Rendezvous with EIC Martin Smith
This issue features Prof Martin Smith, one of the senior members of the SNACC (Society of Neuroscience in Anesthesiology and Critical Care) and a renowned academician. Dr Martin Smith (MS) is an Honorary Consultant Emeritus in Neuroanaesthesia and Neurocritical Care at the National Hospital for Neurology and Neurosurgery, University College London Hospitals, and Honorary Professor at University College London in the UK. Dr Smith is past President of the SNACC and of the Neuroanaesthesia and Critical Care Society (NACCS) of Great Britain and Ireland. He has been the Editor-in-Chief of the Journal of Neurosurgical Anesthesiology (JNA), the official journal of SNACC, since 2018.
GR: Why did you choose a career in neuroanesthesia? Who/what influenced you for this decision?
MS: During training, my primary interest was critical care. I didn’t have much exposure to neuroanesthesia until the last year of training and, to my surprise, I enjoyed it! Neurocritical care was in its infancy in the UK in the late 1980s. The hospital in which I was doing neuroanesthesia training had no critical care facilities for neurosurgical cases; critically ill patients were managed on general neurosurgical wards in beds with basic provision for mechanical ventilation and limited (or no) other organ system support. Plans to open a neurosurgical critical care unit were at an advanced stage, and, shortly after I completed my neuroanesthesia training, I was appointed as the inaugural director of the new neurosurgical critical care unit at the National Hospital for Neurology and Neurosurgery. Working with others to set up a brand-new facility was an exciting time!
GR: Where did you receive your initial training in neuroanesthesia and neurocritical care, and who were your mentors?
MS: My neuroanesthesia training was at the National Hospital for Neurosurgery in Queen Square, London, UK, a specialist neuroscience institute now part of the multi-specialty University College London Hospitals organisation. The two UK neuroanesthesiologists who had the greatest impact on me during my training were Dr Doreen Jewkes and Dr Stuart Ingram, both now deceased. They were remarkable clinicians who managed hugely complex neurosurgical procedures without most of the paraphernalia that we now regard as essential for even the most minor cases. Both were Past Presidents of the UK Neuroanaesthesia and Critical Care Society (NACCS).
Drs. Jewkes and Ingram continued to be mentors during my early years as a consultant at Queen Square. I also met some of the ‘greats’ of neuroanaesthesiology when I attended my first SNACC annual meeting in 1992. Several of them became mentors and, subsequently, close friends; the support and advice from colleagues outside the UK was a great encouragement during the early stage of my career. Given my own experience, I recommend that Fellows and early year Faculty seek mentors outside their country of practice as well as locally.
GR: What has been the most challenging aspect of your educational career and/or training?
MS: In common with most colleagues wherever they work in the world, balancing clinical, academic, and personal activities has been a continuous challenge. Obtaining grant funding was a particular challenge early in my career, but persistence and encouragement/support from colleagues and mentors resulted in success and I was able to begin an academic career in earnest.
GR: What has been the most satisfying aspects of your professional career?
MS: There have been many, but I will focus on the three most important. First, working in a neurocritical care unit as part of a multidisciplinary team has been incredibly fulfilling. I was privileged to work alongside amazing medical, nursing, and allied health professional colleagues. Second, my 30-year collaboration with Professor Clare allowed me to develop a successful academic career alongside my clinical responsibilities. Collaborating with a Medical Physicist and Biomedical Engineer who is comfortable in the clinical space, whose aim is to develop technology that can answer clinically relevant questions, and who is driven by how technological advances can impact patient-centered outcomes has been a transformational experience. Finally, it has been a privilege to work with and mentor so many clinical and academic trainees; their commitment, enthusiasm and dedication was an inspiration throughout my career. Many have gone on to lead internationally recognized clinical and academic programs and I am incredibly proud of their achievements.
GR: You are a past President of SNACC and also of NACCS. How would you rate the ongoing collaboration between SNACC and other societies for the advancement of perioperative neurosciences?
MS: As the international society of our speciality, it is right that SNACC develops relationships and collaborations with national societies of neuroanesthesia and neurocritical care for mutual benefit. The SNACC Newsletter has been an important forum for highlighting the work of national societies and the importance of such collaboration. The UK Society (NACCS) has recently included access to the Journal of Neurosurgical Anesthesiology as a benefit of membership, and I hope that other national societies that do not have their own journal might consider doing the same.
GR: You have been a neuroanaesthesiologist and neurointensivist; this model works well in the UK. How would you suggest the next generation of neuroanaesthesiologists succeed in pursuing both– neuroanaesthesia and neurocritical care?
MS: The model of combining a career in neuroanesthesiology and neurocritical care has worked well in the UK and several other countries. However, as models of care provision change there is a greater emphasis on neuroanesthesiologists/neurointensivists choosing either operating room or critical care practice. I can understand the practicalities, such as rota issues, which are driving this change, though I do believe that there should still be opportunities to work in both areas where possible. I am not ‘territorial’ about the base speciality of neurointensivists but am clear that they must be specifically trained in neurocritical care and related specialties. Neurointensivists must have expertise in general critical care issues, such as advanced systemic organ support, as well as detailed knowledge of neurological issues and their inter-relationship with systemic organ systems.
GR: You are the Editor-in-Chief of the JNA. What are your expectations from authors especially those who are SNACC members?
MS: My expectations of SNACC members who submit their work to JNA are the same as for any author! All submitted manuscripts should lie within the scope of the journal, and clearly outline the background to the study, concisely report the methods and results, and include a discussion which syntheses the findings of the study in relation to previous work in the field. All clinical studies must also meet the highest research governance and ethical standards. The journal is receiving increased numbers of review articles, including systematic reviews and meta-analyses, which are highly regarded by our readers. Like clinical articles, reviews must have appropriate methodological design (including appropriate search strategies) and present the findings in a concise and accessible manner. The most important piece of advice I can give to prospective authors is to read the Information for Authors and ensure that the manuscript meets all relevant criteria prior to submission.
GR: What advice would you give the residents and fellows for choosing neuroanesthesia as a career option?
MS: Neuroanesthesia and neurocritical care are unique areas of practice that provide clinicians with a complex caseload in a cohort of patients who at often at their most vulnerable. Brain surgery, head injury, stroke, etc., are synonymous in the public’s mind with high risk and poor outcomes, and the ability to modify outcomes in these life-threatening and life-changing situations is a privilege. Despite the undoubted challenges of a career in neuroanesthesiology or neurocritical care, the rewards are substantial.
GR: What would you suggest to the current SNACC leadership for further the growth of neuroanesthesia as a subspeciality across the globe?
MS: In recent years, SNACC has moved from being a society that primarily delivered an excellent annual meeting to a broader membership society providing year-round education in multiple formats, sponsoring clinical guidelines and, more recently, by supporting training through the development of the ICPNT; this shift of emphasis is welcome. One role for SNACC which I believe would benefit the growth of neuroanesthesia as a subspeciality would be for the society to argue the case for the perioperative management of all neuroscience patients to be led by speciality-trained neuroanesthesiologists and neurointensivists. Our cardiac anesthesia colleagues successfully won this debate on behalf of cardiac patients some time ago, and we should now do the same for neuroscience patients. I accept that this is a contentious issue and that the logistical challenges will be substantial, but I believe that we all, in association with our Society, have a responsibility to rise to this challenge. Finally, while developing other areas, SNACC should retain its core role as a forum for the exchange of ideas and the development of friendships and collaborations at which it has excelled since its formation.