@TheOncoPT (00:19)
Hey Onco PT and welcome back to this episode of the Onco PT podcast. And in today’s episode, we are continuing our arc on how to choose the right patient case for your upcoming oncology case report. And in this episode, we’re really going to zoom in on what are the graders looking for in your case report. So we’re actually starting a little bit today with the end in mind. The goal behind all of this, of course,

is for you to write an amazing, a stellar oncology case report as part of your ABPTS oncology specialty certification application. It’s gonna be submitted and there’s going to be graders who are going to read your case report and they’re looking for several criteria, all in essence to determine is this a specialist level thinker in oncology physical therapy? Are you ready to undertake the process of preparing for

to preparing to sit for your oncology specialty certification exam, are you prepared at the end of all of this to pass that exam and become a board certified specialist? So we gotta start with the case report and the criteria here, because this is kind of the gate by which you can either continue through, like you can go through the gate onto the next phase, or if you are going to be stuck on this side of the fence, because your case report,

slows you down or maybe stops you. And so what we’re going to talk about is what actually makes a patient case strong for your case report by looking at it through the lens of what the EVPTS graders are looking for. Because it’s really easy to default to, this was a really complex patient case. This was a really interesting patient case. But these are not things that actually matter in all of this. They feel like they should matter.

but they are not actually what the graders are looking for when they’re looking to see, this a specialist level case report or does this one need some work? Needs improvement if we’re thinking about report card gradings from way back in the day. Now there is a little bit of a disconnect in all of this because oftentimes what you, the oncology physical therapist is thinking about and what feels like a clinically strong case to you,

is not always what translates into a strong case report. That is the distinction we’re trying to make here. This is the mismatch. A strong case clinically does not always translate to a strong case report. Those are not the same thing. Those are not necessarily equivalent to each other because when you’re working with a real human patient in real life, a lot of things matter.

And that’s what makes you such an amazing, wonderful oncology physical therapist. But when someone is reading your case report, that is your retelling of this patient scenario, this encounter that you had with this human, these graders are looking at something very, very specific, which is all about how you think.

how you make decisions to implement specialist level physical therapy for this human in front of you. How you think is what is most important to demonstrate and come across in your case report. The graders themselves are not asking, is this patient case interesting? They don’t care. Now they probably do care that you pick a case report that’s not

boring that they are not going to just dread reading, but they’re not looking at it from the lens of, ⁓ this case is so interesting. They care. Is this a specialist level thinker? Can I look at and pick up on the specialist level thinking here? They’re also not looking at, is this a rare patient case? Is this an exotic patient case that I’ve never ever seen before? No, again,

They are always, always looking at how do you as an onco PT as an emerging specialist think in all of this? Does this case report demonstrate clinical reasoning at the specialist level that is expected of you when you go into the specialty certification process?

What I want you to hear in your head as you’re starting to consider different patient scenarios, different patient cases for your case report, these are the questions that the raters are going to be asking. Can I see, this is me the grader now, can I see how you made decisions in this case? Can I see how you adapted to challenges?

unexpected things along the way, because if that is not the name of the game when it comes to oncology physical therapy, I don’t know what is. Right? In oncology rehab, we know there are always unforeseen challenges, maybe not with every patient, but that is part of the name of the game. And part of being a specialist in oncopathy is rising to the occasion and being able to adapt to sometimes these very unexpected situations. Can I the grader?

See how you connected what you were doing, the examination techniques, the interventions. Can I see how you connected what you did to the evidence that is available? Are you pulling from best available current evidence to inform what you’re implementing in your practice? Are you using the most up-to-date stuff?

Are you maybe, you know, synthesizing, okay, this is working in this patient population. There’s not a lot of research. There’s not a lot of literature for this patient population over here, which is what I chose. But I can make those ties to say, you know what, this is working here. This is how I’m going to adapt it to this patient population and implement it. That is totally fine. Again, this is part of, are you specialist level thinking in all of this? Is this coming across in your case report writing?

So when I’m evaluating on whether a patient case is strong, is a strong choice for my case report, I come back to these three things. And these are not so much a checklist that I want you to say, yep, did that, that is good, as more of a way to ground your decision and to really sit with these criteria to determine is this going to be the best case?

for me to write a full case report on because you do have to write a full case report on this or is this maybe something that I need to push to the back and remove from my consideration here. what the three criteria are, number one, does this actually demonstrate your clinical expertise? Number two, does this case give you enough depth and progression to work with, to write about?

And then number three, can this be supported with evidence? So let’s talk about these three criteria here.

Now that first criteria, which is does this case actually demonstrate my clinical expertise? You’ve heard me say this time and time again, and you’re going to hear me continue to say this across this podcast series that we’re doing because it’s so, so important. And honestly, I think this is probably one of the most commonly missed or under considered areas like criteria when it comes to picking your case report. A lot of times,

physical therapists who struggle in their case report, again, are not picking a case for this criteria. They’re picking it for other reasons. It sounds cool. It was interesting. It was rare. It was exotic. It meant a lot to me personally. Those are all good things to reflect on. Truly, those are the cases that we sit with as on copetes and say, you know what? That was really important to me. That made a really big difference for me.

I didn’t do a very good job here and I could show up better for the human in front of me next time dealing with this by doing XYZ. Those are all super important things and those all make us better on copetes and all of this. But I really want to emphasize what you do to reflect to become a better on copete is not always going to match the kind of case you should be choosing for your oncology case report. There are going to be elements.

that shine through, but you really have to lead the selecting of your case report with does this case demonstrate my clinical expertise in all of it? All of this, excuse me, because that is what the graders are looking for. Remember, this case report is part of your application in order for you to sit for your ABPTS oncology specialty certification examination. And I bring this up again, not to be redundant,

but to drive home the point. is kind of a gatekeeping experience. If you cannot write a case report that adequately demonstrates to the graders that you are a specialist, that you have clinical expertise in all of this, you don’t get to pass go. You don’t get to collect $200 and move on to the next base on the Monopoly board. This is where your journey, I don’t want to say ends, that sounds so final. This is where your journey will be paused.

until you can write a better case report. I’ll put it plain and simple like that. Until you can write a great case report, they are not going to let you move forward with this process.

That’s just how it is. And so it’s really important that you’re able to demonstrate clearly in your case report that you are a specialist in this information, in this area of practice, that you have clinical expertise. I hope it is so clear after going on that tirade here how really, really important this part of writing your case report is.

And like, if you don’t have this, you cannot even move on to these other criteria. So start with this first criteria, get solid on this, and then come back with me to number two, which is, does this case actually give you enough depth and progression to work with? So once we get past picking a case that has ample opportunity for you to demonstrate your clinical expertise in all of this, this oftentimes goes along with it.

because for a case that demonstrates your clinical expertise, a lot of times you really have to show, again, these are the choices I made. We started here and then as the patient improved or even regressed, okay, because as we know, oncology physical therapy is not always linear in we started here, we got better and then the patient left and then they lived the happy rest of their long, long life.

That sounds very ortho. That is not always the case with oncology. And so I don’t want you to think that you have to pick a case that’s like all sunshine and rainbows and flowers and four leaf clovers and whatever else springtime things. That’s not what we’re saying here. What we’re saying is that there is enough to this case for you to really talk about, this is what I did. This is how I change things based on patient response. The patient got better at this. So this is how we progress through this.

The patient struggled with this and so this is how we made adjustments and we worked with this, for example. Again, these are just some examples of what you could see here, but you need a case report that again, you can write a full blown case report on and not just a couple paragraphs summarizing like, you know, I saw this patient for one session. We did a couple exercises of this and then I never saw them again.

I have actually seen that case report come across my desk before. And this is not in any official capacity, right? Like I’m not affiliated in any way with AB PTS. I have seen drafts of case reports that people have sent to me saying, this is my case report. What do you think of it? Do not write a case report on a single encounter with a patient. It’s not enough information to write on, especially when it comes to this next criteria, which is

Can this case be supported with evidence from the literature? Now, as I mentioned previously in this episode, you may be working with a patient who has a more unique presentation, a unique diagnosis, a unique response. That’s okay. And you may not have all the literature in the world to really support, this is what I did here. So let me give an example. Several years ago, back in 2020,

When I wrote my case report, I wrote mine on a patient who I saw for prehab as he was preparing for his hematopoietic stem cell transplant for multiple myeloma. At the time that I was writing that case report, there was still not a lot of literature to support specifically prehab for multiple myeloma.

Prehab for multiple myeloma leading up to hematopoietic stem cell transplant and there were other areas that were not quite well supported at the time in the literature, but you know what is? Prehab. You know what is? Rehab with hematopoietic stem cell transplant. Rehab with multiple myeloma and these other categories. So even though there were areas of my case report that were maybe less

supported directly, I could still pull from other areas to inform, to support the decisions that I did make with this particular patient case. And there’s going to be a lot of areas in your case report that likely do the same thing. Unless you are writing on a super, I don’t want to say like basic in a bad way, but you you could potentially write a case on a person who has

breast cancer, has a tremendous amount of literature supporting it, right? We know the benefits of exercise. We know the benefits of rehab for a person with breast cancer. Like that’s really well supported. That’s really well researched. That’s awesome. Most of the time though, unless you’re picking that specific case, there’s probably going to be more areas that are not as well flushed out as well supported right now in the literature because cancer rehab research is always, always growing.

So this to say, you need to be able to support your decision making in your case report with evidence. It is okay if you don’t have every single aspect of what you did completely well supported. It may just not be there. But the balance is, can you support the majority of what you did with really strong evidence and then make specialist level decisions even now in writing your case report to say,

I may not have the exact paper to say this dosing and this with this particular patient undergoing this particular treatment. This is how I made an informed decision in all of this. Now, usually when a PT is writing their case report and something feels off, it usually comes back to one of these three criteria. Does it demonstrate your clinical expertise? Does it give you enough depth and progression to work with to write about?

Does it have enough evidence that you can support it really well? If something feels off, it is usually because one of these three areas are missing. And this shift is really small because again, this is one decision that you make way, way early on in your case report, AKA which case, which patient case am I choosing for this? This shift is small.

And these three criteria could mean the difference between you picking patient A or patient B, but it truly changes everything because that one small decision you make early on has enormous implications for the life of your case report and not to feel very like.

catastrophic here, but the life and the death of your case report. does your case report make it to completion and ultimately get submitted and accepted by the ABPTS graders? Does it die? Like where it’s not accepted by ABPTS graders or worse, does it not even make it out of Microsoft Word or Google Docs? Because it’s just a draft that lives there because you struggled to even start it and finish it.

let alone get it to the application deadline. You’re not asking yourself when you’re discerning cases, is this a good case? What you need to be asking yourself is, does this case allow me to show how I think and why I made the decisions I did? Which ultimately goes to show the AB PTS graders, whether you’re a specialist or not in oncology physical therapy.

Once you start looking at your case and potential cases through this lens, this decision usually becomes a lot clearer. Not necessarily easier right away, but when you sit with these criteria, when you sit with this approach to picking your patient case, this does become clearer. And you can make that decision much more confidently from the get-go. Knowing

that the rest of your case report is in good hands because you are again starting from a place, a really strong foundation. I am also going to walk you through this a bit more in the YouTube video that I release later this week, especially if you’re wanting to take these criteria and apply it to your own cases. I would really encourage you.

to watch that video. If you haven’t already, please make sure to subscribe to the Onco PT on YouTube and you will get a notification whenever that video goes live. Thank you so, so much for your time again today. I really appreciated getting to spend this time with you. And until next time, this is Elise with the Onco PT. And remember, you are exactly the physical therapist that your patients with cancer need. So let’s get to work.