esearch is easier to criticize than design, fund and complete. Yet research initiation, completion and publication remain essential for any specialty seeking to advance its field by the generation of new knowledge. The request by the ASA NEWSLETTER editor to provide a perspective on research from our Residency Review Committee (RRC) for Anesthesiology is a welcome one. I want to make it clear that I am speaking for myself as an academic anesthesiologist in providing this perspective, not as an official spokesperson for the Accreditation Council for Graduate Medical Education (ACGME) or the RRC. In spite of this disclaimer, I have many program reviews to reflect upon, feedback from other RRC committee members, responsibilities as chair of the RRC and current ACGME/RRC program requirements to guide my thinking.

The ACGME/RRC frequently makes decisions about the adequacy of research within core and subspecialty anesthesiology residency programs. Often there is confusion within a program over what passes as adequate research and scholarly activity. When you examine the standards the RRC uses in making opportunities available for research for our physician trainees, one of the most controversial parts of the role is defining research adequacy. Adequacy is frequently based on the often poorly focused concepts of the quality and volume of the research within the program. Most of you familiar with ACGME/RRC reviews know that the organization desires to follow program requirements in making its accreditation decisions, and these requirements are purposefully designed to be minimum standards.

When systematically reviewing the program requirements linked to research within our academic departments, quality and volume seemed most pertinent to better focusing on research (P.R. = program requirement source):

1. There must be the conduct of clinical and basic research (P.R. I.A.8.).

2. The program director must have significant academic achievements in anesthesiology such as publications, the development of educational programs or the conduct of research (P.R. III.A.1.).

3. All members of the teaching staff must demonstrate a strong interest in … and participation in scholarly activity (P.R. III.B.).

4. Adequate documentation of scholarly activity on the part of the program director, and the teaching faculty at the parent and integrated institutions, must be submitted at the time of the program review. Scholarly activity at affiliated institutions cannot account for or substitute for the educational environment of the parent and integrated institutions. Documentation of scholarly activities is based on … participation in research, particularly projects funded following peer review and/or that result in publications or presentations at regional and national scientific meetings. …While not all members of a teaching faculty can be investigators, clinical and/or basic science research must be ongoing in the department of anesthesiology of the parent and integrated institution(s) (P.R. III.C.).

5. The program must have resources to provide a research track of up to six months devoted to laboratory or clinical investigations (P.R. V.A.3.).

Thus, review of these abstracted program requirements makes it clear that the ACGME/RRC views research as important and essential for the educational training of a physician in our specialty. Currently there are very few programs that demand residents complete research during their core training interval. Those who are most effective in this area are those with mentors trained in translating to a physician-in-training what it really means to grow a research career.

The growth in our country’s surgical volume, along with the other challenges facing academic medicine in the United States, means that clinical demands often drive departmental decisions rather than a coordinated research or department academic plan guide the decision making. It is my belief that research for the generation of new knowledge is critical for our specialty’s long-term health. Without this generation of new knowledge, the best and brightest will not enter the field, and we will be left with other areas of medicine leading change that our specialty should be making. Many argue that clinical demands of patients should always take precedence over research, but in my opinion, that obscures the fundamental problem. The real issue seems to be a lack of will in many departments to develop and focus formal training in research for our young physicians and scientists and to allocate sufficient faculty time within departments for this work. This ultimately leads to a lack of role models in our young faculty who will stimulate and encourage physicians-in-training to make a decision about an academic career.

As an individual who has been engaged in academics for more than 25 years, I can personally reflect that the best training programs are able to keep the generation of new knowledge (real research) alive and well within their departments. Those programs that lack a true sense of inquiry imbedded within their department culture leave a valuable part of the educational experience unavailable to our physician trainees. More effectively developing a sense of inquiry allows trainees to critically evaluate new information, which is an important skill throughout their careers. The RRC has begun exploring a requirement for research training in subspecialty fellowships as a first step in guiding the development of these needed skills.

It is my belief that a wide cross section of our specialty’s leaders must assist truly interested academic departments in establishing resources to compete effectively for peer-reviewed funding. Peer-reviewed funding is the true measure of research success for professional research scientists. Our challenge is to build an adequate foundation of research support and mentorship within our discipline to allow our trainees to gain a positive yet realistic view of the rewards that research success and the generation of new knowledge allow. In my opinion, that opportunity should be available to all interested anesthesiology trainees. The research target within the specialty needs to be raised, and I believe it is fundamentally a question of our will.

David L. Brown, M.D., is Edward Rotan Distinguished Professor and Chair, Department of Anesthesiology and Pain Medicine, MD Anderson Cancer Center, Houston, Texas.