The Daily Dose • Thursday, June 10, 2021

The Future of the Anesthesiology Physician Scientist: An Anesthesia Research Council Update and Needs Assessment

The Anesthesia Research Council (ARC) held a virtual informational and needs assessment session, “The Future of the Anesthesiology Physician Scientist: An Anesthesia Research Council (ARC) Update,” on May 15 at the IARS 2021 Annual Meeting. Fifty-five engaged experts in anesthesiology convened to brainstorm about the four study charges put to the ARC Year 1 Working Group regarding the current status and future of the anesthesiology physician scientist pipeline. To that end, session participants and members of the working group explored the need to recruit, mentor, and retain more research-oriented residents to increase the number of physician scientists in anesthesiology.  

The ARC Year 1 Working Group is chaired by Charles Emala, MS, MD, and is composed of Cynthia Wong, MD, Margaret Wood, MD, Lee Fleisher, MD, Vivianne Tawfik, MD, PhD, Paloma Toledo, MD, MPH, Monica S. Vavilala, MD, and Meghan Lane-Fall, MD, MSHP.

To frame the session, Max Kelz, MD, PhD, Chair of the ARC Steering Committee, shared the focus and goal of the ARC, after which Dr. Emala presented the four study charges and approach to data collection. Dr. Emala encouraged frank discussion in the breakout rooms — one for each study charge — promising anonymity concerning all comments made therein. Then, attendees self-selected into breakout discussions.

Key takeaways from discussion of study charge 1, “Anesthesiology’s Physician Scientist Pipeline, Benchmarked Against Other Specialties,” were the need for improved promotion of the importance of anesthesiology research, the diverse and multidisciplinary nature of anesthesia research, and the need to define compelling research questions in the field. In response to a poll question, the participants unanimously agreed that focusing on the recruitment of research-oriented medical students and those in medical scientist training programs would develop the most candidates into successful anesthesiology physician scientists. It was proposed that, rather than trying to excite residents to engage in research during clinical residency training, actively recruiting medical students with a strong interest in research into the specialty of anesthesiology may be the best approach.

Stakeholders in the “Factors, Barriers and Solutions to Successful Launch of Anesthesiology Physician Scientists” breakout room discussed the models of anesthesiology research, changing the narrative on culture, establishing integrated missions across other departments, built-in research opportunities and leadership for physician scientists, and collaborating with other departments. One attendee proposed that department chairs who are research-oriented physician scientists can effect culture changes that are not possible via a bottom-up approach. Another participant proposed the formation of research networks around questions that garner institutional interest (e.g., opioids) as an effective approach to engender cross-departmental collaboration.

The three discussants of study charge 3, “Diversity: Identifying Factors and Solutions to Barriers that Differentially Affect Underrepresented Groups,” commented on the small number of session attendees who chose to participate in this breakout room. This meaningful, enlightening discussion centered on representation (women directors draw more women candidates), performativity (lip service vs doing the work), the minority tax (financial and emotional burden on minorities), and metrics for determining progress (e.g., presence or number of women in an author group, on editorial boards, speaking at conferences). Attendees noted the need to recruit and promote individuals at earlier stages, retain them, and proactively address attrition of certain groups. Proactive, engaged leadership and committees, along with broad engagement by members and their institutions, can foster this. Key factors to increasing diversity are representation, civility, and culture in the program, as well as the diversity of the city in which the program resides.

The importance of influencing deans (resulting in increased support to faculty engaged in research) and of external validation of whom to invest in were the top takeaways from breakout room 4, “Recommendations to Trainees, Mentors, Chairs, and Deans and Funding, Legislative and Academic Societies to Strengthen the Anesthesiology Physician Scientist Pipeline.” Persistent messaging pays off. One attendee meets regularly with their dean. Shortly after one such conversation, a philanthropist couple with a social justice focus met with the dean, who recalled that most recent conversation and directed the couple toward funding a pain clinic for the underserved. Anesthesiologists must educate funding agencies about the value of anesthesiology research and speak to members of the U.S. Congress and their staff on issues such as combatting maternal mortality and preparing for the next pandemic.  Improving messaging around what anesthesiologists do clinically and in research, and disseminating the value of that work are key to recruiting candidates to be physician scientists and gaining increased validation and research funding outside of the specialty.

The ARC Working Group greatly benefitted from the frank discussions of the motivated stakeholders who engaged with the IARS session. These opinions, views, and visions will further inform the working group’s endeavor to address the current status and future of the anesthesiology physician scientist pipeline. The ARC Working Group will engage with stakeholders inside and outside the specialty of anesthesiology in a planned Summer Summit, with the goal of producing influential publications that can be used to enhance the investment in and recruitment of future anesthesiology physician scientists.

About the Anesthesia Research Council

ARC’s mission is to advance scientific discovery and health care policy through the development and dissemination of research in anesthesiology, perioperative, and pain medicine with the goal to become the go-to resource for state-of-the-art review, synthesis, and future recommendations in anesthesiology, perioperative medicine, critical care, and pain medicine research.

ARC currently is a 3-year pilot plan, supported by the American Society of Anesthesiologists (ASA), Foundation for Anesthesia and Education Research (FAER) and IARS and overseen by a Steering Committee. The Steering Committee, chaired by Max Kelz, MD, PhD, is responsible for choosing the annual study charge to be addressed and generating a series of concrete questions to be addressed resulting in a final work product. The Committee also identifies and recruits a working group of 5–6 people with diverse representation responsible for generating the final product. For more information, click here.