Lown Institute Vignette Competition

Lown Institute Vignette Competition


The Lown Institute is proud to announce that applications for the Vignette Competition for 2018 are now open! We are seeking clinical vignettes written by trainees describing harm or near-harm from medical overuse. In particular, we want to hear about medical interventions that are commonly performed and seem acceptable, rather than errors or obvious malpractice.

Applications should include a clinical vignette that provides an engaging story with pertinent clinical and historical findings. Vignettes must also include a succinct summary of the clinical issues that describes the evidence for medical overuse and suggests an alternative approach going forward. The deadline to submit a vignette is February 12, 2018.

Submit your vignette for the competition today!


Medical overuse – the provision of unnecessary or unwanted medical tests and procedures to patients – is common in our healthcare system, but often goes unnoticed. One third of health care interventions are considered unnecessary, but such instances can be hard to recognize in real time. The purpose of the Lown Institute Vignette Competition is to shine a light on everyday overuse – commonly performed tests and procedures that seem acceptable, but are actually harmful. Sharing stories of the downstream consequences of overuse can be a powerful counterbalance to the ‘more is better’ culture and can help clinicians recognize and avoid overuse.

The goal of this competition is to improve clinicians’ awareness of the harms patients may face as a result of overuse and to share ideas about how the delivery of care may be improved in the future. In an era of increasingly depersonalized health care, we hope to promote the importance of thoughtful, individualized care tailored to the patient. We want to hear your stories!

Why participate?

The authors of the top two vignettes will be eligible for a scholarship of up to $1200 to participate in the 2018 Lown Institute Conference, April 9-10 in Washington, DC, where they will receive an award.

Competition participants will be encouraged to submit their vignettes to the JAMA Internal Medicine’s Teachable Moment series for review. There is no guarantee of acceptance into the Teachable Moments series. Finalists will also be acknowledged on the Lown Institute website.

Examples of vignette topics

Past vignette winners are available for review here. Last year’s winning vignettes illustrated the consequences of polypharmacy and how extra tests in the trauma center create opportunities for error.  Other example topics for vignettes include:

  • Overactive bed alarms cause patients to lose sleep, make patients feel trapped, and result in “alarm fatigue” in clinicians.

  • Off-label drug treatment for insomnia causes patient to go into a coma.

  • Pre-operative testing in an asymptomatic patient leads to benign incidental findings and cancellation of needed surgery.

Key proposal elements

Applications are due on Monday, February 12, 2018. All finalists will be contacted by early March. The Lown Institute will convene a panel of judges to evaluate submissions, and select finalists for further review.

A complete application should be submitted here. A complete application includes:

  1. Authors: Contact information for up to three authors. The first author must be a trainee who is a professional student, intern, resident, fellow, masters or doctoral student, or post-doctoral student.
  2. Vignette: Maximum word count is 800 words (excluding references). Submissions should include an engaging story with pertinent clinical and historical findings, and a succinct summary of the clinical issues describing the evidence for medical overuse and suggesting an alternative approach going forward. The manuscript should be given a title that reflects the specific focus.
  3. References: Up to five references are permitted.
  4. Patient Consent: Patient consent is not mandatory though care should be taken to avoid providing details that might lead to patient identification. Some authors may also choose to submit their vignette to a medical journal, in which case consent is often required. One example of a patient consent form can be found here: Patient consent form.

Eligibility and selection criteria

Vignettes will be judged on the following criteria:

  • Is the vignette engaging and well written? To what extent are the ideas presented in a logical and interesting manner?
  • Does the vignette address a meaningful aspect of medical overuse? Does the vignette describe harm or near harm caused by medical overuse? Does the vignette focus on activities that are commonly performed and seem acceptable rather than errors or obvious malpractice?
  • To what extent does the vignette advance right care? What is the potential for the alternative approach included in the clinical summary to improve quality of care and patient experience?

Vignette Competition Judges

  • Brandon Combs, MD, Associate Professor of Medicine, University of Colorado School of Medicine; Co-founder, Do No Harm Project; Senior Fellow at the Lown Institute; Section Editor, Teachable Moments, JAMA Internal Medicine
  • Chris Moriates, MD, Associate Professor of Internal Medicine; Assistant Dean for Healthcare Value, Dell Medical School, The University of Texas at Austin; Section Editor, Teachable Moments, JAMA Internal Medicine
  • Harry Cho, MD, Assistant Professor of Hospital Medicine, Mount Sinai Hospital; Lown Institute Fellow
  • Vikas Saini, MD, President, Lown Institute

Previous Winners

Learn more about last year’s Vignette Competition winners and finalists.


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