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Experience = Education

Time for the Next Step

Schwartz, Alan Jay MD, MSEd; Nussmeier, Nancy A. MD; Shafer, Steven MD

doi: 10.1213/XAA.0000000000000199
Editorials: Editorial

From the *Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts; and Department of Anesthesia, Stanford University, Stanford, California.

Accepted for publication April 28, 2015.

Funding: None.

The authors declare no conflicts of interest.

Address correspondence to Alan Jay Schwartz, MD, MSEd, Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, 34th St. and Civic Center Blvd., Philadelphia, PA 19104. Address e-mail to

Thanks to you, our authors and readers, A & A Case Reports has secured its place as an educational vehicle for our specialty. To update the information recently provided by Drs. Nussmeier, Saidman, and Shafer1: through March 2015, >1000 case reports describing fascinating clinical scenarios have been submitted. Of these, approximately 200 have been accepted for publication.

A & A Case Reports recounts management of clinical cases that have “educational” value. Educational? Just what is that? tells us education is “the act or process of imparting or acquiring general knowledge, developing the powers of reasoning and judgment, and generally of preparing… intellectually for mature life.”a

Allow us to paraphrase:

Education is the change in or reaffirmation of a behavior based on experience.

There is an obvious link between A & A Case Reports and education. As Dr. Saidman so aptly reminded us, “Case Reports are appreciated by readers for describing ‘real life’ management of difficult or unusual cases not often encountered by practitioners.”2 Authors relate their experiences gained from having provided anesthesia patient care. Readers scan, study, question, and become educated by their experience of reading the case report. Even when we read, we learn through experience. The undisputed value of case reports originates from the author’s experience which when transferred via the reading experience, becomes, “…the germ of the solution…”2 for the clinician, newly educated about established patient care behaviors or new possibilities and therapeutic options.

A & A Case Reports initially sought to publish, “…case reports that make an important teaching point or scientific observation in disciplines related to anesthesiology: perioperative medicine, critical care, and pain management.”3 We believe A & A Case Reports has accomplished this. We have a mandate to continue to champion the education of anesthesiologists by relating the case experiences of authors, most often clinicians themselves.

With A & A Case Reports well established as a venue for clinical case reports, it is appropriate to question whether the initial goal was sufficient. We believe that it was not sufficient. We believe we can do more.

Anesthesiologists are more than the physicians who provide direct perioperative patient care. Anesthesiologists are the educators of future anesthesiologists. There are currently >5500 residents learning in our 133 core programs and >500 fellows learning in our 191 specialty programs.3

Anesthesiologists are clinical directors/managers of operating rooms, outpatient health care facilities, and pain management programs. “In 2011, over 15 million operating room procedures were performed in US hospitals.”b In 2006, 14.9 million surgical and nonsurgical procedures occurred in ambulatory surgery centers.c

Anesthesiologists are patient safety advocates. The American Society of Anesthesiologist’s Anesthesia Quality Institute has collected outcome data from almost 25 million cases through the National Anesthesia Clinical Outcomes Registry.d,e The American Society of Anesthesiologist Closed Claims Project has analyzed >10,000 closed claims, serving as a resource from which better anesthesia patient care outcomes are being devised.e

Anesthesiologists are collaborators in the provision of global health care. Worldwide surgical volume is estimated to be >234 million cases each year.4

Dr. Shafer initially charged A & A Case Reports with publishing “…case reports that make an important teaching point or scientific observation in disciplines related to anesthesiology: [including physician education, healthcare facility management, patient safety and global anesthesia patient care].”5 With this in mind, last year we created Education Case Reports (novel and interesting educational projects) and Management Case Reports (novel and interesting approaches to perioperative and health care facility management, including patient safety initiatives).6

We are expanding the scope of A & A Case Reports to include reports describing local and global initiatives in education, management, economics, and patient safety. This is highlighted in the new tag line on the A & A Case Reports logo (Fig. 1). These are in addition to our established role describing clinical care. We are creating 2 new types of case reports: Global Health Case Reports, and Patient Safety Case Reports. As with the Management Case Reports and Education Case Reports, these describe experiences. If there is an interesting survey of health care resources in a low-resource country, that experience will be welcomed as a Global Health Case Report. The report would describe the experience of conducting the survey, along with sharing the findings. If there is a patient safety project that works in a particular hospital, that experience would be welcomed as a Patient Safety Case Report. The report would describe the experience of undertaking a safety initiative, as well as sharing the results. Experiences belong in A & A Case Reports. Reproducible science belongs in Anesthesia & Analgesia.

Figure 1

Figure 1

We encourage authors to share their experiences in each of these arenas. We believe that A & A Case Reports is uniquely positioned to disseminate information about author’s experiences in many venues that extend beyond direct clinical care. This expanded case reporting format will more broadly educate our readers, for the ultimate benefit of our patients.

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a Accessed March 14, 2015.
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b Accessed March 14, 2015.
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c Accessed March 14, 2015.
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d Accessed March 14, 2015.
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e Accessed March 14, 2015.
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1. Nussmeier N, Saidman LJ, Shafer S. A & A Case Reports: a progress report and an update on requirements for patient consent. A&A Case Rep. 2014;3:141
2. Saidman LJ. Welcome to A & A Case Reports. A&A Case Rep. 2013;1:1–2
3. Brotherton SE, Etzel SI. Graduate medical education, 2013-2014. JAMA. 2014;312:2427–45
4. Weiser TG, Regenbogen SE, Thompson KD, Haynes AB, Lipsitz SR, Berry WR, Gawande AA. An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet. 2008;372:139–44
5. Shafer SL. Anesthesia and analgesia case reports. Anesth Analg. 2013;116:513–4
6. Shafer SL. Education and management case reports. Anesth Analg. 2014;118:915
© 2015 International Anesthesia Research Society