Canadian Journal of Anesthesia 2010 reader survey results October 2010
TABLE OF CONTENTS Executive summary Page 3 Accessing and reading CJA Page 4 Frequency of access Page 4 Amount of access (average minutes per week/month) Page 4 Finding out about articles of interest Page 4 Number of articles read in each issue Page 5 Reasons for turning to CJA Page 5 General assessment of reader views of CJA Page 6 What types of articles readers find useful Page 6 Topics readers wish CJA would address more frequently Page 7 Assessment of CJA and other journals in meeting professional needs Page 9 Other journals important to CJA readers Page 10 Changes readers would like to see with CJA Page 10 Survey respondent demographics: Work setting Page 12 Professional activity Page 13 Primary and secondary specialties Page 13 Age Page 13 2 P age
EXECUTIVE SUMMARY Achieving the Journal s mission, Excellence in research and knowledge translation in anesthesia, pain, perioperative medicine and critical care, requires a commitment to readers and ensuring that the Editors, Editorial Board and the Publisher remain in touch with the customer. It is with that thought in mind that the Journal sought out the opinions of CJA subscribers in October of 2010 by way of a comprehensive online survey. The survey instrument was developed by the senior editorial team of the Journal, and it was tested subsequently amongst a small cohort of readers. The survey was run online using Surveymonkey. This report is an analysis of the results of that undertaking. Of the 2,441 individuals invited on three occasions to participate, 275 (11.3%) took the time to contribute. A large majority, 71.5%, read the print version. Respondents indicated they average 33 minutes a week reading CJA. A majority indicate they read one quarter to one half of the articles in each issue. While readers look to CJA for updates in a number of areas, the top three areas cited were: guidelines to the practice of anesthesia, airway management updates and perioperative medicine. Readers find review articles, systematic reviews and editorials the most useful aspects of the Journal. When asked how important CJA and other medical journals are in meeting their professional needs, CJA ranked at the top of the list, followed by Anesthesia and Analgesia, and Anesthesiology. Respondents were asked to identify any changes they would make to CJA to better meet their needs. Many provided detailed responses to that question on subjects such as online versus print, Continuing Professional Development Modules, quality of existing content and suggestions for future content. The summary data, coupled with the many comprehensive and detailed comments on specific issues of interest, has resulted into a wealth of information CJA can rely upon as it continues to fulfil its important mission. 3 P age
1. HOW DO YOU PREFER TO ACCESS AND READ THE CANADIAN JOURNAL OF ANESTHESIA? Response Percent Response Count Read the print version 71.5% 206 Access and read the online version Access online, print the PDF and read the article 16.0% 46 12.5% 36 2. HOW OFTEN DO YOU ACCESS THE CANADIAN JOURNAL OF ANESTHESIA IN PRINT OR ONLINE? Daily Weekly Monthly Less than monthly Print 1.3% 15.8% 66.7% 12.8% (3) (37) (156) (30) Online 0.0% 10.1% 24.2% 33.8% (0) (20) (48) (67) Yearly Never Response count 0.4% 3.0% (1) (7) 234 6.6% 25.3% 198 (13) (50) 3. ON AVERAGE, SPECIFY HOW MANY MINUTES A MONTH OR WEEK YOU SPEND READING OR ACCESSING AN ISSUE OF THE CANADIAN JOURNAL OF ANESTHESIA. Response count Average Number of minutes per week 120 33.4 minutes per week Number of minutes per month 249 82.2 minutes per month 4. HOW DO YOU INITIALLY FIND OUT ABOUT ONLINE ARTICLES OF INTEREST IN THE CANADIAN JOURNAL OF ANESTHESIA? Response count Response percentage Do not find out about articles of 112 41.7% interest from online sources Table of contents alerts 64 23.8% PubMed 56 20.8% Canadian Anesthesiologists 39 14.5% Society website Google, Google Scholar 29 10.8% Informed by a colleague 25 9.3% Online First 18 6.7% Blogs 1.4% Institute for Scientific Information (ISI) 1.4% 4 P age
5. ON AVERAGE, HOW MANY ARTICLES DO YOU READ IN EACH ISSUE OF THE CANADIAN JOURNAL OF ANESTHESIA? Response Count Response Percentage All, or most 30 11.1% About three quarters 42 15.5% About half 71 26.2% About a quarter 72 26.6% Few 56 20.6% None 0 0.0% 6. TO WHAT EXTENT DO YOU TURN TO THE CANADIAN JOURNAL OF ANESTHESIA FOR UPDATES IN THE FOLLOWING AREAS? Clinically related research Perioperative medicine 12.7% (34) Pain medicine 8.6% (23) Critical care 5.7% medicine (15) Anesthetic 6.0% pharmacology (16) Issues in 6.0% medical (16) ethics Guidelines to the practice of anesthesia Airway management updates Always Usually Sometimes Rarely Never Response count 10.9% 30.8% 41.4% 14.3% 2.6% (29) (82) (110) (38) (7) (266) 31.5% (84) 20.0% (53) 38.8% (104) 21.8% (58) 17.1 (45) 28.0% (75) 14.8% (39) 42.8% (114) 39.2% (104) 36.2% (97) 35.2% (94) 37.6% (99) 40.7% (109) 36.4% (96) 18.4% (49) 30.5% (81) 11.6% (31) 29.6% (79) 31.9% (84) 22.4% (60) 33.4% (88) 5.6% (15) 8.7% (23) 0.7% (2) (268) 4.9% (13) (267) 7.6% (20) (263) 3.0% (8) (268) 9.5% (25) (264) 1.9% (5) (267) 1.5% (4) (265) 5 P age
7. PLEASE INDICATE THE EXTENT TO WHICH YOU AGREE WITH THE FOLLOWING STATEMENTS: THE CANADIAN JOURNAL OF ANESTHESIA CONSISTENTLY PUBLISHES... Strongly agree Articles relevant to my interests 12.4% (33) High quality research 10.6% articles (28) High quality images 10.6% (28) Insightful editorials 24.3% (64) Useful review articles 30.5% (81) Articles which I either cite 7.2% or refer to frequently (19) Highly readable articles 11.0% (29) Agree 64.1% (170) 53.3% (142) 53.6% (141) 58.4% (154) 55.3% (147) 44.9% (119) 58.1% (153) Neither agree or disagree 16.2% (43) 28.7% (76) 29.6% (78) 15.9% (42) 12.0% (32) 36.2% (96) 23.6% (62) Disagree 6.4% (17) 6.0% (16) 5.7% (15) 1.5% (4) 2.3% (6) 9.8% (26) 6.5% (17) Strongly disagree Response count 0.8% (2) (265) 1.1% (3) (265) 0.4% (1) (263) 0.0% (0) (264) 0.0% (0) (266) 1.9% (5) (265) 0.8% (2) (263) 8. GIVEN YOUR PROFESSIONAL INFORMATION NEEDS, WHAT TYPES OF ARTICLES AND FEATURES DO YOU FIND USEFUL? Very useful Useful Not useful Response count Average rating (5) (4) (3) (2) (1) (1-5) Editorials 93 97 60 16 2 268 3.98 Reports of original 30 83 114 30 7 264 3.38 investigations Laboratory 6 28 95 98 32 259 2.53 investigations Case reports/case 53 108 80 23 0 264 3.73 series Systematic reviews 100 115 41 6 2 264 4.16 Review articles 143 102 18 2 0 265 4.46 Continuing Professional 98 74 50 35 6 263 3.85 Development Modules Perioperative 29 69 96 52 18 264 3.15 Cardiovascular Rounds Letters to the Editor 13 82 106 55 9 265 3.13 Book reviews 3 41 103 81 35 263 2.60 6 P age
9. PLEASE LIST TOPICS ON WHICH YOU WISH THE CANADIAN JOURNAL OF ANESTHESIA WOULD PUBLISH MORE ARTICLES. Pain (24 related responses): pain, pain medicine, pain management, acute pain, chronic pain, perioperative pain management, management of neuropathic pain, chronic pain treatment in orthopedics, perioperative pain control (multimodal analgesia). Review articles (17 related responses): reviews on new monitoring equipment, review articles, review articles on practical anesthesia for the non-teaching hospital, review use of non-conventional use of analgesics, reviews ambulatory anesthesia, reviews of physiology/pharmacology principles. Perioperative medicine (17 related responses): perioperative management reviews of specific disease states, perioperative medicine, perioperative management, long-term perioperative outcome, perioperative care review articles, perioperative assessments. Regional anesthesia (15 related responses): regional anesthesia, evolution and future of regional anesthesia, regional and rural anesthesia, new approach in regional anesthesia. Pediatric anesthesia (14 related responses): paediatrics, pediatric anesthesia. Education/Teaching (13 related responses): teaching, education of residents, distributed medical education, CME, education program information, education of young anaesthesiologist, continuing professional development, teaching techniques for anesthesia preceptors. Airway management (10 related responses): airway management, difficult airway management, difficult airway in paediatrics, critical review of airway algorithms. Science and Research (10 related responses): clinical original research, scientific advancements, better quality research articles, advances in medicine that may affect anesthesia, assessing quality and validity of research, basic science of anaesthesiology, resident research articles (as an encouragement), research methodology. Critical Care (10 related responses): critical care, critical care review articles. Obstetrical anesthesia: (10 identical responses). Ethics (8 related responses): ethics in training settings, with patients and colleagues, ethical issues. Management (7 related responses): workplace management and communication, OR management, team-building, administration and management, workload balance, staff management. Equipment (7 related responses): equipment, technology, pacemakers, new equipment, good analysis of anesthesia and ICU equipment. Simulation (7 related responses): simulation, uses of simulation. 7 P age
Pharmacology (5 related responses): pharmacology reviews, new drugs, pharmacology synthesis, narcotics and other analgesics. International Issues/Trends (4 related responses): international career development, anesthesia delivery differences among different countries, international practice comparisons,anesthesia world outside of Canada and the US. Politics and Policy (4 related responses): medical politics, health policy in Canada relevant to anesthesia, societal problems through the lens of anaesthesiology, access and quality of perioperative services for marginalized populations in Canada. Finance and Economics (4 related responses): health economics, cost-effectiveness, financial and billing issues, costs. Geriatric and elderly (3 related responses): perioperative management of geriatric patients, anesthesia for geriatrics, anesthesia for aging patients. Cardiac anesthesia (3 related responses): cardiac paediatrics, cardiac anesthesia. Trauma (3 related responses): trauma care, trauma anesthesia, principles of resuscitation and trauma. Patient Safety (3 related responses): patient safety. Neuroanesthesia (3 identical responses). Obesity (3 related responses): morbid obesity, anesthesia and the obese patient. Other: TEE/Echo; clinically relevant; Transthoracic echocardiography - focused exam in non cardiac anesthesia practise; assessment of patient's volemic status; blood conservation; case reports; intravenous fluids; editorials; thoracic; current recommendations for care of patient with lung disease for non-pulmonary surgery; blood transfusion; clinical topics which are used everyday even though everybody knows them - it means it becomes a quick revision; peripheral nerve blockade; ambulatory anesthesia (2); coagulation; review of statistics; transplant anesthesia; images should be good quality; CRM; randomized clinical trials; locoregional; continuing professional development modules in statistics and scientific article readings; guidelines; total intravenous anesthesia; review or synthesis on various coexisting comorbidities; postoperative analgesia; regional anesthesia review of anticoagulation guidelines; analgesia for arthroplasty (literature review); brief reviews of articles such as BJ of anesthesia; EBM Meta-Analysis; update in techniques; anesthetic drugs;; case reports managed in a community hospital setting; clinically relevant; Masimo Radical 7 - Cooximetry as a useful tool or gimmick; anesthesia and Alzheimer delirium; quality control issues; recent updates in changes of standards of practice; articles dealing with practice issues such as alternative providers; social accountability of medical training; community anesthesia practice; important advances in cardiology; impact of anesthesia on outcome short and long term; case reports; use of ultrasound; articles on how to re: ultrasound for epidural, central line...; intravenous anesthesia; original investigation; current use of vasopressors; endocrinology; regional anesthesia for non-anesthesiologists; pro-con 8 P age
debates; current guidelines for specific problems; emergency resource management; changes in approaches to problems; global health; CPD; new approach in cardiovascular anesthesia; anesthesia related mortality (with respect to brain activity); complications in anesthesia; monitoring depending on type of surgery; literature review on all subjects relevant to anesthesia; pathophysiology; standards and guidelines; articles regarding blood products; cases; outcomes; review of standards; systematic reviews; clinically relevant; neuro-monitoring; patient outcomes; M&M trouble cases; less muscle relaxants; intensive care; community continuity of care; case-based learning (like NEJM cases); regional blocks; long term effects of anesthetics beyond the operating room; anesthesia/critical care in small centres; respiratory physiology; coagulation issues; medical legal issues; internal medicine reviews i.e. pick a medical topic and review the condition, diagnosis, anesthetic implications, treatment, etc.; monitoring updates; practice guidelines; history of anesthesia; anesthesia for ambulatory surgery; hypothermia complications related to positioning; preoperative evaluation; interesting clinical case reviews; innovative techniques out of the box thinking. 10. PLEASE RATE FROM 5 TO 0 HOW IMPORTANT EACH OF THE FOLLOWING JOURNALS IS IN MEETING YOUR PROFESSIONAL INFORMATION NEEDS (5 = VERY IMPORTANT; 0 = NOT IMPORTANT/DO NOT READ). Very Important (5) (4) (3) (2) (1) Do not read (0) Response count Average rating Canadian Journal of 74 109 63 15 6 0 267 3.86 Anesthesia Anesthesiology 56 94 58 15 8 35 266 3.26 Anesthesia & 14 103 36 11 5 37 264 3.44 Analgesia British Journal of 25 72 81 25 10 70 263 2.49 Anaesthesia Canadian Medical 7 22 57 63 66 48 263 1.85 Association Journal New England Journal 20 32 57 35 34 86 264 1.91 of Medicine Journal of the 4 8 32 36 26 155 261 0.94 American Medical Association The Lancet 5 17 45 26 35 135 263 1.20 9 P age
11. PLEASE LIST ANY OTHER MEDICAL/ANESTHESIOLOGY JOURNALS THAT ARE VERY IMPORTANT TO YOU. Anaesthesia (18) Critical Care Medicine (17) Pediatric Anesthesia (17) Regional Anesthesia and Pain Medicine (11) Pain (8) Chest (8) Anesthesia and Intensive Care (7) International Journal of Obstetrics Anesthesia (7) European Journal of Anesthesiology (6) Circulation (5) Journal of American Society of Echocardiography - JASE (5) Current Opinion in Anesthesia (4) Anesthesia Clinics (4) Obstetrical Anesthesia Digest (2) British Medical Journal (2) Note: Approximately 60 unique responses were provided, a majority of which were journals from various countries. Other unique responses included: Nature Medicine, Nature Reviews Neuroscience, Quality and Safety in Health Care, and Transfusion. 12. WHAT ONE CHANGE WOULD YOU MAKE TO THE CANADIAN JOURNAL OF ANESTHESIA TO BETTER MEET YOUR NEEDS? Online access: available only online for me; make it easier to access online an easy to use interface; recent changes to Springer website have made content more difficult to access; more liberal electronic access; simpler interface electronically; transition to an open access model; online version only; determine if members want online only and no hard copy; email me the table of contents and links rather than send the print version; direct online access without having to route through CAS website; it would be useful to receive a print copy in addition to having online access; easier access to online version and CDP it always seems to be a challenge can t seem to find obvious link on website which usually terminates my efforts I would access online a lot more often if it was straightforward; continue 10 P age
move to electronic format; fix the interface with PubMed when I am on the university PubMed page and the article link takes me to the CJA url it goes to the CJA home page rather than directly to the chosen article; option of not receiving print copy with only online access; online table of contents alert. Print/Appearance/Graphics: explore less conventional scientific paper formats with more graphics; change glossy finish to matte; improve quality of printing gone downhill since Springer took over; print on recycled paper for those of us who prefer paper to electronic version; don t wrap in plastic; although I support the environmental principle of avoiding printed versions in favour of online versions, the printed version is much easier for me to read especially in the down times of my schedule; improve the layout and graphics on title page; involve trainees in the design; make print version available for those with student memberships. Publication Schedule: publish 6 issues per year; publish less frequently as CJA seems to be getting thinner; less frequent publication, 8 times per year, as the Journal is getting thinner over time. CPD/CME: change the CME modules to be similar to Anesthesiology and A&A (i.e. single article with relevant questions to answer); more CME credits/modules; monthly CME articles; absolutely more CPD modules the ones you have done were fantastic; more accessible references for CPD modules and ones that are not 90+ pages long; introduce high quality audio visual interactive CPD modules; more learning modules; user-friendly CME modules the current modules are a nightmare to get on to and complete online; more frequent CME; more CPD articles; CME modules; more development regarding continuing education; list of important continuing education. Overall quality of content: This is an excellent journal - it is VERY important to the community of anesthesiologists in Canada and around the world - Don Miller is doing an outstanding job as Editor-in- Chief; better balanced editing with more clinical relevance; the attempt to publish anything has diluted the Journal severely (and others as well I might add) - Canadians are abandoning it as a site for their research - even the CJA Editorial board publishes their articles in other journals -it would not be a stretch for me to say that I would not miss it - I only continue on as I am a Canadian anesthesiologist and support the CAS - you have a huge hill to climb to get back to respectability; be more selective about articles for publication I was embarrassed to see an article on organizing a medication drawer really!; reduce the research reports which have very little use to the practice of anesthesia; I find that cutting edge research gets published in Lancet, NEJM, Anesthesiology, thus I don't expect cutting edge research from a Canadian Journal - however I do appreciate practice patterns from other Canadian hospitals; the Journal seems to be getting smaller I would be willing to read more articles if the quality was maintained; better proofreading some of the English is very substandard; needs a lot of work; continue the good work; I would like more content of quality equal to that already being published; I am a GP anesthesiologist who started reading the journal about 5 years ago and it is the journal that I read most completely - most of my reading is done when researching particular topics but I feel that reading your journal keeps me in touch with current issues in anesthesia - keep up the good work; I very much like the comprehensive reviews done by this journal I also really like those original research articles that have a Canadian basis of experience; it is very good as is; no important changes; the current content meets my needs; keep up the good work. 11 P age
Suggestions re future content: bring back the list of dates and locations of national and international meetings in anesthesia (5 similar responses); more information on teaching; concentrated brief reviews single topic in two or three pages; do not publish research of marginal clinical relevance; more Canadian content; have people reviewing articles that are knowledgeable in the area and not just anyone; practice guidelines i.e. OSA or PIH or preop peds sedation; pediatric subsection; more correspondence and discussion; more review on respiratory, cardiac, nephrology medicine; quarterly article on what s new in medicine; remove obscure case reports and also reports of laboratory investigations; clinically relevant topics, studies and articles; I enjoy case reports especially from trouble cases to learn from our mistakes or mishaps; increase, if possible, the volume of currently clinical research reporting; laboratory investigations are of little interest to me as a clinician; wider expression of a world view of anesthesia; add critical care in a real manner; consider monthly reviews on a topic; more emphasis on well written case reports; more review articles; more clinically relevant material less laboratory investigations; more case reports; less reports on extremely rare conditions; less Japanese material; more critical care articles; better international quality review articles and international editorials; teach to enable research; make it more relevant to clinical practice; make sure articles by Francophone authors are also available in English this has been a long standing problem particularly with articles by authors in France; more reports of original investigation; more variety of topics other than airway, blood conservation and risk stratification as these topics have become too repetitive; insist on higher quality research i.e., studies with large enough numbers to have power, minimize the retrospective or correlational studies, studies that rigorously control/standardize all many variables of anesthetic practice other than the one being studied; less esoteric research and more practical topics; most of us are not in teaching hospitals and appreciate quick and dirty helpful hints, etc.; increase clinical content; more interesting case reports; more pediatric related research; include more editorialists from outside of Canada and the US; less academic; more book reviews; more frequent articles in French; explanations of the statistical data of publishes studies; more review articles on one subject; more original contributions; more real clinical studies; more innovations; more review articles; studies with more clinical impact; comparison of practices, e.g. how are C-sections performed in Canada, the US and in France? 13. WHICH OF THE FOLLOWING BEST DESCRIBES YOUR WORK SETTING? Response Count Response Percent University/teaching hospital 157 59.0% Other hospital/healthcare facility 89 33.5% Private practice 10 3.8% Retired 5 1.9% Other 5 1.9% Other work settings included: remote teaching hospital; administration; teaching but not overrun with residents; private practices in a 300-bed community hospital, private free standing ambulatory surgical centre. 12 P age
14. WHICH OF THE FOLLOWING BEST DESCRIBES YOUR PROFESSIONAL ACTIVITY? Response Count Response Percent Anesthesiologist 229 87.3% Researcher/scientist 3 1.1% Teaching professional 5 1.9% Administrator 4 1.5% Trainee 12 4.6% Retired 3 1.1% Other 6 2.3% Note: other professional activities included: anesthesiologist and researcher-scientist, anesthesiologist/intensivist, GP anesthesiologist, and anesthesiologist/researcher/administrator. 15. WHAT ARE YOUR PRIMARY AND SECONDARY SPECIALTIES (check all that apply)? Primary Secondary Anesthesiology 94.7% 1.0% Pain Medicine 2.2% 49.1% Critical Care Medicine 2.6% 41.4% Internal Medicine 0.4% 8.6% 16. PLEASE INDICATE YOUR AGE. Response Count Response Percent Under 35 23 8.6% 35-44 54 20.3% 45-54 96 36.1% 55-64 68 25.6% 65 or older 25 9.4% 13 P age