Changes: Thank You, Dr. Eisenach

IT is an Anesthesiology tradition that an incoming Editor-in-Chief shares his or her perspectives on the path and endeavors of one’s predecessor and the Journal under that person’s aegis. I respect that important tradition. More importantly, this new Editor-in-Chief wouldn’t dare miss the opportunity to profusely thank Editor-in-Chief (2007 to 2016) James C. Eisenach, M.D. (F.M. James Professor of Anesthesiology and of Physiology and Pharmacology, Wake-Forest University School of Medicine, Winston-Salem, North Carolina) and celebrate his and Anesthesiology’s spectacular accomplishments. Two of the Managing Editors who worked closely with Jim also join in this perspective.

It is also a Journal tradition that an outgoing Editor-in-Chief writes one last editorial, a “lap of honor” in his last issue, to enumerate his successes and share his final views. Jim decided to skip that opportunity, in his usual low-key manner. But we’re just not going to let that pass unnoticed.

Aegis: “The protection, backing, or support of a particular person” (Oxford dictionary). This is but one way to describe, albeit insufficiently, Jim’s role at Anesthesiology. Another way is to use the modern lexicon of research itself: significance, innovation, approach, environment, and contributions to science. But neither does this capture Jim’s passion. Leadership is a far better descriptor. Robert Gates, former Central Intelligence Agency Director, Secretary of Defense, and Leader of Texas A&M University and the College of William and Mary, said “A leader’s heart must be on fire with belief in what (s)he seeks to do.”¹  That’s certainly Jim.

Jim has been a visionary leader and a creative and motivating force for innovation at Anesthesiology. The Journal has undergone numerous changes in look, feel, organization, and content over the past decade, only some of which are enumerated below. What hasn’t changed is Jim’s discharge of the Editor-in-Chief’s role as an unfaltering advocate for scientific and editorial excellence, and as a vigorous and principled defender of scientific and editorial integrity and editorial independence.

In his 2007 inaugural editorial, Jim wrote of his amazement at the change in the electronic world in general, progress in medical communication, and in Anesthesiology in particular.²  He metaphorically described amazement through the eyes of a young woman from a small village in France, who joins a travelling circus headed for the big time, in the musical Carnival. As Jim anticipated, change in communication at Anesthesiology has indeed been amazing during his tenure, continuing a trajectory established decades earlier. Editor-in-Chief (1963 to 1970) Leroy Vandam, M.D., wrote about his “conception of the journal as a potent force in education, in raising professional standards, for the reflection it may cast upon the specialty and our Society.”³  Editor-in-Chief (1997 to 2006) Michael M. Todd, M.D., in his inaugural editorial, predicted with great foresight that communication and education would be the two areas in which he expected to see the greatest change.⁴  Two years later, Editor-in-Chief Mike Todd and future Editor-in-Chief Jim Eisenach chronicled the history of communication in society and in medical publishing and described the emerging role of “The Internet” and how Anesthesiology would be affected by it and evolve with it.⁵  Echoing Dr. Vandam’s description of the Journal as a “potent force,” they wrote “moving forward, rather than getting lost, necessitates that we define what we are seeking and where indeed we want to go.” Now, nearly two decades hence, no aspect of the Journal is untouched by “The Internet” and electronic communication, ranging from the submission, review, and dissemination of scientific publications to the emerging (experimental) role of social media in Anesthesiology.

Numerous other changes have come to Anesthesiology under Jim’s aegis, and the leadership and vision also of the other members of the Editorial Board—29 smart and creative individuals with whom he worked, with strong support from the Journal staff. Job one was to change Anesthesiology, “often perceived as a relic of old-style communication and change-resistant peer review,”⁵  to a modern Journal, embracing new modes of communication while maintaining its focus on publishing quality research. Soon thereafter, in order to better serve the multiple constituencies of authors and readers, investigators and practitioners, and American Society of Anesthesiologists (ASA) members, with greater clarity and strategic direction, Jim and the Editorial Board refined the Anesthesiology mission statement: “Promoting scientific discovery and knowledge in perioperative, critical care, and pain medicine to advance patient care.” Jim embodied and advanced that mission for nearly a decade.

It is not possible to chronicle all of Dr. Eisenach’s accomplishments as Editor-in-Chief, and the many changes to the Journal; nor is that our purpose. Rather, it is to highlight a model of determined and focused leadership, exemplary character, and stewardship of the Journal. Identifying direction, setting goals and benchmarks, and moving forward to advance the Journal and specialty are phrases which define Jim’s term as Editor-in-Chief from 2007 through 2016.

A major early focus was on readership. Dr. Eisenach’s January 2010 editorial noted “practice-changing research cannot change practice if it is not read, and we want to increase the number of anesthesiologists who open and read the work published in Anesthesiology.” Clarity emanating from the newly revised mission statement led to a reorganization of the contents into the divisions defining our specialty: sections on perioperative medicine, critical care medicine, and pain medicine, subdivided into basic science and clinical science, and later a new section on education. The printed journal’s front matter was expanded to attract attention and better deliver a focused message. This included This Month in Anesthesiology, a synopsis of highlighted articles in each issue; Science, Medicine, and the Anesthesiologist, a brief overview of key literature from outside the specialty and relevant to anesthesiologists’ clinical practice; Infographics in Anesthesiology, complex information presented quickly and clearly; and expanded numbers of editorials to highlight the issues’ articles. The original investigations themselves saw new highlight boxes, to deliver the “take-home message”: what did we already know and what did we learn that is new. There were experiments with calls for papers, themed issues, guest-edited issues, and those featuring a particular department of anesthesiology.

As envisioned by Mike Todd and then Jim Eisenach, digital publishing continued to grow in importance, and Jim was attuned to the industry trends and responsive changes needed at the Journal. These changes included enhanced electronic delivery, apps, new content delivery platforms to make content easier to find and read and search, and articles curated by content tagging. To draw in ASA members, make browsers into readers, and reach a broader audience, there are now podcasts, video abstracts, weekly electronic alerts of article publication, press releases, and experiments with social media.

Another major focus was on authors. Foremost, and always unwavering, was Jim’s emphasis on recruiting the very best new science and authors in the specialty, “to attract and promote new discoveries of relevance to physician anesthesiologists.”⁶  But also recognized was that process matters. Review times were shortened, the number of reviews per paper decreased, a fast-track (“triage”) review option was initiated, and the time from acceptance to publication was reduced. Communications to authors were clarified. All this occurred while maintaining the principle that the high standard of peer review, and independence of editorial content from any undue influence, must both be vigorously defended and maintained.

Growth and creativity in Anesthesiology have not been limited to the print edition, or even the electronic edition. Over the past decade, Anesthesiology has taken an increasingly active role in the Annual Meeting of the ASA and achieved greater collaboration with the ASA on several activities. The Journal Symposium, started in 1991, in which a specific research topic is selected for the Annual Meeting and associated Journal edition, just celebrated its 23rd yr. The Journal highlights the best abstracts at the meeting and participates in the Celebration of Research. A new session at the Annual Meeting on important clinical trials was inaugurated in 2015.

Jim also recognized the solemn responsibility of Anesthesiology, to the specialty and to the scientific community more broadly, to maximize the quality and uphold the integrity of science published in the Journal. Through editorials and changes to the instructions to authors, Anesthesiology has, under Jim’s aegis, taken efforts to encourage research replication through the public availability of protocols and statistical code for randomized clinical trials⁷ ; to improve the quality of research conduct, reporting, and transparency of preclinical investigation in cells and animals by instituting required elements for publication⁸ ; and to improve the quality and transparency of observational studies by requiring that authors transparently report to reviewers, and in an article, whether an analysis plan was developed before the data were accessed and analyzed, and has strongly encouraged authors to do so.⁹  Such proactive and difficult efforts reflect the importance of the principles under which Jim operates, his passion for quality, and the need for Anesthesiology to lead the scientific community.

And now, let’s do the numbers. Over the past 10 yr, Anesthesiology has published 1,677 original investigation articles. More than half of these articles originated with authors from outside the United States. Out of the 7,224 articles submitted to the Journal, 1,684 were accepted. From 2008 to 2014, annual manuscript submissions increased from 900 to 1300, publications of NIH-supported research increased from 80 to 150, and those of Foundation for Anesthesia Education and Research (FAER)-supported research increased from 13 to 22.⁶  The impact factor, one metric of journal prestige (imperfect and abused as it is), has risen from 3.4 (in 2002) to 6.1 in 2014. Average time to decision on a submitted manuscript has decreased from 6 to 3 weeks, and time from manuscript acceptance to appearance online has shrunk to 3 weeks. On the Journal web site, monthly page views for 2015 averaged 183,000. The weekly eTOC alerts average a 30% open rate, and more than 10,000 articles are viewed monthly by those alerted via the ASAP Weekly. The monthly Editor-in-Chief podcast averages 20,000 downloads a month, substantially increased from 700 only a year ago. The Journal’s social media presence has grown since 2014 from 2,900 followers on Facebook in January 2014 to more than 6,200 in January 2015.

Those associated with Anesthesiology during his tenure understand that Jim’s heart was on fire with the belief in what he did. Those associated with Anesthesiology during his tenure owe Dr. Eisenach a debt of gratitude. His commitment to excellence, his forward-thinking vision, and his sensitivities to the specialty have advanced medicine, our specialty, and the Journal and set the stage for future growth and development.

Anesthesiology will lose Jim’s leadership, but not his legacy or vision. And fortunately for anesthesiology and the ASA and the FAER, he is not going far. Jim becomes the President of FAER, to lead that organization and further its efforts. He will remain as an advocate for the common mission of FAER and Anesthesiology: to promote scientific discovery and knowledge to advance patient care. In essence, he’ll simply be moving upstream in the process, from research publication to research funding and to developing the careers of the next generation of clinician-scientists.

In Jim’s 2007 editorial, he wrote also of the warm, familiar world of the young girl’s village, where everybody knew her name. He then said “we are a community of trainees, clinicians, and scientists, and Anesthesiology will strive to remain familiar and relevant to this big family.”

From the big family of ASA members, Editorial Board members, journal authors and readers, investigators and practitioners, trainees, clinicians, scientists, and journal staff, and on behalf of the patients we care for, we thank you, Dr. Eisenach.