A Curriculum to Teach Learners How to Develop and Present a Case Report

Case to Vignette: A Framework to Elevate Narrative by Embracing Vignette-Based Learning in Medicine

Clinical vignettes play many roles in the practice of medicine and are a near-universal method of sharing stories in clinical medicine. The act of preparing clinical vignettes is also highly valuable: organizing a case into narrative form promotes active learning, anticipating and answering clinical questions that occur in real-life practice. Clinical vignettes are integral to instructional techniques such as morning report and case-based learning, where they are utilized to foster clinical reasoning, illustrate key points, and apply medical knowledge to clinical practice. Developing a vignette facilitates reflection and deliberate practice, which are crucial for lifelong learning. Clinical vignettes are also important entries to scholarship, particularly for those earlier in their careers. They are highly adaptable to different formats like clinical vignette abstract and poster presentations, case reports, case series, clinical images, or specific clinical reasoning submissions. While these benefits are familiar to many practitioners, they may lack a structured framework to leverage vignettes' full potential as agents of professional and scientific development. We propose a framework to describe the value of clinical vignette development through four different lenses: 1) vignettes as curriculum; 2) vignettes for professional advancement; 3) vignettes for scientific advancement; and 4) vignettes for joy in practice.

Short-Term Training with Basic Science Research Literature Advances Medical Students' Skills for Adaptive Expertise

Physicians must adapt their learning and expertise to the rapid evolution of healthcare. To train for the innovation-efficient demands of adaptive expertise, medical students need to acquire the skill of adaptive self-regulated learning, which includes accessing, interpreting, and synthesizing emerging basic and translational research to support patient care. In response, we developed the course Medical Student Grand Rounds (MSGR). It engages all pre-clerkship students at our institution with self-regulated learning from translational basic research literature. In this report, we describe MSGR's methodology and important outcomes. Students found, interpreted, critically assessed, and presented basic research literature about self-selected clinically relevant topics. In less than one semester and mentored by basic science researchers, they completed eight milestones: (a) search research literature databases; (b) choose a clinical topic using searching skills; (c) outline the topic's background; (d) outline a presentation based on the topic's mechanistic research literature; (e) attend translational research-oriented grand rounds by faculty; (f) learn to prepare oral presentations; (g) write an abstract; and (h) present at Grand Rounds Day, emphasizing their topic's research literature. Graded milestones and end-of-course self-assessments indicated students became proficient in interpreting research articles, preparing and delivering presentations, understanding links among basic and translational research and clinical applications, and pursuing self-regulated learning. Qualitative analysis of self-assessment surveys found most students thought they progressed toward the learning objectives: find scientific information about a research topic (56% positive responses), interpret and critically assess scientific information (64%), and prepare and deliver a scientific presentation (50%). Milestones improve time management and provide a scaffolded method for presenting focused research topics. MSGR equips students with critical thinking skills for lifelong, adaptive, self-regulated learning-a foundation for adaptive expertise. The master adaptive learner cycle of planning, learning, assessing, and adjusting is a conceptual framework for understanding students' MSGR learning experiences.

A Case for Case Reports: How to Write One and Promote Mentorship, Scholarship and Faculty Development

Introduction Case reports form the base layer of the evidence pyramid, describing new or emerging diseases, side effects to treatments, common presentations of rare diseases, or rare presentations of common diseases. An important scholarly pursuit, writing case reports can be hindered by lack of time, training, and mentorship. Here, we describe a workshop incorporating case writing skills with mentorship opportunities to engage faculty and learners. Methods We designed and implemented a virtual, synchronous workshop addressing knowledge and attitudes on case reports for trainees and academic faculty at distributed sites. Participants discussed the contributions of case reports to the medical literature, key features of successful cases, approaches to writing learning objectives, and how to develop interesting cases into dynamic case reports. Case reports were discussed as a way to mentor learners to disseminate interesting cases as a source of clinical experience and academic productivity. A retrospective pre-post survey was collected two months after the workshop to evaluate its utility. Results Fifteen out of 42 participants responded to the survey. As a result of the workshop, respondents noted improvement in confidence in identifying and writing case reports and identifying and working with mentors or mentees, regardless of level of training or specialty. At the follow-up, seven (47%) respondents had identified a case and 10 (67%) had identified a mentor/mentee to write a case report with. Discussion This workshop, successfully delivered virtually, demonstrates the utility of a brief educational intervention in improving participant confidence in identifying and writing case reports with mentorship.

Building a Local Research Symposium: The Crossroads of Scholarship, Education, and Faculty Development

Introduction

Demonstrating research productivity for faculty and trainees is challenging in primarily community-based settings, where academic, structural, and financial resources for faculty development in scholarship may be limited. More tools are needed to guide faculty leaders in community-based settings to develop opportunities locally.

Methods

At our community-based children's hospital with recent academic affiliation and a new residency program, we developed an annual research symposium targeted to faculty and trainees. We refined tools for solicitation and scoring of abstracts, speaker selection, skill-building workshops, scholarly case report presentations, and a mentored poster session. We worked with available resources, kept costs flexible and low, and secured local partnerships to defray expenses. Evaluation consisted of session evaluations and trends in abstract submissions, institutional review board (IRB) submissions, and resident scholarly productivity over 4 years.

Results

Scholarship improved over the symposium's first 4 years, with increased attendance (from 80 to 150), abstract submissions (from 29 to >50), IRB-approved research projects (from 65 to 123), and positive feedback on symposium evaluations. From our first three resident classes, 61 resident-authored abstracts were presented at our symposia, with 33 presented at regional and national meetings and 15 converted to peer-reviewed manuscripts.

Discussion

We have developed a local research symposium to meet the needs of a new hospital's faculty and trainees. Evaluation data have allowed us to tailor the program to stakeholder needs. We provide a tool kit of generalizable resources for community-based programs to build on these efforts in a high-yield and cost-effective manner.

What is Evidence-Based Functional Medicine in the 21st Century?

The 21st century has already demonstrated itself to be an era of change for medicine and science. There is a new openness-to ideas, to a shift in perspectives, to a redefinition of evidence and the many ways it can be gathered. New interest in real-world data, patient-experience information has also become an increasingly important contributor to the evaluation of treatment effectiveness. It is a fertile time on many fronts, including an expanded reach for a systems biology formalism and the Functional Medicine movement.