Anesthesiology (2016)
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Robert B. Sweet, Founding Chair, 1952-1976
The University of Michigan Medical School advanced anesthesiology from a section of surgery to departmental status in 1949, making it one of the early academic departments of anesthesiology in the United States. Dr. Warren Wilmer served as acting chair until Dr. Robert B. Sweet was appointed as the first permanent chair in 1952. Sweet had completed a surgical residency program at Michigan, then trained in anesthesiology at the Massachusetts General Hospital. Sweet’s first goal was to develop an excellent clinical program to support the well-respected Department of Surgery, which had trained the Mayo brothers.
Soon after Sweet assumed the chairmanship of the department, he recruited Dr. Lewis W. Lewis, who had trained under Dr. Duncan Alexander in McKinley, Texas, as an assistant professor. In addition to Lewis, by 1956 the department had two other instructors. In the 1950s there were few formally trained anesthesiologists to recruit as faculty. In the 1920s the Department of Surgery had a visiting exchange program with St. Bartholomew’s in London for young surgeons. On Sweet’s behalf, Dr. Frederick Collier, chair of surgery at Michigan, asked his colleagues at St. Bartholomew’s if there were any young anesthesiologists who would be interested in spending a year in the U.S. Consequently, in 1956 Dr. Thomas Boulton came to spend a year in Ann Arbor supported in part by the Fulbright Scholar Program. Boulton served as the third instructor and enjoyed the year so much he encouraged others to follow him, establishing a yearly tradition that continued into the 21st century. (Dr. Boulton ultimately became the chair of anesthesiology at Oxford).
In 1955, the first residents in anesthesiology started their program; they would graduate in 1957. The first class consisted of Dr. George Alter, Dr. Edmund M. Krigbaum, and Dr. Leonard Waltz.
In 1969, the Mott Children’s Hospital opened and was staffed by a new pediatric anesthesia service which ultimately grew into the largest fellowship in the department (nine fellows per year as of 2012). In 1972, the Department initiated a service of local anesthetic blocks for non-operative pain; this established the foundation for a Pain Fellowship in 1981.
In the field of research, the Department first studied electrophysiology measurements evaluating the depth of anesthesia in 1963 and conducted the first phase-II studies of ketamine, led by Dr. Edward F. Domino at the University of Michigan in 1965. The first clinical studies on ketamine involved anesthesiologist Dr. Gunter Corssen and were published in 1966.
Veteran’s Administration Hospital
In 1953, the Veterans’ Administration opened a hospital in Ann Arbor. Medical and surgical services were staffed with faculty from the University of Michigan. Anesthesiology services were provided by nurse anesthetists until the new department at the University grew sufficiently to provide physician anesthesia. In 1962, David Learned, a recent graduate, went to the VA to start the physician anesthesia service. He left one year later for private practice and Dr. Thomas Corbett took over as the chief of service in 1963. He stepped down in 1973 and was replaced by Dr. Anne Hill, who served until 1975. At that time, Dr. Sweet stepped down as chair of the Department and went on to direct anesthesia services at the VA in 1975. He continued in that role until 1981, when Dr. Robert Myyra was appointed chief; he continued for the next 20 years as the clinical and teaching services grew. In 1999, a new surgical wing opened at the VA with nine operating rooms and an adjacent intensive care unit. In 2014, when Myyra retired, Dr. Michael Lee became the VA’s chief of service. In 2013, the Department of Anesthesiology was asked to direct the VA’s surgical ICU, and the full critical care service was initiated in the summer of 2014. In 2016, Anesthesiology and Perioperative Medicine was designated as a new service in the VA with Dr. Mark Hausman being appointed as Chief of Service. This service encompasses the preoperative evaluation clinic, intraoperative anesthesia, acute pain service, and surgical critical care.
Dr. Peter Cohen, Chair 1976 – 1985
Dr. Sweet stepped down as chair of the Department of Anesthesiology in 1975. A national search was initiated with the goal of finding an individual who would develop a more extensive research program. Dr. Peter J. Cohen became the second chair of the department in 1976 and he recruited a large group of faculty. Many of these faculty were recruited from the University of Colorado, including Dr. Paul Knight, who ultimately became the director of research. Other recruits included Dr. Sujit Pandit, who directed ambulatory anesthesia and later became president of Society for Ambulatory Anesthesia; Dr. Alan Brown, who started a Difficult Airway Clinic; Dr. Michael Nahrwold, who directed cardiac anesthesia; Dr. Jeff Lane; and Dr. Jorde Waldron, who directed pediatric anesthesia at the Mott Children’s Hospital.
Cohen further developed subspecialty services and fellowships. A pediatric anesthesia service had been developed in 1969 but the first fellowship was not initiated until 1983. The Department initiated a pain clinic in 1979 and a pain fellowship in 1981. The obstetric anesthesia service was started in 1978 and a fellowship was initiated in 1990. With the development of a surgical liver transplant program, a transplant anesthesia team was begun in 1985.
Thomas J. DeKornfeld, MD, Interim Chair, 1984-86
In 1984, Peter Cohen stepped down as chair and Dr. Thomas J. DeKornfeld took his place as interim chair. During that time, the Department’s residency program was growing; to facilitate that program, Dr. DeKornfeld thought it best to discontinue training nurses in anesthesia. The University closed the nurses’ training program in anesthesia in 1985. The residency program was increased to 18 per class and the faculty was expanded to meet the clinical needs.
Jay S. Finch, MD, Interim Chair 1986-87; Chair 1987-1989
In 1986, Dr. Jay S. Finch replaced DeKornfeld as interim chair. He was named the permanent chair in 1987, but, unfortunately, not long after this appointment, Finch developed renal failure and had to step down as chair in 1989.
Georgine M. Steude, MD Interim Chair, 1989-1990
Dr. Georgine Steude replaced Finch as interim chair, having been the director of pediatric anesthesiology. She helped the Department expand to meet the demands of increasing clinical service needs and expanded the residency to 20 per class. The Department had to seek permission to recruit high-quality faculty in the clinical track to meet ever-expanding service needs. Steude also recruited Niall Wilton as the director of pediatric anesthesia.
The British Wave, 1980-1990
The 1980s was tumultuous with respect to departmental leadership: a chair stepped down; there was an inconclusive search; then two interim chairs; and finally the unanticipated retirement of the permanent chair who was ultimately appointed.
The Department’s clinical service and education needs continued to grow with the expansion of the surgical programs and the opening of the new University Hospital to replace “Old Main” in 1986. The new facility included eighteen adult operating rooms, three medical procedure rooms, five adult intensive care units, and 500 in-patient beds. Recruiting and retaining faculty was more challenging given the turnover in the Department’s leadership. Fortunately, a constant supply of British visiting faculty not only came for their one-year appointments as “rotators” (as they were referred to) but many chose to immigrate to the U.S. permanently and join the regular University of Michigan faculty. Within this group there were notable figures who ultimately assumed key administrative and leadership roles in the department. In 1983, Dr. Timothy Rutter came as a rotator with additional training in pain management. In 1985 he returned and became the director of the chronic pain program and later that year was appointed clinical director of the operating rooms in the Adult Hospital. In 1989, he was appointed associate chair for clinical affairs for the Adult Hospitals. Dr. Niall Wilton, who had come from Southampton as a rotator, held the position of chief of the pediatric anesthesia service from 1989 to 1994, when he left the Department. Also in 1985, Dr. Allan Brown was recruited from the University of Colorado; he had originally been trained in England. He initiated what may have been the nation’s first Difficult Airway Clinic with Dr. Martin Norton. A liver transplant program was initiated and was headed by Dr. Douglas McLaren, another British transplant. Finally, Dr. Donald Mackie, who was also on the Liver Transplant Team, developed the Department’s first quality assurance program. Mackie became the chief physician of New Zealand’s national health system in 2011.
Kevin K. Tremper, PhD, M.D., Chair, 1991-
In 1875, a senior resident completing his training in surgery at the University of Michigan presented his required senior thesis entitled: “Anaesthetics and their Use.” This 46-page, neatly handwritten manuscript described the state of the art of anesthesiology in impressive detail. His name was Robert Tremper and he left Michigan to practice surgery in Los Angeles, California. One hundred and fifteen years later, in January 1991, relationship unknown, Dr. Kevin K. Tremper, left Los Angeles to become the U-M Department of Anesthesiology’s fourth chair.
Kevin Tremper’s initial vision for the Department would foster significant growth over the next decade. First, a financial model was designed to allow the Department to have a positive margin to enable growth of an endowment for academic pursuits. Second, the Department was given the directorship of a surgical intensive care unit (cardiothoracic ICU) to meet the needs of its growing residency and to fulfill the requirements of any first-rate anesthesia department, i.e., clinical leadership of a surgical ICU. Third, funds were allocated for a perioperative information system for the purposes of clinical care, education, and research. It was envisioned that in the future anesthesia departments would use automated systems to collect perioperative data, which would be integrated with the educational program and ultimately produce a database for clinical research. In 1990, the only system available was called Archive and that system had proprietary hardware along with software that was not integrated with the hospital. Therefore, it was not a system that would grow with the institution. Tremper discussed the need for a new system with the hospital director, John Forsyth, who authorized $1.25 million for the Department to initiate this effort. He also agreed that if more funds were required they would be provided. Fourth, the department would be able to have 50 percent of its faculty appointed in the clinical track to enable expansion of the clinical program to cover service and educational needs. The financial model and a plan to increase the residency size from 20 to 24 residents per year was also approved.
At the start of his tenure, Tremper initiated in-house faculty call and a faculty salary program that would provide a clinical incentive shared among all faculty participating in the call system. Those over 55 or with medical contraindications did not have to take call, but also did not receive the clinical bonus/quarterly profit sharing plan. That clinical incentive for taking call was determined every three months depending on the department’s profitability, taking half the department’s profits for the faculty incentive and the other half invested in an academic endowment in the University of Michigan endowment program: Funds Functioning as Endowment.
Shortly after his arrival, Dr. Tremper recruited two faculty from southern California. One was Dr. Theodore Sanford, of the University of California- San Diego Department of Anesthesiology, to become the director of the residency program. He was appointed as a full professor in the clinical track, the first such professor not only in the Department but in the University. Until then, most faculty were required to be in the instructional tenure track. Recruiting and appointing Sanford in the clinical track made a statement that the Anesthesiology Department highly valued clinicians and that a faculty member on that pathway could be recognized as a full professor and a departmental leader. The second recruit was Dr. Norah Naughton as director of obstetric anesthesiology. Over the next two years she modernized the obstetric anesthesia care and initiated a fellowship position, the first fellow being Dr. Linda Polley.
The goal for the next few years was to progressively develop subspecialty-trained faculty groups in cardiac anesthesia, transplant, critical care, neuroanesthesiology, and pain management. During the same period, the residency program increased to 24 per class, with fellows in pediatric anesthesia, obstetrical anesthesia, and pain management.
The primary researcher in Anesthesiology was Paul Knight, who left shortly after Tremper’s arrival to become chair of anesthesiology at the University of Buffalo. At that point, Dr. Bert La Du took over as associate chair for anesthesiology research. He had joined the department after stepping down as chair of the Department of Pharmacology. Dr. La Du was a noted pharmacogeneticist who had identified 25 distinct genetic variations in cholinesterase that accounted for prolonged action of succinylcholine. He also conducted fundamental work on peroxidase enzymes. This family of enzymes inactivates peroxidase and other insecticides as well as nerve gases. They have also been noted to protect against the development of cardiovascular disease.
In this era a series of fellowships were initiated (or approved by the Accreditation Council for Graduate Medical Education) in cardiac anesthesia, pain, critical care medicine, pediatric anesthesia, and obstetric anesthesia. Two additional fellowships were initiated later—the neuroanesthesiology fellowship in 2007, and the regional anesthesia fellowship in 2013.
In the early 1990s, the Department grew in faculty and clinical services with more residents and further development of subspecialty training.
Under the administration of President Bill Clinton, proposed changes in the national health care system would have placed greater emphasis on primary care and capitated health systems. The administration proposed that 55 percent of medical graduates should enter primary care fields while 45 percent should enter specialties. Medical schools around the country, including Michigan’s, began to emphasize primary care and deemphasize specialty care. The result was a decline in anesthesiology residents. While there were more than 1,800 senior anesthesiology residents in 1996, only 143 medical students matched into the field that April. U-M, which had 24 positions, matched only three, while such prestigious institutions as the University of Pennsylvania matched zero for 24 positions. This produced a significant problem for Michigan and other academic anesthesiology departments throughout the country. Ultimately, applicants from other specialties were recruited into the residency class. At Michigan, the 1996 class was twelve residents, far short of the normal twenty-four. As it turned out, the perceived shortage of anesthesiologists was not to be and the needs for anesthesiologists throughout the country did not diminish, but the damage had been done. The graduating class of 2000 was less than half the size of the graduating class of 1999, and the 2001 and 2002 classes were not much larger. This resulted in a nationwide shortage of anesthesiologists of roughly 4,000.
All of these developments complicated the development of the clinical, educational, and research programs at Michigan. Drs. Tremper, Sanford, Rutter, and Paul Reynolds (chief of pediatric anesthesiology) worked to cover the clinical and educational needs of the institution through this shortage of residents. In 1996, with caseloads increasing, Tremper won approval to recruit certified registered nurse anesthetists to make up the deficit in residents and meet the needs of expanding surgical cases and ORs.
Ambulatory Anesthesia Program
When Ambulatory Surgery and Anesthesia were at their infancy, Dr. Sujit Pandit directed the program in one designated operating room at the Old Main Hospital. Later when the program expanded Dr. Tremper started two free-standing Ambulatory Surgery facilities, one in Livonia and one at the East Ann Arbor Medical Center. Dr. Loren Levy and Dr. Norah Naughton became the first Directors of those facilities respectively.
British Wave II
The shortage of residents matching into anesthesiology in the mid-1990s foretold a shortage of faculty by the early 2000s. Anticipating the need, Dr. Tremper made plans to increase the number of British visiting faculty from roughly eight to ten per year to a peak of 22 visiting faculty by 2000. The would be the second “British wave.” These visiting faculty from Great Britain allowed the Department to cover its clinical and educational obligations. The planning also enabled Tremper to identify outstanding academic faculty in the early 2000s, hire them as permanent clinical and instructional track faculty, and reduce the number of rotators.
Quality and Safety Initiatives
In October of 2010, Dr. James Bagian was recruited to the Department as professor of Anesthesiology with a joint appointment in the College of Mechanical Engineering. He was also recruited to be the chief safety officer for the U-M Health System. As a NASA astronaut, Bagian had participated in two Space Shuttle missions, one of them as the lead mission specialist for the first dedicated Life Sciences Spacelab mission. He was a Fellow of the Aerospace Medical Association, a member of the National Academy of Engineering, the Institute of Medicine, and the recipient of numerous awards for his work in the field of patient safety and aerospace medicine. Most recently he had served as the first and founding director of the Department of Veterans Affairs’ National Center for Patient Safety; there he developed numerous patient safety tools and programs that were adopted nationally and internationally.
In early 2011, Dr. Bagian was asked to develop and implement a medical team training (MTT) program for all of U-M’s operating rooms. This was undertaken to improve patient safety and efficiency by improving communication based on techniques and tools—particularly checklist-guided briefings and debriefings—demonstrated at the Department of Veterans Affairs. ORs were closed for half a day so that all personnel could participate in the training. The Anesthesia Department also spearheaded the development of a formal debrief system for all ORs so that matters requiring attention could be recorded and acted on.
The Anesthesia Department also introduced the use of systematic physical observations to verify that MTT tools and techniques were working properly. As a result, Dr. Bagian secured institutional support to use physical observation to ensure that required quality and safety processes were being performed. This led to the creation of a Perioperative Quality Improvement Committee, led by Dr. Satya Krishna Ramachandran.
Renewed Research Investment: Dr. Ralph Lydic
During this period it was agreed that the Department needed to reinvest in basic laboratory research. Three areas were targeted as primary focuses: anesthetic mechanisms/consciousness; pain; and inflammation. Each of these processes is instrumental to the fundamental properties of anesthesia and the surgical insult. After a nationwide search in 2000, the Department recruited Ralph Lydic, PhD, and his wife Helen Baghdoyan, PhD, who were internationally renowned researchers in the field of sleep neurobiology and the founders of a nationally recognized preclinical research program. (Their research identified brain regions and neurochemical mechanisms regulating states of anesthesia, sleep, and pain.) Before coming to Michigan, they had worked at Harvard and Pennsylvania State University. They brought their NIH-funded research program to Ann Arbor, and over the next few years, they recruited two other funded sleep researchers, Mark Opp and Gina Poe.
During the 1990s, funds generated from the quarterly investment in academic endowments grew at double-digit rates, taking the department’s endowment funds from approximately $600,000 to over $30 million dollars by the year 2000. Until this point, all interest from the endowment had been reinvested in the endowment, thereby producing accelerated appreciation. In the early 2000s, the need to recruit new faculty at a time when high-quality candidates were scarce required increases in salaries and call incentives. Therefore, during that period the quarterly distribution for taking call was adjusted to approximately equal to the Department’s margin on operations. In spite of that, because of the impressive returns of realized gains in the University endowment account, the Department’s academic endowment continued to grow.
By 2005, the time was right to recruit tenure-track academic anesthesiologists in each of the subspecialties: obstetrical anesthesia, pediatric anesthesia, critical care medicine, transplant, neuroanesthesiology, pain, and outcomes research.
In obstetric anesthesia, Jill Mhyre, a Robert Woods Johnson Scholar, and Melissa Bauer joined the faculty; both had fellowships in critical care and obstetric anesthesiology, and both joined Linda Polley’s Obstetric Anesthesiology Research Program. In pediatric anesthesiology, Olubukola Nafiu was recruited from Great Britain to conduct research in pediatric obesity and its perioperative consequences. In critical care, Andrew Rosenberg, James Blum, and Michael Maile were recruited.
The year 2005-06 brought more expertise from the United Kingdom—David Healy in head and neck anesthesia, Paul Picton in transplant anesthesia, and Satya Krishna Ramachandran in perioperative sleep apnea. Recruits from the U.S. included Chad Brummett, Sachin Kheterpal, and George Mashour.
A Perioperative Information System and an Outcomes Research Database
In 1995, an effort was begun to develop a perioperative information system; this was funded by $1.25 million promised at the time of Tremper’s recruitment as chair. In 1994, Michael O’Reilly had been recruited from the University of Vermont; he was interested in basic research in sepsis and perioperative information systems. In 1995, a project called Michigan Operating Room Care, or MorCARE, was initiated to develop a perioperative information system in cooperation with an outside contractor. After a prolonged search, an Ann Arbor start-up software company, SEC, was chosen. SEC’s president, Vik Kheterpal, M.D., was a graduate of the Medical School; its chief technology officer, Sachin Kheterpal, Vik’s brother, was a student at the Medical School in 1998 and 1999—a medical student during the day and a programmer on nights and weekends. The MorCARE system was developed rapidly over the next 18 months. In 2000, it was implemented in the main operating rooms, then throughout the institution over the next 12 months. In 2001, SEC was purchased by General Electric. For the next decade, Michigan continued as the development site for GE perioperative software. The MorCARE product’s name was changed to Centricity and marketed throughout the country. Sachin Kheterpal became a GE employee; then, in 2005, after receiving his MD and a master’s degree in business administration, also from Michigan, he returned to clinical medicine as an intern and resident in Anesthesiology. In 2008, he joined the faculty.
Anesthesiology Clinical Research Committee (ACRC)
With the development of a large clinical database from the Centricity system and the recruitment of young assistant professors in the instructional track, multiple individuals were requesting data and conducting observational research studies. It became clear that with multiple faculty attempting to conduct research in the same institution with the same large database, there could be problems with competing or overlapping studies. Therefore, in 2008, the Department initiated a committee called the Anesthesiology Clinical Research Committee (ACRC). This committee met monthly (later every other week), charged with approving any clinical study to be conducted in the Department, with investigators preparing comprehensive proposals with respect to the introduction, methods, statistics, and references. The initiation of the ACRC facilitated work of high quality and ultimately a higher rate of acceptance of articles in prominent journals.
Multicenter Perioperative Outcomes Group (MPOG)
In the early 2000s, anesthesia information management systems (AIMS) were being accepted and implemented in academic programs throughout the country. Michigan’s Department of Anesthesiology already used the high-resolution database developed from its MorCARE/Centricity database for producing outcomes studies. It was envisioned that if data from multiple academic institutions were shared in one large database, the utility of that large research database would be extremely valuable for perioperative outcomes research. One of the difficulties was that institutions used different AIMS. In addition, there were technical, legal, and “social” reasons inhibiting the sharing of data on a large scale. In February of 2008, Dr. Tremper met with a dozen other academic chairs of large anesthesia departments to discuss the possibility of forming a data-sharing cooperative. He proposed that interested departments with AIMS send representatives to Ann Arbor to discuss the development of such a data-sharing organization. In August 2008, eight such departments sent faculty to an inaugural meeting and formed the Multicenter Perioperative Outcomes Group (MPOG). Michigan’s Sachin Kheterpal had just completed his residency and understood the technical aspects of merging data from various AIMS vendors. He also had conducted extensive observational research using Michigan’s data. He was thus in a position to understand the technical and academic aspects as well as the utility of such a data-sharing organization. Thus, he was chosen to lead MPOG. Over the next three years all of the group’s goals were achieved. Under Dr. Kheterpal’s direction, and with the help of several specialist programmers who had worked on Michigan’s Centricity program, a database was developed that would allow the retrieval and storage of data from various AIMS vendors (Centricity, Picis, CompuRecord, IMDsoft, and EPIC). An umbrella IRB at was established at Michigan to allow data from multiple institutions to be stored and investigated. As the database grew, MPOG developed a mechanism for reviewing and approving proposals for access to the data. Proposals were submitted from institutions throughout the U.S. and Europe.
Lucy Waskell’s Research
In 1995, Dr. Lucy Waskell became the first pre-clinical researcher recruited to the VA’s Division of Anesthesiology. Dr. Waskell continued her NIH- and VA-funded research on cytochrome P450 in laboratories provided by the VA Hospital. Her work on that crucial enzyme system in the liver made fundamental contributions to the field.
Expansion of Translational Neuroscience Research
In January of 2007, Dr. George Mashour came to U-M as its first fellow in neuroanesthesia. He had just completed his anesthesiology residency (and chief residency) at the Massachusetts General Hospital. Before that, he had completed his M.D. and Ph.D. in neuroscience at Georgetown University and two Fulbright scholarships. He came to Michigan with the goal of being both a clinician and a scientist with an academic focus to better understand how the brain generates consciousness. Shortly after his arrival, Dr. Mashour responded to an RFP from the American Society of Anesthesiologists (ASA) for individuals interested in investigating the clinical value of a commonly-used brain monitoring device for the operating room. Mashour was one of two faculty members in the country to receive this grant to study the prevention of intraoperative awareness with recall in patients undergoing general anesthesia. The other was Michael Avidan, of Washington University in St. Louis. In the summer of 2008, Drs. Mashour and Avidan initiated what is to date the largest prospective, randomized trial ever attempted in the field of anesthesiology. More than 26,000 patients were prospectively recruited from six hospitals at four institutions in the U.S. and Canada. The results of these two massive trials were published as lead articles in the New England Journal of Medicine and Anesthesiology, as well as other journals. While Dr. Kheterpal’s work established an infrastructure for major retrospective observational trials, Dr. Mashour’s work established an infrastructure for major prospective interventional trials. This infrastructure would later form the basis for NIH- and institutionally-funded research in perioperative genetics.
While this monumental clinical neuroscience study was being conducted, Dr. Mashour developed NIH-funded basic and translational neuroscience efforts, investigating consciousness using animal models, human volunteers and surgical patients. With a multidisciplinary team of anesthesiologists, neuroscientists, physicists, and biomedical engineers, Mashour was the first to introduce novel network science techniques to the study of brain state transitions during anesthesia. This resulted in the first study ever to find a common neural mechanism across all major classes of anesthetics, which resulted in a cover article in the field’s flagship journal. The work of Mashour’s group also shed light on the neurobiology of the near-death state, attracting worldwide recognition for the Department.
Pain, Clinical and Translational Research
Also in 2008, Dan Clauw, a rheumatologist in the Department of Internal Medicine studying chronic pain and fibromyalgia, joined Anesthesiology as a senior investigator and research mentor for junior faculty. Dr. Clauw had been recruited to U-M in 2002 to write the Clinical and Translational Science Award (CTSA) for the institution. After receiving a $55-million CTSA, Clauw found that being the administrator of the award was not as interesting to him as conducting his own research and working with young investigators developing their own research careers. Michigan did not then have an extensive pain research program. Dr. Clauw requested a transfer of his faculty appointment to Anesthesiology so he could work with the faculty in anesthesiology research. Over the next three years, he assisted junior faculty in receiving NIH funding via CTSA and directly from NIH.
NIH funding for clinical research dramatically increased with his assistance and the efforts of Chad Brummett, James Blum, George Mashourand Sachin Kheterpal. Together, these faculty members have developed an international reputation for Michigan in clinical research. Dr. Mashour received the ASA Presidential Scholar Award in 2011; Dr. Kheterpal receiving the same award in 2013. In 2012, senior investigator Ralph Lydic received the ASA Excellence in Research Award. In the December 2013 issue of Anesthesiology, the Michigan department was highlighted as a pioneer in research. That issue featured Michigan’s Department on the cover, with 14 articles by or about Michigan researchers.
| Recognition by the ASA | |||
|---|---|---|---|
| 2010 | Emery A. Rovenstine Lecturer (Ref. 8) | Kevin Tremper, Ph.D., M.D. | |
| 2010 | Emery A. Rovenstine Lecturer (Ref. 8) | Kevin Tremper, Ph.D., M.D. | |
| 2011 | Presidential Scholar | George Mashour, M.D., Ph.D. | |
| 2012 | Excellent in Research Award | Ralph Lydic, Ph.D. | |
| 2013 | Presidential Scholar | Sachin Kheterpal, M.D. | |
| 2013 | December Issue, Anesthesiology, Pioneers in Academic Anesthesiology | Department of Anesthesiology | University of Michigan |
| 2014 | Lewis H. Wright Memorial Lecture | James P. Bagian, MD, PE | |
Fast Forward Research Program
In 2012, the Medical School initiated a Fast Forward Research Program to accelerate clinical and laboratory research at Michigan. A sum of $100 million was allocated to this effort. This research funding followed the Medical School’s acquisition of the 170-acre, 2.5-million-square-foot Pfizer Research Complex on North Campus, renamed the North Campus Research Complex. The Department of Anesthesiology moved its Center for Perioperative Outcomes Research (CPOR), led by Sachin Kheterpal, to the facility; the staff includes faculty, statisticians, and 14 programmers.
The Fast Forward Program requested proposals for innovative research programs that would move Michigan ahead of its academic competitors. In addition to internal Requests for Proposals (RFP) for these innovative research programs, the Medical School decided that two basic infrastructure components were needed to help the institution move forward in observational research and clinical genetics research. At this time, Dr. Sachin Kheterpal had the largest perioperative clinical research program in the world, housed in the NCRC space. Leaders of the Medical School asked him to extend his perioperative research data repository to all of clinical care at the University of Michigan Medical Center. This would develop a research data repository of cleaned and categorized data extracted from the electronic medical record. A grant of $5 million was provided to Dr. Kheterpal to develop this research data repository.
At the same time, the institution sought to collect blood samples for genetic analysis from a large number of patients who consented to allow not only analysis of their genes but follow-up research. A year prior to this decision, Chad Brummett had received NIH funding to conduct a focused trial examining the possible genetic components of chronic pain after elective knee surgery. He already had a system for collecting blood samples and consenting patients. He, too, was asked by the dean for research and the dean of the Medical School to expand his effort to collect 50,000 samples from consenting patients to be in this large genetics data repository.
In 2012, Kheterpal and Brummett initiated efforts to develop the institution’s infrastructure for observational and genetic research as part of their Fast Forward Research Program.
Subspecialty Clinical Programs and Expansion of Fellowships
During the early 2000s, the number of residencies and fellowships grew. Pediatric anesthesiology went from seven to nine fellows per year; pain from six to seven fellows per year, critical care from two to four to six fellows per year; and cardiac anesthesiology from two to four to six fellows per year. Neuroanesthesia was initiated with one to two fellows per year and obstetric anesthesiology one fellow per year. In 2013, the Department initiated a fellowship in regional anesthesia. Starting in the academic year 2013-14, there were 24 interns, 30 residents per class, and 30 fellows, totaling 144 trainees. This made the U-M Department of Anesthesia the largest training program in the nation. From the initiation of the Department to the present day, the educational and research missions have been driven and supported by a progressive increase in the clinical caseload in U-M’s operating rooms. Figure 2 demonstrates how the surgical procedures anesthetics caseload increased from approximately 16,000 per year in 1986 to some 70,000 cases per year in 2014. This consistent growth in the number and diversity of surgical procedures, and the excellence of the surgical departments at U-M, have been fundamental to the development of an excellent Department of Anesthesiology.
The University of Michigan’s Department of Anesthesiology has witnessed tremendous growth in the past 50 years. With outstanding clinical care, one of the largest and most advanced education programs in the country, and an internationally-renowned research program. We have established a unique foundation that we hope will result in remarkable advances over the next 50 years.
