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Other Specialties Might Have a GPS

Kwon, Albert H. MD; Nabzdyk, Christoph S. MD

doi: 10.1213/ANE.0000000000002485
Letters to the Editor: Letter to the Editor

Published ahead of print September 19, 2017.

Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts,

Published ahead of print September 19, 2017.

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To the Editor

In our recent article about academic and entrepreneurial productivity of anesthesiologists, we argued that there are insufficient supportive elements for residents and young faculty members to foster research throughout training and the early faculty stage.1 Given the modular nature of anesthesiology training and practice, providers can easily move between working environments such as clinical and research when compared to other disciplines without adversely affecting patient care. This flexibility should put anesthesiology trainees and faculty members at an advantage when it comes to providing block time for research.

Surprisingly, evidence suggests that our specialty underperforms with regard to academic output. Hurley et al2 reported in 2014 that “the overall publication rate of anesthesiologists associated with medical schools was low” and called “for increased use of structured resident and fellow research education programs as well as recruiting more MD/PhD and PhD scientists to the field […] to improve the publication productivity of academic anesthesiology departments.” Likewise, the median h index of US academic anesthesiologists was found to be 1, with a total of 3 publications.3 In comparison, the average h index of neurosurgery residents was found to be 2.5, and the median h index for academic neurosurgeons was 9.4,5 Academic general surgery consultants in the United Kingdom were found to have a mean h index of 5, with an average of 15 publications.6 More importantly, when compared to surgery program directors, program directors in anesthesiology had less National Institutes of Health (NIH) funding, lower h indices, and fewer publications.7

We acknowledge the concerns of the authors regarding the logistical and financial constraints of many residency programs and anesthesiology departments. As discussed previously, establishing a research/entrepreneurial track within a residency program might only be reasonable in a major academic department. While funding sources for postdoctoral research, such as NIH T-32 programs, exist at some institutions, it does not appear to be as widely available, particularly at the residency level, when compared to surgical residency programs. Considering that successful models exist in other specialties, it seems reasonable to consider pathways analogous to the American Board of Internal Medicine Research Pathway. According to Todd et al,8 91% of American Board of Internal Medicine Research Pathway graduates have ongoing research efforts, with 58.6% of total professional effort spent on research. In addition, more than 85% reported extramural funding, with 81.4% receiving federal funding. The Foundation for Anesthesia Education and Research Medical Student Anesthesia Research Fellowship Program is a great start for students to develop a research portfolio.9 It is imperative that these research efforts are also supported throughout residency and fellowship to increase the chances of young faculty members becoming competitive for future grant funding. This may in turn improve job satisfaction for some academic anesthesiologists and may decrease the burnout rate.

Given that anesthesiology is a young, interdisciplinary, and evolving specialty, there is certainly no paucity of research questions to be asked, collaborations to be fostered, and innovations to be made. For a start, we may just have to borrow the global positioning system (GPS) from other specialties to navigate safely around the Sirens’ rocks.

Albert H. Kwon, MDChristoph S. Nabzdyk, MDDepartment of AnesthesiologyPerioperative and Pain MedicineBrigham and Women’s HospitalHarvard Medical SchoolBoston,

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1. Kwon AH, Marshall ZJ, Nabzdyk CSWhy anesthesiologists could and should become the next leaders in innovative medical entrepreneurism. Anesth Analg. 2017;124:998–1004.
2. Hurley RW, Zhao K, Tighe PJ, Ko PS, Pronovost PJ, Wu CLExamination of publications from academic anesthesiology faculty in the United States. Anesth Analg. 2014;118:192–199.
3. Pagel PS, Hudetz JAAn analysis of scholarly productivity in United States academic anaesthesiologists by citation bibliometrics. Anaesthesia. 2011;66:873–878.
4. Sarkiss CA, Riley KJ, Hernandez CM, et al.Academic productivity of US neurosurgery residents as measured by H-index: program ranking with correlation to faculty productivity. Neurosurgery. 2017;80:975–984.
5. Spearman CM, Quigley MJ, Quigley MR, Wilberger JESurvey of the h index for all of academic neurosurgery: another power-law phenomenon? J Neurosurg. 2010;113:929–933.
6. Abdelrahman T, Brown J, Wheat J, Thomas C, Lewis WHirsch index value and variability related to general surgery in a UK Deanery. J Surg Educ. 2016;73:111–115.
7. Culley DJ, Fahy BG, Xie Z, et al.Academic productivity of directors of ACGME-accredited residency programs in surgery and anesthesiology. Anesth Analg. 2014;118:200–205.
8. Todd RF III, Salata RA, Klotman ME, et al.Career outcomes of the graduates of the American Board of Internal Medicine Research Pathway, 1995-2007. Acad Med. 2013;88:1747–1753.
9. Toledo P, McLean S, Duce L, Wong CA, Schubert A, Ward DSEvaluation of the Foundation for Anesthesia Education and Research Medical Student Anesthesia Research Fellowship Program Participants’ Scholarly Activity and Career Choices. Anesthesiology. 2016;124:1168–1173.
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