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 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/

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.  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/

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