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The Cumulative Effect of the Specialty’s Investment in Research

This article originally appeared in the March 2015 issue of the ASA Newsletter.

It has been 29 years since the Foundation for Anesthesia Education and Research started awarding mentored career development grants for research. And nearly three decades into FAER’s existence – perhaps now more than ever – we are witnessing the cumulative effect of the specialty’s investment in research.

One recent example comes from the Perelman School of Medicine at the University of Pennsylvania, where last summer, Mariah Kincaid, B.S., an M.D./M.P.H. candidate from Tufts University who will graduate in May, participated in a FAER-funded anesthesia research fellowship, alongside mentors and former FAER grant recipients Mark D. Neuman, M.D., M.Sc. and Lee Fleisher, M.D. Call it a “snowball effect:” It was a FAER recipient (Dr. Fleisher, Research Starter Grant, 1990) mentoring a FAER recipient (Dr. Neuman, Mentored Research Training Grant, 2011) mentoring a FAER recipient (Ms. Kincaid, Medical Student Anesthesia Research Fellowship, 2014).

The Study
Together, Dr. Fleisher, Dr. Neuman and Ms. Kincaid completed a project studying web-based marketing of transcatheter aortic valve replacement (TAVR) and revealed findings with implications for anesthesiologists, internists, cardiologists, cardiac surgeons and, of course, patients. Their analysis was published in the January 12 issue of JAMA Internal Medicine.

As a research team, they reviewed the websites of 262 hospitals listed in the Society of Thoracic Surgeons and the American College of Cardiology’s Transcatheter Valve Therapy Registry with information about TAVR. They abstracted information into a standardized form that identified 11 potential benefits and 11 potential risks of TAVR compared to open aortic valve replacement. The majority of the websites (99%) identified at least one benefit of TAVR, while only 26% provided information on risks associated with the procedure. “Nearly all hospital websites reviewed mentioned benefits of TAVR while very few described the adverse outcomes also associated with the novel medical device,” Ms. Kincaid says. “Additionally, significantly fewer websites quantified risks as opposed to benefits of TAVR.”

The majority of adults in the United States seek out health information online, and hospital websites are a particular source for patient education. “Our main funding suggests that there is room for improvement in the way hospitals present information on this procedure to patients,” Dr. Neuman adds.

Dr. Fleisher notes that patients likely “ will receive additional information from their physicians directly, but a key question is whether these websites appropriately provide information similar to the requirements for direct-to-consumer advertising of drugs.” This is an important policy question.

“Our analysis determined that while hospital websites universally mention the potential benefits of TAVR, they rarely present any information on the procedure’s known risks,” Neuman said in a press release. “Hospitals have an opportunity to encourage appropriate use of this treatment by presenting a more balanced view of both the known risks and benefits of TAVR.”

The Fellowship
Although FAER did not fund the research of Dr. Fleisher and Dr. Neuman directly for this study, the project did come about at the time of Ms. Kincaid’s FAER-funded Medical Student Anesthesia Research Fellowship. When she arrived at Penn for her fellowship, she and Dr. Neuman collaborated to identify a project that would allow her to pursue her interests, add to her skillset and result in valuable findings to be published in a manuscript.

She set out on her MSARF experience to gain more insight into academic anesthesiology, specifically in the area of health services research. “It was during the MSARF experience that I became more fully cognizant of the incredible potential for health sciences research in anesthesia,” she said. “With the huge number of patients requiring administration of an anesthetic each year, anesthesiology and perioperative medicine are ripe targets for public health studies and subsequent interventions or policy changes that impact the care of millions of individuals.”

Ms. Kincaid says the MSARF experience “further prepared me to think critically, to function with independence while still understanding my knowledge and skill deficits, and to continually seek creative ways to integrate anesthesiology and research in public health. The first-hand experience taking a project from concept to publication and follow-up studies also equipped me with a fundamental skillset that will be hugely valuable as I continue a career in academic anesthesiology.”

One of the goals of the MSARF program is to encourage talented medical students to enter careers in academic anesthesiology. Ms. Kincaid is an example of that, and the work she did under the mentorship and leadership of Dr. Fleisher and Dr. Neuman serves as an example of the importance of early career research grant funding and its compounding effects on the specialty.

Ultimately, “The fact that all three of us have been funded by FAER at some point, emphasizes the importance of funding researchers who can make contributions in different areas and having individuals available to mentor the next generation,” said Dr. Fleisher.

Learn More
•    For more information about FAER research grant funding, visit FAER.org/research-grants.
•    For more information about the MSARF program, visit FAER.org/MSARF.
•    To support these programs and research in anesthesiology, donate online at FAER.org/donate.