CytoJournal Quiz Cases: Publishing open-access, PubMed-searchable cytopathology cases with educational messages.

Since at least the era of Hippocrates and perhaps as far back as Ancient Egypt,[1] case reports have been an important form of medical communication. Traditionally, case reports are descriptions of unusual or novel clinical occurrences detailing the symptoms, diagnosis, treatment, and/or outcomes of individual patients. Case reports have been essential for disseminating new pieces of medical knowledge, such as the recognition of new diseases, diagnostic challenges, the detection of adverse drug effects, and the discovery of previously unknown associations between conditions. For instance, case reports were vehicles for the first descriptions of histopathological abnormalities in the brain of a woman with dementia, later known as Alzheimer’s disease;[2] the presence of Kaposi’s sarcoma and immunoregulatory defects in homosexual men, now recognized as features of AIDS;[3] and recently, the occurrence of fetal microcephaly in a pregnant woman infected with Zika virus.[4] Over the last several decades, however, the value of case reports has been questioned. With the rise of evidence-based medicine, case reports have been relegated to the bottom of the hierarchy of evidence.[5] Because case reports are uncontrolled and often describe only a single patient, they cannot provide evidence of causality and do not produce generalizable knowledge. Case reports that describe rare occurrences may not be useful to most practitioners,[6] and some believe that case reports can even cause harm by drawing attention to extremely unusual circumstances.[7,8] Furthermore, case reports are not frequently cited in the literature,[9] which reduces the impact factors of the journals in which they are published. Considerations such as these have led some journals to cease publishing case reports altogether or to severely restrict the number of case reports per issue. Emerging from the debate over the value of case reports, however, is the consensus that case reports still do serve a purpose in an evidence-based medicine world.[10] In particular, case reports are increasingly seen as having educational value,[11,12] giving readers a chance to encounter different clinical scenarios and reflect upon their own decision-making and practice. Reading case reports can help physicians develop the “pattern recognition” skills[13] necessary for distinguishing between conditions with similar presentations, avoiding diagnostic pitfalls, recognizing unusual disease courses, or identifying unexpected outcomes of a treatment. Although case reports are not frequently cited, they can be among the most highly read articles in a journal because they are short and entertaining, with benefits comparable to a storytelling approach.[14,15] Moreover, writing a case report is a relatively quick and easy way for young healthcare professionals to begin engaging in scholarship and to meet growing expectations to publish.[16,17] Therefore, in response to the changing status of case reports in medical publishing, new journals have launched that exclusively publish case reports,[18] and the format of some journals’ case reports has been adapted to emphasize their educational value.[5]