Behind The Knife: The Surgery Podcast

An ever-present spectre looming over the hearts of general surgeons everywhere! Please join our Emergency General Surgery team for a journal review about Clostridium difficile (C. diff) infection. Dr. Ashlie Nadler and Dr. Jordan Nantais are joined by guest Dr. Marika Sevigny, recent graduate of trauma and acute care surgery at the University of Toronto, as Dr. Graham Skelhorne-Gross prepares for his upcoming fellowship at Harborview. Paper 1: Ahmed et al. Risk factors of surgical mortality in patients with Clostridium difficile colitis. A novel scoring system. Eur J Trauma Emerg Surg. 2022 Jun. - Risk score development study using data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) - 525 adult (18-89) patients undergoing colectomy between 2012 and 2016 - Split data into training (80%) and testing (20%) datasets -  Identified mortality risk factors to create and validate a scoring system - Scores ranged from 0 to 37 with the highest score predicting an 83.9% risk

It’s that time of year (again!)- when medical students across the country are preparing their residency applications. The process can be a bit daunting, and there have been a number of changes to process for the 2024 application cycle. Join our education fellow, Dr. Jessica Millar, and Dr. David Hughes as they review the “nuts and bolts” of this year’s residency application cycle.  Guests: David Hughes, MD- Clinical Associate Professor of Endocrine Surgery, General Surgery Residency Program Director- University of Michigan  Important Dates: - June 7, 2023: ERAS application opens at 9 a.m. ET. - September 6, 2023: Residency applicants may begin submitting MyERAS applications to programs at 9 a.m. ET. - September 15, 2023: Registration for the NRMP Match Opens  - September 27, 2023: Residency programs may begin reviewing MyERAS applications, MSPEs, and supplemental ERAS application data (if applicable) at 9 a.m. ET. - October 26-31, 2023: Common Interview Release Window - January 31, 2024: Registration for th

The first BTK THROW DOWN!  A spicy debate…a war of words…a battle of ideas!  This fiery episode features leaders in the field of trauma surgery discussing the optimal approach to vascular access in trauma patients.  A recent study titled “Moving the Needle on Time to Resuscitation: An EAST Prospective multicenter study of vascular access in hypotensive injured patients using trauma video review” concluded that intraosseous access should be considered a first line therapy in hypotensive trauma patients.  Is this appropriate?  Crazy?  Just so crazy it might work?  Let’s get ready to ruuuummmmbbbbbbllllllleeeee! Hosts:  Patrick Georgoff, MD (@georgoff) Nina Clark, MD (@clarkninam) Guests:  Ryan Dumas, MD – UT Southwestern (@RPDumasMD) Michael Vella, MD, MBA – University of Rochester (@MichaelVella32) Bellal Joseph, MD – University of Arizona (@TopKnife_B) Moving the Needle on Time to Resuscitation: An EAST Prospective multicenter study of vascular access in hypotensive injured patients using trauma video revi

In this two-part series, we come to you LIVE! from the 2023 Annual meeting of the American Association of Endocrine Surgeons in Birmingham, Alabama. If you think evaluating and managing patients with primary hyperparathyroidism is difficult, patients with secondary and tertiary hyperparathyroidism can be even more difficult to evaluate and manage. Join Drs. Barb Miller, Sophie Dream, Jessica Liu McMullin, and Herb Chen as they break down the controversies and complexities associated with evaluation and management of these patients and discuss the recently published AAES guidelines on the definitive surgical management of patients with secondary and tertiary renal hyperparathyroidism. Part 1 focuses on the impetus for creation of these guidelines, the differences in evaluation and indication for surgery when seeing patients with renally mediated hyperparathyroidism, and preoperative planning. Part 2 focuses on intraoperative and postoperative management, parathyroid autotransplantation, and renal transplant re

In this two-part series, we come to you LIVE! from the 2023 Annual meeting of the American Association of Endocrine Surgeons in Birmingham, Alabama. If you think evaluating and managing patients with primary hyperparathyroidism is difficult, patients with secondary and tertiary hyperparathyroidism can be even more difficult to evaluate and manage. Join Drs. Barb Miller, Sophie Dream, Jessica Liu McMullin, and Herb Chen as they break down the controversies and complexities associated with evaluation and management of these patients and discuss the recently published AAES guidelines on the definitive surgical management of patients with secondary and tertiary renal hyperparathyroidism. Part 1 focuses on the impetus for creation of these guidelines, the differences in evaluation and indication for surgery when seeing patients with renally mediated hyperparathyroidism, and preoperative planning. Part 2 focuses on intraoperative and postoperative management, parathyroid autotransplantation, and renal transplant re

The anterior abdominal stab wound! Who gets explored? When do you get imaging? Who gets serial abdominal exams? How does this change depending on the location of injury? Join Drs. Cobler-Lichter, Kwon, Meizoso, and Urréchaga in their first episode as the new Miami Trauma team  - as they discuss how to navigate the nuances of stab wounds to the torso! Hosts: - Michael Cobler-Lichter, MD, PGY2: University of Miami/Jackson Memorial Hospital/Ryder Trauma Center @mdcobler (twitter) - Eva Urrechaga, MD, PGY6/R4: University of Miami/Jackson Memorial Hospital/Ryder Trauma Center @urrechisme (twitter) - Eugenia Kwon, MD, Trauma/Surgical Critical Care Fellow: University of Miami/Jackson Memorial Hospital/Ryder Trauma Center - Jonathan Meizoso, MD, MSPH Assistant Professor of Surgery University of Miami/Jackson Memorial Hospital/Ryder Trauma Center @jpmeizoso (twitter) Learning Objectives: - Identify the differences in management of abdominal/thoracoabdominal stab wounds depending on location of injury - Identify who

In the fourth episode of the “Innovation in Surgery” series, Drs. Patrick Georgoff and Dan Scheese sit down with Dr. Mark Piehl to discuss his innovation, LifeFlow. Additionally, Dr. Piehl covers multiple other topics in this episode, including circulation-first resuscitation and the process of innovation from the physician’s perspective. 410 Medical Website: https://410medical.com Reel Emergency trauma podcast: https://www.youtube.com/watch?v=unog3YkFSOE Prehospital emergency care case report from the episode: https://pubmed.ncbi.nlm.nih.gov/36703273/ Dr. Piehl’s Resuscitation review article: https://link.springer.com/content/pdf/10.1007/s40138-021-00237-6.pdf Dr. Piehl’s Shock article on circulation-first resuscitation in trauma: https://pubmed.ncbi.nlm.nih.gov/36703273/ Preliminary data on prehospital trauma resuscitation with LifeFlow (Larger version of this with historical controls to be presented at AAST): https://410medical.com/app/uploads/2023/04/ESO-Poster-Presentation-April-2023.pdf “Unravel

In this episode of Behind the Knife the vascular surgery subspecialty team discusses a case of an infected endovascular aortic graft. Although rare, aortic graft infections remain a devastating complication.  What options do you have to fix this problem? In this episode, we will cover the who is at risk of this, how they present, and what options you have to fix it. Hosts:  Dr. Bobby Beaulieu is an Assistant Professor of Vascular Surgery at the University of Michigan Dr. Frank Davis is an Assistant Professor of Vascular Surgery at the University of Michigan Dr. David Schechtman is a Vascular Surgery Fellow at the University of Michigan Dr. Drew Braet is a PGY-3 Integrated Vascular Surgery Resident at the University of Michigan Learning Objectives ·      Understand the incidence of and the relevant risk factors for aortic graft infections ·      Review the spectrum of presenting symptoms and relevant workup for aortic graft infections ·      Understand surgical treatment options including options for in-situ

Have you transitioned a portion of your practice to the robot, but would be hesitant to book an urgent/call case on the robot? Have you wondered if the robot might be useful in your emergency or acute care surgery practice? Join University of Washington MIS Surgeons, Drs. Andrew Wright, Nicole White, and Nick Cetrulo, and Resident Drs. Ben Vierra and Paul Herman as they discuss the growing use of the robot for acute cases and provide tips on appropriate case selection.  Hosts:  1.     Andrew Wright, UW Medical Center – Montlake and Northwest, @andrewswright  2.     Nick Cetrulo, UW Medical Center - Northwest, @Trules25  3.     Nicole White, UW Medical Center - Northwest  4.     Paul Herman, UW General Surgery Resident PGY-3, @paul_herm  5.     Ben Vierra, UW General Surgery Resident PGY-2  Learning objectives:   - Describe the importance of the MIS approach in EGS  - Review 3 articles on robotic EGS outcomes  1) Robotic surgery in emergency setting: 2021 WSES position paper  2) Emergent robotic versus lapar

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 lik

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 ·       Di

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 receiv

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 thes

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

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

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 Yea

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

You just finished a difficult case in which a complication occurred. Feelings of guilt, sadness, and anxiety are pouring over you. You can't help but think you are a terrible surgeon, maybe even a terrible person. Does this sound familiar? Complications have profound psychological impact on surgeons. Find out how one surgeon decided to do something about it by creating a peer support program. Join Jessica Millar and Patrick Georgoff as they discuss the second victim syndrome with Dr. Haytham Kaafarani (@hayfarani).  References:  - The Surgeon as the Second Victim? Results of the Boston Intraoperative Adverse Events Surgeons' Attitude (BISA) Study: https://pubmed.ncbi.nlm.nih.gov/28093300/ - Design and Impact of a Novel Surgery-Specific Second Victim Peer Support Program: https://pubmed.ncbi.nlm.nih.gov/31857209/  - When Things Go Wrong: The Surgeon as Second Victim: https://pubmed.ncbi. nlm.nih.gov/30480564/  Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, vid