Case report writing should not be considered a "resume padder" in medical school
It helped me learn important clinical skills more than the books
Across Reddit, Student Doctor Network, and other popular online medical forums for medical trainees, there seems to be a perception that writing case reports in medical school is simply a way “to get your publication numbers up” to look competitive for the Match. I had a few thoughts about that.
In an era where the USMLE Step 1 Exam has become pass/fail, research experience has become one of the main indices by which medical students are evaluated when applying to the Match. This has created somewhat of a “research industrial complex” where medical students attempt to publish as many papers and present posters at as many conferences as possible to boost their application and match into competitive residencies. The pros and cons of this phenomenon merit its own separate post, but for now, know one thing: research publications = gold to a medical student.
To me, “resume-padding” occurs more often in the context of student organizations - I would consider this in a student who joins every club at school and amasses many leadership positions in activities that they are clearly not interested in. They add many lines to their CV but ultimately accomplish little to nothing in their roles. I have observed this occurring at my own medical school, where nearly every club has a leadership structure in their charter that contains at least 2 “Co-Presidents.” Do you know of any companies with multiple CEOs? Are there any medical school with multiple deans? This is clearly an attempt for as many people as possible to obtain a “President” title for their residency applications.
I do not like to consider this phenomenon when it comes to any type of research, be it an abstract, case report, poster, or original investigation. Research can be a great way to explore different aspects of medicine and there is always something to learn, even if you are not particularly interested in it. Any type of research work will likely always take more effort than being the third “Co-President” of the fourth club at your medical school that collects school supplies for children in need for only one week of the year.
I personally have found research as a meaningful way to explore my chosen specialty to a deeper level. I have participated in research on a variety of medical topics which you can check out here.
I assume that this view of case reports derives from the notion that they are easier to complete compared to original investigations or literature reviews. Having published both an original investigation and a case report, I can certainly agree that with the latter, it takes less time to conduct and prepare a journal-ready draft. However, I disagree with the idea that they are evidence of an applicant trying to pad their resume. In fact, case report-writing has greatly improved my understanding of medicine and has taught me valuable clinical skills.
I wrote my first case report about the successful management of a severe case of hypertrophic cardiomyopathy (HOCM) in a pregnant woman with a complicated pregnancy and multiple comorbidities. She required complex treatment via multidisciplinary team including multiple medical disciplines such as cardiology, obstetrics, and maternal-fetal medicine.
The case wasn’t particularly groundbreaking, but one of my research mentors who had participated in the patient’s care recommended it to me as a good learning opportunity. At the time of starting this project, I had just finished my cardiology unit during my first year of medical school - so I knew the basics but pitifully little about the real-life management of heart disease.
The key to writing a good case is to know everything about the patient. This meant deeply analyzing all documentation and imaging not only through their hospital stay, but also their follow-up care after they were discharged. I was forced to critically examine every lab test, every imaging study, and every differential diagnosis that was considered at each stage of her care. Understanding why each step was taken was just as, if not more important than simply knowing how the patient was treated.
It was not until my clinical rotations started this year when I realized that this is the way medicine was really practiced. It would be great if you showed up in the patient’s hospital room and you are handed a sheet of the entire relevant history, physical examination findings, and relevant lab tests that they so neatly present to you on board exam questions. Many times, you simply are presented with a patient who shows up very sick and has no idea what is going on. It is up to you and your team to figure out what questions to ask, what examination to conduct, and how to intervene. On my rotations, I was once again tasked to take ownership of my patients and to know everything about them, scouring through their chart just as I did while writing my case report.
This project also drilled cardiac physiology into my head like nothing else. In class, I had learned the basics of these concepts very rapidly (as you must in medical school) and in isolation of clinical application. Sure, I could name a few vessels in the heart and mechanism of action of a few drugs - but I repeatedly failed to figure out the big-picture of what was going on my patient. I met with my mentor several times to discuss the absolute minutia of the case. How can magnesium sulfate worsen left ventricular outflow obstruction in pregnant patients with HOCM? Why would we avoid diuresis of a HOCM patient with respiratory distress due to pulmonary edema? How does continuous-wave Doppler echocardiography actually estimate the left ventricular outflow gradient?
Through this rigorous investigation, I grew a deeper understanding of the pathophysiology of HOCM and ironed out many of my misconceptions that I simply had no time to address in class alone. Cardiomyopathy and management of heart failure are coincidentally highly tested concepts on the USMLE Step 2 exam. My proficiency improved to the point that I rarely get practice questions on these topics wrong. There were even several practice questions that I only answered correctly by directly thinking about the management of my case report patient.
Case report writing is a great example of the way that medicine should be taught - through patients and not only through books. But given the time constraints and misplaced priorities in medical education, this is sadly a rare occurrence. If I look at the resume of a medical student and see that they have published many case reports, I would not think that they are “resume padding” but instead that they have an advanced understanding of clinical medicine compared to someone who has not.