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My Time as Editor-in-Chief: What a Long Strange Trip It's Been

Gaba, David M. MD

doi: 10.1097/SIH.0000000000000188

From the Center for Immersive and Simulation-based Learning and Department of Anesthesiology, Perioperative and Pain Medicine, Stanford School of Medicine, Stanford, CA; and Simulation Center and Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, CA.

Reprints: David M. Gaba, MD, Center for Immersive and Simulation-based Learning Li Ka Shing Center 291 Campus Drive, LK311C Stanford, CA 94305-5134 (e-mail:

The author declares no conflict of interest.

It has been public knowledge for more than 6 months that I would be retiring from my post of 11 years as editor-in-chief (EIC) of Simulation in Healthcare by mid 2016. However, it is quite likely that many readers of the journal have remained unaware of this change. In this issue of Simulation in Healthcare, both I and the new EIC, Mark Scerbo, PhD, will be providing our individual perspectives on the journal. Mine will be mostly reminiscences about its formation and history. Dr. Scerbo took over as EIC on July 1, 2016; however, we decided that it would make sense for me to remain as the effective EIC for most papers that were first sent for peer review or accepted under my watch. Mark will be the assigning and deciding EIC for all submissions that first arrive at the journal on or after July 1. Whenever appropriate, we will consult with each other.

Perhaps, readers wonder why I decided to retire from my EIC position. Eleven years is a long time. Although being EIC is both an honor and intellectually interesting, it is also hard work that—sort of like clinical work—is never done. And, although I stopped doing clinical work 6 years ago (after 27 years of paying my dues, daytime and on-call, as an academic anesthesiologist at Stanford, working clinically at VA Palo Alto Health Care System) I have two real “day jobs” as (1) Associate Dean for Immersive and Simulation-Based Learning at Stanford School of Medicine, where I oversaw/see the design, building, and operation of a 28,000 ft2 simulation center at Stanford (the largest by far of the five simulation centers in the Stanford family), and as (2) the founder and co-director (with my long-time academic partner Steve Howard) of the Simulation Center at VA Palo Alto originally opened in 1995. Over the next year, our VA Palo Alto Center will move into its own 9000 ft2 building that I designed. I also teach in many simulation instructor courses and courses for anesthesiology residents and maintenance of certification in anesthesiology. I am significantly involved in various simulation research projects, and I mentor many more junior colleagues from all disciplines and domains in pursuing their own simulation-based research. And, I continue to write scholarly works about patient safety and simulation. So, I have plenty to keep me busy!

I decided that after an exciting 11 years at the helm of the journal, it was time for me to step back and also that it was appropriate to finally get some “new blood” in the position. Any endeavor such as this periodically needs new (often younger) people with fresh ideas and a fresh eagerness to address them. Some readers may fear or hope that I am riding off into the sunset with no more connection to the journal. Happily for me (you may have your own feelings), I will be staying on the editorial board. In fact, the board of directors of the Society for Simulation in Healthcare (SSH) has just voted to establish the position of “Founding Editor-in-Chief” for me, and I will appear on the journal's masthead in that capacity. I have volunteered to be an advisor to the EIC, associate editors (AEs), and managing editor at their discretion.

Eleven years ago, I was selected as the first EIC of the then new peer-reviewed scholarly journal of the Society for Medical Simulation, but the name was changed fairly quickly to the Society for Simulation in Healthcare. Interestingly the journal always carried the word “healthcare” in its title rather than the words “medicine” or “medical.” I was chosen from a short-list of two candidates; both of us were well qualified. As I recall, I was told that by all accounts, it was a close vote. The other candidate has gone on to be heavily involved with SSH in other leadership roles. I am grateful that I was selected as EIC, and I appreciate the trust that the society vested in me for more than a decade.

Starting a journal from scratch was an interesting and rewarding endeavor. Referring to my notes from July 2005, we had to decide many things, such as: Would we use single-blinded review (reviewers know who the authors are but not vice-versa); double-blind review; or open review (we opted for single-blinded like many other journals)? How many AEs would we have? Representing what disciplines or arenas of healthcare and simulation? Would the AEs have specific “departments” or “sections”? What would our journal “style sheet” be (eg, we chose American version/spelling of English, a preference for the spelling “mannequin” vs. “manikin”)? From my document of 2005 are clearly visible many of the threads that were woven together to create the journal. Associate editors were from surgery, critical care, Europe, nursing (it took us a while), and psychology/human factors. There are no separate sections for the different modalities of simulation or for applications to specific domains. In addition to the usual empirical papers, editorials, and review papers, we added “scenarios,” “technical reports,” and reviews of educational materials. Fortunately, we did not have to invent our processes of peer review and decision from scratch. I had served as an AE of the journal Anesthesiology (and also on the editorial boards of a few others), so we were able to copy many of our procedures and style for references from that journal. In addition, we were fortunate because our publishing company (Lippincott, Williams and Wilkins, a part of Wolters Kluwer Health, Inc) also publishes a plethora of healthcare journals including Anesthesiology, so many of their processes were familiar to me.

Our first managing editor was Beverlee Anderson, who before this gig was instrumental in starting both the International Meeting on Simulation in Healthcare (IMSH) and the SSH (she was the SSH's first executive director). After SSH grew bigger and with the journal at its inception, she moved from the SSH Executive Director position to the managing editor role. As I was a founding board member of the society, I had known her for years; we were great partners at the journal. Sadly, Beverlee passed away in 2009. We will always miss her—a tribute editorial by Dan Raemer and me appears (Simulation in Healthcare 4:188-90, (2009)). Fortunately, for the journal and just as she would have wanted it, we quickly found a new managing editor, Karl Durst, who remains in that position today. He had previously been in roles of managing editor and even “publisher” (the person who represents the publishing company to the journal leadership and staff) for other journals in the same company. This was certainly fortuitous; he hit the ground running and he has guided the operational aspects of the journal conscientiously and astutely ever since.

I was not familiar, however, with all of the duties of the EIC. The most important of these is the “makeup” of the next print issue of the journal. As you might imagine, we have a “pipeline” of manuscripts in various stages of review, ultimate acceptance, production including copyediting, typesetting and graphics, and proofing (with the involvement of the corresponding author). Although we use a system of “electronic publication ahead of print,” releasing all articles electronically as soon as they finish production, the print issue is the journal of record. Approximately 4 to 6 weeks before the release of the next print issue, the EIC looks at the “pool” of papers that have completed production and selects the ones that will be published in that issue and in what order they will appear. Every journal and possibly every EIC have its own style for order of papers. In case readers have not noticed, my style is to have Editorials (if any) first, followed by Empirical Investigations (though I am both a theorist and an experimentalist, I guess my heart belongs most to those who design and collect real data!), followed by Concepts & Commentaries, Review Articles, Special Articles, Case Scenarios, Technical Reports, (occasional reviews of books or educational materials), and Letters to the Editor. Because all rules are made to be broken, eagle-eyed readers can no doubt find issues with a somewhat different order. Quite possibly, EIC Scerbo will have his own ideas about journal style, article types, and their order.

Making up the issue is fun. The EIC has to balance many different factors, including the number of pages of scholarly content against the “page budget” for the year and against the number of articles that will remain in the pipeline available for the subsequent issues. As making tradeoffs between various choices and multiple constraining goals was a familiar part of clinical work for me as an anesthesia professional, I enjoyed this process. I strived hard to have a balance of articles in each issue across different topics, different clinical domains, different types of simulation, and different target populations of participants. It was my hope that every issue had “something for everyone.” Only readers can say whether I achieved this goal ever, sometimes, or frequently.

An early milestone for the journal was to become indexed by PubMed, the premiere index of publication in healthcare. This was a more arduous process than anticipated because just before we applied, it seemed that the bar to being indexed was raised considerably higher than it had been in the past. Our first application was turned down. Although typically a reapplication would not be considered for 2 years, we successfully petitioned to apply in 1 year and did in fact begin being indexed in 2008. Once indexed, all contents published from the first issue were entered into the database. Because searching PubMed is the most common mechanism for scholars in healthcare to look for previous publications, ensuring indexing there was a critical step for the maturation of the journal.

One other goal that I achieved during my time as EIC was to make the content of the journal available without charge to everyone in the world 1 year after its official publication. This too was the result of a set of tradeoffs. On the one hand, immediate open access of content for free to everyone, while at the same time ensuring a rigorous process of journal management, peer-review, and production, can generally be achieved only with an “author pays” system with fees from authors typically in the range of US $1000 to $2000 per article. In fields where many studies are sponsored by external grant funding, this may work okay because the grants can typically cover the author fee. However, the young field of simulation has many studies by early career investigators with no external funding and scant internal resources—performed “on a shoestring” as the American saying goes. Such authors cannot easily pay these fees. However, at the other extreme, locking up the published content forever behind a “paywall” does an injustice to readers who cannot or choose not to be members of SSH or subscribers. Many people around the world and their work institutions cannot afford the cost of individual or institutional subscriptions. On the other hand (former US President Harry Truman once said—after being subjected to all sorts of conflicting economic advice— “Give me a one-handed economist!”), to be fully transparent, the SSH receives payments from the publisher including a share of advertising revenue. Trying to operate a journal with free access and without “author pays” would also deprive the society of an important source of income. Balancing all these competing forces generated a reasonable compromise—one used by many other journals—to give subscribers/members premium access to our content in the first year as a fair reward for membership or subscription, while making that content available thereafter for everyone in the world to read without fee. The SSH and I have felt that this was a good way to go. Of course, such decisions and policies need to be re-evaluated periodically.

Along with the growth of the society, the journal has grown. We first published quarterly, but since 2010, every other month. We first had four AEs; now, we have eleven. The first four were all men; now, six of eleven are women. We have four non-MD AEs (all with PhDs, one of whom is an RN, PhD). One of the MDs also holds a PhD. It has been a distinct honor and pleasure for me to work with our AEs. They are all experts in simulation in healthcare in their own right, and they have given so much of their time and effort to this collective scholarly endeavor with only a token annual honorarium. I am grateful for their collegiality and support.

I am also grateful to the countless peer reviewers who volunteer their time without even token remuneration (well, our lucky “top ten” reviewers do receive an invitation to the editorial board's hotel-catered dinner meeting at IMSH). Without the expertise and diversity of backgrounds of our reviewers, we would not be able to provide rigorous scholarly evaluation of manuscripts. Moreover, we consider it our duty to provide as much useful feedback as possible to authors, either to guide their revisions toward a goal of ultimate acceptance and publication or, even if their paper is rejected, to guide their future scholarly work. This feedback is based largely on the content of the reviews. We know that our field is small but growing rapidly, and the education of relatively inexperienced authors comes with the territory.

Finally, I am grateful to the readers. On the whole, both anecdotal and survey data have shown that our readers like the journal and its content. They see it as an important benefit of society membership. Sometimes, they send us interesting Letter's to the Editor. I have received many e-mails from authors. Occasionally, there are (often justified) complaints, but mostly, they are appreciative of the efforts put in by our reviewers, AEs, managing editor, and me.

All of these things have made me quite happy to be the founding and, until recently, current EIC. I am very grateful that we have a worthy successor who will do a fabulous job of carrying the torch and leading the journal to new and greater achievements. As the Grateful Dead sing: “Sometimes the light's all shining on me/Other times I can barely see/Lately it occurs to me.…/What a long strange trip it's been.” So, Simulation in Healthcare, “get back truckin' on….”

© 2016 Society for Simulation in Healthcare