Ophthalmology is an extremely popular specialty, with the competition ratio at ST1 level entry being 10:1 in 2023 [1]. Consequently, applicants are required to achieve higher portfolio scores to remain competitive. For those considering a career in ophthalmology, two points are available on the portfolio for publishing two case reports as the first author [2].
This task can be daunting for new foundation doctors or medical students who have yet to publish. In this article, I will outline the tips and pitfalls I have learned when publishing case reports, aiming to guide future learners.
Finding a case
The first step in writing a case report is finding a suitable case. This could be one you’ve encountered yourself or one suggested by a senior. My best advice is to involve a senior first, who may already have a pile of suitable cases and can help determine if one you have found is suitable. There are a few important considerations to keep in mind…
Select a case which has an impact
Different journals have varying criteria, but the key is to choose a case report that contributes to the existing literature. There’s no point in publishing a case which already has many other publications – yours should add something unique to the field. For instance, consider cases that offer further educational opportunities, showcase unusual presentations of conditions, highlight rare conditions, feature interesting imaging, or discuss new treatment.
Obtain written consent early
The sooner you can get written consent, the better. Delaying consent until the end of the process risks wasting time if the patient subsequently declines publication. Additionally, obtaining consent may become challenging if the patient has been discharged or relocated. Obtaining formal written consent while the patient is still accessible is the most straightforward approach. Some journals, such as BMJ Case Reports, have specific consent forms they require [3]. However, many journals accept generic consent forms. It’s a good idea to get multiple consent forms signed, such as one for BMJ Case Reports and then find a generic form online, which can be used for multiple journals.
Drafting the report
After selecting your topic, the next step is to draft your case report. CARE case report guidelines provides a comprehensive checklist and guide on typical sections and essential inclusions [4]. Following this guide is an effective way to ensure your case stays focused and covers all relevant points.
However, it’s important to note that while this structure works for many case reports, some variation may be necessary to suit specific cases. If you know which journal you are aiming for, you should aim to tailor your writing to it. Looking at other cases in that journal for ideas is always helpful. The main sections to include are outlined below:
- Summary / abstract – a brief 150-word summary of the entire article. This should be written last, after proofreading the rest of the content.
- Background – provide background information on the condition or treatment discussed in your article. Explain why this case is important, why it’s being reported, and what gap in the literature it fills.
- Case presentation – describe the presenting features and presenting complaint of the patient, including relevant medical, social and family history, but be sensitive to patient confidentiality.
- Investigations – detail all investigations performed to aid diagnosis. Include relevant images while ensuring patient confidentiality.
- Differential diagnosis – guide the reader through important differentials and how they were excluded. Provide details on why certain differentials don’t fit the case, supported by references if necessary. You shouldn’t just list differentials.
- Treatment – describe pharmacological and non-pharmacological treatments given to the patient.
- Outcome and follow-up – discuss the patient’s outcome, any treatment side- effects, and treatment effectiveness. Include follow-up information, even if it involves routine check-ups and patient discharge.
- Discussion – this section serves as the main conclusion and is formed of a literature review. Discuss points of interest in the case and its implications for the literature. Reference similar cases, guidelines, and their relevance. Address any difficulties or complications encountered and how they were managed.
- Learning points – while not required for every journal, include around three bullet points summarising the key takeaways from the case report.
Most case reports typically range from 1000–2500 words in length, although some journals may have specific word limits.
Make sure you thoroughly proofread the article yourself. Poor language or grammar is one of the most common reasons case reports are rejected. A good tip is to read the article aloud to make sure it flows, and you have explained all decisions made. You should expect your report to require several iterations after the first draft. Take it to any senior who is willing to help, but don’t forget you should expect to add their name as an author.
Including photos / figures
You should include images of any investigations you describe in the report but be aware of patient confidentiality by excluding any identifiable information, such as patient IDs.
Not all images need to be included, especially if normal. However, it’s essential to include images that help paint a full clinical picture. It’s worth remembering that some journals charge extra for images, particularly in colour. Guidelines usually aren’t copied in as images but are instead referenced. However, it may help illustrate your point by including diagrams.
It is worth noting that different journals may have their own requirements for images and figures. Some prefer labelled and explained images, while others prefer information in the paragraph preceding the image. It is best to write the article first, then tweak the formatting to each journal’s requirements during the publishing process.
Publishing the report
Once you and your co-authors have finalised the report, the next step to submit for publication.
It’s important to ensure that all contributors are listed as authors, with their names in the correct order. The first author is typically the individual who contributed the most to the work, while the last author is usually the most senior supervising author. Authors in the middle are listed in decreasing order of their input to the case report.
When selecting a journal for submission, remember that you cannot publish the same report in multiple journals simultaneously. You must declare that the report is not under consideration elsewhere. Therefore, choose a single journal and submit your report exclusively to that one. If your submission is unsuccessful, consider acting on any feedback received or try submitting to another journal.
Before submitting your report, it’s important to remember that case reports are getting more difficult to publish, and so you should be aware that some journals have high publication charges, often ranging from £200 to £300. Ensure you check this beforehand to avoid any surprises! Some journals may also request a withdrawal fee, but you generally only need to pay this if you’ve entered into a signed agreement.
However, there are exceptions to these charges, and it’s advisable to aim for free publication whenever possible. For your portfolio, it’s ideal to target peer-reviewed and PubMed-cited journals to maximise points. Journals like BMJ Case Reports offer an annual fellowship, which may already be covered by your hospital or university subscription. I recommend reaching out to your facility’s librarian to confirm membership status. BMJ Case Reports also provide feedback on submitted reports, making it a good starting point.
In addition to BMJ Case Reports, there are many other reputable journals that publish case reports. Examples of open access journals to target include the European Journal of Ophthalmology, Austin Journal of Ophthalmology and Canadian Journal of Ophthalmology. Cureus is another popular option that allows for free publications, provided the article meets their publishing requirements. Before submitting, thoroughly review your article, paying close attention to figures and references to ensure they adhere to the correct layout and format.
If you’re considering which journal to aim for, consult your seniors or colleagues for recommendations on journals they’ve had positive experiences with. They may have insights from past publications that can guide your decision.
Once chosen, ensure that your article aligns with the layout preferences of the chosen journal, particularly regarding references. You may need to convert your references to a specific style required by the journal.
Presenting
If you’ve written and published your case report, you may have the opportunity to present it at a regional or national meeting, which can enhance your portfolio score. However, this process may require some planning and preparation in advance.
The best approach is to identify upcoming regional or national meetings in ophthalmology and check if they accept abstract submissions for posters. This abstract is distinct from the 150-word summary included at the beginning of the case report. Instead, it follows a similar structure to the case report but is condensed to fit within a small word limit (often around 300 words). I recommend seeking feedback from a senior, preferably one who assisted with the case report, before submission.
Abstract submissions for most meetings typically open several months before the conference date. It’s advisable to start looking at conferences approximately six months in advance. While many conferences may not accept case reports for presentations, I suggest submitting to any that do. Keep in mind that if your abstract is accepted, you’ll be required to pay the conference attendance fee.
Additionally, consider exploring opportunities to present at university, deanery, or foundation program meetings. Currently, the ophthalmology portfolio does not specify that presentations must be at ophthalmology meetings, so presenting at regional deanery meetings, for instance, is also an option.
Summary
In conclusion, writing a case report offers an excellent opportunity to enhance your portfolio score while contributing valuable knowledge to the growing body of literature in ophthalmology. While it may seem daunting at first, numerous resources and guides are available, making it achievable for prospective applicants. I hope that these points prove helpful to future applicants and address some of the questions they may have.
References
1. Competition Ratios for 2023. Health Education England.
https://medical.hee.nhs.uk/medical-training
-recruitment/medical-specialty-training/
competition-ratios/2023-competition-ratios
2. Ophthalmology Evidence Folder 2024. Severn Deanery.
https://www.severndeanery.nhs.uk/
recruitment/vacancies/show/oph-st1-24/
evidence-folder-lib
3. Patient Consent and Confidentiality. The BMJ.
https://www.bmj.com/about-bmj/
resources-authors/forms-policies-and
-checklists/patient-confidentiality
4. How to write a Case Report. CARE case report guidelines.
https://www.care-statement.org/
writing-a-case-report
[All links last accessed January 2024]
Declaration of competing interests: None declared.
