what is nursing case report

Case Report: A Beginner’s Guide with Examples

A case report is a descriptive study that documents an unusual clinical phenomenon in a single patient. It describes in details the patient’s history, signs, symptoms, test results, diagnosis, prognosis and treatment. It also contains a short literature review, discusses the importance of the case and how it improves the existing knowledge on the subject.

A similar design involving a group of patients (with the similar problem) is referred to as case series.

Advantages of case reports

Case reports offer, in general a fast, easy and cheap way to report an unusual observation or a rare event in a clinical setting, as these have very small probability of being detected in an experimental study because of limitations on the number of patients that can be included.

These events deserve to be reported since they might provide insights on some exceptions to general rules and theories in the field.

Case reports are great to get first impressions that can generate new hypotheses (e.g. detecting a potential side effect of a drug) or challenge existing ones (e.g. shedding the light on the possibility of a different biological mechanism of a disease).

In many of these cases, additional investigation is needed such as designing large observational studies or randomized experiments or even going back and mining data from previous research looking for evidence for theses hypotheses.

Limitations of case reports

Observing a relationship between an exposure and a disease in a case report does not mean that it is causal in nature.

This is because of:

• The absence of a control group that provides a benchmark or a point of reference against which we compare our results. A control group is important to eliminate the role of external factors which can interfere with the relationship between exposure and disease
• Unmeasured Confounding caused by variables that influence both the exposure and the disease

A case report can have a powerful emotional effect (see examples of case reports below). This can lead to overrate the importance of the evidence provided by such case. In his book Against Empathy: The Case for Rational Compassion , Paul Bloom explains how a powerful story affects our emotions, can distort our judgement and even lead us to make bad moral choices.

When a case report describes a rare event it is important to remember that what we’re reading about is exceptional and most importantly resist generalizations especially because a case report is, by definition, a study where the sample is only 1 patient.

Selection bias is another issue as the cases in case reports are not chosen at random, therefore some members of the population may have a higher probability of being included in the study than others.

So, results from a case report cannot be representative of the entire population.

Because of these limitations, case reports have the lowest level of evidence compared to other study designs as represented in the evidence pyramid below:

Real-world examples of case reports

Example 1: normal plasma cholesterol in an 88-year-old man who eats 25 eggs a day.

This is the case of an old man with Alzheimer’s disease who has been eating 20-30 eggs every day for almost 15 years. [ Source ]

The man had an LDL-cholesterol level of only 142 mg/dL (3.68 mmol/L) and no significant clinical atherosclerosis (deposition of cholesterol in arterial walls)!

His body adapted by reducing the intestinal absorption of cholesterol, lowering the rate of its synthesis and increasing the rate of its conversion into bile acid.

This is indeed an unusual case of biological adaptation to a major change in dietary intake.

Example 2: Recovery from the passage of an iron bar through the head

This is an interesting case of a construction foreman named Phineas Gage. [ Source ]

In 1848, due to an explosion at work, an iron bar passed through his head destroying a large portion of his brain’s frontal lobe. He survived the event and the injury only affected 1 thing: His personality!

After the accident, Gage became profane, rough and disrespectful to the extent that he was no longer tolerable to people around him. So he lost his job and his family.

His case inspired further research that focused on the relationship between specific parts of the brain and personality.

• Sayre JW, Toklu HZ, Ye F, Mazza J, Yale S.  Case Reports, Case Series – From Clinical Practice to Evidence-Based Medicine in Graduate Medical Education .  Cureus . 2017;9(8):e1546. Published 2017 Aug 7. doi:10.7759/cureus.1546.
• Nissen T, Wynn R.  The clinical case report: a review of its merits and limitations .  BMC Res Notes . 2014;7:264. Published 2014 Apr 23. doi:10.1186/1756-0500-7-264.

Further reading

• Case Report vs Cross-Sectional Study
• Cohort vs Cross-Sectional Study
• How to Identify Different Types of Cohort Studies?
• Matched Pairs Design
• Randomized Block Design

Case Reports: How to Write a Case Report

• How to Write a Case Report
• Case Report Resources
• YouTube Resources

Consensus-Based Clinical Case Reporting Guidelines

Gagnier JJ, Riley D, Altman DG, Moher D, Sox H, Kienle GS, for the CARE group: The CARE guidelines: Consensus-based clinical case reporting guideline development. Dtsch Arztebl  Int 2013; 110(37): 603-8.

Select Journals Accepting Case Reports

Case Report Templates

The CAse REporting (CARE)  team created templates in nine languages to assist clinicians, researchers, and educators with the ultimate goal of improving the completeness, transparency, and usefulness of case reports.  

English , Spanish , German , Chinese , Dutch , French , Japanese , Korean , Portuguese

• Case Report Journals

A list of case report journals can be found in the pdf below. It provides information on the year launched, open-access status, reported questionable publishing practices, and whether the journal is indexed in Medline. The majority of these journals are open-access and will require a submission fee.

BMJ Case Reports

• BMJ Consent Form

The Library has an institutional fellowship with  BMJ Case Reports  which allows faculty, staff, and students at Weill Cornell Medicine to submit case reports without paying an individual fellowship fee. Use our  fellowship code  when you are ready to publish. 

Please note: BMJ Case Reports, like most journals, requires a signed consent form in order for a case report to be considered for publication. 

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Writing a case report in 10 steps

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• Victoria Stokes , foundation year 2 doctor, trauma and orthopaedics, Basildon Hospital ,
• Caroline Fertleman , paediatrics consultant, The Whittington Hospital NHS Trust
• victoria.stokes1{at}nhs.net

Victoria Stokes and Caroline Fertleman explain how to turn an interesting case or unusual presentation into an educational report

It is common practice in medicine that when we come across an interesting case with an unusual presentation or a surprise twist, we must tell the rest of the medical world. This is how we continue our lifelong learning and aid faster diagnosis and treatment for patients.

It usually falls to the junior to write up the case, so here are a few simple tips to get you started.

First steps

Begin by sitting down with your medical team to discuss the interesting aspects of the case and the learning points to highlight. Ideally, a registrar or middle grade will mentor you and give you guidance. Another junior doctor or medical student may also be keen to be involved. Allocate jobs to split the workload, set a deadline and work timeframe, and discuss the order in which the authors will be listed. All listed authors should contribute substantially, with the person doing most of the work put first and the guarantor (usually the most senior team member) at the end.

Getting consent

Gain permission and written consent to write up the case from the patient or parents, if your patient is a child, and keep a copy because you will need it later for submission to journals.

Information gathering

Gather all the information from the medical notes and the hospital’s electronic systems, including copies of blood results and imaging, as medical notes often disappear when the patient is discharged and are notoriously difficult to find again. Remember to anonymise the data according to your local hospital policy.

Write up the case emphasising the interesting points of the presentation, investigations leading to diagnosis, and management of the disease/pathology. Get input on the case from all members of the team, highlighting their involvement. Also include the prognosis of the patient, if known, as the reader will want to know the outcome.

Coming up with a title

Discuss a title with your supervisor and other members of the team, as this provides the focus for your article. The title should be concise and interesting but should also enable people to find it in medical literature search engines. Also think about how you will present your case study—for example, a poster presentation or scientific paper—and consider potential journals or conferences, as you may need to write in a particular style or format.

Background research

Research the disease/pathology that is the focus of your article and write a background paragraph or two, highlighting the relevance of your case report in relation to this. If you are struggling, seek the opinion of a specialist who may know of relevant articles or texts. Another good resource is your hospital library, where staff are often more than happy to help with literature searches.

How your case is different

Move on to explore how the case presented differently to the admitting team. Alternatively, if your report is focused on management, explore the difficulties the team came across and alternative options for treatment.

Finish by explaining why your case report adds to the medical literature and highlight any learning points.

Writing an abstract

The abstract should be no longer than 100-200 words and should highlight all your key points concisely. This can be harder than writing the full article and needs special care as it will be used to judge whether your case is accepted for presentation or publication.

Discuss with your supervisor or team about options for presenting or publishing your case report. At the very least, you should present your article locally within a departmental or team meeting or at a hospital grand round. Well done!

Competing interests: We have read and understood BMJ’s policy on declaration of interests and declare that we have no competing interests.

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• Published: 30 January 2023

A student guide to writing a case report

• Maeve McAllister 1  

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As a student, it can be hard to know where to start when reading or writing a clinical case report either for university or out of special interest in a Journal. I have collated five top tips for writing an insightful and relevant case report.

A case report is a structured report of the clinical process of a patient's diagnostic pathway, including symptoms, signs, diagnosis, treatment planning (short and long term), clinical outcomes and follow-up. 1 Some of these case reports can sometimes have simple titles, to the more unusual, for example, 'Oral Tuberculosis', 'The escapee wisdom tooth', 'A difficult diagnosis'. They normally begin with the word 'Sir' and follow an introduction from this.

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Guidelines To Writing a Clinical Case Report. Heart Views 2017; 18 , 104-105.

British Dental Journal. Case reports. Available online at: www.nature.com/bdj/articles?searchType=journalSearch&sort=PubDate&type=case-report&page=2 (accessed August 17, 2022).

Chate R, Chate C. Achenbach's syndrome. Br Dent J 2021; 231: 147.

Abdulgani A, Muhamad, A-H and Watted N. Dental case report for publication; step by step. J Dent Med Sci 2014; 3 : 94-100.

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How to Write a Nursing Case Study Paper (A Guide)

Most nursing students dread writing a nursing case study analysis paper, yet it is a mandatory assignment; call it a rite of passage in nursing school. This is because it is a somewhat tricky process that is often overwhelming for nursing students. Nevertheless, by reading this guide prepared by our best nursing students, you should be able to easily and quickly write a nursing case study that can get you an excellent grade.

How different is this guide from similar guides all over the internet? Very different!

This guide provides all the pieces of information that one would need to write an A-grade nursing case study. These include the format for a nursing case study, a step-by-step guide on how to write a nursing case study, and all the important tips to follow when writing a nursing case study.

This comprehensive guide was developed by the top nursing essay writers at NurseMyGrade, so you can trust that the information herein is a gem that will catapult your grades to the next level. Expect updates as we unravel further information about writing a nursing case study.

Now that you know you've discovered a gold mine , let's get right into it.

What Is a Nursing Case Study?

A nursing case study is a natural or imagined patient scenario designed to test the knowledge and skills of student nurses. Nursing case study assignments usually focus on testing knowledge and skills in areas of nursing study related to daily nursing practice.

As a nursing student, you must expect a nursing case study assignment at some point in your academic life. The fact that you are reading this post means that point is now.

While there is no standard structure for writing a nursing case study assignment, some things or elements must be present in your nursing assignment for your professor to consider it complete.

In the next section, you will discover what your instructor n expects in your nursing case study analysis. Remember, these are assignments where you are given a case study and are expected to write a case analysis report explaining how to handle such scenarios in real-life settings.

The Nursing Case Study Template

The typical nursing case study has nine sections. These are:

• Introduction
• Case presentation (Patient info, history, and medical condition)
• Diagnosis/Nursing assessment
• Intervention/Nursing care plan
• Discussion and recommendations

The Structure of a Nursing Case Study Analysis

You now know what nursing professors expect in a nursing case study analysis. In this section, we will explain what to include in each section of your nursing case study analysis to make it an excellent one.

1. Title page

The title page is essential in all types of academic writing. You must include it in your nursing case study analysis or any other essay or paper. And you must include it in the format recommended by your college.

If your college has no specific title page format, use the title page format of the style requested in the assignment prompt. In nursing college, virtually all assignments should be written in Harvard or APA format .

So, check your assignment prompt and create your title page correctly. The typical title page should include the topic of your paper, your name, the name of your professor, the course name, the date you are submitting the paper, and the name of your college.

2. Abstract

Most nursing professors require you to include an abstract in your nursing case study analysis. And even when you are not explicitly required to write one, it is good to do so. Of course, you should consult with your professor before doing so.

When writing an abstract for your paper, make sure it is about 200 words long. The abstract should include a brief summary of the case study, including all the essential information in the patient presentation, such as the history, age, and current diagnosis.

The summary should also include the nursing assessment, the current interventions, and recommendations.

3. Introduction

After writing the title page and the abstract, start writing the introduction. The introduction of a nursing case study analysis must briefly include the patient's presentation, current diagnosis and medication, and recommendations. It must also include a strong thesis statement that shows what the paper is all about.

You shouldn't just write an introduction for the sake of it. If you do so, your introduction will be bland. You need to put in good effort when writing your introduction. The best way to do this is to use your introduction to show you understand the case study perfectly and that you will analyze it right.

You can always write your introduction last. Many students do this because they believe writing an introduction last makes it more precise and accurate.

4. Case Presentation (Status of the Patient)

After introducing your nursing case study analysis, you should present the case where you outline the patient's status. It is usually straightforward to present a case.

You must paraphrase the patient scenario in the assignment prompt or brief. Focus on the demographic data of the patient (who they are, age, race, height, skin tone, occupation, relationships, marital status, appearance, etc.), why they are in the case study or scenario, reasons they sought medical attention, chief complaint, and current diagnosis and treatment. You should also discuss the actions performed on the patient, such as admission to the ICU, taking vital signs, recommending tests, etc.

In short, everything necessary in the patient scenario should be in your case presentation. You only need to avoid copying the patient scenario or case study word-for-word when writing your case presentation.

5. Diagnosis and Assessment

After the case presentation, you should explain the diagnosis. In other words, you should explain the condition, disease, or medical situation highlighted in the case presentation. For example, if the patient is a heavy smoker and he has COPD, it is at this point that you explain how COPD is linked to heavy smoking.

This is the section where you thoroughly discuss the disease process (pathophysiology) by highlighting the causes, symptoms, observations, and treatment methods. You should relate these to the patient's status and give concrete evidence. You should describe the progression of the disease from when the client was admitted to a few hours or days after they were stabilized. Consider the first indication of the disease that prompted the patient to seek further medical assistance.  

Your paper should also elucidate the diagnostic tests that should be conducted and the differential diagnosis. Ensure that each is given a well-founded rationale.

When explaining the condition, go deep into the pathophysiology. Focus specifically on the patient's risk factors. Ensure you get your explanation from recent nursing literature (peer-reviewed scholarly journals published in the last 5 years). And do not forget to cite all the literature you get your facts from.

In short, this section should explain the patient's condition or suffering.

6. Nursing Intervention

After the diagnosis and nursing assessment section, your nursing case study analysis should have an intervention section. This section is also known as the nursing care planning section. What you are supposed to do in this section is to present a nursing care plan for the patient presented in the patient scenario. You should describe the nursing care plan and goals for the patient. Record all the anticipated positive changes and assess whether the care plan addresses the patient's condition.

A good nursing care plan details the patient's chief complaints or critical problems. It then describes the causes of these problems using evidence from recent medical or nursing literature. It then details the potential intervention for each problem. Lastly, it includes goals and evaluation strategies for the measures. Most professors, predominantly Australian and UK professors, prefer if this section is in table format.

Some nursing professors regard the intervention section (or nursing care plan section) as the most critical part of a nursing case study. This is because this part details precisely how the student nurse will react to the patient scenario (which is what the nursing professors want to know). So, ensure you make a reasonable effort when developing this section to get an excellent grade.

7. Discussion and Recommendations

The intervention section in a nursing case study is followed by a discussion and recommendations section. In this section, you are supposed to expound on the patient scenario, the diagnosis, and the nursing care plan. You should also expound on the potential outcomes if the care plan is followed correctly. The discussion should also explain the rationale for the care plan or its significant bits.

Recommendations should follow the discussion. Recommendations usually involve everything necessary that can be done or changed to manage a patient's condition or prevent its reoccurrence. Anything that enhances the patient's well-being can be a recommendation. Just make sure your key recommendations are supported by evidence.

8. Conclusion

This is the second last section of a typical nursing case study. What you need here is to summarize the entire case study. Ensure your summary has at least the case presentation, the nursing assessment/diagnosis, the intervention, and the key recommendations.

At the very end of your conclusion, add a closing statement. The statement should wrap up the whole thing nicely. Try to make it as impressive as possible.

9. References

This is the last section of a nursing case study. No nursing case study is complete without a references section. You should ensure your case study has in-text citations and a references page.

And you should make sure both are written as recommended in the assignment. The style section is usually Harvard or APA. Follow the recommended style to get a good grade on your essay.

Step-By-Step Guide to Writing a Nursing Case Study

You know all the key sections you must include in a nursing case study. You also know what exactly you need to do in each section. It is time to learn how to write a nursing case study. The process detailed below should be easy to follow because you know the typical nursing case study structure.

1. Understand the Assignment

When given a nursing case study assignment, the first thing you need to do is to read. You need to read two pieces of information slowly and carefully.

First, you need to read the prompt itself slowly and carefully. This is important because the prompt will have essential bits of information you need to know, including the style, the format, the word count, and the number of references needed. All these bits of information are essential to ensure your writing is correct.

Second, you need to read the patient scenario slowly and carefully. You should do this to understand it clearly so that you do not make any mistakes in your analysis.

2. Create a Rough Outline

Failure to plan is a plan to fail. That is not what you are in it for anyway! In other words, do not fail to create an outline for your case study analysis. Use the template provided in this essay to create a rough outline for your nursing case study analysis.

Ensure your outline is as detailed as it can be at this stage. You can do light research to achieve this aim. However, this is not exactly necessary because this is just a rough outline.

3. Conduct thorough research

After creating a rough outline, you should conduct thorough research. Your research should especially focus on providing a credible and evidence-based nursing assessment of the patient problem(s). You should only use evidence from recent nursing or medical literature.

You must also conduct thorough research to develop an effective intervention or nursing care plan. So when researching the patient's problem and its diagnosis, you should also research the most suitable intervention or do it right after.

When conducting research, you should always note down your sources. So for every piece of information you find, and what to use, you should have its reference.

After conducting thorough research, you should enhance your rough outline using the new information you have discovered. Make sure it is as comprehensive as possible.

4. Write your nursing case study

You must follow your comprehensive outline to write your case study analysis at this stage. If you created a good outline, you should find it very easy to write your nursing case study analysis.

If you did not, writing your nursing case study will be challenging. Whenever you are stuck writing your case study analysis paper, you should re-read the part where we explain what to include in every section of your analysis. Doing so will help you know what to write to continue your essay. Writing a nursing case study analysis usually takes only a few hours.

5. Reference your case study

After writing your case study, ensure you add all in-text citations if you have not already. And when adding them, you should follow the style/format recommended in the assignment prompt (usually APA or Harvard style).

After adding in-text citations exactly where they need to be and in the correct format, add all the references you have used in a references page. And you should add them correctly as per the rules of the style you were asked to use.

Do not forget to organize your references alphabetically after creating your references page.

6. Thoroughly edit your case study

After STEP 5 above, you need to edit your case study. You should edit it slowly and carefully. Do this by proofreading it twice. Proofread it slowly each time to discover all the grammar, style, and punctuation errors. Remove all the errors you find.

After proofreading your essay twice, recheck it to ensure every sentence is straightforward. This will transform your ordinary case study into an A-grade one. Of course, it must also have all the standard sections expected in a case study.

Recheck your case study using a grammarly.com or a similar computer grammar checker to ensure it is perfect. Doing this will help you catch and eliminate all the remaining errors in your work.

7. Submit your case study analysis

After proofreading and editing your case study analysis, it will be 100% ready for submission. Just convert it into the format it is required in and submit it.

 Nursing Case Study Tips and Tricks

The guide above and other information in this article should help you develop a good nursing case study analysis. Note that this guide focuses entirely on nursing case scenario-based papers, not research study-based nursing case studies. The tips and tricks in this section should help you ensure that the nursing case study analysis you create is excellent.

1. Begin early

The moment you see a nursing case study assignment prompt, identify a date to start writing it and create your own deadline to beat before the deadline stated in the prompt.

Do this and start writing your case study analysis early before your deadline. You will have plenty of time to do excellent research, develop an excellent paper, and edit your final paper as thoroughly as you want.

Most student nurses combine work and study. Therefore, if you decide to leave a nursing case study assignment until late to complete it, something could come up, and you could end up failing to submit it or submitting a rushed case study analysis.

2. Use the proper terminology

When writing an essay or any other academic paper, you are always encouraged to use the most straightforward language to make your work easy to understand. However, this is not true when writing a nursing case study analysis. While your work should certainly be easy to understand, you must use the right nursing terminology at every point where it is necessary. Failure to do this could damage your work or make it look less professional or convincing.

3. Avoid copying and pasting

If you are a serious nursing student, you know that copying and pasting are prohibited in assignments. However, sometimes copying and pasting can seem okay in nursing case studies. For example, it can seem okay to copy-paste the patient presentation. However, this is not okay. You are supposed to paraphrase the verbatim when presenting the patient presentation in your essay. You should also avoid copy-pasting information or texts directly. Every fact or evidence you research and find should be paraphrased to appear in your work. And it should be cited correctly.

4. Always ask for help if stuck

This is very important. Students are usually overwhelmed with academic work, especially a month or two to the end of the semester. If you are overwhelmed and think you will not have the time to complete your nursing case study analysis or submit a quality one, ask for help. Ask for help from a nursing assignment-help website like ours, and you will soon have a paper ready that you can use as you please. If you choose to get help from us, you will get a well-researched, well-planned, well-developed, and fully edited nursing case study.

5. Format your paper correctly

Many students forget to do proper formatting after writing their nursing case study analyses. Before you submit your paper, make sure you format it correctly. If you do not format your paper correctly, you will lose marks because of poor formatting. If you feel you are not very confident with your APA or Harvard formatting skills, send your paper to us to get it correctly formatted and ready for submission.

Now that you are all set up ...

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We have experienced nursing experts available every day of the week to provide nursing assignment help. They can easily research and write virtually any nursing assignment, including a nursing case study. So, if the information provided in this article isn't making you feel any optimistic about writing an excellent nursing case study, get help from us.

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• Roberta Heale 1 ,
• Alison Twycross 2
• 1 School of Nursing , Laurentian University , Sudbury , Ontario , Canada
• 2 School of Health and Social Care , London South Bank University , London , UK
• Correspondence to Dr Roberta Heale, School of Nursing, Laurentian University, Sudbury, ON P3E2C6, Canada; rheale{at}laurentian.ca

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What is it?

Case study is a research methodology, typically seen in social and life sciences. There is no one definition of case study research. 1 However, very simply… ‘a case study can be defined as an intensive study about a person, a group of people or a unit, which is aimed to generalize over several units’. 1 A case study has also been described as an intensive, systematic investigation of a single individual, group, community or some other unit in which the researcher examines in-depth data relating to several variables. 2

Often there are several similar cases to consider such as educational or social service programmes that are delivered from a number of locations. Although similar, they are complex and have unique features. In these circumstances, the evaluation of several, similar cases will provide a better answer to a research question than if only one case is examined, hence the multiple-case study. Stake asserts that the cases are grouped and viewed as one entity, called the quintain . 6  ‘We study what is similar and different about the cases to understand the quintain better’. 6

The steps when using case study methodology are the same as for other types of research. 6 The first step is defining the single case or identifying a group of similar cases that can then be incorporated into a multiple-case study. A search to determine what is known about the case(s) is typically conducted. This may include a review of the literature, grey literature, media, reports and more, which serves to establish a basic understanding of the cases and informs the development of research questions. Data in case studies are often, but not exclusively, qualitative in nature. In multiple-case studies, analysis within cases and across cases is conducted. Themes arise from the analyses and assertions about the cases as a whole, or the quintain, emerge. 6

Benefits and limitations of case studies

If a researcher wants to study a specific phenomenon arising from a particular entity, then a single-case study is warranted and will allow for a in-depth understanding of the single phenomenon and, as discussed above, would involve collecting several different types of data. This is illustrated in example 1 below.

Using a multiple-case research study allows for a more in-depth understanding of the cases as a unit, through comparison of similarities and differences of the individual cases embedded within the quintain. Evidence arising from multiple-case studies is often stronger and more reliable than from single-case research. Multiple-case studies allow for more comprehensive exploration of research questions and theory development. 6

Despite the advantages of case studies, there are limitations. The sheer volume of data is difficult to organise and data analysis and integration strategies need to be carefully thought through. There is also sometimes a temptation to veer away from the research focus. 2 Reporting of findings from multiple-case research studies is also challenging at times, 1 particularly in relation to the word limits for some journal papers.

Examples of case studies

Example 1: nurses’ paediatric pain management practices.

One of the authors of this paper (AT) has used a case study approach to explore nurses’ paediatric pain management practices. This involved collecting several datasets:

Observational data to gain a picture about actual pain management practices.

Questionnaire data about nurses’ knowledge about paediatric pain management practices and how well they felt they managed pain in children.

Questionnaire data about how critical nurses perceived pain management tasks to be.

These datasets were analysed separately and then compared 7–9 and demonstrated that nurses’ level of theoretical did not impact on the quality of their pain management practices. 7 Nor did individual nurse’s perceptions of how critical a task was effect the likelihood of them carrying out this task in practice. 8 There was also a difference in self-reported and observed practices 9 ; actual (observed) practices did not confirm to best practice guidelines, whereas self-reported practices tended to.

Example 2: quality of care for complex patients at Nurse Practitioner-Led Clinics (NPLCs)

The other author of this paper (RH) has conducted a multiple-case study to determine the quality of care for patients with complex clinical presentations in NPLCs in Ontario, Canada. 10 Five NPLCs served as individual cases that, together, represented the quatrain. Three types of data were collected including:

Review of documentation related to the NPLC model (media, annual reports, research articles, grey literature and regulatory legislation).

Interviews with nurse practitioners (NPs) practising at the five NPLCs to determine their perceptions of the impact of the NPLC model on the quality of care provided to patients with multimorbidity.

Chart audits conducted at the five NPLCs to determine the extent to which evidence-based guidelines were followed for patients with diabetes and at least one other chronic condition.

The three sources of data collected from the five NPLCs were analysed and themes arose related to the quality of care for complex patients at NPLCs. The multiple-case study confirmed that nurse practitioners are the primary care providers at the NPLCs, and this positively impacts the quality of care for patients with multimorbidity. Healthcare policy, such as lack of an increase in salary for NPs for 10 years, has resulted in issues in recruitment and retention of NPs at NPLCs. This, along with insufficient resources in the communities where NPLCs are located and high patient vulnerability at NPLCs, have a negative impact on the quality of care. 10

These examples illustrate how collecting data about a single case or multiple cases helps us to better understand the phenomenon in question. Case study methodology serves to provide a framework for evaluation and analysis of complex issues. It shines a light on the holistic nature of nursing practice and offers a perspective that informs improved patient care.

• Gustafsson J
• Calanzaro M
• Sandelowski M

Competing interests None declared.

Provenance and peer review Commissioned; internally peer reviewed.

Read the full text or download the PDF:

How to Write a Case Study Paper for Nursing

A well-written case study paper for a nursing program requires some planning and consideration. All too often, students begin writing before they complete appropriate, preliminary steps. Ideally, before you start a paper, you should already have determined the focus and format of it. You will then follow this up with a fact-gathering step in which you will gather and collate the content of your paper. Finally, there is the construction/execution step in which you will write the paper in a standard format (such as the APA style) and edit it.

A nursing case study paper contains several sections that fall into three categories:

1. The status of the patient

• Demographic data
• Medical History
• Current diagnosis and treatment

2. The nursing assessment of the patient

• Vital signs and test results
• Nursing observations (i.e., range of motion, mental state)

3. Current Care Plan and Recommendations

• Details of the nursing care plan (including nursing goals and interventions)
• Evaluation of the current care plan
• Recommendations for changes in the current care plan

Patient Status

The first portion of the case study paper will talk about the patient — who they are, why they are being included in the study, their demographic data (i.e., age, race), the reason(s) they sought medical attention and the subsequent diagnosis. It will also discuss the role that nursing plays in the care of this patient.

Next, thoroughly discuss any disease process. Make sure you outline causes, symptoms, observations, and how preferred treatments can affect nursing care. Also, describe the history and progression of the disease. Some important questions for you to answer are: 1) What were the first indications that there was something wrong, and 2) What symptoms convinced the patient to seek help?

Nursing Assessment

When you are discussing the nursing assessment of the patient, describe the patientΓÇÖs problems in terms of nursing diagnoses. Be specific as to why you have identified a particular diagnosis. For example, is frequent urination causing an alteration in the patientΓÇÖs sleep patterns? The nursing diagnoses you identify in your assessment will help form the nursing care plan.

Current Care Plan and Recommendations for Improvement

Describe the nursing care plan and goals, and explain how the nursing care plan improves the quality of the patientΓÇÖs life. What positive changes does the nursing care plan hope to achieve in the patientΓÇÖs life? How will the care plan be executed? Who will be responsible for the delivery of the care plan? What measurable goals will they track to determine the success of the plan?

The final discussion should be your personal recommendations. Based on the current status of the patient, the diagnosis, prognosis, and the nursing care plan, what other actions do you recommend can be taken to improve the patientΓÇÖs chances of recovery? You must support your recommendations with authoritative sources and cite appropriately per APA style guidelines.

Creating a well-written nursing case study paper doesnΓÇÖt need to be a grueling challenge. It can be gratifying, and itΓÇÖs good practice for assessing patients while out in the field, too. Keep in mind that your instructor will not only grade you on the quality of the content of your paper but by how you apply the APA style, as well. If you find that you are spending too much time formatting your paper, consider using formatting software as a helpful tool to ensure accuracy, so you donΓÇÖt lose points on a well-written paper because of some formatting errors.

For more information about APA or MLA formats, contact us today.

David Plaut

David Plaut is the founder of Reference Point Software (RPS). RPS offers a complete suite of easy-to-use formatting template products featuring MLA and APA style templates, freeing up time to focus on substance while ensuring formatting accuracy. 

Reference Point Software is not associated with, endorsed by, or affiliated with the American Psychological Association (APA) or with the Modern Language Association (MLA).

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How to Write a Nursing Case Study [Examples, Format, & Tips]

✒️ case study topics for nursing students.

• 🩺️ The Basics
• 💉 Nursing Case Study: Writing Rules

📑 Nursing Case Study Format

📝 nursing case study examples.

• ⏱️ Tips on Quick Writing

🔗 References

A nursing case study is an in-depth analysis of the health situation of an individual patient.

The analysis is based on:

• medical history,
• other relevant criteria.

In most cases, you will be asked to diagnose to suggest the first aid measures. Alternatively, nurses can be asked to describe a patient in their practice and analyze the correctness of their actions. The purpose is to recreate a realistic hospital setting in the classroom and make students reflect on the treatment process from diagnosis to treatment.

• Anaphylactic shock in a teenager with peanut allergy.
• Non-compliant patient with diabetes: ways to improve adherence.
• Telehealth intervention for managing chronic disease.
• Communication strategies to address vaccine hesitancy in a rural community.
• Postpartum hemorrhage in a new mother: risk factors and interventions.
• Ways to improve recognition of dehydration in aging adults.
• The effective ways of maintaining work-life balance for nurses.
• Cultural competency in providing care to migrants and refugees.
• Why should every patient’s medical history remain confidential?
• The use of massage therapy in relieving pain.
• The challenges facing medicine in 2024.
• How does modern technology impact nursing?
• The significance of regular follow-up appointments with the healthcare provider.
• What are the primary treatments for postpartum depression?
• The use of steroids in cancer treatment.

🩺️ Nursing Case Study: What Is It About?

As a nursing student, you should understand that no two patients are the same. Each has a unique clinical record and condition. And although most nursing case study tasks will ask you to suggest a diagnosis or treatment, your focus should rest on the patient.

Busy nurses can sometimes see their patients in the framework of an illness to be treated or a procedure to be fulfilled. But you should do your best to remember that each patient is a living person with a complex set of needs, emotions, and preferences. A ready-made textbook answer is rarely the best solution for them. Moreover, it rarely helps to analyze a condition in isolation from the patient.

In a nursing case study, your task is to analyze a disorder or illness as a part of a specific medical situation. If you don’t do that, your case study becomes an essay (theoretical and generalized). It is the difference between the two assignment types.

Once again:

A case study in nursing emphasizes the particular patient’s condition. Meanwhile, a nursing essay will explore the disease, prevention methods, treatment, or possible consequences of the disease.

Even if the case is hypothetical, it should focus on the suggested reality. On the other hand, essays are usually literature-based. You are expected to do some reading for a case study too, but you should research and present the information within the context of the patient. In simple terms, a case study uses information in the actual application, and an essay uses it for the sake of generalized suggestions.

💉 How to Write a Nursing Case Study: 3 Key Rules

• Do the fieldwork. Before setting your hands to writing, you should collect all of the available materials: clinical notes, results of medical tests, x-rays, sickness records, etc. Use this information to draw a clear picture of the story. It is always helpful to ask yourself, “What is interesting or unusual about this patient’s condition?” In the course of writing, recall your answer from time to time not to get lost in words. It will help you to convey a definite and appropriate message.

• Stick to the facts. A nursing case study should be an accurate description of the actual situation. Restrain from speculating about the inherent mechanisms of the illness or the general treatment methodology. In fact, students are rarely prepared enough to discuss pathology and physiology. Leave this to reputable experts. The best result you can provide in a case study is an honest account of clinical events.
• Concentrate on the patients and their progress. Remember that a nursing case study is a story of a patient’s progress and not a narrative about their nurse. No matter how efficiently the medical specialist acted, it would be incorrect to add any praiseful remarks. The optimal way is to tell the story in its logical and time order and outline the result of treatment. In this case, the outcome will speak for itself.

Introduction

It is where you should tell the reader why this case is interesting . Place your study in a social or historical context. If, during your preliminary research, you found some similar cases, describe them briefly. If you had a hard time diagnosing the patient or your proposed treatment is complicated, mention it here. Don’t forget to cite the references to each of them!

The introduction should not exceed several paragraphs. The purpose is to explain why the reader will benefit from reading about the case.

Case Presentation

• Why did the patient seek medical help? (Describe the symptoms.)
• What is known about the patient? (Mention only the information that influenced your diagnosis. Otherwise, explain why some information is irrelevant to the diagnosis.)
• Stick to the narrative form. (Make it a story!)
• What are the variants for diagnosis? (Make a shortlist of possible disorders that fall under the patient’s symptoms. But make it specific: not just “pneumonia” but “bilateral pneumonia,” for example. Besides, this point is optional.)
• What were the results of your clinical examination? (If you saw the patient in person.)
• Explain the results of lab tests. (The words “positive” or “negative” are not always clear.)

Actions and Their Results

This section describes the care that has been provided and/or is planned. You can answer the following questions in narrative form . If some information is missing, skip the point:

• What preliminary actions have been taken? (Be specific: not just “wound care,” but “wound cleaning and dressing.”)
• How long has the patient been under care?
• Has the previous treatment given any visible result?
• Why was it suspended or finished?
• Why did the patient withdraw from treatment (if applicable)?
• How could you improve the patient’s condition if the result was negative?
• If the disease is incurable (like in the case of diabetes), which activities would stabilize the patient’s condition?
• If possible, include the patient’s reports of their own physical and mental health.

In this section, you should identify your questions about the case. It is impossible to answer all of them in one case study. Likewise, it is unreal to suggest all the relevant hypotheses explaining the patient’s condition. Your purpose is to show your critical thinking and observation skills. Finalize your conclusion by summarizing the lessons you learned from the nursing case study.

Whenever you directly or indirectly cite other sources or use data from them, add these books and documents to the references list. Follow the citation style assigned by your professor. Besides, 15 items are already too much. Try to make a list of up to 10. Using textbooks as references can be viewed as bad manners.

Include all the tables, photographs, x-rays, figures, and the journal of medication usage in this section. Unless required otherwise in the assignment, start each item from a new page, naming them “Appendix A,” “Appendix B…”.

Below you will find case study samples for various topics. Using them as a reference will improve your writing. If you need more ideas, you are welcome to use our free title-generating tool .

• Case study: healing and autonomy.
• Sara’s case study: maternal and child nursing.
• COPD medical diagnostics: case study.
• Care standards in healthcare institutions: case study.
• Acute bacterial prostatitis: case study analysis.
• Alzheimer disease: the patient case study.
• The treatment of foot ulcers in diabetic patients: case study.
• Hypertension: C.D’s case study.
• Myocardial infarction: cardiovascular case study.
• Major depressive disorder case.
• Case study of the patient with metabolic syndrome .
• Pulmonary analysis case study .
• Older adults isolation: Case study .
• The holistic care: Case study .
• Obesity in the Elderly: The Case Study.
• Medical ethics: Case study .
• Patient diagnoses and treatment: Case study .
• Obesity case study: Mr. C .
• Nurse Joserine: Case study problems .
• Chronic stable angina: Case study .
• Fetal abnormality: Case study .
• Researching SOAP: Case study .
• Case study for a patient with hormonal disorders .
• “Walking the Tightrope”: A case study analysis .
• ARNP approach: Case study analysis .
• Case study on biomedical ethics in the Christian narrative .
• Thermal injury: Case study .
• Ethical dilemma in nursing: Case study .
• Asthma: A case study of the patient .
• Asthma discharge plan: Mini case study .
• Case study: An ethics of euthanasia .
• Case study: Head-to-toe assessment steps .
• Pain management strategies: Case study .
• Case study: Inflammatory bowel disease .
• Sleep deprivation and insomnia: The case study .
• The case study of a heart failure .
• Porphyria cutanea tarda: Disease case study .
• Case study: Hardy Hospital case summary .
• Obesity and its complications: Case study .
• Angina disease case study .
• Nursing ethics case study .
• Case study of a patient: Assessment and treatment plan .
• Cecile case study: Mrs. J .
• Nursing power in the emergency department: Case study .
• Heart failure case study: Mrs. J .
• Application of ethics in nursing: Case study .
• Sudden visual impairment: Case study .
• Epidemiology case study: Outbreak at Watersedge — Public health discovery game .
• Wellness of senior citizens: Case study .
• Healthcare organization evaluation: Case study of Banner Health .

⏱️ Bonus: Tips on Writing a Case Study in Record Time

Need to prepare a case study on nursing or in another field? Below you’ll find a collection fo tips that will help you do it as quickly as possible!

3 Shortcuts for a Quick Start

If you’re about to start writing a case study, you should check yourself if you’re not doing any of the following:

• spending too much time on selecting a topic;
• reading too much before selecting a topic;
• making conclusions too early – creating bias.

Instead of killing time doing the three useless things discussed above, consider these:

• Choose approach. Note that there are 2 major approaches to case studies: the analytical approach (investigating possible reasons without making any conclusions) and problem-oriented approach (focusing on a particular problem and investigating it).
• Skim some sources (DON’T READ THEM). Select several sources. Simply skim abstracts and conclusions.
• Start making notes early. Simply reading is ineffective unless you’re lucky to have a phenomenal memory. Always make notes of any useful arguments.

4 Shortcuts Not to Get Stuck in the Middle

Even if you kick started your case study, it’s too early to celebrate it. Consider the following traps in the middle of the project:

• Watch the structure. The classic logical structure is your formula of success. It will help you move from one point to another without the unnecessary procrastination:
• Respect the logic. Make your case study flow – make logical transitions between the different parts and make it consistent. Avoid changing your position throughout the paper.
• Be detail-oriented. Any trifle deserves attention when you write a case study.
• Avoid bias. Be sure that all your opinions are based on the specific arguments form the case study. Avoid pouring your biased views into the project.

3 Shortcuts for a Happy Ending

• Offer a realistic solution. College case study is a rehearsal of real-life situations. Take the responsibility for your suggestions.
• Keep your conclusion short. Avoid repeating the details and don’t include any new information.
• Consider creating a Power Point. If your task is not only writing a case study, but also presenting it – why not create PowerPoint slides to help you?

As the last step on your way to a perfect nursing case study, prepare the title page. Its format usually depends on the professor’s requirements. But if you know the citation style, our Title Page Maker is a perfect tool to apply the right formatting and accelerate the process. And if you have any know-how on how to write a medical case study, you are very welcome to share it with other students in the comments below.

❓ Nursing Case Study: FAQ

What is a case study in nursing.

A nursing case study explores the condition of a patient. It is based on previous clinical records, lab reports, and other medical and personal information. A case study focuses on the patient and describes the treatment that was (or should be) applied and its (expected) outcome.

How to Write a Nursing Case Study?

• Collect the bulk of data available about the patient.
• Read literature about the diagnosed condition.
• Focus on the individual patient and their symptoms.
• Describe the situation and outline its development in time.
• Analyze the actions of the medical personnel that have been done.
• Plan further treatment of the patient.

Why Are Case Studies Good for Nursing Students?

Nursing case studies offer you a priceless opportunity to gain experience of different patient conditions and cure methods without visiting the clinic. You can think about whether the proposed treatment was appropriate or wrong and suggest a better solution. And the best thing, your teacher will indicate your mistakes (and no patient will be hurt in the process).

Why Are Case Studies Important in Nursing?

• You learn to distinguish the relevant data and analyze it.
• You learn to ask the right questions.
• You learn to evaluate the severity of symptoms.
• You learn to make better diagnoses.
• You train your critical thinking in terms of treatment methods
• Case studies are in-class simulators of authentic atmosphere in a clinical ward.
• What is a case study? | Evidence-Based Nursing
• Case Studies – Johns Hopkins Medicine
• Case Study Research Design in Nursing
• Case study report for Nursing | Learning Lab – RMIT University
• Case Study or Nursing Care Study? – jstor

Research Paper Analysis: How to Analyze a Research Article + Example

Film analysis: example, format, and outline + topics & prompts.

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In Case You Missed It: Report Shows Access To Nursing Home Care Is Worsening

• Limiting Admissions:
• Forty-six (46) percent of nursing homes are currently having to limit new admissions.
• Fifty-seven (57) percent of nursing homes have a waiting list for new residents.​ ​
• Downsizing:
• Since 2020, there are 62,567 fewer nursing home beds.
• Twenty (20) percent of nursing homes have closed a unit, wing, or floor due to labor shortages.
• Closures:
• Since 2020, at least 774 nursing homes have closed.
• ​These closures have displaced 28,421 residents.

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Inquiry Into ‘Killer Nurse’ Won’t Weigh Key Question: Is She Innocent?

More than 20 experts have called on the U.K. government to delay a public inquiry into the case of Lucy Letby, who was convicted of murdering babies, because of growing concerns about the evidence.

By Mark Landler

Reporting from London

A public inquiry into the case of Lucy Letby, a British neonatal nurse convicted of killing seven babies, has come under fire from scientific and medical experts who have called for it to be delayed or broadened to consider whether the deaths could have been caused by other factors.

The inquiry, set to begin on Sept. 10 , will cast a fresh spotlight on one of the most haunting murder cases in recent British history. Conscientious and well liked by her colleagues, Ms. Letby was found guilty of killing seven infants, and trying to kill seven others, in a busy public hospital in 2015 and 2016.

Ms. Letby, 34, was sentenced to life in prison last year and her requests for appeals have so far been denied . But questions about the handling of the investigation and the evidence used to convict her have grown harder to ignore, with prominent experts in statistics and neonatal medicine arguing that both were gravely flawed.

Under the terms of its mandate, the inquiry will not scrutinize those questions. Instead it will hold hearings to probe the experiences of the families of the babies who died and the conduct of nurses, doctors, and other health workers at the Countess of Chester Hospital, southeast of Liverpool.

Led by Kate Thirlwall, an appeals court justice, the inquiry aims to determine “whether suspicions should have been raised earlier, whether Lucy Letby should have been suspended earlier, and whether the police or other external bodies should have been informed sooner about suspicions about her.”

The thornier question — whether Ms. Letby might have been wrongfully convicted — falls beyond the scope of the inquiry, which was announced in 2023 by the health secretary in the last Conservative government.

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What a new indictment means for Donald Trump’s federal 2020 election interference case

• Published: Aug. 28, 2024, 1:55 p.m.

FILE - Special counsel Jack Smith speaks about an indictment of former President Donald Trump, Aug. 1, 2023, at a Department of Justice office in Washington. (AP Photo/Jacquelyn Martin, File) AP

• The Associated Press

Special counsel Jack Smith is pressing forward with his 2020 election interference case against Donald Trump, with a new indictment that aims to salvage the prosecution after the Supreme Court slammed the door on the possibility of a trial before the November election.

The new indictment, filed Tuesday in Washington, includes the same criminal charges, but narrows the allegations in an attempt to comply with the Supreme Court’s ruling that former presidents have broad immunity from prosecution.

Here’s what to know about the case and what happens next:

Why file a new indictment?

In its ruling last month, the Supreme Court’s conservative majority said former presidents are absolutely immune from prosecution for official acts that fall within their “exclusive sphere of constitutional authority.”

Furthermore, former presidents are at least presumptively immune for other official actions, the Supreme Court said, but prosecutors can try to make the case that those allegations remain part of the indictment. But former presidents do not enjoy immunity for unofficial, or private, actions, the justices said.

As a result, the Supreme Court said Trump is immune from prosecution for conduct involving his interactions with the Justice Department, effectively stripping those allegations from the indictment. The justices sent the case back to U.S. District Judge Tanya Chutkan to analyze what other allegations could potentially proceed to trial.

In rewriting the indictment now, Smith’s team aims to make that job easier for Chutkan by removing references to allegations it believes could be considered official acts for which Trump could be entitled to immunity.

• Trump faces new indictment by feds in Jan. 6 case

What’s different?

The new indictment does away with any reference to Trump’s interactions with Justice Department officials, whom prosecutors alleged he tried to enlist in his failed effort to undo his election loss. Prosecutors alleged Trump tried to use the Justice Department to conduct sham election fraud investigations and send a letter to states falsely claiming that significant fraud had been detected.

The new indictment also deletes details about Trump’s communications with certain other federal government officials, like the Director of National Intelligence and senior White House attorneys, who prosecutors say told Trump that his election fraud claims were false.

It also adds language designed to back up prosecutors’ contentions that the actions that form the basis of his case were taken by Trump in his personal capacity as a candidate rather than his professional capacity as president.

For example, the new indictment says Trump “had no official responsibilities” related to Congress’ certification of the 2020 election, “but he did have a personal interest as a candidate in being named the winner of the election.”

The first page of the old indictment refers to Trump as the 45th U.S. president. The new indictment says only that Trump “was a candidate for President of the United States in 2020.”

It also deletes references to certain Trump statements made from the White House, like the video Twitter message he had taped from the Rose Garden in which he asked his supporters at the Capitol on Jan. 6, 2021, to go home but reassured them, “We love you, you’re very special.” But comments Trump made during his speech near the White House before the riot remain in the indictment. That was a “campaign speech at a privately-funded, privately organized political rally,” the indictment says.

Smith’s team noted that a new grand jury that had not previously heard evidence in the case brought the indictment. That move was likely designed to prevent Trump’s lawyers from arguing that the entire case was tainted because the grand jury that brought the original indictment heard evidence the Supreme Court now says must stay out.

What stayed the same?

Trump remains charged with four counts: obstruction of an official proceeding, conspiracy to obstruct an official proceeding, conspiracy to defraud the U.S. and conspiracy against the right to vote. While the Supreme Court ruled in a different case in June that the Justice Department applied the obstruction charge too broadly against Trump supporters who stormed the Capitol, prosecutors kept that charge against Trump, suggesting they believe it will survive review in his case.

The indictment maintains a slew of allegations against Trump, including that he pressured state officials to subvert the results of the election and participated in a scheme orchestrated by allies to enlist slates of fraudulent electors in battleground states who would falsely attest that Trump had won in those states. Trump “had no official responsibilities related to the convening of legitimate electors or their signing and mailing of their certificates of vote,” the new indictment says.

It also retains allegations that Trump sought to pressure Vice President Mike Pence to reject legitimate electoral votes and that Trump and his allies exploited the chaos at the Capitol on Jan. 6 in an attempt to further delay the certification of President Joe Biden’s victory.

What’s Trump saying?

Trump acted with predictable fury, railing against the new indictment on his Truth Social platform as an act of “desperation” that has “all the problems of the old Indictment and should be dismissed IMMEDIATELY!”

He also asserted that Smith had revised the original indictment to “circumvent” the Supreme Court ruling, but the exact opposite is true: in paring down the case and the allegations, the special counsel’s office was clearly trying to comply with, rather than get around, the spirit of the opinion.

Trump also claimed that by bringing the new indictment, the Justice Department violated an internal “policy” against any investigative action that could affect a campaign within 60 days of an election.

But the reality is more complicated, and the policy he cited about the indictment is actually more an informal and unwritten practice than a hard-and-fast rule.

It is true that longstanding Justice Department guidance cautions against taking overt investigative action in the run-up to an election. Memos from attorneys general issued over the years say prosecutors should never pursue criminal charges or visible steps — such as executing a search warrant — for the purpose of affecting an election.

The goal is to avoid raising fresh allegations against a candidate that the candidate might not have sufficient time to respond to, or that voters might not have enough time to absorb before casting ballots. But that guidance wouldn’t seem to be relevant here, in part because the revised indictment doesn’t include any new claims against Trump for voters to consider — to the contrary, it actually subtracts allegations against him.

What about the trial and what’s next?

The case is now back in Judge Chutkan’s hands, but it doesn’t mean a trial is going to happen anytime soon. There will likely be months of legal wrangling over which allegations involve official conduct that should be struck from the indictment.

On Friday, Smith’s team and Trump’s lawyers are due to propose a schedule for future proceedings in light of the Supreme Court’s ruling. And the two sides are scheduled to be back in Chutkan’s courtroom next week for the first time in months to discuss the path forward.

Trump’s lawyers could mount new efforts to dismiss the case. His legal team has sought at every turn to delay the criminal cases against him and may ask for more time to determine the impact of the Supreme Court’s ruling.

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Case Reports, Case Series – From Clinical Practice to Evidence-Based Medicine in Graduate Medical Education

Jerry w sayre.

1 Family Medicine, North Florida Regional Medical Center

Hale Z Toklu

2 Graduate Medical Education, North Florida Regional Medical Center

Joseph Mazza

3 Department of Clinical Research, Marshfield Clinic Research Foundation

Steven Yale

4 Internal Medicine, University of Central Florida College of Medicine

Case reports and case series or case study research are descriptive studies that are prepared for illustrating novel, unusual, or atypical features identified in patients in medical practice, and they potentially generate new research questions. They are empirical inquiries or investigations of a patient or a group of patients in a natural, real-world clinical setting. Case study research is a method that focuses on the contextual analysis of a number of events or conditions and their relationships. There is disagreement among physicians on the value of case studies in the medical literature, particularly for educators focused on teaching evidence-based medicine (EBM) for student learners in graduate medical education. Despite their limitations, case study research is a beneficial tool and learning experience in graduate medical education and among novice researchers. The preparation and presentation of case studies can help students and graduate medical education programs evaluate and apply the six American College of Graduate Medical Education (ACGME) competencies in the areas of medical knowledge, patient care, practice-based learning, professionalism, systems-based practice, and communication. A goal in graduate medical education should be to assist residents to expand their critical thinking, problem-solving, and decision-making skills. These attributes are required in the teaching and practice of EBM. In this aspect, case studies provide a platform for developing clinical skills and problem-based learning methods. Hence, graduate medical education programs should encourage, assist, and support residents in the publication of clinical case studies; and clinical teachers should encourage graduate students to publish case reports during their graduate medical education.

Introduction

Case reports and case series or case study research   are descriptive studies to present patients in their natural clinical setting. Case reports, which generally consist of three or fewer patients, are prepared to illustrate features in the practice of medicine and potentially create new research questions that may contribute to the acquisition of additional knowledge in the literature. Case studies involve multiple patients; they are a qualitative research method and include in-depth analyses or experiential inquiries of a person or group in their real-world setting. Case study research focuses on the contextual analysis of several events or conditions and their relationships [ 1 ]. In addition to their teaching value for students and graduate medical education programs, case reports provide a starting point for novice investigators, which may prepare and encourage them to seek more contextual writing experiences for future research investigation. It may also provide senior physicians with clues about emerging epidemics or a recognition of previously unrecognized syndromes. Limitations primarily involve the lack of generalizability and implications in clinical practice, which are factors extraneous to the learning model (Table ​ (Table1 1 ).

There is disagreement among physicians on the value of case reports in the medical literature and in evidence-based medicine (EBM) [ 2 ]. EBM aims to optimize decision-making by using evidence from well-conducted research. Therefore, not all data has the same value as the evidence. The pyramid (Figure ​ (Figure1) 1 ) classifies publications based on their study outlines and according to the power of evidence they provide [ 2 - 3 ]. In the classical pyramid represented below, systematic reviews and a meta-analysis are expected to provide the strongest evidence. However, a recent modification of the pyramid was suggested by Murad et al. [ 2 ]: the meta-analysis and systematic reviews are removed from the pyramid and are suggested to be a lens through which evidence is viewed (Figure 1 ). 

Modified from Murad et al. [ 2 ]

Because case reports do not rank highly in the hierarchy of evidence and are not frequently cited, as they describe the clinical circumstances of single patients, they are seldom published by high-impact medical journals. However, case reports are proposed to have significant educational value because they advance medical knowledge and constitute evidence for EBM. In addition, well-developed publication resources can be difficult to find, especially for medical residents; those that do exist vary in quality and may not be suitable for the aim and scope of the journals. Over the last several years, a number (approximately 160) of new peer-reviewed journals that focus on publishing case reports have emerged. These are mostly open-access journals with considerably high acceptance rates [ 4 ]. Packer et al. reported a 6% publication rate for case reports [ 5 ]; however, they did not disclose the number of papers submitted but rejected and neither did they state whether any of the reported cases were submitted to open-access journals.

The development of open-access journals has created a new venue for students and faculty to publish. In contrast to subscription-based and peer-reviewed e-journals, many of these new case report journals are not adequately reviewed and, instead, have a questionably high acceptance rate [ 4 ]. There, however, remains the issue of the fee-based publication of case reports in open-access journals without proper peer reviews, which increases the burden of scientific literature. Trainees should be made aware of the potential for academic dilution, particularly with some open-access publishers. While case reports with high-quality peer reviews are associated with a relatively low acceptance rate, this rigorous process introduces trainees to the experience and expectations of peer reviews and addresses other issues or flaws not considered prior to submission. We believe that these are important skills that should be emphasized and experienced during training, and authors should seek these journals for the submission of their manuscripts.

Importance of Case Reports and Case Series in Graduate Medical Education

The Accreditation Council for Graduate Medical Education (ACGME) has challenged faculties to adapt teaching methodologies to accommodate the different learning modalities of the next generation of physicians. As evidenced by its implementation by ACGME, competency-based medical education is rapidly gaining international acceptance, moving from classic didactic lectures to self-directed learning opportunities with experiential learning aids in the development of critical cognitive and scholarly skills. As graduate medical educators, we are in agreement with Packer et al. about the value of the educational benefits resulting from student-generated case reports [ 5 ]. Case study assignments help residents develop a variety of key skills, as previously described. EBM is an eventual decision-making process for executing the most appropriate treatment approach by using the tools that are compatible with the national health policy, medical evidence, and the personal factors of physician and patient (Figure ​ (Figure2). The 2 ). The practice of identifying and developing a case study creates a learning opportunity for listening skills and appreciation for the patient’s narrative as well as for developing critical learning and thinking skills that are directly applicable to the practice of EBM. This critically important process simultaneously enhances both the medical and the humanistic importance of physician-patient interaction. In addition, case-based learning is an active learner-centered approach for medical students and residents. It serves as a curricular context, which can promote the retention of information and evidence-based thinking.

Modified from Toklu et al. 2015 [ 3 ]

The value of case studies in the medical literature is controversial among physicians. Despite their limitations, clinical case reports and case series are beneficial tools in graduate medical education. The preparation and presentation of case studies can help students and residents acquire and apply clinical competencies in the areas of medical knowledge, practice-based learning, systems-based practice, professionalism, and communication. In this aspect, case studies provide a tool for developing clinical skills through problem-based learning methods. As a result, journals should encourage the publication of clinical case studies from graduate medical education programs through a commonly applied peer-review process, and clinical teachers should promote medical residents to publish case reports during their graduate medical education.

The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Do not disregard or avoid professional medical advice due to content published within Cureus.

The authors have declared that no competing interests exist.

Trump indicted again in federal election interference case following Supreme Court immunity ruling

WASHINGTON — Former President Donald Trump has once again been indicted over his efforts to overturn his 2020 presidential election loss, an effort that culminated in the Jan. 6 attack on the U.S. Capitol.

A federal grand jury on Tuesday returned a superseding indictment that charges Trump with the same four counts he faced in the original indictment last August : conspiracy to defraud the United States, conspiracy to obstruct an official proceeding, obstruction of and attempt to obstruct an official proceeding and conspiracy against rights.

The new indictment was returned following the Supreme Court's decision on presidential immunity last month , which barred the government from using certain "official acts" Trump took in his role as president in its prosecution.

“The superseding indictment, which was presented to a new grand jury that had not previously heard evidence in this case, reflects the Government’s efforts to respect and implement the Supreme Court’s holdings and remand instructions,” special counsel Jack Smith's office said in Tuesday's filing.

Trump blasted the new indictment as “shocking” and “a direct attack on democracy” in a string of social media posts. “The case has to do with ‘Conspiracy to Obstruct the 2020 Presidential Election,’ when they are the ones that did the obstructing of the Election, not me,” he wrote . His campaign also sent out a fundraising email within two hours of the filing, saying Trump was "just indicted again" and urging supporters to "stand with Trump" by donating.

While the charges are the same, some of the evidence has been whittled down in light of the Supreme Court's ruling, which expanded what could be considered official acts.

Gone from the superseding indictment are the sections that detailed Trump’s conversations with Justice Department officials in which he is alleged to have asked them to support his false claims of election fraud. Former Justice Department official Jeffrey Clark , who backed Trump's claims and was almost named acting attorney general, has been removed as an unindicted co-conspirator. Prosecutors also removed references to advice Trump got from or conversations he had with direct advisers in the Oval Office, like White House counsel Pat Cipollone, and references to some of his tweets from that period.

The new indictment also notes Vice President Mike Pence's role as president of the Senate on the day of the electoral vote count — Jan. 6, 2021 — in an apparent nod to concerns from the Supreme Court about whether evidence of Trump's campaign to get Pence to intervene in the count should be allowed. The Supreme Court ruling said, "Whenever the President and Vice President discuss their official responsibilities, they engage in official conduct," and there is therefore a "presumption of immunity" around their conversations. But the ruling also noted that Pence's responsibility of "'presiding over the Senate' is 'not an ‘executive branch’ function.”

Other parts of the new indictment are the same, with prosecutors again taking the position that Trump didn't actually believe the lies he was spreading in the wake of his 2020 election loss and that he knew that they were, in fact, lies.

“These claims were unsupported, objectively unreasonable, and ever-changing, and the Defendant and his co-conspirators repeated them even after they were publicly disproven," the indictment says. "These claims were false, and the Defendant knew that they were false."

While many Jan. 6 defendants have told courts that they now recognize they were tricked and lament that they were “gullible” enough to fall for the misinformation about the 2020 election that Trump promoted , Trump himself has never publicly admitted that he realizes he was spreading misinformation.

Trump's state of mind will be a major issue at a future trial , which won't take place before Election Day and could be complicated if he wins. If Trump is victorious, he or his appointees would almost certainly kill the case, as well as other Jan. 6 prosecutions: Trump has referred to Capitol rioters as " hostages " and " unbelievable patriots ," and he has indicated he would pardon many, if not all, Jan. 6 defendants. (Trump said he would "absolutely" consider pardoning every Jan. 6 criminal defendant, but his campaign has said pardons would be issued case by case.)

Trump's legal team had prepared for the possibility of a new indictment, according to a source familiar with the defense team's thinking, but believes the revised indictment still contains "fatal" flaws under the Supreme Court's reasoning.

“We don’t think they’ll be able to prove this was all purely campaign-related,” the source added, suggesting the timing works in the former president's favor.

The defense team is expected to ask for briefing schedule to argue why the superseding indictment should be dismissed too — a process that could drag out for months.

Trump's original challenge on immunity grounds led U.S. District Judge Tanya Chutkan to fr e eze the underlying case in December while he appealed. The case was returned to her court this month; the defense and the prosecution are scheduled to file a joint status report Friday laying out their proposed schedules for proceeding.

Any litigation on pending immunity questions must be settled before other action in the case, the Supreme Court ruling said. That could take multiple forms, from a public evidentiary hearing with witnesses or a fully on-paper process consisting of multiple rounds of briefings followed by written rulings from the judge.

Trump is also using the immunity ruling to fight his conviction on charges of falsifying business record in New York. His attorneys contend that the indictment in that case should be dismissed because the grand jury was presented with evidence of official acts — tweets and conversations with advisers — that shouldn't have been considered.

A new grand jury brought the new indictment in the federal case. The slimmed-down allegations could also be a way for prosecutors to avoid extensive fights over evidence they were concerned wouldn't be allowed because of the Supreme Court ruling.

Ryan J. Reilly is a justice reporter for NBC News.

Daniel Barnes reports for NBC News, based in Washington.

Dareh Gregorian is a politics reporter for NBC News.