he last several years have witnessed considerable expressions of concern evident in published articles, oral presentations and committee deliberations over the future of anesthesiology as a physician-led specialty. Although many have expressed views as to future paradigms of clinical anesthesia practice that must be addressed in order to anticipate the future role of physician anesthesiologists in the perioperative environment to include preoperative, intraoperative, postoperative and critical care and pain management, a common thread evident in all of these discussions is the impact of academic training programs as an essential component to ensure adaptability and survival. Recognition of anesthesiology as a medical specialty is closely if not totally affixed to the contribution to medical science and education dependent on the success and productivity of our academic programs. Thus major effort has been made in attempting to evaluate the current state of our academic programs and to predict their future.

Continued efforts by the Accreditation Council for Graduate Medical Education (ACGME), the Residency Review Committee (RRC) for Anesthesiology and the American Board of Anesthesiology (ABA) have led to cautious optimism regarding the current state of clinical anesthesia training and the quality of our resident graduates, thus providing us with a continuous influx of outstanding physician trainees and resultant clinical anesthesiologists. While the clinical training has continued to thrive, unfortunately the same cannot be said for the growth and productivity in the areas of scholarly research activity among our core and subspecialty programs.

Several reviews of available data, most often derived from National Institutes of Health (NIH) statistics, have demonstrated a significant underfunding of anesthesia-based research far below that expected given the numbers of approved anesthesiology training programs and academic faculty. Further examination reveals that less then half of the current academic programs have any NIH funding, with only a small number holding multiple grants. It is acknowledged that this data does not consider alternative funding sources such as the Veterans Administration, Department of Defense, subspecialty funding organizations or industry support; however, competitive funding from NIH still remains a “gold standard” in evaluating scholarly research activity. It therefore has to be acknowledged, as it has been stressed in nearly all published and oral venues, that a deficiency of anesthesia research from our academic programs is a reality and that continued failure to improve this state will be a major impediment to the continued recognition and growth, if not survival, of anesthesiology as an essential physician-led specialty.

Over the last four years, the Foundation for Anesthesia Education and Research (FAER) has led a series of retreats composed of leadership representation from all of our major anesthesiology organizations. These retreats have examined options to encourage the growth of academic research productivity in our specialty. One proposal has been to recognize those programs that demonstrate meaningful contributions to anesthesiology medical science while maintaining outstanding clinical training by designation as “Centers of Excellence.” In considering the application of such a designation, much deliberation involves whether to apply it to core anesthesiology programs or subspecialties. Although it has been the impression of many that ACGME, through the RRC, should increase the intensity of its review of research scholarly productivity in evaluating core programs for accreditation, it is recognized that ACGME establishes requirements necessary to ensure consistent training experiences and educational processes that lead to accreditation of programs. The organization does not have an edict to establish program requirements at a level needed to achieve the productivity required to sufficiently grow the scientific aspect of our specialty or any other specialty.

It has, therefore, been proposed by the retreat participants and FAER that a Center of Excellence designation be applied to subspecialty training programs. This designation would recognize both clinical training and research productivity as necessary components for recognition as a Center of Excellence. Although the logistics of this program must still be developed and evaluated before any implementation can be considered, the following initial components have been proposed:

1. All subspecialty training programs would be eligible to be designated as Centers of Excellence.

2. Criteria would be established by FAER and subspecialty societies. Such criteria would then be used to evaluate the scholarly productivity and education that would satisfy awarding this designation to an individual subspecialty training program.

3. Those subspecialty training programs so designated would be recognized as providing nine to 12 months of clinical training and a further 12 or more months of research training in a fellowship capacity.

4. Funding for the additional year of training would be sought in collaborative efforts between FAER, subspecialty societies, ASA and other anesthesiology organizations. Local institutions and departments obviously would carry at least part of the costs associated with this designation and the additional year of employment each fellow would require.

The designation of “Center of Excellence” may serve to attract high-quality fellows. It also may provide incentive for programs to add research expertise and productivity. The growth and survival of anesthesiology as a respected and desirable medical specialty is dependent on the excellence of our training programs, both as venues for clinical training and the attainment of new knowledge through basic and clinical research. Prompt action is needed to grow the new knowledge that will propel our specialty into the future.

Myer H. Rosenthal, M.D., is Professor of Anesthesia, Stanford University School of Medicine, Stanford, California.