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Education and Management Case Reports

Shafer, Steven L. MD

doi: 10.1213/ANE.0000000000000214
Editorials: Editorial

From the Editor-in-Chief, Anesthesia & Analgesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California.

Accepted for publication February 14, 2014.

Funding: None.

The author declares no conflicts of interest.

Reprints will not be available from the author.

Address correspondence to Steven L. Shafer, MD, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Dr., MC-5640, Stanford, CA 94305–5640. Address e-mail to

My recent visit to the Department of Anesthesiology and Perioperative Medicine at Oregon Health & Science University (OHSU) left me incredibly impressed. In addition to outstanding research programs, the sine qua non of academic departments, enthusiastic faculty members described innovative projects advancing health care and education at OHSU. These included novel management of the critical care units, innovative approaches to ambulatory regional anesthesia, and unique educational programs that leveraged state-of-the-art informatics. In each case, I was asked by the faculty member: “Where can I publish this work?”

Good question! Many academic anesthesiologists are tasked with patient care, resident education, and perioperative management. This is the mandate of faculty in a “clinician-educator” track. In some departments, the vast majority of faculty are clinician-educators. Although these faculty members are not engaged in traditional hypothesis-testing research, they still must demonstrate academic productivity to advance their careers. The “gold standard” for demonstrating academic productivity is peer-reviewed publication.

Unfortunately, nearly all papers submitted to Anesthesia & Analgesia that describe education or management projects get rejected. The reason is that the authors are describing a local project, typically well executed, but lacking a hypothesis, an objective measurement of results, a control group, and any assurance the results could be reproduced elsewhere. The paper is rejected because it isn’t science. This is the sharp end of the stick. The conclusions lack scientific validity.

However, the same is true for case reports. Nobody pretends that case reports have scientific validity, although they may presage profound discoveries.1 Case reports are useful, of course, because we learn from sharing interesting and unusual cases with our colleagues. Indeed, learning from “science” is a fairly recent phenomenon. Learning from shared experience may be fundamentally linked to human evolution.

In just the same way that traditional case reports are an N = 1 clinical vignette, published so we can learn from each other’s experience, single institution education and management projects are an N = 1 (i.e., 1 institution) vignette. We need a venue to publish management and education reports, again so we can learn from each other’s experience.

Anesthesia & Analgesia recently introduced a new online journal: A&A Case Reports. A&A Case Reports publishes clinical case reports. However, after my visit to OHSU, we decided to extend the definition of “Case Report” to include “Clinical Case Reports” (the traditional definition), “Education Case Reports” (novel and interesting educational projects), and “Management Case Reports” (novel and interesting approaches to perioperative management).

A&A Case Reports is now soliciting submissions of Education Case Reports and Management Case Reports. Management Case Reports and Education Case Reports will undergo rigorous peer review, the hallmark of Anesthesia & Analgesia. Accepted reports will be published online under the imprimatur of Anesthesia & Analgesia, a recognized standard of academic excellence. They will provide a peer reviewed record of outstanding contributions by clinician-educators to the education and management missions of their departments and institutions.

Our intent is to publish a quarterly issue of A&A Case Reports devoted to Education Reports, and a quarterly issue of A&A Case Reports devoted to Management Reports. Of course, this depends on the volume of reports submitted. We will increase the frequency of publication if this proves to be popular.

To my colleagues at OHSU, thank you! I heard your question: “Where can I publish the exciting education and management projects?” I have an answer: A&A Case Reports is now accepting Education and Management Case Reports. Our broader definition of Case Report creates a venue by which you can share with your academic colleagues your experiences, successes, failures, and lessons learned.

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Dr. Steven L. Shafer is the Editor-in-Chief for Anesthesia & Analgesia. This manuscript was handled by Dr. James G. Bovill, Guest Editor-in-Chief, and Dr. Shafer was not involved in any way with the editorial process or decision.

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Name: Steven L. Shafer, MD.

Contribution: This author wrote the manuscript.

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1. Bigelow HJ. Insensibility during surgical operations produced by inhalation. Boston Medical and Surgical Journal. 1846;35:309–17
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