The grind of surgical training has been celebrated in the past, but to what end? With mounting evidence that supports a high prevalence of burnout in the surgical community, surgical educators and leaders are often called to develop initiatives to address the detrimental and potentially irreversible effects on trainees’ wellness during surgical training. We invite Dr. David Rogers, who has personally experienced burnout, to share his insight and expertise in improving workplace wellness. Spoiler: it’s not as easy as group yoga sessions and daily donuts. Hosts: Dr. David Rogers Dr. Jeremy Lipman Dr. Judith French Dr. Amy Han Learning Objectives 1.     Listeners will be able to define wellness in the context of surgical training. 2.     Listeners will be able to better characterize and recognize signs of burnout among surgeons and surgical trainees. 3.     Listeners will be able identify strategies for overcoming burnout.  4.     Listeners will be able to apply conceptual frameworks from workplace wellness outside of medicine that can guide developing effective programs that promote wellness in surgical education community. References: Torres-Landa S, Moreno K, Brasel KJ, Rogers DA. Identification of Leadership Behaviors that Impact General Surgery Junior Residents' Well-being: A Needs Assessment in a Single Academic Center. J Surg Educ. 2022;79(1):86-93. doi:10.1016/j.jsurg.2021.07.017 Coverdill JE, Bittner IV JG, Park MA, Pipkin WL, Mellinger JD. Fatigue as impairment or educational necessity? Insights into surgical culture. Acad Med. 2011;86:S69-72. Dyrbye LN, Thomas MR, Harper W, et al. The learning environment and medical student burnout: a multicentre study. Med Educ. 2009;43(3):274-282. doi:10.1111/j.1365-2923.2008.03282.x Dyrbye L, Shanafelt T. A narrative review on burnout experienced by medical students and residents. Med Educ. 2016;50(1):132-149. doi:10.1111/medu.12927 Bordage G. Conceptual frameworks to illuminate and magnify. Med Educ. 2009;43(4):312 319. doi:10.1111/j.1365-2923.2009.03295.x Bakker AB, de Vries JD. Job Demands–Resources theory and self-regulation: New explanations and remedies for job burnout. Anxiety, Stress, & Coping. 2021;34: 1-21. Georgiadis F. Author Dr Amit Sood: Rising Through Resilience; Five Things You Can Do To Become More Resilient. Medium. https://medium.com/authority-magazine/author-dr-amit-sood-rising-through-resilience-five-things-you-can-do-to-become-more-resilient-673b0a1e9f2a. Published 2020. Accessed May 10, 2022. Gino F. Are You Too Stressed to Be Productive? Or Not Stressed Enough? Harvard Business Review. Published October 5, 2017. https://hbr.org/2016/04/are-you-too-stressed-to-be-productive-or-not-stressed-enough Goleman D. Primal Leadership, with a New Preface by the Authors : Unleashing the Power of Emotional ... Intelligence.Harvard Bus Review Press; 2016. Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Colorectal liver metastasis (CRLM) is a complex clinical situation requiring multidisciplinary management. In this episode from the Hepato-Pancreato-Biliary team at Behind the Knife, we review the genomics of CRLM, discuss a journal article investigating the frequency and impact of these mutations on survival in patients with stage IV disease, and interview the senior author Dr. Jean-Nicholas Vauthey about this research and his career in HPB. Hosts: Timothy Vreeland, MD, FACS (@vreelant) is an Associate Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center Daniel Nelson, DO, FACS (@DWNelsonHPB) is an Associate Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at William Beaumont Army Medical Center Connor Chick, MD (@connor_chick) is a PGY-5 General Surgery resident at Brooke Army Medical Center Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a PGY-4 General Surgery resident at Brooke Army Medical Center Beth (Elizabeth) Carpenter, MD (@elizcarpenter16) is a PGY-3 General Surgery resident at Brooke Army Medical Center Guest: Jean-Nicholas Vauthey, MD (@VautheyMD) is a Professor of Surgical Oncology, Chief of HPB, and Dallas/Fort Worth Living Legend Chair for Cancer Research at MD Anderson.  He is the Principal Investigator of the study discussed in the episode in addition to numerous other articles describing the genomics of colorectal liver metastases. Learning Objectives: In this episode, we review basic mutations found in metastatic colorectal cancer and broadly discuss these in a clinical context.  We review a journal article from Kawaguchi et al. in which authors analyze prognostic relevance of signaling pathways in patients undergoing resection of CRLM, later validated in an external cohort of unresected patients.  We conduct an interview with the senior author of the study regarding relevant methodologic details, next steps in his research, and how to apply this information now and in the future to the care of patients with CRLM. Links to Papers Referenced in this Episode: Journal Article: Kawaguchi Y, Kopetz S, Kwong L, Xiao L, Morris JS, Tran Cao HS, Tzeng CD, Chun YS, Lee JE, Vauthey JN. Genomic Sequencing and Insight into Clinical Heterogeneity and Prognostic Pathway Genes in Patients with Metastatic Colorectal Cancer. J Am Coll Surg. 2021 Aug;233(2):272-284.e13. doi: 10.1016/j.jamcollsurg.2021.05.027. Epub 2021 Jun 7. PMID: 34111531; PMCID: PMC8666966. Recommended Additional Podcasts on CRLM: The AHPBA Podcast: 1.     Episode 1: Dr. Jean Nicolas Vauthey - Colorectal Liver Metastases (https://podcasts.apple.com/us/podcast/episode-1-dr-jean-nicolas-vauthey-colorectal-liver/id1501441845?i=1000467381474) Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Acute limb ischemia is simultaneous one of the most fun but frustrating diseases to treat in vascular surgery. In this episode of Behind the Knife, the vascular surgery team gives a concise overview of the diagnosis/workup and treatment of patients with acute limb ischemia and talks about some of the difficult decision making regarding treatment modality given all the exciting technology available today. Dr. Nicholas Osborne is an Associate Professor of Vascular Surgery at the University of Michigan and the Chief of Vascular Surgery at the Ann Arbor Veteran’s Affairs Healthcare System. Dr. Frank Davis is a Chief Resident in the Integrated Vascular Surgery program at the University of Michigan. Dr. Craig Brown is a PGY-6 in the General Surgery program at the University of Michigan. Papers discussed in this Episode: AHA/ACC/SVS, etc Guidelines on the Management of Patients with Lower Extremity Peripheral Artery Disease https://pubmed.ncbi.nlm.nih.gov/27851992/ Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

It’s 1AM and the emergency department is calling about *insert terrifying foregut problem you haven’t seen since you were an intern here* and you wake up in a cold sweat to realize it was just a dream…this time. Tune in to this clinical challenge episode for some tips and tricks for managing foregut nightmares with Drs. Mike Weykamp, Nicole White, Andrew Wright, and Nick Cetrulo from the University of Washington’s Minimally Invasive Surgery team.  Referenced articles and videos:  1.     Rodriguez-Garcia HA, Wright AS, Yates RB. Managing obstructive gastric volvulus: challenges and solutions. Open Access Surgery. 2017 https://www.dovepress.com/getfile.php?fileID=35414 2.     Yates RB. Giant PEH: Management Principles for Unique Clinical Circumstances. 2017 SAGES Annual Meeting. Houston, TX. 2017 https://www.youtube.com/watch?v=vq6cZL2-pho 3.     Millet I, Orliac C, Alili C, Guillon F, Taourel P. Computed tomography findings of acute gastric volvulus. Eur Radiol. 2014.  https://pubmed.ncbi.nlm.nih.gov/25278244/ 4.     Mazaheri P, Ballard DH, Neal KA, Raptis DA, Shetty AS, Raptis CA, Mellnick VM. CT of Gastric Volvulus: Interobserver Reliability, Radiologists' Accuracy, and Imaging Findings. AJR Am J Roentgenol. 2019.  https://pubmed.ncbi.nlm.nih.gov/30403524/ 5.     Barmparas G, Alhaj Saleh A, Huang R, Eaton BC, Bruns BR, Raines A, Bryant C, Crane CE, Scherer EP, Schroeppel TJ, Moskowitz E, Regner JL, Frazee R, Campion EM, Bartley M, Mortus JR, Ward J, Margulies DR, Dissanaike S. Empiric antifungals do not decrease the risk for organ space infection in patients with perforated peptic ulcer. Trauma Surg Acute Care Open. 2021. https://pubmed.ncbi.nlm.nih.gov/34079912/ 6.     Horn CB, Coleoglou Centeno AA, Rasane RK, Aldana JA, Fiore NB, Zhang Q, Torres M, Mazuski JE, Ilahi ON, Punch LJ, Bochicchio GV. Pre-Operative Anti-Fungal Therapy Does Not Improve Outcomes in Perforated Peptic Ulcers. Surg Infect (Larchmt). 2018. https://pubmed.ncbi.nlm.nih.gov/30036134/ 7.     Wee JO. Gastric Volvulus in Adults. In: UpToDate, Louie BE (Ed), UpToDate, Waltham, MA. (Accessed on May 15, 2022.) https://www.uptodate.com/contents/gastric-volvulus-in-adults Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Determining when to order imaging for blunt cerebrovascular injury is a diagnostic quandary that has long engendered controversy. Today we discuss a paper that introduced universal CT angiogram of the neck to screen for BCVI in all blunt trauma patients and then compared the result to what would have happened if some of the current screening guidelines were utilized. Join us as we discuss their fascinating results and what it means for blunt trauma patients going forward. Hosts:  Elliott R. Haut, MD, Ph.D., a senior, nationally recognized name in trauma and acute care surgery at Johns Hopkins University. Dr. Haut is a past president of The Eastern Association for the Surgery of Trauma (EAST).  Marcie Feinman, MD, MEHP, the current program director of General Surgery Residency at Sinai Hospital of Baltimore and editorial board member of SCORE. She received her Master's in Education in the Health Professions from Johns Hopkins.  David Sigmon, MD, MMEd, a PGY-6 resident at the University of Illinois at Chicago who plans on going into trauma surgery. He did two years of research in surgical education at the University of Pennsylvania where he also received his Master’s in Medical Education.  LITERATURE Black JA, Abraham PJ, Abraham MN, et al. Universal screening for blunt cerebrovascular injury. J Trauma Acute Care Surg. 2021;90(2):224-231. https://pubmed.ncbi.nlm.nih.gov/33502144/ Kim DY, Biffl W, Bokhari F, et al. Evaluation and management of blunt cerebrovascular injury: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2020;88(6):875-887. https://pubmed.ncbi.nlm.nih.gov/32176167/ Biffl WL, Moore EE, Offner PJ, Brega KE, Franciose RJ, Elliott JP, Burch JM. Optimizing screening for blunt cerebrovascular injuries. (1999) American journal of surgery. 178 (6): 517-22. https://pubmed.ncbi.nlm.nih.gov/10670864/ Geddes AE, Burlew CC, Wagenaar AE, Biffl WL, Johnson JL, Pieracci FM, Campion EM, Moore EE. Expanded screening criteria for blunt cerebrovascular injury: a bigger impact than anticipated. (2016) American journal of surgery. 212 (6): 1167-1174. https://pubmed.ncbi.nlm.nih.gov/27751528/ Ciapetti M, Circelli A, Zagli G et-al. Diagnosis of carotid arterial injury in major trauma using a modification of Memphis criteria. Scand J Trauma Resusc Emerg Med. 2010;18 (1): 61. https://pubmed.ncbi.nlm.nih.gov/21092211/ Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Please join Drs. Brian Gray, Amanda Jensen and Manisha Bhatia from Indiana University as they discuss TEF management and the use of a post-operative transanastomotic feeding tubes in pediatric surgery. Journal Article links:  Wang, C., Feng, L., Li, Y., & Ji, Y. (2018). What is the impact of the use of transanastomotic feeding tube on patients with esophageal atresia: a systematic review and meta-analysis. BMC Pediatr, 18(1), 385. doi:10.1186/s12887-018-1359-5 https://pubmed.ncbi.nlm.nih.gov/30541487/ Bence, C. M., Rymeski, B., Gadepalli, S., Sato, T. T., Minneci, P. C., Downard, C., . . . Midwest Pediatric Surgery, C. (2021). Clinical outcomes following implementation of a management bundle for esophageal atresia with distal tracheoesophageal fistula. J Pediatr Surg, 56(1), 47-54. doi:10.1016/j.jpedsurg.2020.09.049 https://pubmed.ncbi.nlm.nih.gov/33131776/ LaRusso, K., Joharifard, S., Lakabi, R., Nimer, N., Shahi, A., Kasasni, S. M., . . . Emil, S. (2022). Effect of transanastomotic feeding tubes on anastomotic strictures in patients with esophageal atresia and tracheoesophageal fistula: The Quebec experience. J Pediatr Surg, 57(1), 41-44. doi:10.1016/j.jpedsurg.2021.09.014 https://pubmed.ncbi.nlm.nih.gov/34666898/ Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Join Shreya Gupta, MD and Jonathan Abelson, MD as they discuss highlights from the American Society of Colon and Rectal Surgeons.  Dr. Sharon Stein and Dr. Erin King-Mullins are the guest speakers. They are discussing female leadership, diversity and inclusion topics, and much more! This is episode 2 of 2. Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

*** FELLOWSHIP APPLICATION: https://docs.google.com/forms/d/e/1FAIpQLScxkGQTz-rh5OfPJBBdyvVZ4Pq2R8NWgBUOC1dt8VQHtvawhw/viewform *** Join Shreya Gupta, MD and Jonathan Abelson, MD as they discuss highlights from the American Society of Colon and Rectal Surgeons.  This is episode 1 of 2.   Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

In this insightful discussion, the hosts explore the puzzling relationship between bariatric surgery and gastroesophageal reflux disease (GERD). They question whether weight loss alone can alleviate GERD symptoms and delve into the impact of vertical sleeve gastrectomy on these conditions. The nuances of hiatal hernia repairs and their effect on postoperative GERD are highlighted, as well as contradictions in existing research. The importance of ongoing monitoring and tailored care for patients is emphasized, revealing the complexities of surgical outcomes.

*** FELLOWSHIP APPLICATION: https://docs.google.com/forms/d/e/1FAIpQLScxkGQTz-rh5OfPJBBdyvVZ4Pq2R8NWgBUOC1dt8VQHtvawhw/viewform *** How do you decide if a pancreatic head mass is resectable? Does vascular involvement matter? What impacts survival? Join the Surgical Oncology team as they dive into operative considerations when operating on borderline resectable and locally advanced pancreatic cancer. Break the nihilism and find out about the options available for patients with this dreaded malignancy. Learning Objectives:  In this episode, we review the various definitions for resectability in pancreatic cancer, as well as the various prognostic markers and decision points to consider when deciding which patients may benefit from an operation.  Hosts:  Adam Yopp, MD, FACS (@AdamYopp) is an Assistant Professor of Surgery at the UT Southwestern Medical Center and is Chief of the Division of Surgical Oncology. He also serves as Surgical Director of the Liver Tumor Program. Caitlin Hester, MD (@CaitlinAHester) is a 2nd Year Complex General Surgical Oncology Fellow at the MD Anderson Cancer Center. Gilbert Murimwa, MD (@GilbertZMurimwa) is a PGY-3 General Surgery Resident at the UT Southwestern Medical Center and a research fellow in the Hamon Center for Therapeutic Oncology Research. Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.