To the Editor
A recent paper by Ahmad et al.1 discussed the status of resident research education in anesthesiology. They surveyed residency program directors and concluded that a structured residency research curriculum and a supportive chairperson were predictive factors for an increased number of resident publications. Wood,2 in an accompanying editorial, advocated for research-intensive residency program tracks involving a subset of residency programs that can support such efforts. Previous work by the same group3 indicated that prior research and publications as a medical student did not increase the likelihood of selecting such a student, and the accompanying editorial4 expressed concern that we are not selecting students who are ready to go on to a career as a clinician–scientist. Subsequent letters5–7 highlighted the problems with funding resident research time as well as an academic culture in anesthesiology departments. However, we are not the only specialty troubled by the lack of resident research, and Rothberg8 recently listed 7 barriers to resident involvement in research. These factors can be divided into 3 categories: Resident (insufficient interest, limited time availability, and lack of research skills); Departmental (paucity of mentors, limited faculty time, and an absence of a research curriculum); and External (inadequate extramural funding). Not enumerated in Rothberg’s paper8 but concerns about current income for the faculty and future income (tied to already incurred debt) for the residents may also be a barrier. Ahmad et al.1 should be commended for isolating both resident and departmental factors, but the relative importance of these and the other factors has yet to be determined and so cannot suggest a comprehensive solution.
I would like to advocate for an approach that coordinates all aspects of improving research training in anesthesiology from recruiting and supporting medical students to systematically developing improved curriculum with trained mentors and a supportive department environment. This would create a welcoming and nonrestrictive “pipeline” to become an independent anesthesiologist clinician–scientist. Even residents who “leak” from the pipeline should still see more rewarding careers so that the admittedly difficult path to National Institutes of Health funding will not discourage talented students, residents, and junior faculty from starting down the “pipe.” If we, as a medical specialty, are to succeed both in advancing our specialty and achieving the respect that we desire, particularly in this time of uncertain and possibly diminishing government support for research and increased pressure for clinical productivity, academic departments (both those with significant extramural research funding and those without, perhaps through the Society of Academic Anesthesia Associations), anesthesiology professional organizations (e.g., American Society of Anesthesiologists, Association of University Anesthesiologists, and the subspecialty societies), accrediting and credentialing organizations (e.g., the Accreditation Council for Graduate Medical Education and the American Board of Anesthesiology), and grant-making foundations (e.g., Foundation for Anesthesia Education and Research, Anesthesia Patient Safety Foundation and International Anesthesia Research Society) must all work together to ensure that collectively we have lowered all the barriers to medical students seeking a clinician–scientist career in anesthesiology and made the tools available for them to succeed. Such collaboration may be unprecedented and the sacrifices required painful, but I believe it must be accomplished for the future of the specialty.
Denham S. Ward, MD, PhD
Foundation for Anesthesia Education and Research
Department of Anesthesiology
University of Rochester School of Medicine and Dentistry
Rochester, New York
1. Ahmad S, De Oliveira GS Jr, McCarthy RJ. Status of anesthesiology resident research education in the United States: structured education programs increase resident research productivity. Anesth Analg. 2013;116:205–10
2. Wood M. Maintaining and fostering the future success of academic anesthesia: recruiting and training the next generation of academic anesthesiologists. Anesth Analg. 2013;116:1–3
3. de Oliveira GS Jr, Akikwala T, Kendall MC, Fitzgerald PC, Sullivan JT, Zell C, McCarthy RJ. Factors affecting admission to anesthesiology residency in the United States: choosing the future of our specialty. Anesthesiology. 2012;117:243–51
4. Fleisher LA, Evers AS, Wiener-Kronish J, Ulatowski JA. What are we looking for? The question of resident selection. Anesthesiology. 2012;117:230–1
5. Nemergut EC. Resident research and graduate medical education funding. Anesthesiology. 2013;118:757–8
6. Pryde PG. Ensuring future academic anesthesiologists: a matter of recruiting “the best” residents? Anesthesiology. 2013;118:758–9
7. Fleisher LA, Evers AS, Wiener-Kronish J, Ulatowski JA. In reply: Resident research and graduate medical education funding, and ensuring future academic anesthesiologists: a matter of recruiting “the best” residents? Anesthesiology. 2013;118:759–60
8. Rothberg MB. Overcoming the obstacles to research during residency: what does it take? JAMA. 2012;308:2191–2