Journal of the Scholarship of Teaching and Learning, Vol. 11, No. 1, January 2011, pp. 139 – 154.

Case report writing in a Doctor of Physical Therapy Education

program: A case study
Michael J. Fillyaw1

Abstract: Case reports are an established form of scholarship used for teaching
and learning in medicine and health care, but there are few examples of the
teaching and learning activities used to prepare students to write a case report.
This report describes the implementation of two courses that prepare physical
therapy students to write and disseminate a patient/client-centered case report.
The first course is taught in a distance-learning format and is taken concurrently
with a 12-week clinical experience where the student collects case data from a
patient/client who consents to be the subject of the report. The second course is
campus-based and supports the student’s dissemination of the case report as a
manuscript and oral and poster presentations. After three years, we have
experienced widespread support from the students, patients/clients, and clinics.
Factors that may have contributed to the students’ positive experiences include
course organization, student engagement, and support of the instructor, peers,
and clinical community. This information can assist educators in all professional
health care disciplines to establish or modify courses that prepare students to
write case reports.

Keywords: college instruction, teaching methodology, experiential learning, course

Design.

In health care disciplines, a case report is a detailed description of the clinical presentation,
diagnosis, treatment, and outcomes of a patient (or case), often with an unusual or novel
condition, to be shared for medical or educational purposes (Dictionary, 2010). In public health,
case reports have been credited with showing how exposures and disease are related, such as the
association of acquired immunodeficiency syndrome with sexual activity and severe acute
respiratory syndrome with West Nile virus (Moore 2009). In clinical medicine Vandenbroucke
(2001) suggests the potential roles of case reports include recognizing and describing new
diseases or rare manifestations of disease, detecting side effects of drugs, and medical education
and audit. In physical therapy, case reports provide detailed descriptions of how therapists meet
clinical, managerial, and educational challenges (Fitzgerald, 2007) and have been called the
“currency of practice” (Rothstein, 2002, p. 1063).
Case reports are considered ideal vehicles for teaching scientific writing (Neely, 2008),
but there are only a few published reports describing how students are prepared to write a case
report. Perry (1998) required undergraduate students in epidemiology and public health to write a
case report summarizing the evidence supporting one intervention used in the management of a
patient. Mostrom (1999) described a multitrack model in physical therapy that offered students
three “inquiry” options: an individual thesis, a collaborative research project, or a case report.

1
Michael J. Fillyaw, PT, MS, is Associate Professor, Department of Physical Therapy, University of New England, 716 Stevens
Ave, Portland, ME, 04103 (mfillyaw@une.edu).
Fillyaw, M. J.

Good (2009) reported his methods for having chiropractic students write a case report about a
fictitious patient. Klos (1976) described an optional case writing project for students in
psychology. However, these reports do not provide detailed descriptions of the strategies used to
teach case report writing to students, nor do they report the student view of the experience. The
purpose of this report is to describe the implementation and outcomes after three years of two
courses that prepare students to write and disseminate a patient/client-centered case report.
Although the methods were developed and applied in a physical therapy education program, the
model could be adapted to any discipline interacting with patients/clients.

I. Background.

Prior to revising our curriculum in preparation for awarding the Doctor of Physical Therapy
(DPT) degree, like many physical therapist education programs we required all students to
complete a group research project. However, a number of changes in the education community in
physical therapy informed our decision to offer writing a case report as an alternative scholarly
project for students. First, there was a growing disenchantment for requiring students preparing
for clinical practice to complete a research project. Rothstein (1993, 1998) argued that, as a
profession of practitioners, it made more sense that student physical therapists be able to write a
case report than to have participated in a research project, which, he argued, were often poorly
conceived and supervised by faculty with inadequate research credentials. A second change was
the evolution in physical therapy to a doctoring profession. In discussing the clinical doctorate,
Threlkeld (1999) forecasted that doctors of physical therapy would be writing case reports
among other new responsibilities. In moving to the DPT degree, some physical therapist
education programs revised the research curriculum to integrate clinical decision making and
evidence-based practice (Ross, 2004), or permitted different forms of scholarly projects,
including case reports (Mostrom, 1999). Furthermore, the call for more case reports by peer-
reviewed physical therapy journals (Childs, 2004; McEwen, 2004; Partridge, 2003; Rothstein,
1989, 1993, 2002; White, 2004) helped to legitimize case reports as a form of scholarship.
The primary objective for including case report writing in the DPT curriculum is to
provide a reflective and scholarly activity that enables students to demonstrate attainment of the
behaviors, skills, and knowledge that describe the expected performance of physical therapists at
entry into the practice of physical therapy. A secondary objective is to prepare graduates to
contribute to the scholarship of physical therapy by (a) writing a case report in accordance with
the requirements of a professional journal, (b) disseminating the report as both oral and poster
presentations. To achieve these objectives, the program included Case Report 1 (CR1) and Case
Report 2 (CR2) in its new curriculum for the Doctor of Physical Therapy degree. The physical
therapy faculty planned it so both the case report and research project options would require
students to complete two, 2-credit courses, so the choice of a scholarship project would be based
on their interests and goals and not on a difference in the number of courses or credits associated
with each project. The author accepted responsibility for developing the course descriptions,
schedules, objectives, learning activities, dissemination plans, grading rubric, and patient consent
form.

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A. Case Report 1.

CR1 is a distance-education course offered concurrently with the students’ second 12-week
clinical practicum (CP2) in the sixth semester (beginning of the third academic year) of the DPT
program. Course activities include reading and writing assignments that prepare students to
collect data about a patient/client they select to be the subject of the case report. Any
patient/client or management scheme that is infrequently encountered in practice or that has not
been described in the literature may be the subject of the case report (Rothstein, 2002).
Communication with the clinic. Prior to Clinical Practicum 2, the academic program
informs the clinical coordinator at each site that his or her student will be enrolled in CR1 along
with the clinical practicum and will need to collect information about a patient/client in
preparation for writing a case report. This information also is shared with the clinics through the
program’s Clinical Education Handbook. In addition, the student discusses the requirements for
CR1 with his or her clinical instructor during orientation to the clinic.
Consent and confidentiality of protected health information. To protect the right to
privacy (Uniform Requirements, 2010), the student obtains written consent from the
patient/client, or his or her legally authorized representative using the consent form developed by
the education program for this purpose, or the clinic’s form, if one is available. The patient/client
is informed that the student will assemble information from the medical history, physical therapy
examination, and treatments to present as a case report at the university, and that it may be
published or presented at a professional conference. The patient/client is assured that the case
report is not research, no experimental therapies will be used, and the services recommended by
the physical therapist or student physical therapist will be provided whether or not the person
participates as a case report subject. To assure compliance with the Health Insurance Portability
and Accountability Act (HIPAA) (Understanding Health Information, 2010), the student
removes all protected health information from any patient/client records, forms, or notes before
the information leaves the clinic. As an activity documenting the examination and treatment of a
single patient, a clinical case report is a medical/educational activity that does not meet the
definition of research – “a systematic investigation, including research development, testing and
evaluation, designed to develop or contribute to generalizable knowledge” (Code of Federal
Regulations, 2010) – and therefore does not need to be reviewed by the university’s Institutional
Review Board for the Protection of Human Subjects.
Assignments. In the first three weeks of CR1, usually before identifying a patient/client,
the students read selected articles about the value of case reports to physical therapy (Childs,
2004; Fitzgerald, 2007; McEwen, 2004; Summers, 2004; White, 2004), the framework of a case
report (LaPier, 2004), and the requirements for preparing a case report for a professional journal
(Physical Therapy Information, 2010). After selecting a patient/client, the student completes four
assignments, based on the elements of the patient/client management model in physical therapy
(Guide to PT Practice, 2003), which facilitate collecting and reporting information about the
patient/client (Table 1).

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Table 1. Writing Prompts to Facilitate Collecting and Reporting of Patient/Client Data.

Assignment 1: Examination and Purpose

1. What is the patient’s chief complaint or problem? What is the medical diagnosis?
2. State the reasons for referral to physical therapy.
3. Provide pertinent information about the patient’s medical and social history, living environment,
social and health habits, functional status and activity level, and medications.
4. Provide pertinent information from the systems review.
5. Construct a Table that reports the results of the tests and measurements.
6. Provide citations on the reliability and validity of the individual tests and measures.
7. Explain why you selected this patient/client for a case report. How will your case report add to the
body of knowledge in physical therapy?
8. State the purpose of your case report.

Assignment 2: Evaluation, Diagnosis, and Prognosis

1. Discuss your interpretation of the information you obtained in the examination (history, systems
review, tests and measurements).
2. What are the patient’s impairments, functional limitations, and disabilities?
3. Explain how any comorbidities may affect prognosis, goals, expected outcomes, and plan of care.
4. What is the patient’s physical therapy diagnosis from the Guide to Physical Therapist Practice?
5. What is the patient’s prognosis for improvement with physical therapy? Provide a rationale for your
prognosis that is based on theoretical argument, clinical experience, or previous research.
6. What are the short-term and long-term or discharge goals for physical therapy?
7. What goals and outcomes does the patient (or family) have for physical therapy?

Assignment 3: Plan of Care and Interventions

1. Outline the physical therapy plan of care for: coordination, communication, and documentation,
patient/client related instruction, and procedural interventions.
2. Explain your decision-making process that led from evaluation, diagnosis, and prognosis to the
plan of care and the selection of the interventions.
3. What interventions were provided?
4. Describe the chronology of interventions and explain the rationale for any changes over time.
5. Provide a rationale for the interventions based on theoretical argument, clinical experience, or
previous research.
6. Explain the rationale for any changes that were made in the intervention.

Assignment 4: Outcomes
1. Estimate the number of physical therapy treatment sessions the patient received.
2. Include Table(s) of the results of the most relevant tests and measures or outcome measures made at
admission and discharge from PT (or initial and final measures).
3. Include any Figure(s) (e.g., photographs, etc) or Appendix you plan to include in the report.

B. Case Report 2.

CR2 is a campus-based course that meets for two hours a week in the fall semester after CP2.
Class activities include lectures and discussions that support writing the case report manuscript, a

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workshop on making a poster, peer review meetings, and meetings with the instructor. An
instructor-developed grading rubric, which considers credibility, completeness, accuracy,
organization, grammar, punctuation, spelling, and clarity of expression, is used to evaluate the
manuscript. (Appendix)
Peer review. During two class periods, pairs of students use the grading rubric to review
and provide feedback on two draft manuscripts. A draft is operationally defined as a manuscript
that contains all the required elements, follows the organization of a case report, and expresses
ideas in a consistent style that is grammatically appropriate for professional communication
including correct spelling and punctuation, clear word choice and sentence structure, and correct
scientific and medical terminology. The first draft includes the Title Page, Background and
Purpose, Patient History and Review of Systems with Clinical Impression, Examination with
Clinical Impression, and References. The second draft includes the Intervention, Outcome,
Discussion, References, Tables, Figures, Appendices, and Abstract. The goal of the peer review
is for students to evaluate their partner’s paper from the perspective of the instructor (Rieber,
2006). Using the grading rubric as a checklist ensures that each draft is reviewed by the same
criteria and the author receives feedback on all aspects of the manuscript.
Instructor review. After each peer review session, the student has one week to revise the
draft manuscript before submitting it to the instructor for grading. After grading the draft, the
instructor meets individually with each student to provide detailed written and oral feedback
based on the grading criteria. The final course grade is the weighted average of all the graded
activities: 75% from the final manuscript and 25% from the drafts of the manuscript and slides
for the oral and poster presentations. The oral and poster presentations are graded pass-fail.
Dissemination. In addition to writing a “full” traditional case report manuscript (Physical
Therapy, 2010), students make oral and poster presentations, modeled after presentations at
meetings of the American Physical Therapy Association (APTA), at the college’s Scholarship
and Research Symposium. Also, students are encouraged to submit an abstract of the case report
for presentation at one of the professional meetings of the APTA.

II. Methodology.

The twenty-four students who elected to write a case report during the first three years of the
DPT degree program participated. To assess the students’ perceptions of the course design and
delivery, both quantitative and qualitative information were collected from the college’s end-of-
semester course and instructor evaluation forms and from student responses to open-ended
questions about the peer review aspect. The students’ responses to the college evaluations and
peer review questions were anonymous. To assess the effect of instructor feedback on student
writing, the differences in students’ scores on the two draft manuscripts and the final manuscript
were analyzed by a repeated measures analysis of variance followed by paired t-tests for multiple
comparisons using Systat 11.0 for Windows statistical software. The project was exempt from
oversight by the university’s Institutional Review Board for the Protection of Human Subjects.

III. Findings.

The support for the case report has been universal among students, clinical instructors, and
patients/clients. Although students have other assignments during their clinical, no one reported
these hindered data collection for the case report, or vice versa. No clinic has expressed any

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concerns about students’ data collection during the clinical and every patient/client asked to be
the subject of a case report has agreed. The subjects of the case reports reflect the diversity of
patients/clients who receive physical therapy services in hospitals, inpatient rehabilitation
centers, outpatient clinics, and skilled nursing facilities (Table 2).

Table 2. Selected Titles of Student Case Reports.

Inpatient setting
A Function-based Approach in the Physical Therapy Management of a 78 year-old Patient with
Incomplete Spinal Cord Injury

Energy Conservation for a 78 year-old Male with End Stage Idiopathic Pulmonary Fibrosis

Functional and Resistance Training Following Shunt Revision in 7-year-old Male with Type I
Chiari Malformation

Functional Training and Interdisciplinary Discharge Planning for a Patient with Parkinson’s
Disease

Inpatient Physical Therapy for a 20-year-old Patient Following Rotationplasty

Mobility Training for a Patient with Bilateral Oculomotor Nerve Paralysis and Hemiparesis
Following a Stroke
Outpatient setting
A Comprehensive 12-week Physical Therapy Plan of Care after a Calcaneal Osteotomy to Correct
Cavovarus Foot Deformity

A Comprehensive Physical Therapy Intervention Plan Following a Bimalleolar Fracture with

Open Reduction Internal Fixation

Early Physical Therapy Intervention for a Work Related Upper Trapezius Strain with
Neurologic Symptoms

Outpatient Rehabilitation Following Total Shoulder Arthroplasty in a Young Man with a

History of Locked Posterior Shoulder Dislocation

Physical Therapy Management of a Runner with a Chronic Adductor Strain and a True Leg
Length Discrepancy

A. Course and instructor evaluations.

Eighty-nine per cent and 75% of eligible students completed evaluations for the course and
instructor for CR1 and CR2, respectively. All students responding to the course evaluations
strongly agreed or agreed that the objectives of CR1 and CR2 were clear, the pace of the courses
was appropriate, and that assignments were useful in developing or enhancing relevant practical
skills. Of the students who provided an overall course rating for CR1, 75% rated it as excellent

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or above average and three rated it as average. For CR2, 94% rated CR2 as excellent or above
average and 6% rated it as average.
All students who provided an overall rating for the instructor strongly agreed or agreed he
was well prepared, presented the material clearly and in an orderly and logical manner, inspired
confidence in his knowledge of the subject, showed respect for the questions and opinions of the
students, and displayed genuine concern with the student’s progress. Eighty-three percent of the
students, who rated the instructor for CR1, rated him excellent or above average; 17% rated him
average. Of the students who rated the instructor for CR2, 94% rated him excellent or above
average and 6% rated him average.

B. Peer review.

All but one student reported the peer review process helped them write the case report
manuscript and prepare their presentations. Student anonymous responses to open-ended
questions about the peer review process are included in Table 3.

C. Effect of instructor feedback on student writing.

The mean (SD) grades for the three drafts of the case report were 86.0 (7.3), 88.2 (8.0), and 97.8
(1.4), respectively. Overall, there was a curvilinear increase (F (1, 23) = 6.5, p = 0.02) in scores
from the first draft to the final draft. The mean increase of 2.2 points [95% CI = - 1.2 to 5.7]
from draft 1 to draft 2 was not statistically significant (p = 0.19). The increase of 11.8 points
from draft 1 to the final draft [95% CI = 9.0 to 14.7] and the increase of 9.6 points from draft 2 to
the final draft (95% CI = 6.5 to 12.8) were statistically significant (p < 0.001).

IV. Discussion.

This is the first report to describe the teaching and learning activities and outcomes of courses in
a physical therapy education program that prepare students to write and disseminate a patient/
client centered case report. The course and instructor evaluation data indicate the overall design
and delivery of CR1 and CR2 are successful and well received by students. As with any single
case study, the findings cannot be generalized to students in other health care education
programs, nor do they suggest a causal relationship between the teaching and learning activities
employed and the student outcomes. Nonetheless, the findings suggest a number of themes that
can stimulate further study and have implications for teaching case report writing in any
discipline.

A. Systematic approach and course organization.

Many students identified the systematic, step-by-step process used to collect patient/client data to
write the manuscript, and to prepare the oral and poster presentations as important to their overall
learning experience. One student commented the “practical, organized way that paralleled
organization of the plan of care in the clinical setting” was most valuable during CR1. Several
students said the reading and writing assignments helped them understand the structure of a case

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Table 3. Students’ Comments about Peer Review.

Describe the aspects of the peer review that you found to be helpful

I think having someone else look at your paper and be able to determine what can be added or
removed is helpful. I have a difficult time finding areas that need more detail/clarification.

It was helpful to have someone else to problem solve with and discuss other options. For example, we
discussed our introductions quite a bit and this process validated my thoughts but also helped me find
ways to cut it down and make changes.

I always think it's a good idea to let someone else read your paper for sentence structure, grammar, and
spelling since it is hard to pick up those errors in your own writing.

I found different ways to approach problems that I had encountered while writing.

The peer review sessions and individual work sessions with the instructor provided a good amount of
feedback to help finalize the paper, presentation, and poster.

It was also great to have someone else read your work. I find that I often overlook little things that could
be changed because it is my own work.

I thought it was a productive use of time. It is good to have someone else look at your paper because it is
sometimes hard to think outside your own box.

The outline and the grading sheet provide excellent guidance on what the case report should contain.
Meeting with you is an excellent supplement to the peer review because it provides that added expertise
on case reports.

Describe the aspects of the peer review process that were not helpful to you

Didn’t find peer review helpful; would have preferred open time on project.

Provide any ideas you have to improve the peer review process

I feel I do not have enough expertise on case reports/journal articles/manuscripts. I felt comfortable
suggesting changes with grammar, spelling, formatting, and some of the content but I wish I had a better
understanding of what a strong case report really is. I feel that this is something that will come with time
and that you would not be able to teach to us in advance.

The only aspect I can think about to improve the peer review process is to have more communication with
the other students to ask questions or get feedback about our ideas. We did that a little with another
group and I think it was helpful to us as well as to them.

Maybe have a "check in before you leave" as a group to hear answers to questions that each person has
asked you and listen to problems other students encountered.

I don't think I would change anything. I would say to have more people read and be involved in the

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review process, but I also know I would feel uncomfortable being forced to do that
report and prepared them for collecting data from their patient/client. One student wrote, “The
independent nature of the course helped me continue to develop my management and
organizational skills, as well as to develop my ideas on the case.” Two students commented that
the second of the two draft manuscripts was more involved than the first and recommended that
they be reorganized to equalize the amount of writing between the two.

B. Instructor support.

A number of attributes of the instructor appear to be important to students’ learning and

satisfaction with writing the case report. Preparedness, orderly, logical, and clear presentations,
respect for students’ questions and concern for student progress were reported as characteristics
of the instructor that were most valuable to their overall learning experience. Many students
commented that the instructor’s responsiveness, well-thought, timely and supportive feedback,
knowledge, and experience were important to their overall learning experience. For CR2, many
students noted the scheduling of deadlines, due dates, and individual meetings with the instructor
helped keep them on track and manage the workload. These comments reflect Sellheim’s (2003)
findings that faculty enthusiasm, respectful and positive attitudes toward students, concern with
helping students to understand, valuing students' input, and accessibility all contribute to a
“positive presence” that enhances student learning. Furthermore, evidence that writing improves
when students have a better understanding of how they are being assessed (Beason, 1993) and
are made aware of their strengths and weaknesses (Higgins, 2002) is found in the significant
improvement in the average grade from drafts one and two to the final manuscript.

C. Student engagement.

Students are successful when their writing is personally meaningful, practical, or purposeful
beyond the classroom (Haas, 2007). Writing and disseminating a case report requires the student
to be actively involved in information gathering and problem solving, to make explicit clinical
decision-making, to consult the literature for information related to their plan of care, and to
demonstrate skills in professional writing and presentation. Because the students perceived the
assignments to be directly related to their professional roles and responsibilities, their writing
was authentic. One student said, “Writing a case report is an important aspect of the DPT
degree.” Another said, “The opportunity to write and present a case report was valuable to my
overall learning experience in the program.” Not every student was as enthusiastic about the
poster presentation, however, and two students recommended it not be required.

D. Peer review.

Following Childs’ (2004) recommendation that colleagues critically review case reports prior to
submission for publication, peer review has been a valuable way for students to provide feedback
and suggestions to each other before submitting the paper to the instructor. Only one student
reported the peer support process used in CR2 was not helpful, preferring instead to use the time
working privately.
Peer support is widely used to help students at every level improve their writing
(Armstrong, 2008; Haas, 2007; Rieber, 2006; Topping, 2003). First, the author has an

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opportunity to edit and improve the work before it is graded by the instructor. As one student
stated, “Having this before we meet one on one with you makes us write our sections in advance
and then have ample time to look at it again and make corrections before it is due (improves the
quality of our draft before meeting with you).” The same student added, “I think it is a good idea
to have it structured into class time.” Second, the discussion between the author and reviewer
cause both to rethink the assignment, which leads to improvement in both their papers (Haas,
2007). One student described the experience this way, “I found the peer review much more
helpful than I thought it was going to be. Afterwards, my partner and I discussed how each of us
was going to use some of each other’s ideas in our own paper…the peer review process is
definitely going to be a key part of writing a quality case report.” Using the grading rubric during
the peer review session seemed to be helpful. One student said, “It was good to have the grading
sheet so the reviewer can say whether or not you missed some sections or should elaborate on
others.” Lastly, students   may   be   less   threatened   in   peer   settings,   more   likely   to   ask  
questions  of  their  peers,  and  more  likely  to  react better to comments from their peers than to
teacher’s comments (Haas, 2007). One student echoed this opinion, “I did find the peer review
process helpful. I found it to be an easy and comfortable process to have a fellow student read
my case report and give suggestions before meeting one on one with you.” One caveat about
peer review is that authors must understand that peer review is only a part of the submission
process and that they are responsible for their final submission. A side benefit of peer support to
the instructor is the final manuscript is of higher quality and easier to grade.
The case report provides an alternative assessment activity for faculty to evaluate the
student’s ability to apply essential knowledge and skills by producing something significant and
related to previous instructional activities and clinical applications (Kossman, 2005). In physical
therapy, no other form of standardized written communication gives the detailed and credible
descriptions of the decision-making process for an individual patient that a case report provides
(Childs, 2004; McEwen, 2004). It provides evidence that the student is prepared for clinical
practice. Writing the report requires the student to make explicit the choice of examination
procedures, the logic behind the evaluation, diagnosis, and prognosis, the rationale for the choice
of treatments, and to summarize the outcomes. In the process of working with the patient/client,
the student must demonstrate the behaviors, skills, or knowledge that describe the expected
performance of entry-level physical therapists, particularly in the areas of communication,
clinical reasoning, evidence-based practice, education, screening, examination, evaluation,
diagnosis, prognosis, plan of care, intervention, outcomes assessment, management of care
delivery, and practice management (Evaluative Criteria, 2009). Disseminating the case report
demonstrates the student is prepared to contribute to the evidence for practice; a minimum
required skill of physical therapist graduates (Minimum Required Skills, 2004).
By writing a case report, students exemplify evidence-based practice (Sackett, 2000).
First, they define their need for information about the patient/client’s examination, diagnosis,
prognosis, or treatment into an answerable clinical question. Second, they search the peer-
reviewed medical literature for the best evidence to answer the clinical question. Third, they
appraise the evidence for validity, impact, and applicability to their patient. Fourth, they integrate
the research evidence with their clinical expertise and experience along with the patient’s
circumstances and preferences to develop a patient/client care plan. By illustrating the value of
the clinician’s expertise and the input of the patient/client, a case report demonstrates that
randomized controlled trials provide only one kind of evidence used to make clinical decisions
(Browman, 1999). Indeed, the Journal of Medical Case Reports encourages authors to invite the

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patient to contribute to the case report by including an optional Patient's Perspective section,
where the patient describes their experience of the disorder and treatment (Instructions for JMCR
Authors, 2010).
Although disseminating the case report outside of the university is not an expected
outcome of the courses, it is disappointing nonetheless that no student elected to submit a case
report for publication or conference presentation. Offers by the instructor to assist students with
the submission process after the course has ended have not been successful. Requiring students
to submit an abstract for an APTA conference was considered, but CR2 ends several months
before the call for abstracts is posted, so it does not seem practical to require submission as a
course requirement. Moreover, it is unreasonable to expect that the accepted student would be
able to attend the conference the following year. Anecdotal feedback from students provides
some insight into the reasons why they do not submit an abstract for presentation. The deadlines
for submission of abstracts to the APTA conferences are just a few months after graduation when
the graduate’s priorities are preparing for the licensing examination, searching for a job, and
relocating. Also, because of the uncertainties of where they will be living and working, students
don’t know if they can afford to attend a conference, or will be given time off by their employer
to attend.
Future research should include the development of valid and reliable rubrics for
evaluating case report manuscripts and presentations, and the effects of peer review on students’
writing and learning. Interrater reliability will be particularly important when different faculty
teach multiple sections of the courses. Additional attention needs to be paid to identifying the
barriers to submission for presentation or publication and to developing strategies that promote
submission of quality case reports for publication and conference presentation. Finally, it is
recommended that faculty and clinicians share the teaching and learning activities they use for
case report writing and evaluate how writing a case report affects students' clinical behaviors and
professional development. If case reports are to illustrate the scholarship of practice (McEwen,
2004), educators have a responsibility to prepare students to contribute to the scholarship of their
profession by writing and presenting a patient case report.

Acknowledgements

The author would like to thank the DPT students, the physical therapists who supported them
during their clinical assignments, and all the patients who agreed to serve as a subject for the
student’s case report. In addition, I would like to thank the reviewers for their helpful
suggestions and Elizabeth Dyer, Reference and Instruction Librarian, for assistance in proof
reading and editing.

Appendix. Grading Rubric for the Case Report Manuscript.

TITLE PAGE (5 pt)

Title clearly describes topic and states that the manuscript is a case report
Author’s name, titles, location
Acknowledgements
ABSTRACT (5 pt)
Structure: Background and Purpose, Case Description, Outcomes, and Discussion; ≤ 275 words
BACKGROUND and PURPOSE (20 pt)

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Scholarly presentation of background literature concerning the clinical problem

Provides a clear statement of purpose supported by the background information
CASE DESCRIPTION
Patient History and Review of Systems (20 pt)
Documentation of HIPAA compliance and patient consent
Demographic characteristics, medical history, patient/family goals for physical therapy
Clinical Impression 1 (10 pt)
Reviews the primary problem, the potential differential diagnoses, and the plan for examination
Examination – Tests and Measures (20 pts)
Examination procedures are consistent with Clinical Impression 1
Cite available studies on reliability and validity of measurements OR
Make presumptive arguments that the measurements would be reasonably reliable and valid
Clinical Impression 2 (10 pt)
Provide a statement confirming or denying the initial impression based on the examination
Physical therapy diagnosis
Prognosis
Plan of care including:
• Plans for referral or consultation
• Plans for additional testing (measures, time points) or follow-up evaluation of outcomes
• Plan for intervention
• Short- and/or long-term goals
Intervention (20 pts)
Detailed description of the physical therapy services for 3 areas of patient/client management:
• Coordination, communication, documentation
• Patient/client-related instruction
• Procedural interventions:
Chronology of interventions and changes in treatment with rationale
Indicators of patient compliance (e.g., attendance and performing home program)
Cites credible primary literature to support intervention(s) used
OUTCOME (20 pts)
Present the outcomes over the time points indicated in the follow-up plan
Compare final outcomes to baseline
Tables and Figures can be used to enhance the description
DISCUSSION (20 pts)
Summarize how the case demonstrated the intended purpose.
Relates findings to the literature and/or Background/Purpose of the case report
Avoids definitive cause-and-effect statements or generalizations to other patients
Discuss potential implications for clinical practice
Offers suggestions for future research
REFERENCES (5 pts)
Accurately follows American Medical Association style
30 or fewer
TABLES and FIGURES (0 – 5 pts)
Professional quality: accurate details clearly presented with legends and footnotes
Maximum of 6
APPENDICES (0 – 5 pts)

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Provide essential material not suitable for Figures, Tables, or text

Accurate/adequate details clearly presented
ORGANIZATION, COMMUNICATION, AND LANGUAGE (35 pts)
Formatting:
• Pages double-spaced, with page numbers AND line numbers
Organization:
• Content correctly placed in appropriate sections
Communication and Language:
• Non-biasing, people-first language
• Correct grammar, spelling, and punctuation
• Appropriate scientific and medical terminology/abbreviations
• International System of Units for all measurements (English units in parentheses)
• ≤ 3,500 words (excludes Title page, Abstract, References, Tables, Figures, Appendix)

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