We Are What We Make: Transforming Research in Anesthesiology: The 45th Rovenstine Lecture
We Are What We Make: Transforming Research in Anesthesiology: The 45th Rovenstine Lecture
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我们就是我们所做的：改变麻醉学研究：第 45 届罗文斯汀讲座
作者：
J. Reves
他是一位杰出的麻醉学家，纽约大学医学中心麻醉学系主任兼贝尔维尤医院麻醉科主任，美国麻醉学委员会的创始人和前任主席，美国麻醉学家协会(ASA)的前任主席，以及该学会1957年杰出服务奖的获得者。Rovenstine讲座成立于1962年，今天是第45次纪念讲座。我不认识罗文斯丁博士，但我读过他的著作。让我将他总结为麻醉学的一位非凡的早期领导者，他的一生的服务对我们的专业产生了巨大的影响，直到今天也是如此。我希望你们都能理解为他做演讲是一种荣幸。我意识到我站在你和午餐之间--这对任何在麻醉师面前的人来说都是一个危险的地方，因为午餐休息时间是最不可预测的，而且总是需要的。意识到这一点，我想起了亚历山大·希尔德(Alexander Hed，B.A.，M.A.，Ph.)(田纳西州纳什维尔范德比尔特大学荣誉校长)在纽约举行的一年一度的“Dixie晚宴”上报道的一段小插曲。这场晚宴由南方社会(Southern Society)(由那个大城市里富裕但流离失所的南方人组成)主办，“演讲者恰好在午夜被介绍，并大张旗鼓地发表了‘他的演讲’--(意识到时间已经很晚了)获奖者起立，报出他在新泽西州普林斯顿的门牌号和街道名称，然后坐了下来。”你没那么幸运。我们(所有从事麻醉学的人)就是我们(那些在学术界的麻醉师)挣的钱。我们的学术部门有三个使命：(1)教育，(2)临床服务，(3)研究。我们尤其为我们培养的优秀医生和我们提供的临床护理感到自豪。我们必须在这两个方面出类拔萃，我们确实做到了。然而，今天我将把重点放在我们的研究任务上，这是我们做得不太好的，需要转变。在选择这个主题时，我知道罗兹在他的精彩著作《创造未来：美国大学的角色》(The Creation of the Future：The Role of the American University)中提出的告诫：“自从霍勒斯·曼(Horace Mann)宣布要驱散愤怒的暴徒，只需宣布一场关于教育的讲座以来，这个世纪几乎没有什么变化。”我想对此进行研究。关注麻醉学研究有几个原因：首先，这是我从开始读医学院的那个夏天开始就一直致力于的事情。其次，我认为这是一个学术麻醉学可以而且必须做得更好的领域。第三，最近在我们的期刊《麻醉学》和其他地方表达了一系列的担忧。最后，我一直坚信，除非我们通过研究质疑我们所做的和我们所知道的，否则我们永远不会通过做新的和更好的事情来改进。通用电气20世纪60年代的口号--“进步是我们最重要的项目”--一直是，也将永远是我的职业信条。这肯定也是麻醉学的座右铭。本讲座的其余部分分为三个部分：(1)研究现状，(2)我们研究绩效的根本原因分析，以及(3)改善我们研究现状的计划。
THIS lectureship honors Emery Andrew Rovenstine, M.D., who was a distinguished anesthesiologist, Chair of the Department of Anesthesiology, New York University Medical Center and Director of Anesthesia, Bellevue Hospital, a founder and past president of the American Board of Anesthesiology, past president of American Society of Anesthesiologists (ASA), and recipient of the Society’s 1957 Distinguished Service Award. The Rovenstine Lecture was established in 1962 and today is the 45th commemorative lecture. I did not know Dr. Rovenstine, but I have read his writings. Let me sum him up as an extraordinary early leader in anesthesiology whose lifetime of service had an enormous impact on our specialty and does to this day. I hope you all understand the privilege it is to give a lecture in his honor. I realize that I stand between you and lunch—a dangerous place for anyone in front of anesthesiologists since lunch breaks are most unpredictable and always needed. Aware of this, I am reminded of a vignette reported by Alexander Heard, B.A., M.A., Ph.D. (Chancellor Emeritus, Vanderbilt University, Nashville, Tennessee) on the occasion of an annual “Dixie Dinner” in New York hosted by the Southern Society (made up of wellheeled but displaced Southerners in that big city) where “the speaker was introduced exactly at midnight and with great fanfare to give ‘his address’—(realizing the lateness of the hour) the honoree arose, gave his house number and street name in Princeton, NJ, and sat down.” You are not that fortunate. We (all who practice anesthesiology) are what we (those anesthesiologists who are in academia) make. Our academic departments have three missions: (1) education, (2) clinical service, and (3) research. We are especially proud of the excellent physicians we educate and the clinical care we provide. We must excel in these two, and we do. However, today I will focus on our research mission, something we do less well, and that needs transformation. In choosing this subject, I am aware of the admonition given by Rhodes in his wonderful book, The Creation of the Future: The Role of the American University: “little has changed in the century that has passed since Horace Mann declared that to disperse an angry mob, all that would be necessary would be to announce a lecture on education,” and I would add research to this. There are several reasons to focus on anesthesiology research: First, it is something that I have been committed to since the summer before I began medical school. Second, I think it is an area in which academic anesthesiology can and must do better. Third there has been a flurry of worry expressed in our journal, ANESTHESIOLOGY, and elsewhere of late. Finally, I have always been convinced that unless we question what we do and what we know through research, we will never improve by doing things new and better. The General Electric slogan of the 1960s, “Progress is our most important project,” has been and always will be my professional credo. It must be the motto of anesthesiology as well. The remainder of this lecture is in three parts: (1) the present status of research, (2) a root cause analysis of our research performance, and (3) a plan to improve the current state of our research.