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.  In this last episode of the intern bootcamp mini-series, we’ll talk about tips & tricks as well as good habits to establish in order to dominate intern year. Hosts: Shanaz Hossain, Nina Clark Tips for New Interns:  GENERAL TIPS FOR SUCCESS ON THE WARDS Spend time with the patient! Trust, but verify. Be kind to everyone. Stay humble. Be flexible. Seek and apply feedback. HOW TO LEARN IN THE OR Double scrub as many cases as you can. Write down/record everything after a case. MAINTAIN YOUR PERSONAL SANITY Figure out your stress outlets and what brings you joy. Decompress after work. Maintain work/life boundaries. Keep in touch with loved ones. Vacations are meant for relaxation.Repeat after me: NO WORK ON VACATION! 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/

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.  Today, we’re hitting the wards and tackling some of the scary clinical scenarios you will see as an intern. Hosts: Shanaz Hossain, Nina Clark Tips for new interns: THINGS TO REMEMBER ·       BREATHE. In most cases, you have a little bit of time – at least enough to take a breath and calm down outside the room before heading into an emergency. Panic doesn’t help anybody. ·       See the patient. Getting a bunch of pages? Worried about someone? Confused as to what’s going on? Go see the patient and chat with the bedside team. ·       Know your toolbox. There are a ton of people around who can help you in the hospital, and knowing the basic labs/imaging studies and when to use them can help you to triage even the sickest patients. ·       Load the boat. You’ve heard this one from us all week! Loop senior level residents in early. HYPOTENSION ·       Differential: measurement error, patient’s baseline, and don’t miss – SHOCK.            - Etiologies of shock: hemorrhagic, hypovolemic, ·       On the phone: full set of vitals, accurate I/Os, ·       On the way: recent notes, PMH/PSH including from this hospital stay, and vitals/I&Os/studies from earlier in the day ·       In the room: ABCDs – rapidly gives you a sense of how high acuity the patient is ·       Get more info: labs, consider imaging, work up specific types of shock based on clinical concern. ·       Initial management: depends on etiology of hypotension; don’t forget to consider peripheral or central access, foley catheterization for close monitoring of urine output, and level of care  HYPOXEMIA ·       Differential: atelectasis, baseline pulmonary disease, pneumonia, PE, hemo/pneumothorax, volume overload ·       On the phone: full set of vitals, amount of supplemental oxygen required and delivery device, rate of escalation in oxygen requirement ·       On the way: review PMH/PSH, known injuries (known hemothorax/pneumothorax? Rib fractures? Chest tubes in already?), risk factors for DVT/PE, review I/Os for evidence of volume status, vitals and labs for evidence of infection ·       In the room: ABCDs, pulmonary and cardiac exam, volume status exam ·       Get more info: basic labs, ABG if worried about oxygenation, CXR, consider bedside US of the lungs/heart, if high suspicion for PE consider CTA chest ·       Initial Management: supplemental O2, higher level of care, consider intubation or other supplemental oxygenation adjuncts, additional management dependent on suspected etiology ·       ABG Vs VBG (IBCC): https://emcrit.org/ibcc/vbg/  ALTERED MENTAL STATUS ·       Differential: stroke, medication effect, hypoxemia or hypercarbia, toxic or medication effect, endocrine/metabolic, stroke or MI, psychiatric illness, or infections, delirium ·       On the way: review PMH/PSH, recent notes for evidence of altered mentation or agitation, or signs hinting at above etiologies ·       In the room: ABCDs, focal neuro deficits?, alert/oriented? Be sure the patient’s mental status is adequate for airway protection! ·       Get more info: basic labs, blood gas/lactate, CT head noncontrast if concerned for stroke. ·       Initial management: rule out above; if concerned about delirium, optimize sleep/wake cycles, pain control, and lines/drains/tubes.  OLIGURIA ·       Differential: prerenal due to hypovolemia or low effective circulating volume, intrinsic renal disease, post-renal obstruction ·       On the phone: clarify functional foley or bladder scan results, full set of vitals ·       On the way: review PMH/PSH, known injuries (known hemothorax/pneumothorax? Rib fractures? Chest tubes in already?), risk factors for DVT/PE, review I/Os for evidence of volume status, vitals and labs for evidence of infection ·       In the room: ABCDs, confirm functioning foley catheter ·       Get more info: basic labs, urine electrolytes, consider fluid challenge to evaluate responsiveness, consider adjuncts including renal US ·       Initial management: typically consider IVF bolus initially, but if patient not volume responsive, don't overload them -- look for other etiologies!  TACHYCARDIA ·       Differential: sinus tachycardia (pain, hypovolemia, agitation, infection), cardiac arrhythmia, MI, PE ·       On the phone: full set of vitals, acuity of change in heart rate, updated I/Os ·       On the way: Review PMH/PSH, known cardiac history, cardiac and PE risk factors, volume resuscitation, signs concerning for infection, updated I/Os ·       In the room: ABCDs, cardiac/pulmonary exam, evaluate for any localizing signs for infection ·       Get more info: basic labs, EKG, consider CXR, troponins ·       Initial management: depends heavily on etiology 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/

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 talk about how to give and receive consults in the hospital like a pro. We’ll also provide some tips on how to make those long call days a little more manageable. Hosts: Shanaz Hossain, Nina Clark Tips for New Interns:  GIVING CONSULTS Clear and Concise Question! Develop a script, such as: “Hi, this is XX with the general surgery team. We’re calling to request an evaluation for a patient presenting with XX. I can give you the MRN whenever you are ready…” Follow this with a brief H&P. If you are asking another team to perform a procedure on your patient, be prepared with the following information: NPO Status Ability to Consent or Proxy Contact Blood Thinners Urgency of Procedure RECEIVING CONSULTS Make sure you are clear on what the team is asking of you as a consultant. Clarify if the patient is expecting to receive a surgery before talking to them about an operation! Quickly gather information about the patient and their hospital course from the consultant, electronic medical record, and, most importantly, the patient! Note the callback number on the primary team and call them with the plan after you have staffed the patient with your attending. If you are asked to perform a procedure as a consultant, clarify the following information: NPO Status Ability to Consent or Proxy Contact Blood Thinners Urgency of Procedure Develop a system to stay organized and keep track of your to-do list with consults! CALL SHIFTS Bring a survival bag with toothbrush/toothpaste, face wash, deodorant, change of clothes, etc to reset. Try to nap when you can, but: PM round to address non-urgent pages ahead of time Set alarms! 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/

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.  You’ve been a doctor for about 3.5 seconds, and suddenly that bright eyed, bushy-tailed medical student on service is looking to you for advice? Don’t fret, in this episode we’ll give you some tips for how to handle it. Hosts: Shanaz Hossain, Nina Clark Tips for new interns: REMEMBER HOW INTERNS DO AND DO NOT TEACH - Nobody, not even the med students, expect you to be an expert in everything or give a fully-planned formal lecture - You WILL however spend a ton of time working with students on your team – and via modeling and teachable moments, you can help them learn how it’s done! MODELING - Remember how hard everything has been in the few days since you started residency? Think about all the information you’ve picked up, tips and tricks you’re developing for efficiency, and best practices you’re learning in the care of your patients. ALL of these are things you can pass on to students. - Presentations, case prep, answering questions from senior members of the team are ALL excellent opportunities to teach (and show students how you learn yourself, so they can do it independently). TEACHABLE MOMENTS - Find small topics that you know or are getting to know well – things like looking at a CXR, CT scan, etc. - Once you’re getting more comfortable caring for specific disease processes, think about high yield lessons for students: - Acute trauma evaluation and management (ABCDE’s), appendicitis, diverticulitis, benign biliary disease all make great 5 minute chalk talks that you can have in your back pocket IN THE OR - Watch students practice skills, and try to give some feedback and tips that you use (you learned knot tying and suturing more recently than ANYONE else in the OR and probably have some tips that you’re still using to improve) - If you’re not sure where or why the student is struggling with a particular skill (like tying a knot), model doing it yourself in slow motion while watching them do it – often the side by side comparison can help you identify where they’re going astray BE THE RESIDENT YOU WISH YOU HAD - Refer to EVERYONE with respect - Model being a kind, conscientious, and curious physician - Try to find universal lessons and crossover topics that non-surgeons need to know - A great student makes their interns look even better – be explicit about how they can be successful, then advocate for them to have opportunities to show everything they’re learning! 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/

SHOW NOTES 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: from yours truly! High quality illustrations and algorithms that pairs well with the BTK ABSITE podcast episodes. Stay tuned for an updated episodes and companion book in Fall 2023!  - 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/

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 their BTK debut, the Hernia team from Carolinas Medical Center discusses how to approach a hernia patient with loss of domain. This Clinical Challenges episode reviews strategies that optimize patients and provide them with the best chance of fascial closure. So, tune in, and enjoy a data driven conversation with our newest hernia enthusiasts!  Hosts: - Sullivan "Sully" Ayuso, MD - PGY4 General Surgery Resident, sullivan.ayuso@gmail.com, Carolinas Medical Center  - Monica Polcz, MD - Clinical Fellow (PGY-8) in Abdominal Wall Reconstruction, monica.polcz@atriumhealth.org, Carolinas Medical Center  - Vedra Augenstein, MD FACS - Associate Professor of Surgery (11 years in practice), vedra.augenstein@gmail.com, Carolinas Medical Center B  - Todd Heniford, MD FACS - Professor of Surgery (25 years in practice), todd.heniford@gmail.com, Carolinas Medical Center Links to articles: - Katzen et al, Open Preperitoneal Ventral Hernia Repair: Prospective Observational Study of Quality Improvement Outcomes over 18 Years and 1,842 patients, Surgery, 2022 https://pubmed.ncbi.nlm.nih.gov/36280505/  - Bernardi et al, Primary Fascial Closure During Laparoscopic Ventral Hernia Repair Improves Patient Quality of Life: A Multicenter, Blinded Randomized Trial, Ann Surg, 2020 https://pubmed.ncbi.nlm.nih.gov/31365365/  - Deerenberg et al, The Effects of Preoperative Botulinum Toxin A on Abdominal Wall Reconstruction, J Surg Res, 2021 https://pubmed.ncbi.nlm.nih.gov/33360691/  - Bueno-Lledó, Preoperative Progressive Pneumoperitoneum and Botulinum Toxin A in Patients with Large Incisional Hernia, Hernia, 2017 https://pubmed.ncbi.nlm.nih.gov/28124308/  - Maloney et al, Twelve Years of Component Separation Technique in Abdominal Wall Reconstruction, Surgery, 2021 https://pubmed.ncbi.nlm.nih.gov/31358348/  - Ayuso et al, Delayed Primary Closure (DPC) of the Skin and Subcutaneous Tissues Following Complex, Contaminated Abdominal Wall Reconstruction (AWR): A Propensity-Matched Study, Surg Endo, 2022 https://pubmed.ncbi.nlm.nih.gov/34018046/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out more hernia episodes here: https://behindtheknife.org/podcast-category/hernia/

Join BTK's Dr. Kevin Kniery for a discussion on How to do a Liver Transplant with Dr. Shah and Dr. Dageforde. Additional resources: - Watch: Liver Transplant Surgical Techniques - https://www.youtube.com/watch?v=Vk1Ld7Fp5es - Listen: Surgical Technique: Kidney Transplant (Part 1) https://behindtheknife.org/podcast/surgical-technique-kidney-transplant-part-1/ Surgical Technique: Kidney Transplant (Part 2) https://behindtheknife.org/podcast/surgical-technique-kidney-transplant-part-2/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Dr. Buchwald is Professor Emeritus of Surgery and Biomedical Engineering at the University of Minnesota. He is a veteran, world-renowned metabolic surgeon, author, professor and patient healthcare advocate. His book “Healthcare Upside Down: A Critical Examination of Policy and Practice” was born out of Dr. Buchwald’s observations of the healthcare industry over the last 50 years. In it, he explores how healthcare has been turned upside down to serve the administrators of the system and away from its basic function of offering the best care for patients. More importantly, he discusses solutions for turning our broken healthcare system right-side up to better serve all patients. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out other recent episodes here: https://behindtheknife.org/listen/

Application season is almost here! Whether you are about to apply to surgery residency or are part of a program recruiting applicants, there are several recent changes to the process that you should be aware of. Residency recruitment continues to see increased numbers of applications that create challenges for both students and programs. ERAS and other organizations are trying to address these issues with alterations to the application process. Today, we’ll discuss how the ERAS supplemental application, as well as new concepts like a single interview release period and decoupled rank lists, can help. We’re joined by Dr. Jennifer LaFemina, one of the leaders in these efforts within the general surgery recruitment process. Learning Objectives - Listeners will describe current challenges in the residency recruitment process. - Listeners will describe the value that changes such as the ERAS supplemental application can add to the residency recruitment process. - Listeners will recognize the results that changes to the residency application process have had during the first 2 years of implementation in surgery. - Listeners will consider how alterations to the residency application process can be successfully applied within their own program or application. References: LaFemina J, Rosenkranz KM, Aarons CB, et al. Outcomes of the 2021-2022 APDS General Surgery Recruitment Process Recommendations. Journal of Surgical Education. 2023;80(6):767-775. doi:10.1016/j.jsurg.2023.02.019 Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out other surgical education episodes here: https://behindtheknife.org/podcast-category/surgical-education/