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Case Study Research in Medicine

The use of the case study as a research approach within medicine shares many of the features of case studies in general; however, the traditional alignment of the field of medicine with natural science approaches as well as the close relationship between case study research and the clinical practice of medicine have resulted in several distinct forms of case study research. The majority of case study research projects in medicine are premised on empiricist traditions, yet there remain two distinct approaches to the use of case study research in medicine: the first firmly anchored in the language and epistemic assumptions of a logical empiricist research paradigm, and the second, which has embraced an interpretivist orientation or an organizational analytic approach.

Conceptual Overview and Discussion

The case study in clinical research typically fits within an empiricist research paradigm, although many examples of case studies exist that subscribe to interpretivist or mixed methods approaches. Research in medicine has a variety of foci, and researchers from a variety of research traditions (e.g., nursing, rehabilitation medicine) contribute to the totality of research in the field. Similarly, case study research has multiple variants within the field of medicine. In particular, case study research has been used to great effect in the study of the organizational contexts of healthcare. In their 2002 text on embedded case study, Roland Scholz and Olaf Tietje define this type of case study research as program evaluation.

From the literature, three distinct types of case study research in medicine emerge: (1) clinical case studies, (2) interpretive case studies, and (3) program evaluation. Both interpretive case studies and program evaluation have their origins in case study research in the social sciences, and, consequently, share the epistemological features of their progeni-tors. Allied health disciplines (particularly nursing) favor these types of case study research, while researchers in faculties of medicine tend toward clinical case studies as their preferred approach.

The distinguishing variable in the selection of case study type for research in medicine, according to Scholz and Tietje, is the purpose of the case study research. Program evaluation case studies are commonly employed in instances where there are concerns with and/or an interest in changing the current approach. In contrast, interpretive case study research has been employed where the object of the research is medical career issues, work-life issues, or issues of patient perceptions and experience of care. Clinical case studies are employed where the object of research is medical intervention or the diagnoses or definition of disease.

Application

Clinical case studies have a history in medicine as a tool for both teaching and research. As an example, the neurologist Oliver Sacks has used case study to great effect for teaching and research to increase understanding of various aspects of neurological disease. A historical example of the impact of the case study is that of H. M., who underwent bilateral mesial temporal lobe resection in the early 1950s and has been the subject of multiple publications on epilepsy, memory, and temporal lobe function.

With the rise of evidence-based medicine (EBM) in the 1980s there was an increase in awareness of “best evidence” and in the development and use of tools to rate research based on levels or hierarchies of evidence. The Cochrane Collaboration is an example of an organization whose focus is on systematic review of research in healthcare, with most Cochrane reviews being of randomized control trials (RCTs). The RCT has been held up as the gold standard for research in medicine. In the language of EBM, case studies are viewed as being near the other end of the spectrum compared to RCTs and as such are defined as “weak evidence” with respect to medical research. Brian Brighton and colleagues' discussion of the hierarchy of evidence, however, acknowledged that case studies are common in the medical research literature, and recognized their value in terms of identifying areas for research, describing rare occurrences, and building hypotheses.

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