Behind The Knife: The Surgery Podcast

As we move towards a model of Competency-Based Surgical Education, individualization of training may be needed. How can we get the right education to the right trainee at the right time? How can we link education to actual patient outcomes? Precision education aims to do just that, while leveraging technology, data, and analytics to decrease burden on assessors. While this approach offers a lot of promise to advance surgical education, it can be difficult to conceptualize how this would be implemented in practice. We’re joined by an expert in the field of precision medical education, Dr. Jesse Burk-Rafel, to break down what precision education is and how it might integrate into our current system of surgical education Join hosts Nicole Brooks MD, Judith French PhD, and Jeremy Lipman MD, MHPE for this exciting conversation with Jesse Burk-Rafel MD. Learning Objectives 1.     Listeners will define precision education. 2.     Listeners will describe examples of how precision medical or surgical education is being used currently.  3.     Listeners will explain barriers that must be addressed with the implementation of precision surgical education, including bias and issues with data sharing.  4.     Listeners will consider how precision surgical education will evolve, including possible use within their own institution to completement competency-based surgical education. References Desai SV, Burk-Rafel J, Lomis KD, et al. Precision Education: The Future of Lifelong Learning in Medicine. Academic Medicine. 2024;99(4). https://pubmed.ncbi.nlm.nih.gov/38277444/ Richardson J, Santen SA, Mejicano GC, et al. Learner Assessment and Program Evaluation: Supporting Precision Education. Academic Medicine. 2024;99(4). https://pubmed.ncbi.nlm.nih.gov/38166211/ Perrone KH, Abdelaal AE, Pugh CM, Okamura AM. Haptics: The Science of Touch As a Foundational Pathway to Precision Education and Assessment. Academic Medicine. 2024;99(4). https://pubmed.ncbi.nlm.nih.gov/38109654/ Sukhera J. Precision Education and Equity: A Participatory Framework to Advance Equitable Assessment. Academic Medicine. 2024;99(4).  https://pubmed.ncbi.nlm.nih.gov/38109658/ 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

In this Journal Review episode, the Hernia Content Team from Carolinas Medical Center reviews the definition and meaning of a hernia center. In a subspecialty field that is in its relative infancy, the specialization of care at hernia centers is a relatively new concept. The team reviews two relevant publications on hernia centers that help to provide guidance on this topic for the hernia community. Hosts: - Dr. Sullivan “Sully” Ayuso, Chief Resident, Carolinas Medical Center (Charlotte, NC), @SAyusoMD (Twitter) - Dr. Todd Heniford, Chief of GI & MIS, Carolinas Medical Center (Charlotte, NC), @THeniford (Twitter) - Dr. Vedra Augenstein, Professor of Surgery, Carolinas Medical Center (Charlotte, NC), @VedraAugenstein (Twitter) - Dr. Monica Polcz, Attending Surgeon, Baptist Health (Miami, FL), No Twitter handle - Dr. Brittany Mead, GI & MIS Fellow, Carolinas Medical Center (Charlotte, NC), No Twitter handle References:  -Shulkin et al, Characterizing Hernia Centers in the United States: What Defines a Hernia Center?, Hernia, 2022 https://pubmed.ncbi.nlm.nih.gov/33871743/  -Köckerling et al, Accreditation and Certification Requirements for Hernia Centers and Surgeons: the ACCESS Project, Hernia, 2019  https://pubmed.ncbi.nlm.nih.gov/33871743/ 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

VTE prophylaxis is more than just some squeezy leg socks and a one-size fits all dose of enoxaparin!  Ever wonder how VTE prophylaxis is similar to constipation?  Have you or a loved one been hurt by a hospital administrator telling you that VTE is a never event?  Come with us, and our special guest Dr. Bryan Cotton, on this journey to the frontier of research attempting to debunk this myth and improve patient care by reducing VTE rates in trauma patients.   Hosts: - Michael Cobler-Lichter, MD, PGY4/R2: University of Miami/Jackson Memorial Hospital/Ryder Trauma Center @mdcobler (X/twitter) - Eva Urrechaga, MD, PGY-8, Vascular Surgery Fellow University of Pennsylvania Recent graduate of University of Miami/Jackson Memorial Hospital/Ryder Trauma Center General Surgery Residency @urrechisme (X/twitter) - Eugenia Kwon, MD, Trauma/Surgical Critical Care Attending: Loma Linda University Recent graduate of University of Miami/Jackson Memorial Hospital/Ryder Trauma Center Trauma/CC Fellowship - Brandon Parker, DO, Assistant Professor of Surgery, 5 years in practice University of Miami/Jackson Memorial Hospital/Ryder Trauma Center @BrandonParkerDO (X/twitter) - Bryan Cotton, MD, MPH, FACS, Professor of Surgery, 20 years in practice  University of Texas Health Science Center at Houston/Red Duke Trauma Institute at Memorial Herman Hospital @bryanacotton1 (X/twitter) Learning Objectives: - Describe the rationale for the addition of aspirin to chemoprophylactic regimens for VTE -  Identify appropriate screening systems for trauma patients at high risk for VTE -  Describe the rationale for monitoring anti factor Xa levels in the trauma population receiving VTE chemoprophylaxis - List the major conclusions of the two studies discussed regarding the addition of aspirin to VTE chemoprophylaxis regimens in trauma patients, and the change in antithrombin activity levels over time in relation to enoxaparin responsiveness in polytrauma patients Quick Hits: 1.     On adjusted analysis, the standard VTE PPX plus aspirin group had a lower OR of developing VTE, though limitations of this study highlight need for future prospective work 2.     Trauma patients often suffer from decreased activity of antithrombin 3, which may mediate the relatively higher rates of VTE in this population. 3.     Trauma patients who went on to develop VTE were more likely to not achieve satisfactory anti Xa levels, with a VTE rate of 30% in the never-responder group, the group for which Xa levels were never higher than 0.2 4.     Ex vivo supplementation of antithrombin seems to improve enoxaparin responsiveness.  Remember, enoxaparin and heparin are HELPING AT3, not the other way around References 1.     Lammers D, Scerbo M, Davidson A, et al. Addition of aspirin to venous thromboembolism chemoprophylaxis safely decreases venous thromboembolism rates in trauma patients. Trauma Surg Acute Care Open. 2023;8(1):e001140. doi:10.1136/tsaco-2023-001140 https://pubmed.ncbi.nlm.nih.gov/37936904/ 2.     Vincent LE, Talanker MM, Butler DD, et al. Association of Changes in Antithrombin Activity Over Time With Responsiveness to Enoxaparin Prophylaxis and Risk of Trauma-Related Venous Thromboembolism. JAMA Surg. 2022;157(8):713-721. doi:10.1001/jamasurg.2022.2214 https://pubmed.ncbi.nlm.nih.gov/35731524/ 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

Most surgeons know about malpractice lawsuits, but did you know that residents and even medical students can be involved in them? Join us for a discussion of what happens when patients sue their treatment teams -- and what happens when those teams involve trainees. Host: Nina Clark, MD, MS Guests: Cindy Hamra, JD, MA is an associate dean in the GME Office at the University of Washington School of Medicine, where she leads the operational, administrative and finance functions.  UW School of Medicine is sponsors clinical training for over 1600 medical and dental residents in fellows in over 200 programs.  UW Medicine, through the School of Medicine, is the largest sponsor of GME programs in the five-state WWAMI region (Washington, Wyoming, Alaska, Montana and Idaho). Lisa Hammel, JD is the senior director of clinical risk management for UW medicine. Prior to that, she spent over 20 years as a defense attorney primarily working in medical malpractice and professional liability defense.  References: American College of Surgeons: https://www.facs.org/for-medical-professionals/news-publications/journals/rise/articles/litigation-overview/  AMA: https://www.ama-assn.org/medical-residents/residency-life/resident-medical-liability-lawsuits-why-and-how-often-they-happen JAMA Surgery: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5833625/ & https://jamanetwork.com/journals/jamasurgery/article-abstract/2670456 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. Scott Steele and Dan Scheese as they engage in an in-depth conversation with Dr. Michael Valente about the intricate world of appendiceal masses, including carcinoid, adenocarcinoma, and mucinous neoplasms. Despite the complexity of the subject, this episode skillfully deconstructs the topic through the analysis of three distinct cases, illuminating the latest terminology, diagnostic approaches, and management strategies.  Hosts:  Scott Steele, MD (@ScottRSteeleMD) Dan Scheese, MD (@DanScheese13) Guest: Michael Valente, MD (@DrMikeValente) is an Associate Professor of Surgery at the Cleveland Clinic and Program Director of the colon and rectal residency program. Dr. Valente's specialty and research interests include cancer of the appendix, peritoneum, colon, rectum and anus, cytoreductive surgery/HIPEC, complex re-operative surgery, inflammatory bowel disease, advanced endoscopic techniques, laparoscopic and minimally invasive colorectal surgery, and surgical education. Dr. Valente has published numerous peer-reviewed journal articles and book chapters and has presented his research interests both nationally and internationally. 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

Two surgical experts, Keith Lillemoe and Luise Pernar, discuss improving morbidity and mortality conferences in surgery to enhance education and quality improvement. They explore the historical evolution of these conferences, challenges in connecting them with quality improvement initiatives, creating a supportive culture, and the importance of cultural factors in analyzing surgical complications.

It’s that time of year (again!)- when medical students- both US and International- are preparing their residency applications. This year, we have been focusing on the special challenges International Medical Graduates face when applying to US surgical residency positions. In our previous episode, we discussed how residents can make their applications stand out to program directors. Today, we will explore the unique challenges, experiences, and the future of IMGs with special guest Dr. Hasan Alam.  Guests: Hasan Alam, MD- Chair of the Department of Surgery and Professor of Surgery (Trauma and Critical Care) and Cell and Developmental Biology- Northwestern University  Previous DOMINATE the Match Episodes:  Episode 2- “Choose Me” (Personal Statements and Letters of Recommendations) https://behindtheknife.org/podcast/dominate-the-match-episode-2-choose-me/ Episode 3- “The Interview” https://behindtheknife.org/podcast/dominate-the-match-episode-3-the-interview/ Episode 4- “Rank and Match” https://behindtheknife.org/podcast/dominate-the-match-episode-4-rank-and-match/ 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

It’s that time of year (again!)- when medical students- both US and International- are preparing their residency applications. In this episode, we will focus on the special challenges International Medical Graduates face when applying to US surgical residency positions and discuss tips and tricks for making IMG residency applicants standout to program directors in the US.  Guests: David Hughes, MD- Clinical Associate Professor of Endocrine Surgery and General Surgery Residency Program Director- University of Michigan Krishnan Raghavendran, MBBS- Professor of Acute Care Surgery and Critical Care- University of Michigan Link to video:  You can watch Dr. Hughes’s full presentation here: https://youtu.be/iQ0CzH7xHwE Previous DOMINATE the Match Episodes:  Episode 2- “Choose Me” (Personal Statements and Letters of Recommendations) https://behindtheknife.org/podcast/dominate-the-match-episode-2-choose-me/ Episode 3- “The Interview” https://behindtheknife.org/podcast/dominate-the-match-episode-3-the-interview/ Episode 4- “Rank and Match” https://behindtheknife.org/podcast/dominate-the-match-episode-4-rank-and-match/ Residency Program Lists:  - FREIDA Residency and Fellowship Database: https://freida.ama-assn.org/ - Doximity: https://www.doximity.com/residency/?utm_campaign=marketing_resnav_competitor_broad_20210520&utm_source=google&utm_medium=cpc&gclid=CjwKCAjwt52mBhB5EiwA05YKo1J47BLAtTPtsJBmVvXGP2pDXLLqgDIwM0pgkSYjoBhFUOO1ktXDYRoC2bkQAvD_BwE 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

In this engaging discussion, surgeons Andrew Wright, Nick Cetrulo, and Nicole White from UW Medical Center, alongside residents Paul Herman and Ben Vierra, dive deep into the evolution of cholecystectomy techniques. They explore the dramatic rise in robotic surgery and its implications for patient outcomes compared to traditional laparoscopic methods. The team examines the history of bile duct injuries and highlights ongoing efforts to minimize these risks. Insights into training challenges and the importance of surgeon experience add further depth to their analysis.

Join for the forth episode in the Association of Out Surgeons & Allies (AOSA) series for a discussion on gender affirming care and gender affirming surgery. Host: Dan Scheese, MD Andrew Schlussel, DO, Colorectal and General Surgeon, Charlie Norwood VA Medical Center Guests: 1. Dr. Megan Lane (She/her) megalane@med.umich.edu Dr. Lane is a Plastic Surgery resident at the University of Michigan who is planning on going into Gender Affirming Surgery and general reconstruction, she completed a research fellowship in the National Clinician Scholars Program and focused primarily on patient-reported outcomes in gender affirming surgery.  2. Dr. Scott Chaiet (he/him/his/himself) chaiet@surgery.wisc.edu Dr. Chaiet is double board certified by the American Board of Otolaryngology and the American Board of Facial Plastic & Reconstructive Surgery and is currently at the University of Wisconsin. His areas of expertise include rhinoplasty and facial gender surgery. He also practices reconstructive surgery including facial paralysis reanimation. His gender affirming practice includes all areas of the face and Adam’s apple except for hair. 3. Dr. Amy Suwanabol  pasuwan@med.umich.edu Amy Suwanabol is a colorectal surgeon at the University of Michigan and the Ann Arbor VA. She assists the gender affirming surgeons at the University of Michigan in performing robotic assisted vaginoplasty. Her research focuses on optimizing quality of life among surgical patients and their families, surgeon well being, and cancer survivorship.   4. Dr. Monica Llado-Farrulla lladofar@ohsu.edu Dr. Llado-Farulla was born and raised in Puerto Rico, completed a residency in general surgery and then plastic surgery at Tulane and Penn, respectively. She pursued a year of training in advanced gender surgery and is now currently at OHSU, her practice largely focuses on facial feminization, chest affirming surgeries, phalloplasty, autologous breast reconstruction, and limb salvage.  5. Dr. Michele “Mike” Fascelli (he/him/his) FASCELM2@ccf.org Dr. Fascelli is a practicing reconstructive urologist at Cleveland Clinic.  He comppleted his urology training at the Cleveland Clinic in Ohio and then fellowship in urogenital gender affirming surgery with the urology team at OHSU with Dr. Llado-Farulla. He is now the Director of Urogenital Reconstruction and Co-Director of the Gender Affirming Surgery Program at Cleveland Clinic.  He is very committed to LGBTQIA+ urologic access and actively works to protect and expand care to the rainbow community, and to our trans and gender diverse patients.  His practice is currently focused on queer urologic health concerns and genital gender surgery (i.e. vaginoplasty, metoidioplasty and phalloplasty).     Learn more and get involved with AOSA: https://www.outsurgeons.org Twitter/X: @OutSurgeons   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