Tag Archives: academics

A Year Ends and a New One Begins

This academic year was truly like no other.

At the end of July, we graduated three new physician experts in regional anesthesiology and acute pain medicine (RAAPM), and I could not be more proud of them! From our welcome party in the summer of 2019 to a year’s worth of teaching sessions, socials, and medical missions to the opening of the new Stanford hospital, the #COVID19 pandemic and #BlackLivesMatter movement – what a year for our amazing grads! Check out this fantastic graduation video from Dr. Jody Leng:

Our graduating fellows surprised me with the honor of being their Teacher of the Year along with Dr. Ryan Derby! It is such a privilege to be part of our fellows’ training every year and see them grow into physician consultants with RAAPM expertise.

Our new fellows are off to a strong start and are now officially part of our Stanford RAAPM family! If you are interested in learning more about our fellowship program, please visit our fellowship website and contact me with any questions.

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My Favorite Rejections

I tweeted recently about the idea of keeping a “failure resume” which was recommended by an article published in the New York Times.

If I have learned one thing in academics, it’s this – you have to develop thick skin.

Continue reading My Favorite Rejections

Success in scientific journal publication is built on a pile of rejections. For every trainee and junior faculty member out there, know that your mentors have survived countless rejections (failures) to get to where they are today.

Rather than bemoan these rejections, perhaps we should celebrate them instead. Each failure can be a learning opportunity. I dug through some old emails to find a few of my favorite rejections and happily share them below. They fall into one of two general themes.

Theme 1: “It’s not you. It’s me.”

Theme 2: “It’s not me. It’s you.”

Don’t let these rejections get you down. Good research and good writing will eventually find a home in a journal. If you get stuck, reach out to a mentor for guidance. When you see your article published finally, you can look back at those earlier rejections as badges of honor and proof that persistence pays off.

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Reality and the Ivory Tower

At our conferences and workshops focused on regional anesthesiology and acute pain medicine, we present and discuss the latest and greatest advances in nerve block techniques for patients having surgery.  As physicians and scientists, we are very familiar with the evidence supporting the use of nerve blocks for postoperative pain management.  We know they are extremely effective in preventing and treating pain, decreasing the need for opioid medications, and even avoiding the common side effects of general anesthesia such as nausea and vomiting and confusion.

ASRA 2015

We believe in them.  

We are passionate about them.  

We want all patients to have access to them.

Within the meeting sessions and sometimes in the common spaces outside the lecture halls, regional anesthesiologists often vigorously debate various things like:  the best sites and techniques for nerve block injections, needle and catheter equipment, ultrasound transducers and machines, and local anesthetic selection and use of adjuvants among other things.  

For knee replacement patients in particular, we want to provide the best form of pain management while maximizing their postoperative function.  Since 2011, dozens of research articles have studied the more distal adductor canal block for pain management in patients who undergo knee replacement as a replacement for the long-standing incumbent, the femoral nerve block.  In reality, these sites of nerve block placement are mere centimeters apart and represent different sites of injection along the same set of nerves.  Anesthesiologists and surgeons continue to debate this issue in person, in social media, and in publications.

It’s time for a reality check.

I had the opportunity to do a big data study with my friend and colleague, Dr. Stavros Memtsoudis.  In this study of over 191,000 knee replacement patients who had surgery across over 400 hospitals in the United States, only 12.1% of all patients had a peripheral nerve block of any kind!  Over 76% of patients had general anesthesia alone with no other regional analgesic technique. 

A more recent study published this month in the Journal of Arthroplasty evaluated over 219,000 patients who underwent knee replacement, and only 27.3% of patients received a peripheral nerve block.  The database used for this study was NACOR, operated by the Anesthesia Quality Institute and the American Society of Anesthesiologists.  This was brought to my attention through a Tweet sent by My Knee Guide (@mykneeguide).

Screenshot_20160817-203011

Where is the disconnect?  The efficacy of peripheral nerve blocks for pain control in patients having knee arthroplasty was first published more than 25 years ago.  It is easy to assume that such well-established evidence is being applied daily in clinical practice for the hundreds of thousands of patients who receive this surgery every year, but it’s not.  Today, there is more awareness than ever about the risks of opioids, and nerve blocks offer proven opioid-sparing pain relief.  Perhaps this is just another example of the gap separating the “ivory tower” of academics and real life.

In a previous post, I wrote about the obstacles to changing clinical practice, and there are many:

  1. Lack of awareness (don’t know guidelines exist)
  2. Lack of familiarity (know guidelines exist but don’t know the details)
  3. Lack of agreement (don’t agree with recommendations)
  4. Lack of self-efficacy (don’t think they can do it)
  5. Lack of outcome expectancy (don’t think it will work)
  6. Inertia (don’t want to change)
  7. External barriers (want to change but blocked by system factors)

Maybe it’s time to focus less on debating minor differences in the ways we do blocks and focus more on figuring out how to make sure more patients actually get them.  

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