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Nemergut, Edward C. MD*

doi: 10.1213/ANE.0b013e318259f13d
Editorials: Editorial

From the *Department of Anesthesiology, University of Virginia, Charlottesville, VA.

Supported in part by Institutional and Departmental Sources.

The author declares no conflicts of interest.

Reprints will not be available from the author.

Address correspondence to Edward C. Nemergut, MD, Associate Professor of Anesthesiology and Neurosurgery, University of Virginia Health System, P.O. Box 800710, Charlottesville, VA 22908-0710. Adress e-mail to

Accepted April 11, 2012

OpenAnesthesia ( debuted 3 years ago in July 2009 with the broad goal of advancing graduate medical education in anesthesia. Over the past 3 years, OpenAnesthesia has grown from its humble beginnings as an experimental project to become a ubiquitous tool for education with a large, international community of members. Indeed, OpenAnesthesia's phenomenal success has greatly exceeded the expectations of its founders.

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It took more than 8 months for OpenAnesthesia to gain its first 200,000 page views in March 2010. As growth accelerated, it took a little more than a year to cross the 1 million mark in April 2011. Impressively, we crossed the 2 million mark less than 9 months later in January 2012 and the 2.5 million mark in April 2012 (Fig. 1). Currently, OpenAnesthesia continues to grow, bringing more than 150,000 page views each month. The number of unique visitors (the number of individual computer users that access OpenAnesthesia each month—no matter how many times) has increased exponentially from 2000 in July 2009 to more than 26,000 in March 2012 (Fig. 2). OpenAnesthesia has become truly a worldwide community and Figure 3displays page views/hits in 2011 by country of origin. OpenAnesthesia provides more than 4 gigabytes of anesthesia knowledge to the world every day.

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Figure 1

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Figure 3

As originally described in its July 2009 debut, OpenAnesthesia continues to feature several important tools, each designed to enhance learning.1 Briefly, these tools include the “Article of the Month” and “Ask the Experts” podcast interviews as well as the OpenAnesthesia Wiki. Each month, the editorial board of Anesthesia & Analgesia selects an “Article of the Month” to feature from the current issue. The article's authors are interviewed and discuss the article from a general as well as an educational perspective. The interview is designed to enhance the listeners' appreciation of the primary literature. For the “Ask the Experts” podcast, a recognized expert in a particular field answers presubmitted questions by residents (as well as students and anesthesiologists in practice) from around the world. Both interviews are available on the OpenAnesthesia website and as a free downloadable podcast through the iTunes store ( Through this service, OpenAnesthesia is able to provide timely, expert content to learners around the world every month.

A Wiki is a website that is designed so that anyone who can access it can modify its content. The OpenAnesthesia Wiki can be considered an encyclopedic anesthesia textbook where all users contribute, update, and edit its content. As of the writing of this editorial (April 2012), nearly 3400 OpenAnesthesia users have made more than 8600 edits to the Wiki.

Although OpenAnesthesia has been successful, it is the charge of the OpenAnesthesia initiative to continue to push the bounds of innovation and create additional tools to enhance each user's experience.

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To continue to push OpenAnesthesia forward, an Editorial Board was established in the Fall of 2011. Similar to Anesthesia & Analgesia, the OpenAnesthesia Editorial Board consists of leaders in the fields of education, anesthesia, and its subspecialties. The Editorial Board has responsibility for both setting the creative direction for OpenAnesthesia as well as ensuring the content meets the highest ethical and intellectual standards of rigorous scholarship.

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Building on past success, we introduced several new learning tools in 2011 and 2012. In July 2011, we introduced a new video podcast, “Intraoperative TEE Case of the Month” ( Through this tool, we present an operative case that teaches or emphasizes important aspects of intraoperative transesophageal echocardiography (TEE). The video is available on the OpenAnesthesia website and as a free downloadable video podcast through the iTunes store ( Indeed, downloading the podcast allows the tech-savvy user to study echocardiography using their smart phone or tablet computer.

Starting in August 2011, we introduced a “Review Questions of the Week” feature ( that allows members to review a clinical topic each week by answering several multiple-choice questions. These are written by the OpenAnesthesia Editorial Board and have been an extremely popular resource.

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Before the end of 2012, we will introduce what can be most succinctly described as an Internet-based patient simulator, specifically designed to challenge each learner to use and interpret echocardiography in the perioperative or critical care setting. Learners will be presented with a clinical scenario and asked to use the combination of patient history, hemodynamics, and echocardiography to make a clinical diagnosis and guide patient therapy. Instead of merely providing the user with a clinical scenario and the appropriate TEE/transthoracic echocardiographic video to make a clinical diagnosis, the user will be presented with the clinical scenario and have to select the appropriate “view” to solve the problem. After answering questions, the learners are provided with an explanation and have the ability to review the case.

Most importantly, and true to our goal of establishing a community of interested learners, we developed this tool to facilitate interaction between learners. To do this, anyone who can access OpenAnesthesia and work through a case will also be able to submit new cases/questions/etc to the database. This allows learners to take an active role in their own education by writing new content and actively sharing their knowledge with other physicians. The process compels each learner to take charge of their own education, and by doing so, improve the education of others. All submitted cases would be reviewed/edited by the OpenAnesthesia Editorial Board before they would be “live.”

Also before the end of 2012, we intend to produce our first iPhone/iPad App. The App will focus on American Board of Anesthesiology Keywords—one of the most popular sections of the OpenAnesthesia Wiki. Stay tuned and check the OpenAnesthesia website for announcements!

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As I wrote in my original editorial in July 2009, “ is not done.. It is forever dynamic and changing, just like medicine itself.”1 The future of OpenAnesthesia will not be written by me nor any member of the OpenAnesthesia Editorial Board: It will written by you, the person reading this editorial right now who has something to teach (or better, an idea of how we can teach something more effectively to one another).

Have an idea? Send me an email ( OpenAnesthesia is your tool and I want your help to make it better!

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Name: Edward C. Nemergut, MD.

Contribution: This author wrote the manuscript.

This manuscript was handled by: Steven L. Shafer, MD.

1. Nemergut EC. Medical Education on the World Wide Web. Anesth Analg 2009;109:1–2
© 2012 International Anesthesia Research Society