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Correspondence |
The University of Western Ontario, London, Canada, E-mail: davy.cheng{at}uwo.ca
To the Editor:
I appreciate the recent article by Tsui et al. 1 which highlights important threats and recent challenges facing academic anesthesiology. In their observational study, the authors rated the number of publications amongst Canadian university departments. They concluded that the numbers of randomized clinical trials conducted in Canadian departments are decreasing, although the overall numbers of anesthesia publications have not declined significantly. The authors highlight the importance of encouraging anesthesia residents to undertake a dedicated research rotation, the importance of creating an academic environment with protected non-clinical time, and the role of mentorship
I echo their serious concerns regarding the future of our specialty. Without advancing the knowledge base of anesthesia through research, our specialty risks gradual deterioration into a clinical service and technical department, in comparison with our academic peers. However, I have major reservations in the methodology and benchmark metrics on research productivity as presented by Tsui et al.1
Firstly, the study grossly underestimated the number of research publications from the Department of Anesthesia at University of Western Ontario (UWO) for the period 2000-2004. In comparing our annual reports and repeating the MEDLINE search, the UWO Department published 97 peer-reviewed publications instead of 37 as reported by Tsui and colleagues during the five-year sampling frame. Using the definition of study design in Table I of Tsui et al., the UWO Department actually published 13 laboratory investigations, four basic sciences studies, six case reports, four case series, four clinical trials, four cohort studies, five editorials, four invited commentaries, one meta-analysis, one non-clinical study, eight randomized controlled trials (RCT), four multicentre RCTs, 35 reviews, and four systematic reviews. The discrepancies can be explained by limitations of the search strategy and not attributing the publications to the department of anesthesia when they originated from our critical care program or collaborative research programs, particularly when the laboratory was based in another department. Furthermore, their search strategy failed to capture publications in other subspecialty journals including, but not limited to: Transplantation, Brain Research, Stroke, Neuroradiology, and the Journal of Neurocritical Care. I believe that other Departments may also have had their number of peer-reviewed publications significantly underestimated. This underestimation of the full picture of anestheisa research productivity in Canada fails to fully capture for our universities and the international medical community, the considerable past achievements of our many anesthesia researchers in Canada.
Secondly, regarding the benchmark metrics used by Tsui et al., namely the publication rate and impact factor scores, the authors did acknowledge the limitation of ranking institutions based primarily on the total number of publications, and the size of the academic centre was not accounted for. My concern is that the disproportional bias in ‘research productivity’ in smaller university departments may hinder recruitment of young researchers to these departments. To fairly address these rankings, I would propose that the research publication rate should be divided by the number of full time equivalent faculty members within each academic department. This would more closely reflect research productivity within each academic department in context of its clinical and academic deliverables.
It is sometimes easier to follow the path of least resistance when coping with the human resource shortages confronting the specialty of anesthesia. However, within academic departments, we must now more than ever, train and encourage young investigators and educators, and provide them with dedicated mentorship and the necessary resources to allow them to flourish on their academic career paths, and avoid an overly–developed focus on provision of clinical services.
Footnotes
Accepted for publication May 9, 2006.
Reference
1 Tsui BC, Li LX, Ma V, Wagner AM, Finucane BT. Declining randomized clinical trials from Canadian anesthesia departments? Can J Anesth 2006; 53: 226–35.
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