PROPOSAL FOR NEJM CPC (CASE RECORDS OF MGH) — The Peter L. Slavin, MD Academy for Applied Learning in Health Care

Your name

Department

Appointment (resident, fellow, attending)

Contact information

Patient name and MRN

Diagnosis

Conference at which case should be discussed

Case type (check all that apply)

In-patient

Out-patient

Differential diagnosis

Known (to discussant)

Unknown (to discussant)

Management

Both differential diagnosis and management

Brief description of case

Diagnostic test(s)

Major teaching points of the case

Novel feature(s) (check all that apply and explain or add as appropriate)

Disease (e.g., rare, new, emerging infection)

New diagnostic tool(s)

Novel therapy/management

List of proposed speakers (specialty +/- name) and their roles (add rows if needed)

Is anyone else planning to publish this case elsewhere? (please check with attendings, house staff)

Are you aware of any problems that might prevent publication of this CPC? (e.g. medicolegal issues, patient confidentiality)

Other caregivers who should be contacted regarding use of this case as a CPC