case study for medical representative

Further evidence from a 2018 systematic review and meta-analysis revealed a high prevalence of violence against doctors across diverse regions and healthcare settings in India. The need for a national policy to protect healthcare workers is evident, alongside better infrastructure and stronger legal frameworks to deter violence.   A 2017 study from the Indian Journal of Medical Research highlighted the issue of underreporting, with many incidents of violence being ignored or minimised. This study emphasises the need for comprehensive strategies involving legal protections and public awareness to address systemic failures and improve working conditions for healthcare workers.   Actions Taken and Punishments   Government efforts to combat violence against doctors have led to several arrests and legal actions. For example, in the Assam incident involving Dr. Seuj Kumar Senapati, multiple arrests were made, and the accused are currently facing trial under the Assam Doctor Protection Act. The severity of the crime has resulted in some of the accused being denied bail, demonstrating a strong judicial stance.

In West Bengal, those responsible for the 2019 assault on Dr. Paribaha Mukherjee were also apprehended and charged. This case not only led to legal proceedings but also prompted the state to implement stricter laws and enhance hospital security.   In Madhya Pradesh, the perpetrators who attacked the Indore doctor were arrested and charged under the state’s new law categorising such violence as a non-bailable offence. This legal framework has been crucial in ensuring serious consequences for those who commit violence against doctors.   While these measures represent progress, challenges remain in ensuring consistent enforcement and raising public awareness. The medical community continues to advocate for a national law providing uniform protection for healthcare workers across India. Until such a law is enacted, a combination of state-level legislation, increased security, and public education efforts will be vital in addressing this growing concern.   While condemning the recent act of medical violence in Kolkata, healthcare industry body NATHEALTH stated that doctors and healthcare providers require a safe operating environment to deliver care and save lives. "Any act of violence against doctors or healthcare workers is unacceptable. NATHEALTH extends solidarity with medical professionals and urges the Government and law enforcement agencies to take stringent measures to ensure their safety,” said NATHEALTH, the healthcare federation of India.

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Lancet highlights disturbing RG Kar Rape Case: A call for protection of medical professionals

The tragic rape and murder of a postgraduate trainee doctor at RG Kar Medical College and Hospital in Kolkata have made headlines in The Lancet's August 24 edition, drawing international attention to the escalating violence and substandard working conditions faced by medical professionals in India.

The article, authored by Dinesh C. Sharma, underscores the dangerous environment in which healthcare workers operate, exacerbated by overcrowded hospitals, overworked staff, and inadequate facilities. The incident has sparked widespread protests and calls from the medical community for stronger protections and safety measures.

The Lancet article also amplifies concerns raised by the Indian Medical Association (IMA), questioning the safety of female doctors, particularly in rural and district hospitals. IMA's national president, R.V. Ashokan, has advocated for hospitals to be declared "safe zones" and for laws to shield medical personnel from violence.

Despite the embarrassment of international exposure, many in the medical field see this as a crucial moment to address the deep-rooted issues plaguing India's healthcare system, hoping that this spotlight will lead to much-needed reforms and increased security for healthcare workers.

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Top 20 Medical Representative Interview Questions (2024)

1) What are the challenges in being a Pharmaceutical Sales Person?

Free PDF Download: Medical Representative Interview Questions and Answers

2)  What are the key responsibilities of a Medical Representative (MR)?

• Increase Sales
• Increase awareness of the brand
• Increase market share
• Meet and exceed targets
• 6-7 calls per day and fixing appointments
• Manage the territory like a small business
• Build a relationship and convey product information

3)  How can you become a successful pharmaceutical representative?

• Positive Approach
• Good Network and Focussing on Sales call
• Good communication skills
• Good product knowledge
• Understanding market value of your product
• Good research on competitors and their sales target

4)  Explain why pharma sales is different than other sales?

• Pharmaceutical sales is an indirect sales role
• Pharmaceutical sales have no order to close or contract to sign
• It serves for an expert physician promoting product through education and awareness

5)  Is there any software available in the market to help to track their sales and progress?

6) How you can convince a physician to switch to your drug?

• Make your presence by setting small sales initially let say targeting 1 or 2 patient and target bigger later on
• Gain complete knowledge about the drug and observe the prescribing behaviour of physician
• Use your product knowledge and other tools to make physician understand your product.
• Once the physician show his confidence in the product,  push him to prescribe your product for more patients

7) What is your expectation from your sales manager?

• Provide you with all amenities and tools required for job
• Knowledge and tips to increase sales
• One who can assess your potential and set realistic goals
• One who supports and use his knowledge and yours to bring synergetic result

8) What will be your approach if you are given a territory and a list of physician to call on?

• Analyse and see the customers and their potential
• Gather all the data’s of sales particularly in the area you are given
• Target those physician or customers who have bigger sales potential

9) What is the training aspect, if one is selected for the sales representative position?

• University or school studying all the aspect of the product
• Training on field with an experienced representative
• Learning anatomy and physiology to competitor’s products

10) How many product does a med rep usually carry? How do you get bonuses paid on them?

11) how many sales calls are you supposed to make each day, 12) explain what are the pros and cons working for a small scale and large scale pharmaceutical company.

• It is easier to shine and advance at small pharmaceutical companies
• Small scale industries become big pharmaceutical companies very rapidly
• Small companies offer stock options as incentive to stay with them long-term
• Often smaller companies are sell out to larger companies, and the original stockholders get wealthy
• For entertaining clients, small pharmaceutical companies do not provide significant expenses
• Territories are bigger, and you have to drive more instead of working in a limited territory

13) How would you reach a physician who does not see a representative?

• Try to communicate with their staff (receptionists, medical secretaries, practice nurses, etc.)
• Send him product information and literature through e-mail
• Drop literature regarding product to their clinics
• Invite him to speaker meetings and see him at CME meetings

14) What do you prefer a long or short sales cycles?

15) explain as a medical representative what is your selling style to the physician.

• Be clear and precise about your product
• Use Pictures, Illustrations and Drawing and if possible use PowerPoint Presentation to show product
• Support your argument with evidence like case studies or clinical trial results
• Every drug has advantages and disadvantages- do not hide any information about product
• Maintain constant communication with the physician
• Build relationship with physician and staff

16) Explain what is your pre-call planning to a chemist?

• When did the distributor deliver the last order to the chemist
• What is the distributor frequency of visit
• What category of your drugs is the prime focus of his purchase and in what quantities
• Would you like to inform the pharmacy staff about a new drug launch
• Do you have any question about generic substitutions

17) Explain how should a sales call of a representative should end?

• Trial usage
• Repeat prescription
• Continued usage
• Extended usage
• Expanded usage

18) Explain what is meaning of Marketing Mix?

19) explain what is the role of a product manager.

• Market Analysis
• Segment Analysis
• Competitor Analysis
• Qualitative and Quantitative research
• Planning and Preparing the marketing mix
• Delivering the marketing mix

20) Explain what do you find most re-warding about being a med representative?

You might like:.

13 Comments

Great knowledge

Thank you for this informations

I want medical rep job Ple tell me vacancy

It is good work helps patients

That’s help me out to crack a interview thanks a lot

Yah good things for us

Lot of things depends upon company marketing strategies & company atmosphere to achieve the desired target.however medical representative can put their best efforts in market ethically,these days maximum Pharma companies are doing unethical practices and doing harreshment of med.reps in the name of targets,making them sole responsible for sales achievement, maixmum managers are just doing formalities in the field to achieve the target they provke reps for unethical practices & involve them & doctors in corruption activities as a result patients are suffering & looting by the companies day by day many evidence s come in news papers & social media,due to companies unnecessary pressure & work load lot of med.reps have lost their lives, companies are harreshing MRs/SRs day by day ,the future of this profession is in darkness, bcz of companies management behaviour and govt policies/amendments in labour laws, During & after COVID pharma companies got maximum benifits & revenue but harreshing med.reps maixmum physically, mentally & financially A Kolkata base old renowned company not paid 5 months salary & expences to their employees (med.rep) till dated & countinously harreshing unionised more than approx.200 employees (med reps.) FMRAI is fighting leagelly on behalf of its members.

Superb Very important questions and answers about a med representative. Thank you so much .

Thanks for too much important

This is so helpful.. Thank you so much.

Good knowledge,

Thank you for most important information

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Case Reports, Case Series – From Clinical Practice to Evidence-Based Medicine in Graduate Medical Education

Jerry w sayre.

1 Family Medicine, North Florida Regional Medical Center

Hale Z Toklu

2 Graduate Medical Education, North Florida Regional Medical Center

Joseph Mazza

3 Department of Clinical Research, Marshfield Clinic Research Foundation

Steven Yale

4 Internal Medicine, University of Central Florida College of Medicine

Case reports and case series or case study research are descriptive studies that are prepared for illustrating novel, unusual, or atypical features identified in patients in medical practice, and they potentially generate new research questions. They are empirical inquiries or investigations of a patient or a group of patients in a natural, real-world clinical setting. Case study research is a method that focuses on the contextual analysis of a number of events or conditions and their relationships. There is disagreement among physicians on the value of case studies in the medical literature, particularly for educators focused on teaching evidence-based medicine (EBM) for student learners in graduate medical education. Despite their limitations, case study research is a beneficial tool and learning experience in graduate medical education and among novice researchers. The preparation and presentation of case studies can help students and graduate medical education programs evaluate and apply the six American College of Graduate Medical Education (ACGME) competencies in the areas of medical knowledge, patient care, practice-based learning, professionalism, systems-based practice, and communication. A goal in graduate medical education should be to assist residents to expand their critical thinking, problem-solving, and decision-making skills. These attributes are required in the teaching and practice of EBM. In this aspect, case studies provide a platform for developing clinical skills and problem-based learning methods. Hence, graduate medical education programs should encourage, assist, and support residents in the publication of clinical case studies; and clinical teachers should encourage graduate students to publish case reports during their graduate medical education.

Introduction

Case reports and case series or case study research   are descriptive studies to present patients in their natural clinical setting. Case reports, which generally consist of three or fewer patients, are prepared to illustrate features in the practice of medicine and potentially create new research questions that may contribute to the acquisition of additional knowledge in the literature. Case studies involve multiple patients; they are a qualitative research method and include in-depth analyses or experiential inquiries of a person or group in their real-world setting. Case study research focuses on the contextual analysis of several events or conditions and their relationships [ 1 ]. In addition to their teaching value for students and graduate medical education programs, case reports provide a starting point for novice investigators, which may prepare and encourage them to seek more contextual writing experiences for future research investigation. It may also provide senior physicians with clues about emerging epidemics or a recognition of previously unrecognized syndromes. Limitations primarily involve the lack of generalizability and implications in clinical practice, which are factors extraneous to the learning model (Table ​ (Table1 1 ).

There is disagreement among physicians on the value of case reports in the medical literature and in evidence-based medicine (EBM) [ 2 ]. EBM aims to optimize decision-making by using evidence from well-conducted research. Therefore, not all data has the same value as the evidence. The pyramid (Figure ​ (Figure1) 1 ) classifies publications based on their study outlines and according to the power of evidence they provide [ 2 - 3 ]. In the classical pyramid represented below, systematic reviews and a meta-analysis are expected to provide the strongest evidence. However, a recent modification of the pyramid was suggested by Murad et al. [ 2 ]: the meta-analysis and systematic reviews are removed from the pyramid and are suggested to be a lens through which evidence is viewed (Figure 1 ). 

Modified from Murad et al. [ 2 ]

Because case reports do not rank highly in the hierarchy of evidence and are not frequently cited, as they describe the clinical circumstances of single patients, they are seldom published by high-impact medical journals. However, case reports are proposed to have significant educational value because they advance medical knowledge and constitute evidence for EBM. In addition, well-developed publication resources can be difficult to find, especially for medical residents; those that do exist vary in quality and may not be suitable for the aim and scope of the journals. Over the last several years, a number (approximately 160) of new peer-reviewed journals that focus on publishing case reports have emerged. These are mostly open-access journals with considerably high acceptance rates [ 4 ]. Packer et al. reported a 6% publication rate for case reports [ 5 ]; however, they did not disclose the number of papers submitted but rejected and neither did they state whether any of the reported cases were submitted to open-access journals.

The development of open-access journals has created a new venue for students and faculty to publish. In contrast to subscription-based and peer-reviewed e-journals, many of these new case report journals are not adequately reviewed and, instead, have a questionably high acceptance rate [ 4 ]. There, however, remains the issue of the fee-based publication of case reports in open-access journals without proper peer reviews, which increases the burden of scientific literature. Trainees should be made aware of the potential for academic dilution, particularly with some open-access publishers. While case reports with high-quality peer reviews are associated with a relatively low acceptance rate, this rigorous process introduces trainees to the experience and expectations of peer reviews and addresses other issues or flaws not considered prior to submission. We believe that these are important skills that should be emphasized and experienced during training, and authors should seek these journals for the submission of their manuscripts.

Importance of Case Reports and Case Series in Graduate Medical Education

The Accreditation Council for Graduate Medical Education (ACGME) has challenged faculties to adapt teaching methodologies to accommodate the different learning modalities of the next generation of physicians. As evidenced by its implementation by ACGME, competency-based medical education is rapidly gaining international acceptance, moving from classic didactic lectures to self-directed learning opportunities with experiential learning aids in the development of critical cognitive and scholarly skills. As graduate medical educators, we are in agreement with Packer et al. about the value of the educational benefits resulting from student-generated case reports [ 5 ]. Case study assignments help residents develop a variety of key skills, as previously described. EBM is an eventual decision-making process for executing the most appropriate treatment approach by using the tools that are compatible with the national health policy, medical evidence, and the personal factors of physician and patient (Figure ​ (Figure2). The 2 ). The practice of identifying and developing a case study creates a learning opportunity for listening skills and appreciation for the patient’s narrative as well as for developing critical learning and thinking skills that are directly applicable to the practice of EBM. This critically important process simultaneously enhances both the medical and the humanistic importance of physician-patient interaction. In addition, case-based learning is an active learner-centered approach for medical students and residents. It serves as a curricular context, which can promote the retention of information and evidence-based thinking.

Modified from Toklu et al. 2015 [ 3 ]

The value of case studies in the medical literature is controversial among physicians. Despite their limitations, clinical case reports and case series are beneficial tools in graduate medical education. The preparation and presentation of case studies can help students and residents acquire and apply clinical competencies in the areas of medical knowledge, practice-based learning, systems-based practice, professionalism, and communication. In this aspect, case studies provide a tool for developing clinical skills through problem-based learning methods. As a result, journals should encourage the publication of clinical case studies from graduate medical education programs through a commonly applied peer-review process, and clinical teachers should promote medical residents to publish case reports during their graduate medical education.

The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Do not disregard or avoid professional medical advice due to content published within Cureus.

The authors have declared that no competing interests exist.

• Open access
• Published: 27 June 2011

The case study approach

• Sarah Crowe 1 ,
• Kathrin Cresswell 2 ,
• Ann Robertson 2 ,
• Guro Huby 3 ,
• Anthony Avery 1 &
• Aziz Sheikh 2  

BMC Medical Research Methodology volume  11 , Article number:  100 ( 2011 ) Cite this article

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The case study approach allows in-depth, multi-faceted explorations of complex issues in their real-life settings. The value of the case study approach is well recognised in the fields of business, law and policy, but somewhat less so in health services research. Based on our experiences of conducting several health-related case studies, we reflect on the different types of case study design, the specific research questions this approach can help answer, the data sources that tend to be used, and the particular advantages and disadvantages of employing this methodological approach. The paper concludes with key pointers to aid those designing and appraising proposals for conducting case study research, and a checklist to help readers assess the quality of case study reports.

Peer Review reports

Introduction

The case study approach is particularly useful to employ when there is a need to obtain an in-depth appreciation of an issue, event or phenomenon of interest, in its natural real-life context. Our aim in writing this piece is to provide insights into when to consider employing this approach and an overview of key methodological considerations in relation to the design, planning, analysis, interpretation and reporting of case studies.

The illustrative 'grand round', 'case report' and 'case series' have a long tradition in clinical practice and research. Presenting detailed critiques, typically of one or more patients, aims to provide insights into aspects of the clinical case and, in doing so, illustrate broader lessons that may be learnt. In research, the conceptually-related case study approach can be used, for example, to describe in detail a patient's episode of care, explore professional attitudes to and experiences of a new policy initiative or service development or more generally to 'investigate contemporary phenomena within its real-life context' [ 1 ]. Based on our experiences of conducting a range of case studies, we reflect on when to consider using this approach, discuss the key steps involved and illustrate, with examples, some of the practical challenges of attaining an in-depth understanding of a 'case' as an integrated whole. In keeping with previously published work, we acknowledge the importance of theory to underpin the design, selection, conduct and interpretation of case studies[ 2 ]. In so doing, we make passing reference to the different epistemological approaches used in case study research by key theoreticians and methodologists in this field of enquiry.

This paper is structured around the following main questions: What is a case study? What are case studies used for? How are case studies conducted? What are the potential pitfalls and how can these be avoided? We draw in particular on four of our own recently published examples of case studies (see Tables 1 , 2 , 3 and 4 ) and those of others to illustrate our discussion[ 3 – 7 ].

What is a case study?

A case study is a research approach that is used to generate an in-depth, multi-faceted understanding of a complex issue in its real-life context. It is an established research design that is used extensively in a wide variety of disciplines, particularly in the social sciences. A case study can be defined in a variety of ways (Table 5 ), the central tenet being the need to explore an event or phenomenon in depth and in its natural context. It is for this reason sometimes referred to as a "naturalistic" design; this is in contrast to an "experimental" design (such as a randomised controlled trial) in which the investigator seeks to exert control over and manipulate the variable(s) of interest.

Stake's work has been particularly influential in defining the case study approach to scientific enquiry. He has helpfully characterised three main types of case study: intrinsic , instrumental and collective [ 8 ]. An intrinsic case study is typically undertaken to learn about a unique phenomenon. The researcher should define the uniqueness of the phenomenon, which distinguishes it from all others. In contrast, the instrumental case study uses a particular case (some of which may be better than others) to gain a broader appreciation of an issue or phenomenon. The collective case study involves studying multiple cases simultaneously or sequentially in an attempt to generate a still broader appreciation of a particular issue.

These are however not necessarily mutually exclusive categories. In the first of our examples (Table 1 ), we undertook an intrinsic case study to investigate the issue of recruitment of minority ethnic people into the specific context of asthma research studies, but it developed into a instrumental case study through seeking to understand the issue of recruitment of these marginalised populations more generally, generating a number of the findings that are potentially transferable to other disease contexts[ 3 ]. In contrast, the other three examples (see Tables 2 , 3 and 4 ) employed collective case study designs to study the introduction of workforce reconfiguration in primary care, the implementation of electronic health records into hospitals, and to understand the ways in which healthcare students learn about patient safety considerations[ 4 – 6 ]. Although our study focusing on the introduction of General Practitioners with Specialist Interests (Table 2 ) was explicitly collective in design (four contrasting primary care organisations were studied), is was also instrumental in that this particular professional group was studied as an exemplar of the more general phenomenon of workforce redesign[ 4 ].

What are case studies used for?

According to Yin, case studies can be used to explain, describe or explore events or phenomena in the everyday contexts in which they occur[ 1 ]. These can, for example, help to understand and explain causal links and pathways resulting from a new policy initiative or service development (see Tables 2 and 3 , for example)[ 1 ]. In contrast to experimental designs, which seek to test a specific hypothesis through deliberately manipulating the environment (like, for example, in a randomised controlled trial giving a new drug to randomly selected individuals and then comparing outcomes with controls),[ 9 ] the case study approach lends itself well to capturing information on more explanatory ' how ', 'what' and ' why ' questions, such as ' how is the intervention being implemented and received on the ground?'. The case study approach can offer additional insights into what gaps exist in its delivery or why one implementation strategy might be chosen over another. This in turn can help develop or refine theory, as shown in our study of the teaching of patient safety in undergraduate curricula (Table 4 )[ 6 , 10 ]. Key questions to consider when selecting the most appropriate study design are whether it is desirable or indeed possible to undertake a formal experimental investigation in which individuals and/or organisations are allocated to an intervention or control arm? Or whether the wish is to obtain a more naturalistic understanding of an issue? The former is ideally studied using a controlled experimental design, whereas the latter is more appropriately studied using a case study design.

Case studies may be approached in different ways depending on the epistemological standpoint of the researcher, that is, whether they take a critical (questioning one's own and others' assumptions), interpretivist (trying to understand individual and shared social meanings) or positivist approach (orientating towards the criteria of natural sciences, such as focusing on generalisability considerations) (Table 6 ). Whilst such a schema can be conceptually helpful, it may be appropriate to draw on more than one approach in any case study, particularly in the context of conducting health services research. Doolin has, for example, noted that in the context of undertaking interpretative case studies, researchers can usefully draw on a critical, reflective perspective which seeks to take into account the wider social and political environment that has shaped the case[ 11 ].

How are case studies conducted?

Here, we focus on the main stages of research activity when planning and undertaking a case study; the crucial stages are: defining the case; selecting the case(s); collecting and analysing the data; interpreting data; and reporting the findings.

Defining the case

Carefully formulated research question(s), informed by the existing literature and a prior appreciation of the theoretical issues and setting(s), are all important in appropriately and succinctly defining the case[ 8 , 12 ]. Crucially, each case should have a pre-defined boundary which clarifies the nature and time period covered by the case study (i.e. its scope, beginning and end), the relevant social group, organisation or geographical area of interest to the investigator, the types of evidence to be collected, and the priorities for data collection and analysis (see Table 7 )[ 1 ]. A theory driven approach to defining the case may help generate knowledge that is potentially transferable to a range of clinical contexts and behaviours; using theory is also likely to result in a more informed appreciation of, for example, how and why interventions have succeeded or failed[ 13 ].

For example, in our evaluation of the introduction of electronic health records in English hospitals (Table 3 ), we defined our cases as the NHS Trusts that were receiving the new technology[ 5 ]. Our focus was on how the technology was being implemented. However, if the primary research interest had been on the social and organisational dimensions of implementation, we might have defined our case differently as a grouping of healthcare professionals (e.g. doctors and/or nurses). The precise beginning and end of the case may however prove difficult to define. Pursuing this same example, when does the process of implementation and adoption of an electronic health record system really begin or end? Such judgements will inevitably be influenced by a range of factors, including the research question, theory of interest, the scope and richness of the gathered data and the resources available to the research team.

Selecting the case(s)

The decision on how to select the case(s) to study is a very important one that merits some reflection. In an intrinsic case study, the case is selected on its own merits[ 8 ]. The case is selected not because it is representative of other cases, but because of its uniqueness, which is of genuine interest to the researchers. This was, for example, the case in our study of the recruitment of minority ethnic participants into asthma research (Table 1 ) as our earlier work had demonstrated the marginalisation of minority ethnic people with asthma, despite evidence of disproportionate asthma morbidity[ 14 , 15 ]. In another example of an intrinsic case study, Hellstrom et al.[ 16 ] studied an elderly married couple living with dementia to explore how dementia had impacted on their understanding of home, their everyday life and their relationships.

For an instrumental case study, selecting a "typical" case can work well[ 8 ]. In contrast to the intrinsic case study, the particular case which is chosen is of less importance than selecting a case that allows the researcher to investigate an issue or phenomenon. For example, in order to gain an understanding of doctors' responses to health policy initiatives, Som undertook an instrumental case study interviewing clinicians who had a range of responsibilities for clinical governance in one NHS acute hospital trust[ 17 ]. Sampling a "deviant" or "atypical" case may however prove even more informative, potentially enabling the researcher to identify causal processes, generate hypotheses and develop theory.

In collective or multiple case studies, a number of cases are carefully selected. This offers the advantage of allowing comparisons to be made across several cases and/or replication. Choosing a "typical" case may enable the findings to be generalised to theory (i.e. analytical generalisation) or to test theory by replicating the findings in a second or even a third case (i.e. replication logic)[ 1 ]. Yin suggests two or three literal replications (i.e. predicting similar results) if the theory is straightforward and five or more if the theory is more subtle. However, critics might argue that selecting 'cases' in this way is insufficiently reflexive and ill-suited to the complexities of contemporary healthcare organisations.

The selected case study site(s) should allow the research team access to the group of individuals, the organisation, the processes or whatever else constitutes the chosen unit of analysis for the study. Access is therefore a central consideration; the researcher needs to come to know the case study site(s) well and to work cooperatively with them. Selected cases need to be not only interesting but also hospitable to the inquiry [ 8 ] if they are to be informative and answer the research question(s). Case study sites may also be pre-selected for the researcher, with decisions being influenced by key stakeholders. For example, our selection of case study sites in the evaluation of the implementation and adoption of electronic health record systems (see Table 3 ) was heavily influenced by NHS Connecting for Health, the government agency that was responsible for overseeing the National Programme for Information Technology (NPfIT)[ 5 ]. This prominent stakeholder had already selected the NHS sites (through a competitive bidding process) to be early adopters of the electronic health record systems and had negotiated contracts that detailed the deployment timelines.

It is also important to consider in advance the likely burden and risks associated with participation for those who (or the site(s) which) comprise the case study. Of particular importance is the obligation for the researcher to think through the ethical implications of the study (e.g. the risk of inadvertently breaching anonymity or confidentiality) and to ensure that potential participants/participating sites are provided with sufficient information to make an informed choice about joining the study. The outcome of providing this information might be that the emotive burden associated with participation, or the organisational disruption associated with supporting the fieldwork, is considered so high that the individuals or sites decide against participation.

In our example of evaluating implementations of electronic health record systems, given the restricted number of early adopter sites available to us, we sought purposively to select a diverse range of implementation cases among those that were available[ 5 ]. We chose a mixture of teaching, non-teaching and Foundation Trust hospitals, and examples of each of the three electronic health record systems procured centrally by the NPfIT. At one recruited site, it quickly became apparent that access was problematic because of competing demands on that organisation. Recognising the importance of full access and co-operative working for generating rich data, the research team decided not to pursue work at that site and instead to focus on other recruited sites.

Collecting the data

In order to develop a thorough understanding of the case, the case study approach usually involves the collection of multiple sources of evidence, using a range of quantitative (e.g. questionnaires, audits and analysis of routinely collected healthcare data) and more commonly qualitative techniques (e.g. interviews, focus groups and observations). The use of multiple sources of data (data triangulation) has been advocated as a way of increasing the internal validity of a study (i.e. the extent to which the method is appropriate to answer the research question)[ 8 , 18 – 21 ]. An underlying assumption is that data collected in different ways should lead to similar conclusions, and approaching the same issue from different angles can help develop a holistic picture of the phenomenon (Table 2 )[ 4 ].

Brazier and colleagues used a mixed-methods case study approach to investigate the impact of a cancer care programme[ 22 ]. Here, quantitative measures were collected with questionnaires before, and five months after, the start of the intervention which did not yield any statistically significant results. Qualitative interviews with patients however helped provide an insight into potentially beneficial process-related aspects of the programme, such as greater, perceived patient involvement in care. The authors reported how this case study approach provided a number of contextual factors likely to influence the effectiveness of the intervention and which were not likely to have been obtained from quantitative methods alone.

In collective or multiple case studies, data collection needs to be flexible enough to allow a detailed description of each individual case to be developed (e.g. the nature of different cancer care programmes), before considering the emerging similarities and differences in cross-case comparisons (e.g. to explore why one programme is more effective than another). It is important that data sources from different cases are, where possible, broadly comparable for this purpose even though they may vary in nature and depth.

Analysing, interpreting and reporting case studies

Making sense and offering a coherent interpretation of the typically disparate sources of data (whether qualitative alone or together with quantitative) is far from straightforward. Repeated reviewing and sorting of the voluminous and detail-rich data are integral to the process of analysis. In collective case studies, it is helpful to analyse data relating to the individual component cases first, before making comparisons across cases. Attention needs to be paid to variations within each case and, where relevant, the relationship between different causes, effects and outcomes[ 23 ]. Data will need to be organised and coded to allow the key issues, both derived from the literature and emerging from the dataset, to be easily retrieved at a later stage. An initial coding frame can help capture these issues and can be applied systematically to the whole dataset with the aid of a qualitative data analysis software package.

The Framework approach is a practical approach, comprising of five stages (familiarisation; identifying a thematic framework; indexing; charting; mapping and interpretation) , to managing and analysing large datasets particularly if time is limited, as was the case in our study of recruitment of South Asians into asthma research (Table 1 )[ 3 , 24 ]. Theoretical frameworks may also play an important role in integrating different sources of data and examining emerging themes. For example, we drew on a socio-technical framework to help explain the connections between different elements - technology; people; and the organisational settings within which they worked - in our study of the introduction of electronic health record systems (Table 3 )[ 5 ]. Our study of patient safety in undergraduate curricula drew on an evaluation-based approach to design and analysis, which emphasised the importance of the academic, organisational and practice contexts through which students learn (Table 4 )[ 6 ].

Case study findings can have implications both for theory development and theory testing. They may establish, strengthen or weaken historical explanations of a case and, in certain circumstances, allow theoretical (as opposed to statistical) generalisation beyond the particular cases studied[ 12 ]. These theoretical lenses should not, however, constitute a strait-jacket and the cases should not be "forced to fit" the particular theoretical framework that is being employed.

When reporting findings, it is important to provide the reader with enough contextual information to understand the processes that were followed and how the conclusions were reached. In a collective case study, researchers may choose to present the findings from individual cases separately before amalgamating across cases. Care must be taken to ensure the anonymity of both case sites and individual participants (if agreed in advance) by allocating appropriate codes or withholding descriptors. In the example given in Table 3 , we decided against providing detailed information on the NHS sites and individual participants in order to avoid the risk of inadvertent disclosure of identities[ 5 , 25 ].

What are the potential pitfalls and how can these be avoided?

The case study approach is, as with all research, not without its limitations. When investigating the formal and informal ways undergraduate students learn about patient safety (Table 4 ), for example, we rapidly accumulated a large quantity of data. The volume of data, together with the time restrictions in place, impacted on the depth of analysis that was possible within the available resources. This highlights a more general point of the importance of avoiding the temptation to collect as much data as possible; adequate time also needs to be set aside for data analysis and interpretation of what are often highly complex datasets.

Case study research has sometimes been criticised for lacking scientific rigour and providing little basis for generalisation (i.e. producing findings that may be transferable to other settings)[ 1 ]. There are several ways to address these concerns, including: the use of theoretical sampling (i.e. drawing on a particular conceptual framework); respondent validation (i.e. participants checking emerging findings and the researcher's interpretation, and providing an opinion as to whether they feel these are accurate); and transparency throughout the research process (see Table 8 )[ 8 , 18 – 21 , 23 , 26 ]. Transparency can be achieved by describing in detail the steps involved in case selection, data collection, the reasons for the particular methods chosen, and the researcher's background and level of involvement (i.e. being explicit about how the researcher has influenced data collection and interpretation). Seeking potential, alternative explanations, and being explicit about how interpretations and conclusions were reached, help readers to judge the trustworthiness of the case study report. Stake provides a critique checklist for a case study report (Table 9 )[ 8 ].

Conclusions

The case study approach allows, amongst other things, critical events, interventions, policy developments and programme-based service reforms to be studied in detail in a real-life context. It should therefore be considered when an experimental design is either inappropriate to answer the research questions posed or impossible to undertake. Considering the frequency with which implementations of innovations are now taking place in healthcare settings and how well the case study approach lends itself to in-depth, complex health service research, we believe this approach should be more widely considered by researchers. Though inherently challenging, the research case study can, if carefully conceptualised and thoughtfully undertaken and reported, yield powerful insights into many important aspects of health and healthcare delivery.

Yin RK: Case study research, design and method. 2009, London: Sage Publications Ltd., 4

Google Scholar  

Keen J, Packwood T: Qualitative research; case study evaluation. BMJ. 1995, 311: 444-446.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Sheikh A, Halani L, Bhopal R, Netuveli G, Partridge M, Car J, et al: Facilitating the Recruitment of Minority Ethnic People into Research: Qualitative Case Study of South Asians and Asthma. PLoS Med. 2009, 6 (10): 1-11.

Article   Google Scholar  

Pinnock H, Huby G, Powell A, Kielmann T, Price D, Williams S, et al: The process of planning, development and implementation of a General Practitioner with a Special Interest service in Primary Care Organisations in England and Wales: a comparative prospective case study. Report for the National Co-ordinating Centre for NHS Service Delivery and Organisation R&D (NCCSDO). 2008, [ http://www.sdo.nihr.ac.uk/files/project/99-final-report.pdf ]

Robertson A, Cresswell K, Takian A, Petrakaki D, Crowe S, Cornford T, et al: Prospective evaluation of the implementation and adoption of NHS Connecting for Health's national electronic health record in secondary care in England: interim findings. BMJ. 2010, 41: c4564-

Pearson P, Steven A, Howe A, Sheikh A, Ashcroft D, Smith P, the Patient Safety Education Study Group: Learning about patient safety: organisational context and culture in the education of healthcare professionals. J Health Serv Res Policy. 2010, 15: 4-10. 10.1258/jhsrp.2009.009052.

Article   PubMed   Google Scholar  

van Harten WH, Casparie TF, Fisscher OA: The evaluation of the introduction of a quality management system: a process-oriented case study in a large rehabilitation hospital. Health Policy. 2002, 60 (1): 17-37. 10.1016/S0168-8510(01)00187-7.

Stake RE: The art of case study research. 1995, London: Sage Publications Ltd.

Sheikh A, Smeeth L, Ashcroft R: Randomised controlled trials in primary care: scope and application. Br J Gen Pract. 2002, 52 (482): 746-51.

PubMed   PubMed Central   Google Scholar  

King G, Keohane R, Verba S: Designing Social Inquiry. 1996, Princeton: Princeton University Press

Doolin B: Information technology as disciplinary technology: being critical in interpretative research on information systems. Journal of Information Technology. 1998, 13: 301-311. 10.1057/jit.1998.8.

George AL, Bennett A: Case studies and theory development in the social sciences. 2005, Cambridge, MA: MIT Press

Eccles M, the Improved Clinical Effectiveness through Behavioural Research Group (ICEBeRG): Designing theoretically-informed implementation interventions. Implementation Science. 2006, 1: 1-8. 10.1186/1748-5908-1-1.

Article   PubMed Central   Google Scholar  

Netuveli G, Hurwitz B, Levy M, Fletcher M, Barnes G, Durham SR, Sheikh A: Ethnic variations in UK asthma frequency, morbidity, and health-service use: a systematic review and meta-analysis. Lancet. 2005, 365 (9456): 312-7.

Sheikh A, Panesar SS, Lasserson T, Netuveli G: Recruitment of ethnic minorities to asthma studies. Thorax. 2004, 59 (7): 634-

CAS   PubMed   PubMed Central   Google Scholar  

Hellström I, Nolan M, Lundh U: 'We do things together': A case study of 'couplehood' in dementia. Dementia. 2005, 4: 7-22. 10.1177/1471301205049188.

Som CV: Nothing seems to have changed, nothing seems to be changing and perhaps nothing will change in the NHS: doctors' response to clinical governance. International Journal of Public Sector Management. 2005, 18: 463-477. 10.1108/09513550510608903.

Lincoln Y, Guba E: Naturalistic inquiry. 1985, Newbury Park: Sage Publications

Barbour RS: Checklists for improving rigour in qualitative research: a case of the tail wagging the dog?. BMJ. 2001, 322: 1115-1117. 10.1136/bmj.322.7294.1115.

Mays N, Pope C: Qualitative research in health care: Assessing quality in qualitative research. BMJ. 2000, 320: 50-52. 10.1136/bmj.320.7226.50.

Mason J: Qualitative researching. 2002, London: Sage

Brazier A, Cooke K, Moravan V: Using Mixed Methods for Evaluating an Integrative Approach to Cancer Care: A Case Study. Integr Cancer Ther. 2008, 7: 5-17. 10.1177/1534735407313395.

Miles MB, Huberman M: Qualitative data analysis: an expanded sourcebook. 1994, CA: Sage Publications Inc., 2

Pope C, Ziebland S, Mays N: Analysing qualitative data. Qualitative research in health care. BMJ. 2000, 320: 114-116. 10.1136/bmj.320.7227.114.

Cresswell KM, Worth A, Sheikh A: Actor-Network Theory and its role in understanding the implementation of information technology developments in healthcare. BMC Med Inform Decis Mak. 2010, 10 (1): 67-10.1186/1472-6947-10-67.

Article   PubMed   PubMed Central   Google Scholar  

Malterud K: Qualitative research: standards, challenges, and guidelines. Lancet. 2001, 358: 483-488. 10.1016/S0140-6736(01)05627-6.

Article   CAS   PubMed   Google Scholar  

Yin R: Case study research: design and methods. 1994, Thousand Oaks, CA: Sage Publishing, 2

Yin R: Enhancing the quality of case studies in health services research. Health Serv Res. 1999, 34: 1209-1224.

Green J, Thorogood N: Qualitative methods for health research. 2009, Los Angeles: Sage, 2

Howcroft D, Trauth E: Handbook of Critical Information Systems Research, Theory and Application. 2005, Cheltenham, UK: Northampton, MA, USA: Edward Elgar

Book   Google Scholar  

Blakie N: Approaches to Social Enquiry. 1993, Cambridge: Polity Press

Doolin B: Power and resistance in the implementation of a medical management information system. Info Systems J. 2004, 14: 343-362. 10.1111/j.1365-2575.2004.00176.x.

Bloomfield BP, Best A: Management consultants: systems development, power and the translation of problems. Sociological Review. 1992, 40: 533-560.

Shanks G, Parr A: Positivist, single case study research in information systems: A critical analysis. Proceedings of the European Conference on Information Systems. 2003, Naples

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Acknowledgements

We are grateful to the participants and colleagues who contributed to the individual case studies that we have drawn on. This work received no direct funding, but it has been informed by projects funded by Asthma UK, the NHS Service Delivery Organisation, NHS Connecting for Health Evaluation Programme, and Patient Safety Research Portfolio. We would also like to thank the expert reviewers for their insightful and constructive feedback. Our thanks are also due to Dr. Allison Worth who commented on an earlier draft of this manuscript.

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• Volume 2, Issue 1
• Defining representativeness of study samples in medical and population health research
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• http://orcid.org/0000-0001-7177-1847 Jacqueline E Rudolph ,
• Yongqi Zhong ,
• Priya Duggal ,
• Shruti H Mehta and
• Department of Epidemiology , Bloomberg School of Public Health, Johns Hopkins University , Baltimore , MD , USA
• Correspondence to Dr Jacqueline E Rudolph, Department of Epidemiology, Johns Hopkins University, Baltimore, MD 21205, USA; jacqueline.rudolph{at}jhu.edu

Medical and population health science researchers frequently make ambiguous statements about whether they believe their study sample or results are representative of some (implicit or explicit) target population. This article provides a comprehensive definition of representativeness, with the goal of capturing the different ways in which a study can be representative of a target population. It is proposed that a study is representative if the estimate obtained in the study sample is generalisable to the target population (owing to representative sampling, estimation of stratum specific effects, or quantitative methods to generalise or transport estimates) or the interpretation of the results is generalisable to the target population (based on fundamental scientific premises and substantive background knowledge). This definition is explored in the context of four covid-19 studies, ranging from laboratory science to descriptive epidemiology. All statements regarding representativeness should make clear the way in which the study results generalise, the target population the results are being generalised to, and the assumptions that must hold for that generalisation to be scientifically or statistically justifiable.

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https://doi.org/10.1136/bmjmed-2022-000399

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KEY MESSAGES

Researchers frequently refer to whether their sample is or is not representative without clarifying whether they mean that their sample is a simple random sample of their target population or that the results from their sample are merely reflective of what would be seen in the target population

This article provides a comprehensive definition of what it means for a study to be representative, and examines this definition in the context of examples with different study designs

When publishing research, researchers should critically assess whether a study sample is representative of a clearly defined target population, by carefully considering the manner in which they think the results generalise to the target population and the assumptions underlying that hypothesis

Introduction

It is common if not a requirement for medical and population health science researchers to consider the inferences from a study beyond the context of their analysis. Accordingly, many papers mention whether their study sample is representative of, or study results generalise to, some implicit or explicit target population; others refer to a lack of generalisability or representativeness as a limitation. Despite being frequently discussed and debated, 1–4 in common practice, the meaning of representativeness remains ambiguous. Here, we propose a comprehensive definition of representativeness and discuss it in the context of different study designs. We presume no bias in the study’s results; in any real world study, bias will need to be weighed alongside whether the sample is representative or its results are generalisable or applicable to a target population. 5

What is representativeness?

The ambiguity in meaning arises in part because the word “representative” has a broader meaning in English and a more technical definition, and the definition being used is not always clear. In a 2013 series of commentaries on representativeness, 1–4 the concept was defined as occurring when the study sample is a simple random sample of the target population (ie, the sample that arises through representative sampling). A second definition is that the study sample and the results obtained merely resemble what would be expected in the target population, perhaps based on a similarity in personal characteristics. 6 The first definition is more precise and implies a high standard for study design, while the second encompasses a variety of possible interpretations.

Here, we bridge these two uses of the word “representative” and attempt to concretise the second, broader definition. We define a study sample to be representative of a well defined target population if the results estimated in that sample are generalisable to the target population. We consider two ways in which study results can generalise to the target population: in estimate and in interpretation. Box 1 lists a summary of key terms used in this article and figures 1–2 show examples applying the definition of representativeness.

Effect measure modifiers: variables that influence (ie, weaken or strengthen) the relation between the treatment and outcome

Estimate: numerical result (eg, mean, risk, risk difference, risk ratio, odds ratio) obtained in the study sample

Generalisable: findings in the study sample study apply to an overlapping target population (ie, study sample is at least a partial subset of the target population)

Interpretation: knowledge or information learnt from the numerical estimate, such as the direction of effect or other study conclusions

Key covariates: variables that affect the outcome, which might be effect measure modifier on some scale (eg, risk difference, risk ratio, odds ratio) and must be considered if generalising the estimate to a target population

Representative: a study sample is representative of a well defined target population if either the estimate obtained in that sample or the interpretation of the results in that sample are generalisable to the target population

Target population: population to which the researcher seeks to make inference

Transportable: findings in the study sample study apply to a non-overlapping target population (ie, study sample is not a subset of the target population)

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Example where a study sample (which is a simple random sample of the target population) is representative because its results generalise in interpretation and in estimate. Shaded box=treatment group; hashed lines=outcome group. Colours represent different levels of an effect measure modifier on the risk difference scale, which did not affect selection into the study sample

Example where a study sample (which is a convenience sample of the target population) is representative because its results generalise in interpretation even though they do not generalise in estimate. Shaded box=treatment group; hashed lines=outcome group. Colours represent different levels of an effect measure modifier on the risk difference scale, which affected selection into the study sample

To help clarify these definitions, we use as an example a randomised controlled trial that was conducted to measure the efficacy of molnupiravir for treatment of covid-19. 7 Among unvaccinated adults with mild to moderate covid-19 who were not in the hospital, researchers found that the risk of hospital admission or death at 29 days among participants randomised to molnupiravir was 6.8%, compared with 9.7% of participants randomised to placebo. They concluded that treatment with molnupiravir within five days of infection reduced the risk of hospital admission or death. In boxes 2–4 , we explore the definitions in the context of other study designs. 8–10 As with the trial, we use the question, study design, and sample description of these publications to construct a theoretical example. We do not delve into the specific details of the study or comment on whether the researchers fully achieved what we discuss.

Defining representativeness in laboratory science studies

At the start of the covid-19 pandemic, no antiviral drugs for infection or disease had been approved. To assess whether antiviral drug molnupiravir was effective for treating covid-19, researchers in one animal model study gave molnupiravir to mice with human lung tissue before and after infection with SARS-CoV-2, using doses scaled from appropriate human levels to the mouse model. 8 They found that a 2 day course of treatment, started 24 hours after infection, significantly reduced SARS-CoV-2 viraemia in lung tissue.

Target population

All humans with recent SARS-CoV-2 infection.

Generalisability of interpretation

Yes. We likely can hypothesise that the beneficial effect of molnupiravir observed in the mice would be observed in humans, based on the validity of the human lung tissue model and on the observation of a similar pathological response to covid-19 in the lung tissue of the mice as has been seen in the lung tissue of patients with covid-19.

Generalisability of estimate

No. While the study used human lung tissue in mice and used an appropriately scaled dose, the lung tissue was otherwise isolated from human biology, and mouse immune responses differ from those seen in humans in a manner that would be very difficult to quantify.

In this animal model study, generalising the interpretation of the results was the primary goal. Generalisation of the estimate was not relevant, as the drug would be tested further in human studies. When it comes to animal model studies (or cell line studies), we need to recognise that an underlying assumption is that the strength of the unaccounted-for effect measure modifiers (which are likely unknown) and the difference in the distribution of the effect measure modifiers between the study sample and human target population is not large enough to change the inference being made. This strong assumption is why animal studies are followed up by clinical trials to ensure that interpretation does indeed generalise and to obtain a quantifiable estimate of the effect in humans.

Defining representativeness in observational studies

Researchers used testing, hospital, and vaccine registry databases to build an observational cohort of vaccinated adults living in New York, with age matched unvaccinated controls. 9 Their goal was to assess the effectiveness of covid-19 vaccines for preventing SARS-CoV-2 infection and covid-19 related hospital admission in the general population. They found that vaccine effectiveness for preventing infection was highest in the week of 1 May 2021 (93.4%) (when prevalence of the delta variant was negligible), but that effectiveness declined as the delta variant became more prevalent, with a low of 73.5% in the week of 10 July 2021. By contrast, the effectiveness for preventing hospital admission did not wane during this same calendar period. The researchers concluded that their findings were evidence in support of booster vaccines.

Adult residents of New York state.

Yes. We have little reason to suspect that vaccines would not be effective against covid-19 and hospital admission or that we would observe different trends in vaccine effectiveness over time among New York residents who were not included in this study (or residents of other US states).

Additional data needed. The registry based study included a wide range of ages and the different vaccine types (Pfizer, Moderna, and Johnson & Johnson). The paper did not report the distribution of comorbid conditions such as asthma, which could be potential effect measure modifiers. With such information, researchers may be able to determine whether the estimate could be generalised to the broader New York population.

Here, generalising the interpretation and the estimate are both important. Generalising the estimate to the target population requires more effort both from the researchers designing the study and from those analysing the data but could be incredibly useful for informing covid-19 prevention efforts in New York. If we wished to generalise to target populations beyond New York (eg, the entire US), we would need to make assumptions about whether there are effect measure modifiers that differ between New York and the entire US and whether we have them measured.

Defining representativeness in descriptive studies

Researchers sought to capture the burden of covid-19 among people who inject drugs in the San Diego-Tijuana area. 10 Participants from both cities were recruited using street outreach and mobile vans. Blood samples and nasal swabs were collected to test for the presence of SARS-CoV-2 antibodies and RNA. None of the 485 participants had detectable SARS-CoV-2 RNA, but 140 (36.3%) were seropositive based on the presence of antibodies. This proportion was larger than the prevalence reported in the general population for either city. No trends were seen in prevalence of antibodies to SARS-CoV-2 over the study period (October 2020-June 2021).

People who use drugs by injection in the San Diego-Tijuana region.

Yes. It is reasonable that the target population has a higher prevalence of SARS-CoV-2 than the general population, even beyond the time frame and sample studied.

Perhaps. Under an appropriate sampling and recruitment strategy, the 36.3% prevalence of SARS-CoV-2 could be generalised to the full sample of the target population, at least during the time frame examined. We would be unable to generalise the estimate to other points in the pandemic, with different SARS-CoV-2 strains and levels of community exchange.

Just as in the observational study, generalising both the estimate and the interpretation are important for assessing the relevance of this study. We note here that the target population selected was much narrower than those of the previous studies, but this reflects the research and public health goals of the study. The researchers likely could not make statements regarding representativeness to broader target populations (eg, all people who inject drugs in the US) without further evidence.

Generalisable in estimate

A sample is representative if its results are generalisable in estimate. For a given estimand (eg, risk difference, odds ratio, population mean), the estimate obtained in the study sample is the same within a margin of error as what would be estimated in the target population. In the molnupiravir randomised controlled trial, 7 we might hypothesise that the risk difference comparing molnupiravir with placebo estimated in the trial is the same risk difference as would be estimated in the target population of all adults with recent SARS-CoV-2 infection who were not in the hospital. Generalising the estimate obtained in a given study sample might be considered the primary goal when intending to quantitatively inform policy interventions or when obtaining effect estimates in the target population is impossible or infeasible. 11

Generalisability in estimate can be achieved if the distributions of key covariates are the same as in the target population, as would occur in expectation with random sampling. Thus, generalising the estimate aligns closely with the definition of representativeness based on representative sampling. These key covariates are those that affect the variable under study (eg, hospital admission or death) and thus are potential effect measure modifiers of the effect of a treatment on that variable. By effect measure modifiers, we mean variables where the effect of the treatment differs by levels of that variable on some scale (eg, risk difference, risk ratio, odds ratio). In our example, age might be an effect measure modifier because the effect of molnupiravir on hospital admission or death (as quantified by the risk difference) might differ across ages.

More generally, even if the distribution of the key covariates differs between the sample and target population, the sample might still be representative within stratums of the key covariates, such that the stratum specific estimates (eg, risk difference within age categories) can be generalised from the sample to the target population. While this generalisation requires that all the key covariates be measured, the proportion of the sample in the covariate stratums need not exactly match the proportion who fall into that subgroup in the target population.

If we apply this definition of generalisability in estimate to the molnupiravir trial example, suppose our target population is all individuals recently infected with SARS-CoV-2 who were not in the hospital. In this case, we would not be able to generalise the trial’s estimate to the entire target population, even if we could control for post-randomisation factors such as non-adherence, because the trial sample did not include vaccinated individuals. However, the target population does include vaccinated individuals, and it is reasonable to assume that the effect of molnupiravir on disease progression to hospital admission or death would vary by vaccination status. On the other hand, we might be able to generalise our results within the stratum of unvaccinated individuals, provided all other effect measure modifiers were similar. In this case, we would say that the sample is representative within that stratum.

Generalisable in interpretation

A sample is representative if its results are generalisable in interpretation. While the estimates obtained in the sample are not quantitatively the same within a margin of error as those that would be estimated in the target population, we can hypothesise, based on background knowledge, that the interpretation (which could be the direction of effect, general inference from the results, or knowledge gained from an experiment) would remain the same. 12 For example, we might hypothesise that molnupiravir is generally protective against hospital admission or death from covid-19, even in samples other than the study sample. Generalising the interpretation aligns with the broad definition of representative, which states that a study sample resembles what would be expected in the target population.

We often generalise the interpretation of our own results to external populations, and any study that generalises in estimate will also generalise in interpretation. The primary goal in studies examining fundamental laws of nature or asking research questions that are relatively independent of historical and environmental context are to generalise the interpretation, rather than the estimate. Generalising the interpretation should be done cautiously, however, because it is based on hypotheses that the mechanisms or biological processes under investigation in the study sample are (at least approximately) identical to those that would be seen in the target population.

If we apply this definition of generalisability in interpretation to the molnupiravir trial example, 7 it might be reasonable to hypothesise that molnupiravir would have a beneficial impact if given to those individuals infected with SARS-CoV-2, even beyond the enrolled sample of participants with moderate illness who were not in the hospital. We might base this hypothesis on our understanding of the drug’s biological mechanism and the validity of a properly conducted, double blind, placebo controlled trial. In this example, we generalise the interpretation despite the fact that the risk difference comparing molnupiravir with placebo estimated in the trial would differ from the risk difference estimated in the target population (again assuming that the target population is all individuals with recent SARS-CoV-2 infection who were not in the hospital).

In summary, we consider a sample to be representative of a target population if its results can be generalised to that target population either in estimate or in interpretation. Any statements made regarding the representativeness of the study need to make this further qualification. Is it the estimate obtained or the interpretation of the results that are generalisable to the target population? Researchers should also do what they can to safeguard their results from being applied incorrectly. Even in studies with a strong scientific rationale for generalising the interpretation of results to the target population, researchers might need to mention that the estimate obtained in the sample should not be naively generalised to the target population.

Stating which form of representativeness was the goal of the study might also be useful. In the example of the molnupiravir randomised controlled trial, 7 generalising the interpretation regarding drug efficacy to the target population might have been the primary goal. Many trials have this same goal, because the investigators often over sample individuals at high risk for the outcome in order to increase the power of the study. (Even so, clinical trials have received some criticism that they rarely represent a more general target population. 5 ) If it was possible, generalising the estimate to the target population would be useful for predicting how molnupiravir would perform in practice but might not be immediately required for the study results to be meaningful. Further studies would likely need to be conducted to generalise the interpretation to other target populations, such as children recently infected with SARS-CoV2.

Several points relate to defining representativeness and are worth discussing. Firstly, irrespective of the way in which a sample is representative, the target population must be clearly defined. Stating that a sample is representative is meaningless unless researchers specify what population it represents or its results are being applied to. 5 As an example, we showed how specifying different target populations (all individuals v all unvaccinated individuals who were not in the hospital) for the molnupiravir randomised controlled trial had different implications for whether the results were generalisable in estimate.

Secondly, researchers must be clear about the assumptions required for generalising to the target population. When generalising the estimate, these assumptions might be made based on knowledge of whether the study was designed using a simple random sample or whether stratification by relevant key covariates is possible. When generalising the interpretation, the assumptions might be made based on a knowledge of basic scientific premises or the validity of a related animal model. If researchers attempted to generalise the interpretation but the scientific principles underlying that generalisation did not hold (eg, the validity of the animal model for describing human physiology), then the assumptions would be violated, and the inferences in the study would not be representative. In either case, the way to truly test whether the assumptions held would be to estimate the effect of interest in the target population. While we often generalise in estimate because designing a study in the target population would not be feasible, we generally consider such a study necessary to prove hypotheses regarding generalisation of interpretation, especially when the sample is highly removed from the target population (eg, cell line v human population).

Thirdly, a natural extension of generalising the (overall or stratum specific) estimate to a target population are methods to estimate the overall mean of an outcome or the average effect of a treatment on an outcome (rather than a stratum specific estimate) in the target population. 5 13 14 While the study sample might not be representative of the target population as observed, it could be made representative by using methods for generalisability or transportability, such as weighting or standardization to control for the key covariates or effect measure modifiers that differ between the samples. 15 These approaches require measuring and accounting for all relevant key covariates, meeting certain identifiability conditions, and often making model specification assumptions. 13 14 Even further, any study that is representative in interpretation could theoretically be made representative in estimate if all relevant effect measure modifiers were measured and accounted for; however, that is not always possible when the study sample is distant from the target population (eg, laboratory mice to humans).

Fourthly, the concepts of representativeness and generalisability discussed above also relate to the term “applicability” used in certain risk-of-bias tools, such as the PROBAST and QUADAS. 16 17 All concepts centre on the idea that it is important to assess a study and its results in terms of how well they can be related to some target population. While we discussed causal and descriptive studies in this article, the two tools mentioned apply this concept to predictive and diagnostic studies.

Finally, one question that has been raised is whether generalising the interpretation or the estimate is intrinsically more important for health research and for science broadly. It could be argued that generalising the interpretation is the primary aim of scientific inference and thus should be our goal in most studies. 1 The underlying premise is that the goal of science is the discovery of universal knowledge about nature that will hold true in most instances. If we view health research from this viewpoint, then generalising the interpretation is what matters. By contrast, generalisation of the estimate can never be universal. The estimate obtained in a particular study sample will always be tied to a specific scientific or public health question, and the study design and will vary based on the distribution of key covariates across time and populations. However, to inform policies and interventions in the real world, we must be able to predict health outcomes in human populations beyond those we studied. Therefore, generalisation of the estimate (whether obtained via study design or analytical methods) is an important goal. A further argument could be that these endeavours of statistical inference are just as informative for science as the inferences above. Science can be about discovering laws of nature; it can also seek to understand particular facets of nature. For some areas of health research, such as epidemiology and other population health sciences, the facet of nature under study is disease as it occurs in humans at a population level, and true understanding of the disease under study will be contextualised by time, place, history, and social environment. Consideration for how these factors have changed from the original setting to some new time or target population and how these changes might affect the estimate obtained is critical.

While such theoretical debates are important, our comprehensive definition of representativeness does not treat either generalisation of estimate or interpretation as inherently more relevant. That evaluation largely depends on the research question and study design at hand. Health researchers both develop the universal knowledge related to the health of populations and investigate how that knowledge can be applied to improve the health of populations, and the two ends of the research spectrum are fundamentally linked. What is important, then, is that researchers are clear on the manner in which their results can be applied to the target population when they say their study is representative and the assumptions underlying that statement.

Conclusions

We have established the idea that a study sample can be representative of a target population if one of the following is true: the estimate obtained in the study sample is generalisable to the target population or the interpretation of the study results is generalisable to the target population. Whether a study sample can be representative of a target population through the first definition depends on the study design or whether the variables affecting the outcome (which could be effect measure modifiers of the effect of interest) have been measured. On the other hand, even in the absence of simple random sampling or measurement of all key covariates, we can say that the study is representative in terms of its interpretation, direction of effect, or inference, because this requires less stringent assumptions than generalising the study estimate. 12 The example studies provided give guidance on how one might determine whether the study sample from different types of research is representative and whether, for the specific research question, generalising the estimate or the interpretation was the priority.

• Rothman KJ ,
• Gallacher JEJ ,
• Richiardi L ,
• Westreich D ,
• Edwards JK ,
• Lesko CR , et al
• Jayk Bernal A ,
• Gomes da Silva MM ,
• Musungaie DB , et al
• Gralinski LE ,
• Johnson CE , et al
• Rosenberg ES ,
• Dorabawila V ,
• Easton D , et al
• Strathdee SA ,
• Abramovitz D ,
• Harvey-Vera A , et al
• Rudolph JE ,
• Eron JJ , et al
• Buchanan AL ,
• Westreich D , et al
• Degtiar I ,
• Moons KGM ,
• Riley RD , et al
• ↵ Bristol U of. QUADAS-2 [Internet]. University of Bristol . 2022 . Available : https://www.bristol.ac.uk/population-health-sciences/projects/quadas/quadas-2/

Twitter @jerudolph13

Contributors All authors were responsible for the concept of the article. JER wrote the original draft. YZ, PD, SHM, and BL reviewed and edited the manuscript. JER is guarantor. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

Funding This work was supported in part by National Institutes of Health grants R01-CA250851, R01-AI170240, U01-DA036297, and R01-DA057673. The funders had no role in the writing of the report or decision to submit the article for publication.

Competing interests All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/disclosure-of-interest/ and declare: support from the National Institutes of Health for the submitted work; all authors declare no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Provenance and peer review Not commissioned; externally peer reviewed.

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Medical Case Study

Report generator.

The questions we ask decide the limits of scientific knowledge. The groundbreaking discoveries start with an inquisitive thought. We don’t just ask for the sake of asking. Our questions are based on our observation of everyday phenomena. This allows for practical applications of the findings. Medical research is, at its core, dedicated to the improvement of human health. In the medical field, case studies are analyses of the conditions of real people in real-life scenarios. From our investigations, we arrive at a new research direction. It is this cycle of observing what happens and asking why it happens that steers medical research towards a beneficial end.

7+ Medical Case Study Templates and Examples

There is no manual for clinical operations that covers every possible medical case. Occasionally, health personnel would encounter a strange, undocumented condition of their patients. The life of a person is too delicate a constitution just to be handled carelessly. Doctors may refer their dilemma to previously recorded cases related to the situation, or they may attempt to alleviate the symptoms. For future reference, they report their observations, measures taken, and recommendations to the medical community. These studies provide the questions for the next research undertaking . This is how medical case studies shape medical research and the future of human health.

1. Medical Case Study Template

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Medical case studies are like journal entries written by medical practitioners, students, faculty, and researchers. Instead of their morning commute or their daily ordeals in hospitals and laboratories, the pages contain stories of the unusual medical cases that they encounter. Because the case studies are basically informative notes about an undocumented situation, they are useful learning supplements for medical students.  The challenge for writers now is producing a comprehensive resource material that can be used as study aid. We made your work easier with this template! The template contains original headings that you can modify as you see best. Its easy-to-follow layout makes studying your investigation less daunting a task.

2. Case study template

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Your medical case study is an expounded and well-researched original observation. Since you or your team are the ones who witnessed the events you wished to tell, your report should be as clear and detailed.  A well-written case study includes a thorough analysis of the medical situation. What were the tell-tale signs that made you arrive to your diagnosis? What makes this case stand out? How did you get to your conclusion? It is encouraged that you include related articles and studies in your discussion. Your careful analysis of the situation influences how useful a case study is. This template gives a helpful outline and a sample format that you will find helpful as you proceed with your investigation.

3. Case Study Record Template

An entry would include a background of the patients and their medical history. As an author of medical case studies, you are still required to adhere to the guidelines for ethical research. You have to secure consent from your patients that you will use their information and biological specimen for your study. As you collect consented information, it can be hard to work through all these details that your patients will provide for you. How does each part of his or her medical history paint a picture of the patient’s condition? You can download this template that lists the information you might need in your study. The template arranges the information in categories, like the consent form process, screening criteria, medical history, and laboratory test findings. It is editable so you can make this your very own!

4. Free Case Study Template

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There may be multiple formats in writing a case study, but the essential elements remain true for all of these studies.  In your overview, you can write an abstract of the entire case study. Next, you may proceed to illustrate the medical history of the patient and her state during the consultations. Did she look ill? What were her complaints? In the following sections, you can introduce related literature of the case. You should cite journal articles, and if possible, news relevant to your case. You then narrate your response and discuss in detail what can be learned from your study. Download this free template so you can get started on yours!

5. Case Study Writing Template

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Case studies are not a one-size-fits-all manual of operations. Because an entry is considered a novel observation in medical and clinical practice, case studies can still function as informative notes for other doctors.  Your case study will be made available as reference when it is made public. When you submit your case study to a journal for publication, the format of the paper can vary depending on the journal’s requirements. It can also be similar to this template, where the content is arranged into two columns. This downloadable PDF file also includes a guide on how to write the content for your study. There may be information that doesn’t apply to you. Nevertheless, this template will be valuable in the presentation of your report.

6. Case Study Writing General Guide

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After you have obtained the necessary details for your case study, your next challenge is to arrange and logically present the information. The first thing you would write is an introduction about the issue. This guide suggests steps on how to make your introduction and discussion effective. You can add literature and journals that would strengthen your case. You can evaluate the present medical approaches that are being employed to resolve a problem and discuss if they are effective in this case. You should explain why the method isn’t the best solution for your patients’ medical issues. Download and use this free help now!

7. Sample Clinical Case Study

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Not everyone is skilled at writing as they are in treating diseases, which is why we provided these templates and samples to help you better relay your findings and investigations.  You can download and refer to this sample for your case study. It has a case description where you introduce the patient and the medical condition. Then the writers proceed to discuss the concept behind the condition. They included their data and talked about how the numbers were relevant to their case. They summarized their points in their conclusion and added a list of their references. Although the format of your medical case study will depend on the journal you wish to submit it to, this sample can serve as your guide on how to get your report accepted for publication.

8. Medical Case Study Sample

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This sample is another published medical study. C ase studies allow for the detection of weaknesses and gaps in our understanding of human health. This makes case study a valuable resource for improving our techniques in evaluation and treatments. When you are writing your case studies, you are responsible for the direction that science progresses towards. Knowing how to structure your report is then essential so that your findings will be communicated well. We added this example template to help you produce a substantial and informative case study. You can download the PDF file of this study for your personal reference.

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