“What’s going to change at Anesthesiology? Not much, quite a lot, and too soon to tell.”
ANESTHESIOLOGISTS are critically aware of the importance of care transitions and handoff communication. This edition of Anesthesiology sees an important transition in the care and leadership of the Journal, with the retirement of current Editor-in-Chief James C. Eisenach, M.D., and my assuming care as Editor-in-Chief. As a member of the Editorial Board from 2000 to 2009, I enjoyed the privilege of working with several previous Anesthesiology Editors-in-Chief, most recently Dr. Eisenach. I seek to emulate the wisdom and accomplishments of the great leaders of the Journal and the specialty, who sequentially and collectively blazed the Journal’s path and established an unwavering and positive trajectory of excellence.
In this handoff communication, I wish to frame in broad and historical terms the role of Anesthesiology in our specialty, and its vital role in advancing our future and that of the American Society of Anesthesiologists (ASA). With this perspective, which helps inform our motivation, we can then begin to explore the potential that lies ahead and how we may venture forth.
What Defines a Medical Specialty?
Medicare states that a specialty focuses on certain parts of the body, periods of life, or diseases.1 Practically, perhaps this is so. But intellectually, this seems incomplete. The medical historian, George Weisz, in his essay on the emergence of medical specialties, posited that specialization arose in the 19th century not from the advent of new technologies, but rather as a manifest necessity of modern medical science, resulting from the realization of three preconditions: (1) the unification of medicine and surgery, (2) a collective desire to expand medical knowledge, giving rise to “a community of scholars built around the research imperative,” and (3) the need for institutional conditions in order for “new ideals of scientific medicine to take hold and lead.”2 The emerging medical specialties were “a large and integrated community of doctors centered on an organized system of institutions and, most important, devoted to advancing medical knowledge through rigorous empirical clinical research.”2
A specialty exists, therefore, to advance focused medical knowledge and medical teaching. Such advancement requires processes of curiosity, inquiry, investigation, and discovery. Advancement embodies the sequential hierarchical domains of data, information, and knowledge (and ultimately wisdom). And advancement requires the communication and dissemination of knowledge with the goal that it will be incorporated into clinical practice for the improvement of human health. In a classical definition, specialties emerged in their modern configuration “as a form of knowledge production and diffusion, closely linked to clinical practice.”2
The mission of the ASA is “Advancing the practice and securing the future.” The parallels between knowledge production and diffusion, and advancing the practice and securing the future, are unmistakable. Indeed, the concepts are manifestly one and the same.
What Is the Role of a Medical Specialty’s Journal?
Scientific journals serve a specialty’s mission of advancement by communicating and disseminating new knowledge, with the goal of educating their readership. They also foster intellectual rigor through the peer review process, and publishing content that they view as possessing qualities to be emulated. Lastly, journals stimulate and challenge their readers and authors with a marketplace of new ideas, and can take leadership roles through publishing core journal content and associated editorial comments or correspondence. Journals are the engines of a specialty’s knowledge diffusion, and a specialty and its journal should be inseparably joined in that common objective.
A thriving journal is essential to the future of its specialty. Journals are invaluable to the practice they advance, the knowledge they diffuse, and as a symbol to the community (medical and nonmedical) of the identity and value of the specialty that they represent. They serve as a gathering place for creative ideas and critical thinkers, and they serve as a source of pride for their specialty. More prosaically, specialty journals are important for what they publish, and that they publish.
A thriving Anesthesiology is essential to the future of anesthesiology. The mission of Anesthesiology is to “promote scientific discovery and knowledge in perioperative, critical care, and pain medicine to advance patient care.” The journal therefore is the embodiment of the above concepts of a medical specialty. It is both a symbol of practice advancement through new knowledge generation and the carrier of the product of that inquiry. Anesthesiology is the premier journal in our specialty, recognized and respected nationally and internationally. It improves clinical care and clinical teaching. It brings value to patients, investigators, practitioners, the ASA, and the specialty. And it is a statement of our importance, contribution, and value to medicine more broadly.
Who Is the Customer?
This perspective is critical in determining the future direction of the Journal, just as it is for any successful business or service. Our customers are ASA members and nonmembers, authors (those submitting manuscripts and those whose submissions are published), readers, citers, advertisers, private practitioners, academics, pure scientists, anesthesiologists, nonanesthesiologists, the publisher, pharmaceutical and device industries, the collective specialty, medicine more broadly, and ideally also healthcare payers, regulators, and policymakers. Try running a business with that diverse customer base!
The goal of the Journal is to maximize both the richness and the reach of its content, while satisfying the customer(s), achieving the Journal’s mission, and satisfying ASA’s desire to improve scientific understanding, clinical practice, and education in the specialty. Service to all the customers means advancing the practice and securing the future through knowledge production and diffusion, all closely linked to clinical practice.
The decennial question faced by each of my recent predecessors, and theirs before them, has been “What’s going to change?”3–5 I have been asked that many times already. And much like the answers provided by my predecessors, it is “Not much, quite a lot, and too soon to tell.” Anesthesiology historically has been “the repository of the best clinical and laboratory research performed that is related either directly or indirectly and immediately or even remotely and less obviously to our practice,”3 endeavoring to publish “the best clinical and laboratory science and practice information the specialty has to offer”4 and “new discoveries of relevance to physician anesthesiologists.”6 Anesthesiology, going forward, will endeavor to attract and publish the highest quality possible, peer-reviewed, specialty-relevant science—basic and clinical—which asks and addresses important questions. Not much there will change.
Beyond that affirmation lies the realm of “quite a lot, and too soon to tell.” Perhaps it is useful to consider this in different domains, i.e., of content innovation, content reach, and business model innovation, and to place these in the context of increasing accessibility and impact. Regarding content innovation, Anesthesiology presently attracts and publishes (increasingly, by objective criteria) excellent articles and maintains inviolable standards of peer review and editorial independence. It is imperative to protect and maintain these achievements. The Journal works. But we should and will consider additional content areas, beyond those presently published. A corollary of content is authorship. While many Anesthesiology articles come from anesthesiology departments, the universe of important high-quality work of interest to anesthesiologists arises more broadly. Broader authorship may also engender broader readership, and hence impact.
In the domains of business model innovation and reach, most notably content delivery, the unassailable fact is that information transmission and learning methods are changing madly. Traditional print journal articles have been joined, albeit not replaced, by internet/digital content as a favored source of information.7 The latter brings the challenges of multiple platforms and a shrinking quantum of digestible information moving from printed article to page view on a handheld device. Anesthesiology has made remarkable gains in electronic publishing, and that effort will remain an ongoing focus and object of innovation. The nexus of print publication, electronic publication, social media, and media coverage will likely yield new synergies. Journal reach will be an important future focus. We serve, and will endeavor to serve, multiple constituencies, including ASA members across all practice domains, both private practitioners and other practitioners; international anesthesiologists in established practice and in modernizing practice; and nonanesthesiologists who may benefit (as may their patients) from the new knowledge published in the Journal. We will be looking to reach, and to stretch. But no less important a component of reach is reader comprehension of journal content and the ability to convert new knowledge to practice. Thus, not only will we reach out, but also reach in. We will endeavor to explore better ways to communicate—i.e., to present information and to help readers interpret and understand the new knowledge that Anesthesiology publishes—to enable conversion of new information to practice. The goal is to advance our practice and secure the future.
We will go where the science takes us. I look forward to going there with you, and with your help in the journey.
The author thanks William L. Lanier, Jr., M.D., Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, for his very helpful discussions.
Dr. Kharasch is the Editor-in-Chief of Anesthesiology, and his institution receives salary support from the American Society of Anesthesiologists, Schaumburg, Illinois, for this position.