Large scale clinical studies and big data may appear to have eclipsed the need for case reports and clinical vignettes, but that’s not the case. In fact, case studies play a unique role in modern medicine by serving as educational narratives that help clinicians gain new insights into clinical practice and improve patient outcomes, while also allowing physicians to contribute to their specialty’s body of knowledge.
What is a clinical vignette?
Before exploring their value, it’s important to distinguish between clinical vignettes and case reports, as these terms are sometimes used interchangeably but represent different formats and purposes in medical education and publishing.
A clinical vignette is a concise, focused account of a single patient’s case. It tells the story of that case in a way which highlights its unique qualities and explores potential new discoveries and is often used for teaching. Clinical vignettes prioritize clarity and brevity, emphasizing the most relevant details while often omitting comprehensive case history or extensive literature review.
Clinical vignettes are not only an important educational tool for physicians-in-training, but also a valuable means of peer-to-peer learning. “Clinical vignettes are a fantastic opportunity to learn and share interesting cases with our peers,” writes an OBGYN on Sermo.
Unlike full case reports, which can be extensive, vignettes are typically no longer than 2,000 words and concentrate on the most relevant details rather than the entire medical record.These summaries often highlight unusual or rare conditions, diagnostic challenges, or unexpected outcomes—cases that physicians may encounter only once or twice in their careers.
A case report is a formal, detailed medical publication intended for peer-reviewed journals. Case reports follow structured guidelines and provide a comprehensive account of novel, rare, or instructive cases and contribute to the broader medical literature for clinical and research reference.
Why clinical vignettes are essential for medical education and practice
Clinical vignettes play a key role in medical education. 50% of physicians in a Sermo poll said their primary reason for reading or writing vignettes is education and learning. “Medical vignettes have important educational value in the professional development of physicians since they improve diagnostic reasoning and contribute to general clinical knowledge,” writes a nephrologist on Sermo, and the sentiment is echoed by a cardiologist, “Clinical vignettes are a valuable tool for sharing clinical cases and learning. They help in diagnostic reasoning and in solving the clinical case.”
Through studying clinical vignettes, medical students and practicing doctors can improve and test their ability to recognize rare conditions, understand variations in disease presentation and grasp socioeconomic circumstances that can impact the progression of a disease. “Clinical vignettes help you learn about interesting cases and learn from them,” says a family doctor on Sermo. “They also sometimes help you remember what you’ve learned and forgotten. They allow you to open your mind to cases you haven’t seen before.”
Through writing vignettes, doctors and med students learn how to be more concise and identify what is really important about a case, but first they need to identify what they’d like to write about. “My top tip when starting off would be to find a supportive supervisor who has published case reports previously and approach them with a case you would like to write up,” recommends a rheumatologist on Sermo.
Limitations of clinical vignettes
While valuable educational tools, vignettes do not come without their limitations. Due to their concise and focused nature, vignettes often omit comprehensive patient details and the broader clinical context, which can limit their applicability and generalizability to complex medical scenarios. The strength of any clinical conclusions drawn from a vignette are often anecdotal and subject to any biases that the author may hold. Lastly, the format of vignettes is not standardized or reviewed, which may affect the validity of the information.
For these reasons, clinical vignettes are best used in conjunction with robust, evidence-based resources to support thorough medical decision-making and education. Understanding these limitations encourages critical appraisal and the integration of multiple sources of clinical information.
Crafting compelling clinical vignettes: key elements and best practices
A clinical vignette is more than just a dry explanation of the case. It has to be clear and concise, but it also has to tell a story. Some are better able to achieve this aim than others, according to a pediatrician on Sermo. “Publishing medical articles is a great opportunity to stay up-to-date and, on some platforms, to earn a financial incentive,” the physician writes. “But they must be filtered because not all articles are reliable or well-written.”
According to polled Sermo members, the two biggest challenges that arise when writing clinical vignettes are choosing the right case and writing clearly and concisely. “My main tip is to stay focused on the key teaching point—keep it clear and concise,” writes one pediatrician on Sermo. “A big challenge is balancing clinical detail with readability.”
Clinical vignettes are flexible in formatting as they are primarily used in teaching rounds, clinical meetings or peer-to-peer discussions. They may include a brief introduction, a summary of the case presentation, and key takeaway points. Vignettes typically highlight unusual or educational aspects of a case, without comprehensive detail. The discussion is the most critical to get right, according to the majority of respondents in a Sermo poll.
On the other hand, case reports are more formalized and follow standard structures. According to CARE guidelines, the standard format involves a title and abstract, a short introduction to give context, the case description, discussion and conclusion, followed by any keywords, references, acknowledgements and details of informed consent. This sequence and structure aim to enhance transparency, completeness, and clarity of the case report to benefit clinical practice and research. If your goal is for a case report to be published, it’s important to “study guidelines for publishing and follow set standards,” as a general surgeon on Sermo suggested.
While you write a vignette, aim to avoid irrelevant details, medical jargon and excessive abbreviations. If you do use abbreviations, make sure they are common and spell them out upon first mention.When you cite appropriate reports, be sure to double-check them, especially if you’ve relied on AI tools. While AI has an important role in healthcare, generative AI tools have been known to invent citations or “halluciate” details.
Clinical vignettes should always respect patient privacy and must never include information that could identify the patient. Although less formal, the patient’s or caregiver’s consent should be sought prior to publication as is done with case reports.
Once your draft is complete, it’s helpful to have a mentor or peer check for clarity, appropriate levels of detail and whether the vignette is appropriately written. Have someone else read the vignette for technical errors, such as grammar mistakes and typos. Before you turn it in, read it out loud to pick up on any awkward phrasing.
Clinical vignette examples
One of the best ways to learn how to write a good clinical vignette is to read existing reports. Examples are readily available; these come from Interesting Clinical Vignettes: 101 Ice Breakers for Medical Rounds published by the Texas Tech University Health Sciences Center.
Example #1: mild hip pain in a 25-year-old medical student
A 25-year-old medical student is complaining of right hip pain. He is an otherwise healthy individual with a history of mild ankle sprains. He points to the anterior portion of his right groin and describes the pain as a deep, dull ache. The pain worsens after he plays recreational basketball. He states that he has had the pain since high school but cannot recall a specific inciting event. He feels that his hip pain has started to interfere with daily life, especially when he has been sitting and studying for a prolonged period of time. He has seen his chiropractor and reports a normal X-ray of the affected area. His chiropractor diagnosed a groin pull and recommended exercises with over the counter OTC anti-inflammatory medications. The patient reports no improvement and is frustrated with his lack of progress. Upon gait examination, the patient swings his torso towards his affected side. His range of motion is reduced in flexion (less than 90°) and in internal rotation. What is the most likely diagnosis and what is the best next step in the management of this patient?
This case study points toward a diagnosis of femoroacetabular impingement (FAI), in which prolonged periods of sitting can cause abnormal contact between the femoral head and acetabulum. This would be tested for with a flexion, adduction and internal rotation (FADIR) test and an anteroposterior and modified Dunn view radiograph of the pelvis. Treatment is typically surgical, using arthroscopy to regain function, eliminate pain and reduce the risk of osteoarthritis—although a 2024 consensus statement recommends that a more conservative approach should be attempted first in the treatment of selected musculoskeletal injuries.
Example #2: sudden unilateral vision loss in a 65-year-old man
A 65-year old male presents with sudden painless and complete loss of vision in his right eye. He has been experiencing myalgias and fatigue for about one to two weeks prior to his visual complaint. He has a past medical history of hypertension, atrial arrhythmia, and gout. Current medications include lisinopril, amlodipine, amiodarone, and pravastatin. Physical examination reveals a swollen pale optic disc in the right eye and a normal fundus examination of the left eye. What is the most likely diagnosis and what concomitant diagnosis may you consider?
This is most likely anterior ischemic optic neuropathy. Central vein thrombosis, can be ruled out, since the patient does not have the characteristic flame shaped retinal hemorrhages and venous engorgement. Another possibility would be papilledema, but this usually presents bilaterally and not as sudden vision loss. This means a diagnosis of non-arteric AION is most likely, with no accepted treatment other than monitoring and controlling vascular risk factors.
Both of these examples highlight the value of using clinical vignette abstracts in both initial and continuing physician education. For more real-world examples of clinical case discussions, join the Sermo community where you can collaborate with doctors worldwide sharing their patient cases for feedback, review, and education.
Case report examples
As a comparison against the typical format of a vignette, below are several reputable sources to explore examples of formal case reports:
Oxford medical is an open-access, peer-reviewed online journal that publishes insightful case reports across all medical specialties. It is known for educational and original clinical case reports.
The JCIMCR is a platform that publishes case reports and clinical images from a wide range of clinical and medical conditions. It is internationally peer-reviewed.
BMJ publishes case reports in all medical disciplines, including drug interactions and adverse reactions. It was a founding member of the Committee on Publication Ethics (COPE).
Established in 1999, the American Journal of Case reports is one of the oldest journals dedicated to publishing single and series vignettes across all disciplines.
An official journal of the European Federation of Internal Medicine, the EJCRIM represents 38 European countries and publishes case reports in the field of acute and general medicine.
How to share a clinical vignette with the medical community
When you publish a report, it allows you to engage the wider medical community. “Publishing case report [or] medical reviews is a good way to stay updated to see rarest cases and to see things with different approaches,” shares a radiologist on Sermo. “Discussing the case with a multidisciplinary team is a way not only to learn new thing[s] but also to review the noted facts.”
Traditionally, vignettes and case reports are shared through mainstream medical publishing outlets. Medical journals such as those discussed above publish vignettes, and physicians can also present them at clinical-pathologic conferences.The average acceptance rate is roughly 30-50% according to information available on major journal websites. 33% of physicians in a Sermo poll said they typically share their vignettes through conferences or poster sessions, more than any other method.
When submitting, make sure to follow the conference or publication guidelines. For example, many conferences have strict word limits on abstracts so that they fit well in the conference schedule. Your report length and presentation time will likely be limited.
More modern methods include online professional networks like Sermo. “I recommend sharing medical case reports in platforms like Sermo or medical journals,” writes a GP on Sermo. “Many professiona[s]l across the world could have a different experience in case visualization, disease epidemiology, approach based on resources… a lot to learn from multidisciplinary approaches.”
The majority of surveyed physicians on Sermo have written or contributed to at least one vignette, and 38% have contributed multiple times. Sermo members can access large numbers of vignettes and to discussions at scale, while at a conference, peer discussion is limited to those in the room. On Sermo, thousands of doctors can talk about and discuss your case, potentially increasing education or giving the opportunity to further help that patient and others.
Clinical vignettes: key takeaway
Clinical vignettes, while less formal than case reports, allow you to contribute to medical knowledge and improve your own skills. They illustrate unusual cases and allow physicians to share unique patient experiences and stories to foster peer learning.
The practice of writing reports can sharpen your observation, critical thinking and writing skills. On Sermo, physicians can share their case reports and learn from each other, improving their clinical skills and writing more impactful and useful vignettes.
