Behind The Knife: The Surgery Podcast

RE-RELEASE This was first published in 2023 but it's so good we are running it back! Buckle up, PGY-1’s! Intern year is starting whether you’re ready or not. Don’t fret, BTK has your back to make sure you dominate the first year of residency.  This episode, we’ll tackle the resources that you should know about to support your own learning throughout residency. Hosts: Shanaz Hossain, Nina Clark Tips for new interns: STRUCTURE YOUR STUDYING - 2 things you need to do: (1) develop a knowledge base and (2) answer questions - Knowledge base Pick a level-appropriate textbook, read it (ideally all of it) yearly.  Ideally, lead a little bit every day - 10 pages/day is a good goal to start with and you may need to adjust.  - Questions Do some questions every week – 50/week is a good goal to start Plan to do more questions closer to ABSITE! Consider storing everything you learn in one place – either a notebook you carry with you or a cloud-based note app Share this with others, use it to take notes while reading, doing cases, getting feedback, or gaining experience while taking care of patients every day. SPECIFIC RESOURCES  - Textbooks Sabiston: big book, very dense, with a lot of great information. Schwartz: shorter chapters, clinically oriented, ideal for junior residents Cameron: shorter chapters, clinically oriented, ideal for senior residents - ABSITE review books Fiser: Classic, packed with facts but can be difficult to read, good for looking things up quickly BTK ABSITE Companion: https://www.amazon.com/Behind-Knife-ABSITE-Review-Companion-ebook/dp/B0CLBZ273F/ref=sr_1_2?crid=3382SFZ81ZHKA&keywords=absite+review+behind+the+knife&qid=1698106031&sprefix=absite+review+behind+the+knife%2Caps%2C64&sr=8-2 - Question banks TrueLearn: high quality, can be pricy depending on program  SCORE: written/edited by ABS, free for subscribing programs LEARN HOW TO OPERATE?? - Carry suture and a needle driver with you and practice basic moves - Consider a home suture kit for practice when you don’t want to be in sim lab – BTK released one this year - Use VIDEOS to ensure learning things the correct way! Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our new how-to video series on suture and knot-tying skills – https://behindtheknife.org/video-playlists/btk-suture-practice-kit-knot-tying-simulator-how-to-videos/

RE-RELEASE This was first published in 2023 but it's so good we are running it back! Buckle up, PGY-1’s! Intern year is starting whether you’re ready or not. Don’t fret, BTK has your back to make sure you dominate the first year of residency. First up, the first day of intern year. Hosts: Shanaz Hossain, Nina Clark Tips for new interns: BRING WHAT YOU NEED Name badge Scrubs, white coat, and extra clinic clothes Comfortable shoes - even on clinic days Pager Phone Pen Bonus stuff that’s good to keep in your bag: Snacks, extras of everything, toothbrusth/toothpaste/deodorant, suture  STAY ORGANIZED Preround purposefully and systematically  Look at the same things in the same order every day on every patient Write data in the same physical location on your sheet so you can quickly find information on the fly  Keep track of to-do’s from rounds Check box system:  Nina’s system: empty = not done, half full = ordered/needs follow up, full = completely done and followed up on  Don’t forget to look at the results of imaging studies, labs, or consults after they are entered!  Prioritize urgent/emergent things first, then consults and discharges, then routine orders, then notesAs you get more efficient, start drafting your notes as you pre-round – it will save you lots of time later in the afternoon!  OWN THE FLOOR  During the day, be ready to shift your priorities as urgent issues arise.  Develop a system for remembering what happened after rounds so you can quickly update seniors Shanaz’s system: One color for AM rounds, a different color for afternoon events Load the boat! Your team is there to help you. If you are concerned about someone or have a question, ask. There is truly no better time than as an intern. Master the art of getting your seniors’ attention in the OR - be conscientious, be clear in what you’re asking, and be prepared to report back about urgent findings!  Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our new how-to video series on suture and knot-tying skills - https://behindtheknife.org/video-playlists/btk-suture-practice-kit-knot-tying-simulator-how-to-videos/

In this surgical education episode, the Cleveland Clinic General Surgery Education Team explores the past, present, and future of resident autonomy in the operating room. With guest colorectal surgeons Dr. Tracy Hull (recently retired) and Dr. David Rosen (early career faculty), we discuss how autonomy was granted in “the good ole days,” how educational culture and institutional pressures shape current practice, and what thoughtful autonomy looks like moving forward. Through candid stories—from emergent cases and missed enterotomies to thumbtacks pulled off the wall to stop bleeding—we get a nuanced look at what surgical independence really means, and how to responsibly develop it. Join hosts Pooja Varman, MD, Judith French, PhD, and Jeremy Lipman, MD, MHPE, for this conversation about what it means to train competent, confident, and independent surgeons. Learning Objectives By the end of this episode, listeners will be able to  1.     Define operative autonomy and its educational value in surgical training 2.     Identify barriers to providing resident autonomy in modern surgical environments 3.     Discuss strategies for tailoring autonomy to the skill level and readiness of the trainee 4.     Describe approaches to communicating resident involvement to patients References 1.     Sehat AJ, Oliver JB, Yu Y, Kunac A, Anjaria DJ. Declining Surgical Resident Operative Autonomy in Acute Care Surgical Cases. J Surg Res. 2023;281(k7b, 0376340):328-334. doi:10.1016/j.jss.2022.08.041 https://pubmed.ncbi.nlm.nih.gov/36240719/ 2.     Teman NR, Gauger PG, Mullan PB, Tarpley JL, Minter RM. Entrustment of General Surgery Residents in the Operating Room: Factors Contributing to Provision of Resident Autonomy. J Am Coll Surg. 2014;219(4):778-787. doi:10.1016/j.jamcollsurg.2014.04.019 https://pubmed.ncbi.nlm.nih.gov/25158911/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

Join the Behind the Knife Surgical Oncology Team as we discuss the two key studies investigating optimal management strategies of neuroendocrine tumors of the small bowel. Hosts: - Timothy Vreeland, MD, FACS (@vreelant) is an Assistant Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center - Daniel Nelson, DO, FACS (@usarmydoc24) is Surgical Oncologist/HPB surgeon at Kaiser LAMC in Los Angeles. - Connor Chick, MD (@connor_chick) is a 2nd Year Surgical Oncology fellow at Ohio State University. - Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a 1st Year Surgical Oncology fellow at MD Anderson. - Beth (Elizabeth) Barbera, MD (@elizcarpenter16) is a PGY-6 General Surgery resident at Brooke Army Medical Center Learning Objectives: In this episode we review two important papers that discuss optimal management strategies of neuroendocrine tumors (NET) of the small bowel.  The first paper by Singh and colleagues discusses the NETTER-2 trial investigating the role of radioligand therapy for NET as a first-line treatment.  The second article by Maxwell et all challenges surgical dogma regarding optimal debulking cutoffs for debulking of NET. Links to Papers Referenced in this Episode: 1.     Singh S, Halperin D, Myrehaug S, Herrmann K, Pavel M, Kunz PL, Chasen B, Tafuto S, Lastoria S, Capdevila J, García-Burillo A, Oh DY, Yoo C, Halfdanarson TR, Falk S, Folitar I, Zhang Y, Aimone P, de Herder WW, Ferone D; all the NETTER-2 Trial Investigators. [177Lu]Lu-DOTA-TATE plus long-acting octreotide versus high‑dose long-acting octreotide for the treatment of newly diagnosed, advanced grade 2-3, well-differentiated, gastroenteropancreatic neuroendocrine tumours (NETTER-2): an open-label, randomised, phase 3 study. Lancet. 2024 Jun 29;403(10446):2807-2817. doi: 10.1016/S0140-6736(24)00701-3. Epub 2024 Jun 5. PMID: 38851203. https://pubmed.ncbi.nlm.nih.gov/38851203/ 2.     Maxwell JE, Sherman SK, O'Dorisio TM, Bellizzi AM, Howe JR. Liver-directed surgery of neuroendocrine metastases: What is the optimal strategy? Surgery. 2016 Jan;159(1):320-33. doi: 10.1016/j.surg.2015.05.040. Epub 2015 Oct 9. PMID: 26454679; PMCID: PMC4688152. https://pubmed.ncbi.nlm.nih.gov/26454679/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

You have a patient with complicated diverticulitis s/p IR drain with colo-cutaneous fistula and colo-vaginal fistula. They are scheduled for surgery. How will you do it? What is the role for hand assist? How can hand assist help? Tune in to find out! Join Drs. Peter Marcello, Jonathan Abelson, and Tess Aulet as they discuss high yield papers discussing hand assist laparoscopy in Colon and Rectal surgery.  Learning Objectives 1. Describe the technical considerations and how to do hand assist laparoscopic surgery (HALS) 2. Discuss the indications for use of HALS 3. Review literature supporting use of HALS Video Link: https://app.behindtheknife.org/video/journal-review-in-colorectal-surgery-hand-assist-laparoscopy-in-colon-and-rectal-surgery References: Marcello PW, Fleshman JW, Milsom JW, Read TE, Arnell TD, Birnbaum EH, Feingold DL, Lee SW, Mutch MG, Sonoda T, Yan Y, Whelan RL. Hand-assisted laparoscopic vs. laparoscopic colorectal surgery: a multicenter, prospective, randomized trial. Dis Colon Rectum. 2008 Jun;51(6):818-26; discussion 826-8. doi: 10.1007/s10350-008-9269-5. Epub 2008 Apr 17. PMID: 18418653. https://pubmed.ncbi.nlm.nih.gov/18418653/ Jacobs C, Read TE. "Peek port": avoiding conversion during laparoscopic colectomy-an update. Surg Endosc. 2020 Sep;34(9):3944-3948. doi: 10.1007/s00464-019-07165-3. Epub 2019 Oct 4. PMID: 31586252. https://pubmed.ncbi.nlm.nih.gov/31586252/ Heneghan HM, Martin ST, Kiran RP, Khoury W, Stocchi L, Remzi FH, Vogel JD. Laparoscopic colorectal surgery for obese patients: decreased conversions with the hand-assisted technique. J Gastrointest Surg. 2013 Mar;17(3):548-54. doi: 10.1007/s11605-012-2089-x. Epub 2012 Nov 27. PMID: 23188222. https://pubmed.ncbi.nlm.nih.gov/23188222/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

Intern year: where the learning curve is steep and you’re not sure if the patient is crashing or you are. In this episode of Behind the Knife, our surgical education fellows reflect on what they wish they had known before Day 1—and all the humbling, hilarious, and genuinely formative moments along the way. From getting lost wheeling a critical patient through the hospital, to triple-scrubbing just to be acknowledged, to accidentally spraying TPA into your own eye (yes, really)—this episode is a candid conversation about the highs, lows, and everything in between. Whether you're gearing up to start your intern year or reflecting on how far you've come, this is the episode we all needed. Hosts:  Elizabeth Maginot, MD – General Surgery Resident, University of Nebraska Medical Center  @e_magination95 Nina Clark, MD – General Surgery Resident, University of Washington @clarkninam Ayman Ali, MD – General Surgery Resident, Duke University Michelle LaBella, MD – General Surgery Resident, University of North Carolina Emma Burke, MD – General Surgery Resident, Baylor College of Medicine @emmaburke017 Learning Objectives: Identify common misconceptions about intern year—and how to manage expectations Understand how to approach early mistakes with humility and resilience Recognize the importance of teamwork and asking for help Reflect on what makes a strong, dependable intern References BTK Intern Survival Guide: https://app.behindtheknife.org/podcast-series/medical-student-and-intern-survival-guide Institutional pharmacists (seriously, call them—they’re the unsung heroes) Check out our Medical Student and Intern Survival Guide HERE: https://app.behindtheknife.org/podcast-series/medical-student-and-intern-survival-guide

This new series will be a collaboration between BTK and Annals of Surgery, where we will be discussing hot topics in surgery research. No, we won’t be getting into the nitty gritty of methods of individual papers but rather will focus on high-level discussions of contemporary topics that are moving our field forward. Hosts: Cody Mullens, MD is a general surgery resident at the University of Michigan, current Behind the Knife Surgery Education Fellow. (@Cody_Mullens) Justin B. Dimick, MD MPH is the Fredrick A Coller Distinguished Professor and Chair of Surgery at the University of Michigan. He also serves as the Editor in Chief at Annals of Surgery. (@jdimick1) Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

The evidence for climate change is irrefutable. But how does surgical care contribute to global emissions, and is there anything we can do to make surgery more sustainable? Join Jon Williams and our ASGBI partners for the next installment of our BTK/ASGBI collaborative series, where we discuss how to make surgical care greener. Mrs. Cleo Kennington from the UK and Dr. Benjamin Miller from the US are our guest experts, and provide valuable insights into local sustainability efforts you can take home to your hospital, broader concepts of how high-quality care is sustainable, innovations in sustainability, and what the future of sustainable surgery may look like. After listening, you get to decide–Who has more sustainable surgical practices? The UK or US? Mrs. Cleo Kenington is a Consultant Emergency General and Trauma Surgeon at St George’s Hospital, London and was the recent ASGBI Sustainability Lead. She is a big advocate for practicing what she preaches, focusing on how we can reduce the environmental impact at all stages, from cycling to work, preventing complications and unnecessary surgeries, to reducing the use of disposable surgical components.  Dr. Benjamin Miller is a general and minimally invasive surgeon at the Cleveland Clinic, with a clinical focus on complex abdominal wall reconstruction. After earning his MD from University of Minnesota School of Medicine in 2011, Dr. Miller went to Nashville to complete his general surgery residency at Vanderbilt University Medical Center. Following this, he became a MIS/complex ab wall fellow at Cleveland Clinic, after which he joined as faculty in 2023. In addition to his clinical interests, Dr. Miller has a deep passion for sustainability efforts within surgical practice, carrying on the legacy of established sustainability efforts within surgical care at Cleveland Clinic and training the next generation of sustainable surgeons. If you enjoyed this episode, stay tuned for more upcoming BTK/ASGBI collaborative content. If you have any questions or comments, please feel free to reach out to us at hello@behindtheknife.org. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

Join Drs. Michael Rosen, Benjamin T. Miller, Sara Maskal, and Ryan Ellis as they review mesh materials used in hernia repair and the general properties surgeons who perform hernia repairs should know.  Hosts:    - Sara Maskal, MD, Cleveland Clinic  - Ryan Ellis, MD, Cleveland Clinic - Benjamin T. Miller, MD, Cleveland Clinic  - Michael Rosen, MD, Cleveland Clinic  Learning Objectives:   - Understand common mesh materials  - Review properties of the different mesh materials - Understand how to apply knowledge of the different mesh properties to different patient scenarios References:  - Ellis R, Miller BT. Mesh selection in abdominal wall reconstruction: an update on biomaterials. Surgical Clinics. 2023 Oct 1;103(5):1019-28. https://pubmed.ncbi.nlm.nih.gov/37709387/ - Krpata DM, Petro CC, Prabhu AS, Tastaldi L, Zolin S, Fafaj A, Rosenblatt S, Poulose BK, Pierce RA, Warren JA, Carbonell AM. Effect of hernia mesh weights on postoperative patient-related and clinical outcomes after open ventral hernia repair: a randomized clinical trial. JAMA surgery. 2021 Dec 1;156(12):1085-92. https://pubmed.ncbi.nlm.nih.gov/34524395/ - Rosen MJ, Krpata DM, Petro CC, Carbonell A, Warren J, Poulose BK, Costanzo A, Tu C, Blatnik J, Prabhu AS. Biologic vs synthetic mesh for single-stage repair of contaminated ventral hernias: a randomized clinical trial. JAMA surgery. 2022 Apr 1;157(4):293-301. https://pubmed.ncbi.nlm.nih.gov/35044431/ - Maskal S, Miller B, Ellis R, Phillips S, Prabhu A, Beffa L, Krpata D, Rosenblatt S, Rosen M, Petro C. Mediumweight polypropylene mesh fractures after open retromuscular ventral hernia repair: incidence and associated risk factors. Surgical Endoscopy. 2023 Jul;37(7):5438-43. https://pubmed.ncbi.nlm.nih.gov/37038022/ - Harris HW, Primus F, Young C, Carter JT, Lin M, Mukhtar RA, Yeh B, Allen IE, Freise C, Kim E, Sbitany H. Preventing recurrence in clean and contaminated hernias using biologic versus synthetic mesh in ventral hernia repair: the PRICE randomized clinical trial. https://pubmed.ncbi.nlm.nih.gov/33443907/ - Olavarria OA, Bernardi K, Dhanani NH, Lyons NB, Harvin JA, Millas SG, Ko TC, Kao LS, Liang MK. Synthetic versus biologic mesh for complex open ventral hernia repair: a pilot randomized controlled trial. Surgical Infections. 2021 Jun 1;22(5):496-503. https://pubmed.ncbi.nlm.nih.gov/33259771/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

Welcome back to our series on AI for the clinician! Large language models, like ChatGPT, have been taking the world by storm, and healthcare is no exception to that rule – your institution may already be using them! In this episode we’ll tackle the fundamentals of how they work and their applications and limitations to keep you up to date on this fast-moving, exciting technology. Hosts: Ayman Ali, MD Ayman Ali is a Behind the Knife fellow and general surgery PGY-3 at Duke Hospital in his academic development time where he focuses on data science, artificial intelligence, and surgery. Ruchi Thanawala, MD: @Ruchi_TJ Ruchi Thanawala is an Assistant Professor of Informatics and Thoracic Surgery at Oregon Health and Science University (OHSU) and founder of Firefly, an AI-driven platform that is built for competency-based medical education. In addition, she directs the Surgical Data and Decision Sciences Lab for the Department of Surgery at OHSU.  Phillip Jenkins, MD: @PhilJenkinsMD Phil Jenkins is a general surgery PGY-3 at Oregon Health and Science University and a National Library of Medicine Post-Doctoral fellow pursuing a master’s in clinical informatics. Steven Bedrick, PhD: @stevenbedrick Steven Bedrick is a machine learning researcher and an Associate Professor in Oregon Health and Science University’s Department of Medical Informatics and Clinical Epidemiology. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen