How to Write a Clinical Problem Solving Manuscript
A clinical problem solving (CPS) exercise highlights the process by which an experienced clinician approaches a diagnostic puzzle. Compared to a traditional case report, a CPS article places greater emphasis on conveying and analyzing clinical reasoning.
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Introduction A clinical problem solving (CPS) exercise highlights the process by which an experienced clinician approaches a diagnostic puzzle. It is constructed in a manner that emphasizes thought process and reasoning as the case unfolds. A CPS manuscript is a variation on the traditional case report which allows the authors to explore a clinical dilemma in greater detail and present a broader set of teaching points. Writing a CPS manuscript requires a larger investment of time and energy than a traditional case report or clinical image. A CPS project will enhance the author’s understanding of clinical reasoning while advancing their medical knowledge. CPS manuscripts are often published in high-impact journals. This chapter is a step-by-step guide to writing a successful CPS manuscript.
Selecting the Case Characteristics of a suitable case for a CPS manuscript can be summarized by the TEACH acronym (courtesy of Sanjay Saint MD MPH): • Teaching points can be made • Enigma – the diagnosis must be a challenge © Springer International Publishing Switzerland 2017 C.D. Packer et al., Writing Case Reports, DOI 10.1007/978-3-319-41899-5_10
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Chapter 10. How to Write a Clinical Problem Solving
• Answer must be established by a gold standard test • Cool (interesting) case – readers should say “wow” at the end • Honest – authors cannot change the facts of the case Among these, the most important criterion is that the expert discussant must be able to make meaningful teaching points that are relevant to a generalist audience; no other aspect of the case can overcome a deficit in this area.
The Planning Stage Once the primary author identifies a clinical case, it is important to invite a faculty mentor who has coauthored a CPS case previously to participate in the project. This person will often become an active collaborator and coauthor, although neither is assumed. This mentor is rarely the faculty member on the primary team or the consulting service; rather, the primary author should look for someone who understands the process of writing a clinical problem solving case, not the details of the case itself. The authors should contemplate the discussion section of the paper before focusing on the presentation of the case. How will you engage the audience after they have read the case? What topic will you highlight in addition to the final diagnosis? This may include a theme about clinical reasoning, changes in the practice of medicine, or reaffirmation of a principle (e.g., the importance of the social history). Without a narrative to engage the reader, the commentary section is likely to fall flat. Esoteric teaching points about rare diseases are of limited interest to most readers. Authors should determine whether the case has already been published in any format, or if other providers (e.g., a specialty service) intend to do so. Prior dissemination as a poster, abstract, or oral presentation at a medical conference does not preclude publication in most journals, but such presentation should be noted in the a
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