decision point in the form of another multiple-choice question. This pattern may be repeated with additional decision points, or the case may draw to a close.

The key to planning a successful case study is to ask plenty of questions beforehand. Who are the learners? Are they physicians? Nurses? Pharmacists? What are the key learning objectives to be addressed by the case? What information can every learner be assumed to know already, and what information must be supplied in the narrative?

Expect to do an ample amount of research before beginning to write. Seek expert input. Search the Internet for other cases that have been published in the same therapeutic area. Consult current clinical practice guidelines. Familiarize yourself with pertinent laboratory tests in the therapeutic area of interest, along with standard and abnormal lab values. If you are a freelancer, ask your client if a template is available.

When you organize your case, make sure you answer the same  questions every journalist answers in a news story: Who?  Where? When? Why? How? You are essentially telling a short story, so you will need a cast of characters and a plot.

As you draft the narrative, follow a logical time sequence so learners won’t become confused. Normally you will proceed in chronological order, but a more complicated case may allow for flashbacks. Wilson advised writers to add enough human-interest details to make the case interesting, but avoid red herrings that will distract learners. As you prepare decision-point questions, be sure the correct answer is evidence-based, supported by clinical practice guidelines, and tied to specific learning objectives.

Including photos and medical images will add realism and lend visual appeal. X-ray films; MRI, PET, or CT scans; and 3-D computer models can all be used to enhance the learning experience. Snapshots of lab reports or treatment diaries may also be used, but if taken from actual patient records, all identifying information must be removed.

As Kober pointed out, information on drug dosing must be accurate and appropriate. There is no quicker way to lose credibility with learners than to write a multiple-choice question where the correct answer involves a dosing schedule or route of administration that clinicians never use.

The best multiple-choice questions are those that are challenging, align with learning objectives, and have a single correct answer. Kober considers “all of the above” and “none of the above” as signs of laziness in a writer, so they should be used sparingly. If a question is only tangentially related to the learning objectives for the case, or if the language meanders through a series of negations, revise it.

For medical writers, hours invested in perfecting the art of writing a good patient case will be time well spent. As a service to the profession, a peer-reviewed guideline on writing case reports was published in September during the Seventh International Congress on Peer Review and Biomedical Publication. The guideline includes a checklist of points to cover in the narrative and aligns well with the material presented by Kober and Wilson. To download a free copy of the guideline, visit http://www.jmedicalcasereports.com/content/pdf/1752-1947-7-223.pdf.

Don Harting is a freelance medical writer specializing in oncology education. He works from his home in Downingtown, PA.