Comment on: A Blueprint for Undergraduate Students to Work on Medical Cases

Dear Editor,

I am writing to you in regard to the article titled ‘A Blueprint for Undergraduate Students to Work on Medical Cases’¹ published in the Global Journal of Medical Students (Volume 1, Issue 1). The article highlights the importance and relevance of case reports in medical literature. However, a notification recently released by the National Medical Commission (NMC) of India seems to ignore the significance of the same. The NMC, in February 2022, published the ‘Teachers Eligibility Qualifications in Medical Institutions Regulations, 2022’² which is the sixth such notification, since 2009, stating the promotional criteria for medical teachers. While the earlier documents simply mentioned ‘Research publications,’ the latest notifications explicitly states Original papers, Systematic reviews, Meta-analysis and Case series as the only published manuscripts to be considered for promotion.³ Thus, it clearly leaves out case reports from consideration for the same. This may disincentivize doctors in academic settings from reporting novel cases. The inclusion of case series in the list reflects that the reason for excluding case reports is not the diminished significance of unique cases, but the assumption that case reports are too small, quick or easy to publish. While case report may be a preliminary and shorter form of manuscript, it would be wrong to consider them as effortless endeavors. If the only concern regarding the inclusion of case reports in the list of publications to be considered for promotion was the length of the manuscript, requirement of the number of such publications could have been increased (for example, two case reports to be considered equivalent to one original article) instead of ignoring them altogether. Rare cases may not always be witnessed multiple times by the same physician to qualify for writing a case series. Thus, we may lose out on unique occurrences or findings which may have significant implications for clinicians.

The article also states the importance of case reports as valuable tools for young students to acquire competency in authoring literature, as stepping stones towards larger projects with intricate study designs. A goal in graduate medical education should be to assist both undergraduate as well as postgraduate students to expand their critical thinking, problem-solving and decision-making skills. These attributes are required in the teaching and practice of Evidence Based Medicine (EBM). In this aspect, case studies provide a platform for developing clinical skills and problem-based learning methods. As they are relatively simple to write in comparison to other manuscripts like original articles or systematic reviews, medical students could be easily involved in these publications under the mentorship of senior clinicians.

Some have also argued that many academic institutions lack optimum research infrastructure and this may hamper the teacher’s ability to carry out and publish detailed and complex studies, which would be an indispensable requirement for promotion. Case reports seldom face infrastructural roadblocks. Thus, instead of focusing on non-feasible research projects or those with an improper study design due to institutional limitations, the NMC could encourage detailed evaluation, presentation and publication of unique cases which most medical institutions encounter on a day to day basis - The inclusion of case reports in the list of publications to be considered for promotion could be a positive first step in this direction.