Case reports published by residents of Texas Tech University Health Sciences Center, Lubbock, 2008–2013 Dolores Buscemi, MD, Erwin Argueta, MD, and Kenneth Nugent, MD
Case report publications introduce new information into the current body of medical information and provide trainees with an opportunity to develop skills that enhance patient care. However, opportunities for publication are limited because journals often have other editorial priorities and some journals do not want to publish articles that might decrease their impact factors. Using PubMed and Google Scholar, we identified the case report articles published by our residents who completed training between 2008 and 2013. Sixty-one residents published 55 case reports and/or letters. Twenty-five of these publications had 87 citations in the years of publication and up 5 years after publication. Most of these citations occurred in other case reports (36) or in review articles (24). In conclusion, publishing case reports by residents has important benefits for the individual resident and the residency program and provides another resource for medical care.
M
any prominent journals limit the number of case report publications because these articles have a low citation frequency and may lower the journals’ impact factors (1). Other reasons include the possibility that case reports “dilute” other medical publications and that they distract readers from “more important topics” (2). We think that writing and publishing case reports has value because case reports provide a resource for the medical community managing unusual cases, may provide a stimulus for additional research studies, and provide valuable academic experience for residents and fellows. We wanted to determine the level of success our residents had with their efforts: in particular, how many case reports they had published and whether these reports were cited in other journals. METHODS Our residency program at Texas Tech University Health Sciences Center in Lubbock, Texas, has 36 categorical residents and 2 preliminary residents. From 2008 through 2013, we graduated 61 residents. We compiled a list of all residents from 2008 to 2013 who had completed our program and searched for all case report publications by these residents using PubMed and Google Scholar. We determined the impact factors for all journals publishing these case reports using Journal Citations Reports. We then identified and classified all articles that had
Proc (Bayl Univ Med Cent) 2014;27(4):313–314
cited the case reports through 2013 using Google Scholar and Scopus. RESULTS The 61 residents who had graduated published 55 case reports and letters. Thirty-nine journals (69.6%) had impact factors; the median was 1.87 with an interquartile range (25%–75%) of 1.32 to 4.38. Twenty-five case reports had a total of 87 citations (mean 3.48 ± 2.57); the median number of citations for these 25 articles was 2.00, with an interquartile range of 1.00 to 4.25 and an overall range of 1 to 12. The types of articles citing the case reports included 36 case reports (41.4%), 24 review articles (27.6%), 11 letters (12.6%), nine clinical studies (10.3%), three research studies (3.4%), two book chapters (2.3%), one image (1.1%), and one editorial (1.1%). Fifty citing journals had impact factors, and the median was 1.97 with an interquartile range of 1.29 to 3.90. There was no difference in impact factors between the publishing journals and the citing journals using the Wilcoxon Mann-Whitney test (P = 0.40). The Table reports the number of publications, the number of publications with citations, and the time frame for citations. DISCUSSION The Residency Review Committee for Internal Medicine requires residents to do scholarly projects and to develop an understanding of scientific methods needed for medical science. Writing case reports provides valuable learning experiences for residents and fellows and can help meet these requirements. This activity requires review of prior publications, careful analysis of the case, and manuscript preparation with frequent revisions, requiring considerable time and effort. Given the time constraints and limitation of resources in residency training, these projects are more likely to be completed than a clinical research project. This activity allows programs to monitor scholarly activity in its faculty, organize clinical conferences From the Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas. Corresponding author: Dolores Buscemi, MD, Department of Internal Medicine, Texas Tech University Health Sciences Center, 3601 4th Street, Lubbock, TX 79430 (e-mail: [email protected]). 313
Table. Publication and citation dates 2008
2009
2010
2011
2012
2013
Publications
5
3
20
10
7
10
Articles with citations
4
2
11
5
1
2
2009–13
2009–13
2010–13
2011–13
2012–13
2013
Citation years
about important patient care outcomes, and assess resources available for resident training. Programs need to know the attitudes of their residents toward this work to create the most constructive learning environment. Takahashi and colleagues (3) found a significant positive association between resident satisfaction with the program and scholarly activity. Vandenbroucke argues that case reports have “their own role in the progress of medical science” and that they are often “the first line of evidence” (4). Case reports can describe new diseases, report new and important drug side effects, and, of course, promote medical education. He suggests that case reports that just list case after case without any discussion of previous publications are not useful, but case reports with thorough reviews and insightful discussions can contribute to clinical care. Medical publications, especially when using Internet resources, can often provide immediate solutions when managing a patient with an uncertain diagnosis or unclear therapeutic options, and in some situations an “obscure” case report may be the only available resource. Information about new diseases, including, for example, the recognition of the West Nile virus, and about new treatments, such as the first heart transplant, has been disseminated through case report publications (4, 5). Case reports frequently describe adverse reactions to drugs and may identify side effects missed in clinical trials. For example, Loke and associates (6) compared adverse reactions to amiodarone in three sources of information, namely meta-analyses, case
314
reports, and reports sent to the World Health Organization. In that study, case reports reported respiratory complications at a higher frequency than the other two sources. Finally, case reports also lead to additional studies. Albrecht et al (7) reviewed articles published in Lancet between January 1996 and June 1997 and found that 64 case reports and 39 case series generated 24 follow-up trials, including 9 in the register of current controlled clinical trials. None of the case reports in our review generated a study, but 12 were cited in clinical or research studies. 1.
2. 3.
4. 5.
6.
7.
Neely JG, Karni RJ, Nussenbaum B, Paniello RC, Fraley PL, Wang EW, Rich JT. Practical guide to understanding the value of case reports. Otolaryngol Head Neck Surg 2008;138(3):261–264. Buscemi B, Cevik C. Case reports: yes or no. Southwest Respiratory and Critical Care Chronicles 2013;1(3):1–3. Takahashi O, Ohde S, Jacobs JL, Tokuda Y, Omata F, Fukui T. Residents’ experience of scholarly activities is associated with higher satisfaction with residency training. J Gen Intern Med 2009;24(6):716–720. Vandenbroucke JP. In defense of case reports and case series. Ann Intern Med 2001;134(4):330–334. Kantrowitz A, Haller JD, Joos H, Cerruti MM, Carstensen HE. Transplantation of the heart in an infant and an adult. Am J Cardiol 1968;22(6):782–790. Loke YK, Derry S, Aronson JK. A comparison of three different sources of data in assessing the frequencies of adverse reactions to amiodarone. Br J Clin Pharmacol 2004;57(5):616–621. Albrecht J, Meves A, Bigby M. Case reports and case series from Lancet had significant impact on medical literature. J Clin Epidemiol 2005;58(12):1227–1232.
Baylor University Medical Center Proceedings
Volume 27, Number 4
Case report publications introduce new information into the current body of medical information and provide trainees with an opportunity to develop skills that enhance patient care. However, opportunities for publication are limited because journals often have other editorial priorities and some journals do not want to publish articles that might decrease their impact factors. Using PubMed and Google Scholar, we identified the case report articles published by our residents who completed training between 2008 and 2013. Sixty-one residents published 55 case reports and/or letters. Twenty-five of these publications had 87 citations in the years of publication and up 5 years after publication. Most of these citations occurred in other case reports (36) or in review articles (24). In conclusion, publishing case reports by residents has important benefits for the individual resident and the residency program and provides another resource for medical care.
M
any prominent journals limit the number of case report publications because these articles have a low citation frequency and may lower the journals’ impact factors (1). Other reasons include the possibility that case reports “dilute” other medical publications and that they distract readers from “more important topics” (2). We think that writing and publishing case reports has value because case reports provide a resource for the medical community managing unusual cases, may provide a stimulus for additional research studies, and provide valuable academic experience for residents and fellows. We wanted to determine the level of success our residents had with their efforts: in particular, how many case reports they had published and whether these reports were cited in other journals. METHODS Our residency program at Texas Tech University Health Sciences Center in Lubbock, Texas, has 36 categorical residents and 2 preliminary residents. From 2008 through 2013, we graduated 61 residents. We compiled a list of all residents from 2008 to 2013 who had completed our program and searched for all case report publications by these residents using PubMed and Google Scholar. We determined the impact factors for all journals publishing these case reports using Journal Citations Reports. We then identified and classified all articles that had
Proc (Bayl Univ Med Cent) 2014;27(4):313–314
cited the case reports through 2013 using Google Scholar and Scopus. RESULTS The 61 residents who had graduated published 55 case reports and letters. Thirty-nine journals (69.6%) had impact factors; the median was 1.87 with an interquartile range (25%–75%) of 1.32 to 4.38. Twenty-five case reports had a total of 87 citations (mean 3.48 ± 2.57); the median number of citations for these 25 articles was 2.00, with an interquartile range of 1.00 to 4.25 and an overall range of 1 to 12. The types of articles citing the case reports included 36 case reports (41.4%), 24 review articles (27.6%), 11 letters (12.6%), nine clinical studies (10.3%), three research studies (3.4%), two book chapters (2.3%), one image (1.1%), and one editorial (1.1%). Fifty citing journals had impact factors, and the median was 1.97 with an interquartile range of 1.29 to 3.90. There was no difference in impact factors between the publishing journals and the citing journals using the Wilcoxon Mann-Whitney test (P = 0.40). The Table reports the number of publications, the number of publications with citations, and the time frame for citations. DISCUSSION The Residency Review Committee for Internal Medicine requires residents to do scholarly projects and to develop an understanding of scientific methods needed for medical science. Writing case reports provides valuable learning experiences for residents and fellows and can help meet these requirements. This activity requires review of prior publications, careful analysis of the case, and manuscript preparation with frequent revisions, requiring considerable time and effort. Given the time constraints and limitation of resources in residency training, these projects are more likely to be completed than a clinical research project. This activity allows programs to monitor scholarly activity in its faculty, organize clinical conferences From the Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas. Corresponding author: Dolores Buscemi, MD, Department of Internal Medicine, Texas Tech University Health Sciences Center, 3601 4th Street, Lubbock, TX 79430 (e-mail: [email protected]). 313
Table. Publication and citation dates 2008
2009
2010
2011
2012
2013
Publications
5
3
20
10
7
10
Articles with citations
4
2
11
5
1
2
2009–13
2009–13
2010–13
2011–13
2012–13
2013
Citation years
about important patient care outcomes, and assess resources available for resident training. Programs need to know the attitudes of their residents toward this work to create the most constructive learning environment. Takahashi and colleagues (3) found a significant positive association between resident satisfaction with the program and scholarly activity. Vandenbroucke argues that case reports have “their own role in the progress of medical science” and that they are often “the first line of evidence” (4). Case reports can describe new diseases, report new and important drug side effects, and, of course, promote medical education. He suggests that case reports that just list case after case without any discussion of previous publications are not useful, but case reports with thorough reviews and insightful discussions can contribute to clinical care. Medical publications, especially when using Internet resources, can often provide immediate solutions when managing a patient with an uncertain diagnosis or unclear therapeutic options, and in some situations an “obscure” case report may be the only available resource. Information about new diseases, including, for example, the recognition of the West Nile virus, and about new treatments, such as the first heart transplant, has been disseminated through case report publications (4, 5). Case reports frequently describe adverse reactions to drugs and may identify side effects missed in clinical trials. For example, Loke and associates (6) compared adverse reactions to amiodarone in three sources of information, namely meta-analyses, case
314
reports, and reports sent to the World Health Organization. In that study, case reports reported respiratory complications at a higher frequency than the other two sources. Finally, case reports also lead to additional studies. Albrecht et al (7) reviewed articles published in Lancet between January 1996 and June 1997 and found that 64 case reports and 39 case series generated 24 follow-up trials, including 9 in the register of current controlled clinical trials. None of the case reports in our review generated a study, but 12 were cited in clinical or research studies. 1.
2. 3.
4. 5.
6.
7.
Neely JG, Karni RJ, Nussenbaum B, Paniello RC, Fraley PL, Wang EW, Rich JT. Practical guide to understanding the value of case reports. Otolaryngol Head Neck Surg 2008;138(3):261–264. Buscemi B, Cevik C. Case reports: yes or no. Southwest Respiratory and Critical Care Chronicles 2013;1(3):1–3. Takahashi O, Ohde S, Jacobs JL, Tokuda Y, Omata F, Fukui T. Residents’ experience of scholarly activities is associated with higher satisfaction with residency training. J Gen Intern Med 2009;24(6):716–720. Vandenbroucke JP. In defense of case reports and case series. Ann Intern Med 2001;134(4):330–334. Kantrowitz A, Haller JD, Joos H, Cerruti MM, Carstensen HE. Transplantation of the heart in an infant and an adult. Am J Cardiol 1968;22(6):782–790. Loke YK, Derry S, Aronson JK. A comparison of three different sources of data in assessing the frequencies of adverse reactions to amiodarone. Br J Clin Pharmacol 2004;57(5):616–621. Albrecht J, Meves A, Bigby M. Case reports and case series from Lancet had significant impact on medical literature. J Clin Epidemiol 2005;58(12):1227–1232.
Baylor University Medical Center Proceedings
Volume 27, Number 4
