Case reports: Medical students priced out of the market

Dear Sir

Case reports have long been regarded as a stepping-stone for medical students to take their formative steps into publication. They allow students to demonstrate ability and initiative through selectively choosing an interesting or rare case and deriving an important message from it. As the competition for post-graduate jobs continues to increase, publications have become important discriminators in job selection. Case reports provide a realistic opportunity for medical students and junior doctors obtain these in preparation. (McNeill et al. 2007)

Unfortunately, these have fallen out of fashion with the vast majority of traditional print-based journals. Currently, many journals state explicitly they will no longer accept case reports and in other journals, rejection is routine. Despite this, there exists a collection of case-report based journals in the growing open-access literature. We feel, however, that this is far from the silver lining. Publication in open-access journals can cost up to US$2000. To put this into perspective, the average British medical student lives off a £3000 (US$4700) maintenance loan per annum; thus, publication may cost a significant proportion of this fairly insubstantial sum. Therefore, this potentially career-boosting opportunity may depend on the availability of disposable income – realistically, only obtainable from generous benefactors, such as medical students' parents.

For all our efforts to widen the accessibility to medical school, the fall from grace of case-reports may have simply shifted the access barrier to post-graduate career progression. Selection processes occur at increasingly early points post-graduation. As such, students from less-advantaged backgrounds will naturally be disadvantaged if they cannot afford to pay the steep open-access publishing fees of online case report journals, despite having taken the initiative to produce intelligent case reports.

There are several possible solutions to this predicament. Provided that high standards of scientific peer-review are maintained, we implore publishers to adopt a reduced publishing fee option for medical students, or perhaps a fee-waiver, as offered by many open access journals to authors from developing nations and those on the HINARI country list. Change of policy should occur soon if we are to rescue fledgling academics and prevent medical student publishing rates from dipping even lower than they already are.