Surgical Science and the Evolution of Critical Care Medicine

Ferrada, Paula; Cannon, Jeremy W.; Kozar, Rosemary A.; Bulger, Eileen M.; Sugrue, Michael; Napolitano, Lena M.; Tisherman, Samuel A.; Coopersmith, Craig M.; Efron, Phillip A.; Dries, David J.; Dunn, Ty B.; Kaplan, Lewis J.

doi:10.1097/ccm.0000000000005708

Critical Care Medicine

2023

DOI: 10.1097/ccm.0000000000005708

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Surgical Science and the Evolution of Critical Care Medicine

Paula Ferrada

Jeremy W. Cannon

Rosemary A. Kozar

et al.

Abstract: Surgical science has driven innovation and inquiry across adult and pediatric disciplines that provide critical care regardless of location. Surgically originated but broadly applicable knowledge has been globally shared within the pages Critical Care Medicine over the last 50 years.

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Cited by 3 publications

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“…(Ann Surg 2024;279:231-239) BACKGROUND S cientific contributions by surgeons have transformed our understanding of human disease across a spectrum of disciplines, from transplant immunology to hormonal treatment in malignancies. [1][2][3] The historic impact of surgeon-scientists, including 9 recipients of the Nobel Prize, in part reflects a special vantage point from which to ask and answer important questions about the biology and burden of disease. Surgeons can provide a distinct approach and mindset to key scientific questions.…”

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confidence: 99%

Transforming the Future of Surgeon-Scientists

Ladner,

Goldstein,

Billiar

et al. 2023

Annals of Surgery

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Objective: To create a blueprint for surgical department leaders, academic institutions, and funding agencies to optimally support surgeon-scientists. Summary Background Data: Scientific contributions by surgeons have been transformative across many medical disciplines. Surgeon-scientists provide a distinct approach and mindset toward key scientific questions. However, lack of institutional support, pressure for increased clinical productivity and growing administrative burden are major challenges for the surgeon-scientist, as is the time-consuming nature of surgical training and practice. Methods: An American Surgical Association (ASA) Research Sustainability Task Force was created to outline a blueprint for sustainable science in surgery. Leaders from top NIH-sponsored departments of surgery engaged in video and in-person meetings between January and April 2023. A SWOT analysis was performed, and workgroups focused on the roles of surgeons, the department and institutions, and funding agencies. Results: Taskforce recommendations: (1) SURGEONS: Growth mindset: identifying research focus, long-term planning, patience/tenacity, team science, collaborations with disparate experts; Skill set: align skills and research, fill critical skill gaps, develop team leadership skills; DEPARTMENT OF SURGERY (DOS): (2) MENTORSHIP: Chair: mentor - mentee matching / regular meetings / accountability, review of junior faculty progress, mentorship training requirement, recognition of mentorship (e.g., RVU equivalent, awards; Mentor: dedicated time, relevant scientific expertise, extramural funding, experience and/or trained as mentor, trusted advisor; Mentee: enthusiastic / eager, proactive, open to feedback, clear about goals; (3) FINANCIAL SUSTAINABILITY: diversification of research portfolio, identification of matching funding sources, departmental resource awards (e.g., T- / P-grants), leveraging of institutional resources, negotiation of formalized / formulaic funds flow investment from AMC towards science, philanthropy; (4) STRUCTURAL / STRATEGIC SUPPORT: Structural: grants administrative support, biostats / bioinformatics support, clinical trial and research support, regulatory support, shared departmental lab space / equipment; Strategic: hiring diverse surgeon-scientist/scientists faculty across DOS, strategic faculty retention / recruitment, philanthropy, career development support, progress tracking, grant writing support, DOS-wide research meetings, regular DOS strategic research planning; (5) COMMUNITY AND CULTURE: Community: right mix of faculty, connection surgeon with broad scientific community; Culture: building research infrastructure, financial support for research, projecting importance of research (awards, grand rounds, shoutouts); (6) THE ROLE OF INSTITUTIONS: Foundation: research space co-location, flexible start-up packages, courses / mock study section, awards, diverse institutional mentorship teams; Nurture: institutional infrastructure, funding (e.g., endowed chairs), promotion friendly towards surgeon-scientists, surgeon-scientists in institutional leadership positions; Expectations: RVU target relief, salary gap funding, competitive starting salaries, longitudinal salary strategy; (7) THE ROLE OF FUNDING AGENCIES: change surgeon research training paradigm, offer alternate awards to K-awards, increasing salary cap to reflect market reality, time extension for surgeon early-stage investigator (ESI) status, surgeon representation on study section, focused award strategies for professional societies/foundations. Conclusions: Authentic recommitment from surgeon leaders with intentional and ambitious actions from institutions, corporations, funders, and society is essential in order to reap the essential benefits of surgeon-scientists towards advancements of science.

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confidence: 99%

Transforming the Future of Surgeon-Scientists

Ladner,

Goldstein,

Billiar

et al. 2023

Annals of Surgery

Self Cite

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American Trauma Care: A System of Systems

Johnson¹,

Larson²,

Brown³

et al. 2023

Air Medical Journal

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The State of the Union: Trauma System Development in the United States

Rogers,

Larson,

Dries

et al. 2023

J Intensive Care Med

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Injury is both a national and international epidemic that affects people of all age, race, religion, and socioeconomic class. Injury was the fourth leading cause of death in the United States (U.S.) in 2021 and results in an incalculable emotional and financial burden on our society. Despite this, when prevention fails, trauma centers allow communities to prepare to care for the traumatically injured patient. Using lessons learned from the military, trauma care has grown more sophisticated in the last 50 years. In 1966, the first civilian trauma center was established, bringing management of injury into the new age. Now, the American College of Surgeons recognizes 4 levels of trauma centers (I-IV), with select states recognizing Level V trauma centers. The introduction of trauma centers in the U.S. has been proven to reduce morbidity and mortality for the injured patient. However, despite the proven benefits of trauma centers, the U.S. lacks a single, unified, trauma system and instead operates within a “system of systems” creating vast disparities in the level of care that can be received, especially in rural and economically disadvantaged areas. In this review we present the history of trauma system development in the U.S, define the different levels of trauma centers, present evidence that trauma systems and trauma centers improve outcomes, outline the current state of trauma system development in the U.S, and briefly mention some of the current challenges and opportunities in trauma system development in the U.S. today.

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Surgical Science and the Evolution of Critical Care Medicine

Abstract: Surgical science has driven innovation and inquiry across adult and pediatric disciplines that provide critical care regardless of location. Surgically originated but broadly applicable knowledge has been globally shared within the pages Critical Care Medicine over the last 50 years.

Cited by 3 publications

References 439 publications

Transforming the Future of Surgeon-Scientists

Transforming the Future of Surgeon-Scientists

American Trauma Care: A System of Systems

The State of the Union: Trauma System Development in the United States

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