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Anesthesiology, V 120 No 1

January 2014

Hi, this is Jim Eisenach, Editor-in-Chief of Anesthesiology to tell you a bit about this very special issue of the journal and why it applies to you and your practice. Anesthesiology is divided, not by type of article or subspecialty topic, but rather by the fields of medicine which make up our specialty-perioperative, critical care, and pain medicine. As an aside, I know that many readers prefer to focus on particular subspecialty topics or types of articles, and we will soon unveil easier and quicker ways to find these. But the decision to subdivide the journal into fields of medicine rather than subspecialty topics underscores that we are a medical, not nursing, discipline. Four years ago we added a fourth subdivision of the journal devoted to education, including original research, review articles, case-based image discussions, and case-based teaching conferences. This months issue focuses on an education theme with Dr. Alan Schwartz as Guest Editor, and nearly the entire journal is devoted to education. The Editorial Board decided to devote an issue to this topic 2 years ago, and the response to the call for papers was overwhelming. We received well over 100 reviews, original investigations, and opinion pieces in response to this call, and the best of these appear in this months issue. If youre a board-certified physician in a nonacademic practice, which is most of the subscribers to this journal, why should you bother opening up this issue, since it is primarily filled with discussions and research on how to teach and develop residents and academic faculty? If nothing else, I suggest you look at two articles. The first is an article by Dr. Marjorie Stiegler from the University of North Carolina on clinical decision making. I had the privilege of hearing Dr. Stiegler lecture on this topic to our department grand rounds a couple of days ago. The review article, which is equally as riveting as her talk, discusses that the majority of medical errors leading to injury occur from errors in thinking rather than equipment or drug swaps. She describes the various types of traps we all fall into which lead us to ignore important warnings, why and how we focus on what we want to be happening rather than what is, and what strategies we can employ to minimize these errors. These concepts likely apply to many other aspects of our lives, but are well worth any clinician spending some time considering and applying to their clinical practice. The second, also a review article, describes the process by which objective structured clinical examinations are constructed and implemented. Why should we care? Well, for those not yet board certified, this type of examination using simulation will be implemented in the board examination process in 2017. The article is accompanied by an editorial authored by Directors of the American Board of Anesthesiology describing the reasons

for this addition to the certification process and how it will be applied. For those already board certified, this information is important because of the application of structured clinical education and testing to the maintenance of certification process. The concepts in most of the remaining articles, although applied to the setting of teaching and learning during residency, are relevant to lifelong learning. Diane Gambill, Chief Learning Officer at the ASA, provides a concise overview of what the ASA is doing in education and how they are evolving to meet changing needs. Just as health care delivery is being transformed, so is the fundamental basis of resident education, with focus on core competencies and achieving milestones in demonstration of these competencies. This requires a new and more flexible approach to residency training, and Tom Ebert from the Medical College of Wisconsin provides a nice overview on the development of these approaches and the challenges they present. I recently heard an internationally recognized clinician scientist say that a specialty which stops doing research is one generation away from extinction. Our specialty lags well behind most others in number of researchers, successful competition for NIH dollars, and publication of practice-changing studies which are important to public health. There is a clear perception that this is getting worse rather than better. Several academic departments are experimenting with methods to enhance exposure, interest, and training and development in research, and one of these experiments at the University of Pittsburgh and its preliminary success are described in an article by Sakai. They not only show an increase in metrics of success after their program was instituted, but cleverly compare their residents to similarly ranked resident applicants who went elsewhere, and show that these metrics of success were greater in those in their program. Mike Todd, in a provocative editorial, describes the importance of this particular experiment and these experiments in general. He echoes the comments of the clinician scientist regarding extinction of a specialty by describing how individual physicians become fossilized when they stop learning, just as entire specialties can. Several articles assess novel approaches to learning and teaching, including use of low- and high-tech simulation, automated feedback, and validation of assessments. If you are a resident or are on a teaching faculty, I guarantee you will find at least one of these articles thought provoking and impactful. So whether you are in private practice far from the teaching environment, are beginning your residency or preparing for board examinations, or are a faculty member struggling with how to respond to the rapidly changing mandates in the transformation of resident education, you will find something of interest in this issue of the journal. I agree with the Editorial Board that this experiment to highlight teaching as a foundation of the specialty has been a success, and hope that it reminds you to check our education section each month.