Behind The Knife: The Surgery Podcast
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500 afleveringen, van nieuw naar oud
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Intern Bootcamp - Dominate Intern Year
7 juli 2023 · 13 min
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. Lees meer
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/
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Intern Bootcamp - Scary Pages
6 juli 2023 · 23 min
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. Lees meer
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 careHYPOXEMIA
· 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 fr… -
Intern Bootcamp - Consults
5 juli 2023 · 15 min
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. Lees meer
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 …
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Intern Bootcamp - Medical Students
4 juli 2023 · 17 min
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. Lees meer
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 pocketIN 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 par… -
Intern Bootcamp - Resource Overload
3 juli 2023 · 18 min
SHOW NOTES Lees meer
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 basePick 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 startPlan 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
- TextbooksSabiston: 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 thi… -
Intern Bootcamp - The First Day
30 juni 2023 · 16 min
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. Lees meer
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 notes
As 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 …
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Clinical Challenges in Hernia Surgery: Loss of Domain
29 juni 2023 · 39 min
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! Lees meer
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 CenterLinks 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
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How to do a Liver Transplant with Dr. Shah and Dr. Dageforde
26 juni 2023 · 41 min
Join BTK's Dr. Kevin Kniery for a discussion on How to do a Liver Transplant with Dr. Shah and Dr. Dageforde. Lees meer
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.
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Healthcare Upside Down Interview with Dr. Buchwald
22 juni 2023 · 29 min
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. Lees meer
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/
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Journal Review in Surgical Education: Recent Changes to the Residency Application Process
19 juni 2023 · 34 min
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. Lees meer
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.2023.02.019Please 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/
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The Second Victim Syndrome with Dr. Haytham Kaafarani
15 juni 2023 · 50 min
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). Lees meer
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, videos and more.
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen/
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Journal Review in Surgical Oncology: Piperacillin-Tazobactam Compared With Cefoxitin as Antimicrobial Prophylaxis for Pancreatoduodenectomy
12 juni 2023 · 33 min
Join the Surgical Oncology team from UTSouthwestern and the University of Miami as they tackle a journal review covering how to choose perioperative antimicrobial prophylaxis for pancreatoduodenectomy. Listen in as they also review novel methodology and the origins of the study. Lees meer
Learning Objectives:
What antibiotics are you giving before your Whipple? In the group’s final episode together, we review the 1st of its kind, registry linked, pragmatic surgical trial in North America. In the episode we dissect “Piperacillin-Tazobactam Compared With Cefoxitin as Antimicrobial Prophylaxis for Pancreatoduodenectomy - A Randomized Clinical Trial” and discuss the practice changing findings, and the future of surgical clinical trials.Hosts:
Adam Yopp, MD, FACS (@AdamYopp) is an Associate 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 recent graduate of the MD Anderson Complex General Surgical Oncology fellowship and is now a new faculty member in the Division of Surgical Oncology within the Sylvester Cancer Center at the University of Miami where she specializes in surgery for cancers of the liver, pancreas, and other gastrointestinal sites.
Gilbert Murimwa, MD (@GilbertZMurimwa) is a PGY-4 Research Fellow and General Surgery Resident at the UT Southwestern Medical Center. He is studying the pancreatic tumor microenvironment and targeted therapies in the lab of Rolf Brekken within the Hamon Center for Therapeutic Oncology Research. He also does work on access to care, social determinants of health, and interventions to mitigate disparities in surgical and oncologic outcomes under the mentorship of Patricio Polanco.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out surgical oncology episodes here: https://b…
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Leadership in Surgery: Dr. Tom Read
8 juni 2023 · 11 min
Join BTK’s Dr. Scott Steele for a discussion with Dr. Tom Read on leadership opportunities outside of clinical medicine. They discuss Dr. Tom Read's role as the executive chairman for the American Board of Colorectal Surgery. Lees meer
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our other recent episode here: https://behindtheknife.org/listen/
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Leadership in Surgery: Dr. Conor Delaney
5 juni 2023 · 20 min
Join BTK’s Dr. Scott Steele for a discussion with Dr. Conor Delaney on leadership opportunities outside of clinical medicine. They discuss Dr. Conor Delaney's role as the chief executive officer and president of Cleveland Clinic Florida. Lees meer
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our other recent episode here: https://behindtheknife.org/listen/
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Leadership in Surgery: Dr. Bradley Champagne
1 juni 2023 · 22 min
Join BTK's Dr. Scott Steele for a discussion with Dr. Bradley Champagne on leadership opportunities outside of clinical medicine. They discuss Dr. Bradley Champagne's role as the chief medical officer of a large hospital. Lees meer
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our other recent episode here: https://behindtheknife.org/listen/
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Leadership in Surgery: Dr. Amy Lightner
29 mei 2023 · 17 min
Join BTK's Dr. Scott Steele for the first episode of a new leadership series that explores opportunities outside of clinical medicine. In this episode, Dr. Steele sits down with Dr. Amy Lightner who is the Chief Medical Officer for Direct Biologics. Lees meer
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our other recent episode here: https://behindtheknife.org/listen/
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Mattox Vegas TCCACS Keynote Dr. David Nott: Leaving a Legacy in Conflict Zones
25 mei 2023 · 49 min
This spectacular keynote address was given by Dr. David Knott at the “Mattox” Trauma Conference in 2023. Lees meer
Mattox Vegas TCCACS: https://www.trauma-criticalcare.com/
War Doctor: https://www.amazon.com/War-Doctor-Surgery-Front-Line/dp/1419744240/ref=asc_df_1419744240/?tag=hyprod-20&linkCode=df0&hvadid=508953752346&hvpos=&hvnetw=g&hvrand=15602939439351749599&hvpone=&hvptwo=&hvqmt=&hvdev=c&hvdvcmdl=&hvlocint=&hvlocphy=9009673&hvtargid=pla-906115140419&psc=1
The David Nott Foundation: https://davidnottfoundation.com/
Dr. Nott on BTK July 1, 2020: https://behindtheknife.org/podcast/war-doctor-david-nott-on-surgery-in-war-zones/
David gained his medical degree from Manchester University and in 1992 gained his FRCS from the Royal College of Surgeons of England to become a Consultant Surgeon.
He is a Consultant Surgeon at St Mary’s Hospital where he specialises in vascular and trauma surgery and also performs cancer surgery at the Royal Marsden Hospital. David is an authority in laparoscopic surgery and was the first surgeon to combine laparoscopic and vascular surgery.
For the past 30 years David has taken unpaid leave to work for the aid agencies Médecins Sans Frontières, the International Committee of the Red Cross and Syria Relief. He has provided surgical treatment to patients in conflict and catastrophe zones in Bosnia, Afghanistan, Sierra Leone, Liberia, Ivory Coast, Chad, Darfur, Yemen, the Democratic Republic of Congo, Haiti, Iraq, Pakistan, Libya, Syria, Central African Republic, Palestine, Nepal and Ukraine
As well as treating patients affected by conflict and catastrophe and raising hundreds of thousands of pounds for charitable causes, David teaches advanced surgical skills to local medics and surgeons when he is abroad. In Britain, he set up and led the teaching of the Surgical Training for the Austere Environment (STAE) course at the Royal College of Surgeons.
In 2015 David established the David Nott Foundation with his wife Elly. The Foundation suppor…
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Clinical Challenges in Transplant Surgery: Liver Transplant
22 mei 2023 · 18 min
Join our transplant team as they discuss cases of acute and chronic liver disease requiring liver transplant. Lees meer
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out more transplant episodes here: https://behindtheknife.org/podcast-category/transplant/
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Journal Review in Bariatric Surgery: SPLENDID and BRAVES Studies
18 mei 2023 · 26 min
For our last submission as the BTK Bariatric Surgery Team, we thought we would take a minute to review some recent landmark trials in bariatric surgery. Get caught up on the impact of bariatric surgery on obesogenic cancers and non-alcoholic steatohepatitis. Lees meer
Journal articles:
Association of Bariatric Surgery with Cancer Risk and Mortality in Adults with Obesity: https://pubmed.ncbi.nlm.nih.gov/35657620/.Bariatric-Metabolic Surgery versus Lifestyle Intervention plus Best Medical Care in Non-Alcoholic Steatophepatitis (BRAVES): A Multicentre, Open-Label, Randomised Trial: https://pubmed.ncbi.nlm.nih.gov/37088093/.
Ad referenced in episode: A team at the Brooke Army Medical Center is working to better define proficiency-based metrics for competency in commonly performed robotic general surgery procedures. If you are a general surgery resident or practicing surgeon who performs robotic assisted cholecystectomies or inguinal hernia repairs, reach out to the PI, Robert Laverty, MD, at rblaverty@gmail.com for more information on how you could be compensated $500 per video submitted of each (up to $1000 per surgeon).
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other bariatric episodes here: https://behindtheknife.org/podcast-category/bariatric/
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BTK Colorectal Surgery Oral Board Review - Sample Episode 2 - Pouch Complications
15 mei 2023 · 24 min
Our Colorectal Surgery Oral Board Audio Review includes 51 high-yield scenarios designed for Colorectal Surgeons by Colorectal Surgeons. Lees meer
Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as colorectal surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.
Learn more about the full set of 51 scenarios here: https://behindtheknife.teachable.com/p/btk-colorectal-surgery-oral-board-review-course
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more. -
BTK Colorectal Surgery Oral Board Review - Sample Episode 1 - Familial Adenomatous Polyposis
11 mei 2023 · 36 min
Our Colorectal Surgery Oral Board Audio Review includes 51 high-yield scenarios designed for Colorectal Surgeons by Colorectal Surgeons. Lees meer
Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as colorectal surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.
Learn more about the full set of 51 scenarios here: https://behindtheknife.teachable.com/p/btk-colorectal-surgery-oral-board-review-course
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more. -
Clinical Challenges in Pediatric Surgery: Common Pediatric Surgery Scenarios
8 mei 2023 · 26 min
Please join Drs. Brian Gray, Amanda Jensen and Manisha Bhatia from Indiana University as they discuss the nuances of 3 common pediatric general surgery scenarios. Lees meer
Journal Article links:
Nguyen HN, Navarro OM, Bloom DA, Feinstein KA, Guillerman RP, Munden MM, et al. Ultrasound for Midgut Malrotation and Midgut Volvulus: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2022;218(6):931-9.
https://pubmed.ncbi.nlm.nih.gov/35107311/Plut D, Phillips GS, Johnston PR, Lee EY. Practical Imaging Strategies for Intussusception in Children. AJR Am J Roentgenol 2020;215(6):1449-63.
https://pubmed.ncbi.nlm.nih.gov/33084362/Markel TA, Scott MR, Stokes SM, Ladd AP. A randomized trial to assess advancement of enteral feedings
following surgery for hypertrophic pyloric stenosis. J Pediatr Surg 2017;52(4):534-9.
https://pubmed.ncbi.nlm.nih.gov/27829521/St Peter SD, Holcomb GW, 3rd, Calkins CM, Murphy JP, Andrews WS, Sharp RJ, et al. Open versus
laparoscopic pyloromyotomy for pyloric stenosis: a prospective, randomized trial. Ann Surg
2006;244(3):363-70.
https://pubmed.ncbi.nlm.nih.gov/16926562/Dalton BG, Gonzalez KW, Boda SR, Thomas PG, Sherman AK, St Peter SD. Optimizing fluid resuscitation in
hypertrophic pyloric stenosis. J Pediatr Surg 2016;51(8):1279-82.
https://pubmed.ncbi.nlm.nih.gov/26876090/Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other pediatric surgery episodes here: https://behindtheknife.org/podcast-category/pediatric/
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BIG T Trauma Series Ep. 17 - Brain Death
4 mei 2023 · 46 min
On this episode of the BIG T Trauma series Drs. Patrick Georgoff, Teddy Puzio, and Jason Brill discuss brain death and why you as a provider must be able to provide clarity when it is needed most. This episode is packed with useful information on a very complicated topic. So, sit back, relax, and enjoy the show. Lees meer
The World Brain Death Project (JAMA 2020): https://pubmed.ncbi.nlm.nih.gov/32761206/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out the rest of the BIG T trauma series here: https://behindtheknife.org/podcast-series/big-t-trauma/
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Journal Review in Colorectal Surgery: Anastomotic Healing, Leak and Gut Microbiome
1 mei 2023 · 19 min
Upon encountering a patient who develops an anastomotic leak after a straight-forward low anterior resection, you are taken aback, as the patient is healthy and has no apparent risk factors. This prompts you to consider whether the microbiota may have played a role in causing the leak. Lees meer
Join Dr. Carole Richard, Dr. François Dagbert, Dr. Maher Al Khaldi, and Dr. Roy Hajjar in their conversation about the impact of gut microbiota on anastomotic healing and leak.
Learning objectives
- To list the known risk factors for anastomotic leak.
- To understand how preoperative gut microbiota influence anastomotic healing and could lead to leak.Reference
Hajjar R, Gonzalez E, Fragoso G, et al. Gut microbiota influence anastomotic healing in colorectal cancer surgery through modulation of mucosal proinflammatory cytokines. Gut. Published Online First: 30 December 2022. doi: 10.1136/gutjnl-2022-328389Ad referenced in episode: A team at the Brooke Army Medical Center is working to better define proficiency-based metrics for competency in commonly performed robotic general surgery procedures. If you are a general surgery resident or practicing surgeon who performs robotic assisted cholecystectomies or inguinal hernia repairs, reach out to the PI, Robert Laverty, MD, at rblaverty@gmail.com for more information on how you could be compensated $500 per video submitted of each (up to $1000 per surgeon).
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other colorectal surgery episodes here: https://behindtheknife.org/podcast-category/colorectal/
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Association for Academic Surgery: Removing the Mask with Dr. Carrie Cunningham
27 april 2023 · 50 min
Dr. Cunningham is the section head of the Massachusetts General Hospital Endocrine Surgery unit, a NIH-funded researcher, and the immediate past-president of the Association for Academic Surgery. This episode is a recording of her presidential address at their annual Academic Surgical Congress. Lees meer
Guest
Dr. Carrie Cunningham, MD, MPH
Associate Professor of Surgery, Harvard Medical SchoolLearn More
Association for Academic Surgery: https://www.aasurg.org/
Dr. Lorna Breen Heroes foundation: https://drlornabreen.org/Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
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Journal Review in Breast Surgery: Management of Hereditary Breast Cancer
24 april 2023 · 42 min
While you are likely aware of BRCA mutations as a significant risk factor for development of breast cancer (60-80% lifetime risk), there are many other pathogenic gene variants that have been identified in recent years. The surgical treatment of women with hereditary breast cancer differs from that of women with sporadic breast cancer, and women with hereditary breast cancer are also eligible for prophylactic mastectomy or intensive surveillance protocols. In this episode of BTK, we examine current national consensus guidelines for management of hereditary breast cancer, discuss a recent population-based study that establishes risk associated with various genes, and address both surgical and surveillance strategy for patients without breast cancer but with known pathogenic gene variants. Lees meer
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other breast surgery episodes here: https://behindtheknife.org/podcast-category/breast/
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Taking Back the (Bile) Duct: Lap Common Bile Duct Exploration
20 april 2023 · 39 min
Calling all surgeons! It’s time to take back common bile duct stones! Lees meer
Join our surgical education fellow, Shanaz Hossain, as she talks about laparoscopic common bile duct exploration (LCBDE) with Drs. Maggie Bosley, Lucas Neff, and Byron Fernando Santos. Dr. Bosley is a graduating chief resident at Wake Forest and incoming MIS fellow at Washington University in St. Louis. Dr. Neff is an assistant professor of pediatric surgery with Wake Forest Baptist Health and Brenner’s Children’s Hospital. Dr. Santos is an assistant professor of surgery at Dartmouth-Hitchcock Medical Center. As a research resident at Northwestern University, he co-invented a LCBDE simulator that is used to train surgeons in these techniques. He is also a member of the SAGES Safe Cholecystectomy Task Force and has led numerous LCBDE courses.
Join us for a discussion on LCBDE indications, implementation, techniques, and tips for incorporation into patient care. If you’re interested in learning more, check out the instructional video from these surgeons as well as some of their work on LCBDE:
Instructional Video:
https://behindtheknife.org/video-playlists/laparoscopic-common-bile-duct-tutorial-series/
Research Articles
· Anterograde Balloon Sphincteroplasty as an Adjunct to Laparoscopic Common Bile Duct Exploration for the Acute Care Surgery: https://journals.lww.com/jtrauma/Citation/2022/03000/Antegrade_balloon_sphincteroplasty_as_an_adjunct.22.aspx
· Choledocholithiasis – A New Clinical Pathway: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8343507/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
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Clinical Challenges in Hernia Surgery: Specialization in Hernia and Abdominal Wall Surgery
17 april 2023 · 27 min
Hernias are some of the most common problems treated by general surgeons. The field of abdominal wall surgery has rapidly evolved as a result of innovation and the development of new techniques. In this podcast, Drs. Charlotte Horne and Jenny Shao join Vahagn Nikolian to discuss their decision to pursue careers as abdominal wall specialists, the role that hernia surgeons play in modern day surgical programs, and the pathway to becoming a hernia surgeon.
· Dr. Charlotte Horne is an Assistant Professor of Surgery at Pennsylvania State University.
· Dr. Jenny Shao is an Assistant Professor of Surgery at the University of Michigan.
· Dr. Vahagn Nikolian is an Assistant Professor of Surgery at Oregon Health & Science University. Lees meerRecommended Reading:
Shulkin JM, Mellia JA, Patel V, Naga HI, Morris MP, Christopher A, Heniford BT, Fischer JP. Characterizing hernia centers in the United States: what defines a hernia center? Hernia. 2022 Feb;26(1):251-257. doi: 10.1007/s10029-021-02411-x. Epub 2021 Apr 19. PMID: 33871743.
Novitsky YW, Elliott HL, Orenstein SB, Rosen MJ. Transversus abdominis muscle release: a novel approach to posterior component separation during complex abdominal wall reconstruction. Am J Surg. 2012 Nov;204(5):709-16. doi: 10.1016/j.amjsurg.2012.02.008. Epub 2012 May 16. PMID: 22607741.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other Hernia episodes here: https://behindtheknife.org/podcast-category/hernia/
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Clinical Challenges in Trauma Surgery: Renal Trauma
13 april 2023 · 30 min
To operate or not to operate, to drain the urine leak or to not drain it, those are the questions. Join our Miami Trauma team including Drs. Urréchaga, Neeman, and Rattan- in their final episode together! - as they discuss how to navigate the ins and outs of renal trauma! Lees meer
Learning Objectives:
· Define the different renal injury grades and how to manage each,
· Identify when to take the renal trauma patient to the operating room,
· Discuss when to involve IR for urinary drainage or embolization.
· Explain when and how to perform a nephrectomy.
· Debate the treatment of penetrating zone two injuries- to explore or not explore?Quick Hits:
1. Most kidney injuries, the vast majority, can be non-operatively managed.
2. For pretty much all AAST grade of injury, the choice to go to the OR immediately lies in whether the patient is stable or unstable.
3. If there is a urinary leak seen on imaging, it can usually just be observed and followed with repeat imaging to determine the need for drainage, unless the injury is significant or if there is injury to the renal pelvis- then the patient will usually need a drainage procedure.
4. Consider IR in any stable patient found to have active extravasation, fistula, or pseudoaneurysm.
5. In the case of an unstable patient, except very rare circumstances, you should be going to the OR
6. If there is another cause of instability, address that first. If you’re opening Gerota’s fascia, be prepared to commit to a nephrectomy.
7. In penetrating injury, the formal teaching is mandatory exploration of a renal hematoma. Real world experience shows that this isn’t always necessary- such as in tangential injuries or injuries to the periphery- on a case-by-case basis.References
1. Federico C, Moore Ernest E, Yoram K, Walter B, Aari L, Yosuke M, et al. Kidney and uro-trauma: WSES-AAST guidelines. World J Emerg Surg 2019;14:54.
2. Morey AF, Brandes S, Dugi DD 3rd et al: Urotrauma: AUA guideline. J Urol 2014, 192: 327. Published 2014; Amended… -
Journal Review in Surgical Education: The OR Black Box
10 april 2023 · 28 min
Have a grand idea for how to improve education and patient safety in surgery, but unsure how to make it a reality? Perhaps the OR Black Box can inspire you and set you on your path as an innovator. We are joined by Dr. Teodor Grantcharov, one of its creators. The OR Black Box is a system that collects, stores, and analyzes a large amount of data from the operating room beyond just surgical video, such as video and audio of the operating room and patient physiology data. Using the system for feedback through self-directed review, coaching, and integrated AI analysis has changed the way we can learn and teach in surgery, and may have implications for the future of evaluation and credentialing. Lees meer
Learning Objectives
Listeners will describe the value that accessible data review and analysis adds to surgical education.
Listeners will describe how review of operative data could be utilized for more objective evaluation and credentialing, and how this can be used for continuous improvement.
Listers will recognize common barriers to using new technology or process changes in surgery.
Listeners will recognize the importance of a well-developed research question and its application to a clinical need when designing research or innovation in surgery and education.
Listeners will appreciate the long and iterative process required to go from a research idea to implementation and impact on clinical outcomes.
Listeners will organize their own ideas for research utilizing the advice offered in the episode.
References:
1. Goldenberg MG, Jung J, Grantcharov TP. Using Data to Enhance Performance and Improve Quality and Safety in Surgery. JAMA Surg. 2017;152(10):972. doi:10.1001/jamasurg.2017.2888
2. van Dalen ASHM, van Haperen M, Swinkels JA, Grantcharov TP, Schijven MP. Development of a Model for Video-Assisted Postoperative Team Debriefing. J Surg Res. 2021;257:625-635. doi:10.1016/j.jss.2020.07.065
**Fellowship application link: https://forms.gle/PiKM2MMQpE5jSAeW7
Please…
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The Society of Black Academic Surgeons with Dr. Edward Barksdale
6 april 2023 · 44 min
Please join BTK's Dr. Nina Clark and Dr. Shreya Gupta for a discussion with Dr. Edward Barksdale on the important and sensitive topic of the underrepresented in medicine. Lees meer
Society of Black Academic Surgeons: https://www.sbas.net/
References:
Yeo HL, Abelson JS, Symer MM, Mao J, Michelassi F, Bell R, Sedrakyan A, Sosa JA. Association of Time to Attrition in Surgical Residency With Individual Resident and Programmatic Factors. JAMA Surg. 2018 Jun 1;153(6):511-517. doi: 10.1001/jamasurg.2017.6202. PMID: 29466536; PMCID: PMC5875388.McFarling, U.L. ‘It was stolen from me’: Black doctors are forced out of training programs at far higher rates than white residents. STAT. 6/20/2022. Accessed online: 10/1/2022. https://www.statnews.com/2022/06/20/black-doctors-forced-out-of-training-programs-at-far-higher-rates-than-white-residents/
Haruno LS, Chen X, Metzger M, et al. Racial and Sex Disparities in Resident Attrition Among Surgical Subspecialties. JAMA Surg. Published online February 08, 2023. doi:10.1001/jamasurg.2022.7640
**Fellowship application link: https://forms.gle/PiKM2MMQpE5jSAeW7
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/
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Clinical Challenges in Emergency General Surgery: Cirrhotic Patients
3 april 2023 · 33 min
Please join Drs. Graham Skelhorne-Gross, Jordan Nantais and Ashlie Nadler from our Emergency General Surgery Team for a discussion on cirrhotic patients. Lees meer
Child-Pugh Score (https://www.mdcalc.com/calc/340/child-pugh-score-cirrhosis-mortality)
· Bilirubin, albumin, INR, ascites, encephalopathy
· Used to predict operative mortality based on cirrhosis severity
· Mortality in EGS:
- Child-Pugh A: 10% electively and 22% emergently
- Child-Pugh B: 30% electively and 38% emergently
- Child-Pugh C: 80% electively and up to 100% emergentlyModel for End Stage Liver Disease (MELD) (https://www.mdcalc.com/calc/10437/model-end-stage-liver-disease-meld?utm_source=site&utm_medium=link&utm_campaign=meld_12_and_older)
· creatinine, bilirubin, INR, and sodium
· MELD < 20 – 1% increase in mortality with each point increase
· MELD > 20 – 2% increase in mortality with each point increasePre-operative Planning
· Identification of cirrhosis with physical examination, bloodwork and imaging
· Involvement of other medical services (internal medicine, hepatology, ICU) as needed
· Cirrhosis optimization, if possible
· Abdominal wall mappingUnexpected Intraoperative Finding
Communicate unexpected findings to the operative team and think of additional adjuncts you may need such as additional ports, topical hemostatic agents or energy devices.
Think about why you are in the OR. If its an elective situation and can wait, consider bailing. If its emergent, you may have to do something more definitive.
Exposure may be a challenge, you may have to alter your typical approach including where the assistant grabs and retracts. Extra hands are helpful.
Bleeding can be a big deal. If possible, map out the abdominal wall ahead of time with cross-sectional imaging. Stay away from varices around the umbilicus or porta
Ventral Hernia + Cirrhosis
· Ideally, control ascites pre-operatively, if you can’t consider leaving drains
· Small (< 2cm) hernias close primarily
· Larger (>2cm) hernias repair wi… -
Journal Review in Thoracic Surgery: Adjuvant Treatment in Esophageal and GEJ Cancer
30 maart 2023 · 25 min
In this episode, our team discusses the Checkmate 577 trial, the landmark paper which approved the use of nivolumab for adjuvant treatment of stage II & III esophageal & GE junction cancer. Listen as our team reviews the study population, methods and results of this trial & discusses its clinical application as well as potential areas of future research. Lees meer
Learning Objectives:
-Review the staging and treatment of esophageal and GEJ cancer
-Discuss the population, methods, and results of the Checkmate 577 trial
-Understand the mechanism of action of nivolumab and the PD1 pathway
-Discuss the implications of the Checkmate 577 trial in clinical practice and areas of future researchHosts:
Kelly Daus MD, Megan Lenihan MD, Peter White MD, and Brian Louie MDReferenced Material
https://www.nejm.org/doi/full/10.1056/NEJMoa2032125
Kelly RJ, Ajani JA, Kuzdzal J, et al. Adjuvant nivolumab in resected esophageal or gastroesophageal junction cancer. N Engl J Med. 2021;384(13):1191-1203. doi:10.1056/NEJMoa2032125https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7136921/
Han Y, Liu D, Li L. PD-1/PD-L1 pathway: current researches in cancer. Am J Cancer Res. 2020 Mar 1;10(3):727-742. PMID: 32266087; PMCID: PMC7136921.Ad referenced in episode: A team at the Brooke Army Medical Center is working to better define proficiency-based metrics for competency in commonly performed robotic general surgery procedures. If you are a general surgery resident or practicing surgeon who performs robotic assisted cholecystectomies or inguinal hernia repairs, reach out to the PI, Robert Laverty, MD, at rblaverty@gmail.com for more information on how you could be compensated $500 per video submitted of each (up to $1000 per surgeon).
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other thoracic surgery episodes here https://behindtheknife.org/podcast-category/cardiothoracic/
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The Latino Surgical Society with Dr. Minerva Romero-Arenas
27 maart 2023 · 37 min
Please join BTK education fellow, Nina Clark, MD (University of Washington) along with Elina Serrano, MD, MPH (University of Washington) and Minerva Romero Arenas, MD (Weill Cornell Medicine) for a discussion inspired by the experience of trainees who are underrepresented in medicine. Lees meer
Latino Surgical Society: https://www.latinosurgicalsociety.org/
Society of Black Academic Surgeons: https://www.sbas.net/References:
Yeo HL, Abelson JS, Symer MM, Mao J, Michelassi F, Bell R, Sedrakyan A, Sosa JA. Association of Time to Attrition in Surgical Residency With Individual Resident and Programmatic Factors. JAMA Surg. 2018 Jun 1;153(6):511-517. doi: 10.1001/jamasurg.2017.6202. PMID: 29466536; PMCID: PMC5875388.McFarling, U.L. ‘It was stolen from me’: Black doctors are forced out of training programs at far higher rates than white residents. STAT. 6/20/2022. Accessed online: 10/1/2022. https://www.statnews.com/2022/06/20/black-doctors-forced-out-of-training-programs-at-far-higher-rates-than-white-residents/
Haruno LS, Chen X, Metzger M, et al. Racial and Sex Disparities in Resident Attrition Among Surgical Subspecialties. JAMA Surg. Published online February 08, 2023. doi:10.1001/jamasurg.2022.7640
**Fellowship application link: https://forms.gle/PiKM2MMQpE5jSAeW7
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/
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Clinical Challenges in Endocrine Surgery: Adrenalectomy Guidelines Review
23 maart 2023 · 48 min
In this episode the Endocrine Surgery team at BTK goes over two cases to review the American Association of Endocrine Surgeons Guidelines for Adrenalectomy. Lees meer
Dr. Michael Yeh is a Professor of Surgery at UCLA and serves as Section Chief of the UCLA Endocrine Surgery program which he established.
Dr. Masha Livhits is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department
Dr. James Wu is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department
Dr. Na Eun Kim is an Endocrine Surgery Fellow at UCLA in his first year of fellowship
Dr. Rivfka Shenoy is a PGY-5 General Surgery Resident at UCLA who has completed two years of research
Dr. Max Schumm is a PGY-5 General Surgery Resident at UCLA who has completed two years of research. He is a future endocrine surgeon.
Important Papers
Yip L, Duh QY, Wachtel H, Jimenez C, Sturgeon C, Lee C, Velázquez-Fernández D, Berber E, Hammer GD, Bancos I, Lee JA, Marko J, Morris-Wiseman LF, Hughes MS, Livhits MJ, Han MA, Smith PW, Wilhelm S, Asa SL, Fahey TJ 3rd, McKenzie TJ, Strong VE, Perrier ND. American Association of Endocrine Surgeons Guidelines for Adrenalectomy: Executive Summary. JAMA Surg. 2022 Oct 1;157(10):870-877. doi: 10.1001/jamasurg.2022.3544. PMID: 35976622; PMCID: PMC9386598.
Schumm M, Hu MY, Sant V, Kim J, Tseng CH, Sanz J, Raman S, Yu R, Livhits M. Automated extraction of incidental adrenal nodules from electronic health records. Surgery. 2023 Jan;173(1):52-58. doi: 10.1016/j.surg.2022.07.028. Epub 2022 Oct 4. PMID: 36207197.
M. Conall Dennedy, Anand K. Annamalai, Olivia Prankerd-Smith, Natalie Freeman, Kuhan Vengopal, Johann Graggaber, Olympia Koulouri, Andrew S. Powlson, Ashley Shaw, David J. Halsall, Mark Gurnell, Low DHEAS: A Sensitive and Specific Test for the Detection of Subclinical Hypercortisolism in Adrenal Incidentalomas, The Journal of Clinical Endocrinology & Metabolism, Volume 102, Issue 3, 1 March 2017, Pages 786–792, https://doi.org…
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Journal Review in Surgical Critical Care: Nutrition in the ICU - when, how, why
20 maart 2023 · 23 min
In this episode the Critical Care BTK Team tackles nutrition in the ICU. High-yield journal articles will be presented, discussed, and reviewed. ICU nutrition myths will be busted, and listeners will learn about enteral nutrition, parenteral nutrition and other ICU nutrition pearls. Lees meer
References
1. Casaer, M.P., et al., Early versus Late Parenteral Nutrition in Critically Ill Adults. New England Journal of Medicine, 2011. 365(6): p. 506-517.
2. Compher, C., et al., Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition. Journal of Parenteral and Enteral Nutrition, 2022. 46(1): p. 12-41.
3. McClave, S.A., et al., Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient. Journal of Parenteral and Enteral Nutrition, 2016. 40(2): p. 159-211.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 Critical Care episodes here: https://behindtheknife.org/podcast-category/surgical-critical-care/
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Innovations in Surgery: Surgical Robotics
16 maart 2023 · 28 min
In the third episode of the “Innovations in Surgery” series, Behind the Knife’s surgery education fellow, Dan Scheese, sits down with Adam Sachs and Dr. Igor Belyansky to discuss the current state and future of surgical robotics. They discuss the start up of Vicarious Surgical and how they are working to improve the current state of surgical robotics with their innovative ideas. Lees meer
Link for the Vicarious Surgical website which includes a short video demonstration of their single port design: https://www. vicarioussurgical.com/
Adam Sachs is the CEO and Co-founder of Vicarious surgical, a surgical robotics company founded in 2014. As an MIT trained roboticist, Adam has combined his passion for robots with this passion for helping patients and enhancing the work environment for surgeons through the development of proprietary surgical robotics.
Dr. Igor Belyanksy, an internationally-recognized expert in the field of abdominal wall reconstruction and complex laparoscopic and robotic hernia repair. Dr. Belyansky has earned his medical degree from Virginia Commonwealth University, completed his residency at MedStar Union Memorial Hospital, and completed a minimally invasive fellowship at Carolinas Medical Center. Dr. Belyanksy is currently the Medical Director of Anne Arundel Medical Center in Annapolis Maryland.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other Innovations in Surgery episodes here: https://behindtheknife.org/podcast-series/innovations-in-surgery/
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Journal Review in Colorectal Surgery: Local Excision for Rectal Cancer
13 maart 2023 · 35 min
You have a patient who underwent local excision of a rectal cancer. Final pathology demonstrates a T2 lesion. What is the rate of local recurrence? Is excision alone sufficient? Should the patient undergo radical resection or should chemoradiation be offered? Tune in to find out! Lees meer
Join Drs. Peter Marcello, Jonathan Abelson, Tess Aulet and special guest Dr. Jose Guillem MD, MPH, MBA as they discuss high yield papers discussing local excision for Rectal Cancer.
You may follow along with the slides mentioned in this episode here: https://behindtheknife.org/video/journal-review-in-colorectal-surgery-local-excision-for-rectal-cancer/
Learning Objectives
1. Describe the features that increase risk of lymph node involvement in early stage rectal cancer
2. Discuss the different options for management of early-stage rectal cancer
3. Describe patient related factors that favor local excision of rectal cancerReferences:
Kidane B, Chadi SA, Kanters S, Colquhoun PH, Ott MC. Local resection compared with radical resection in the treatment of T1N0M0 rectal adenocarcinoma: a systematic review and meta-analysis. Dis Colon Rectum. 2015 Jan;58(1):122-40. doi: 10.1097/DCR.0000000000000293. PMID: 25489704.Garcia-Aguilar J, Renfro LA, Chow OS, Shi Q, Carrero XW, Lynn PB, Thomas CR Jr, Chan E, Cataldo PA, Marcet JE, Medich DS, Johnson CS, Oommen SC, Wolff BG, Pigazzi A, McNevin SM, Pons RK, Bleday R. Organ preservation for clinical T2N0 distal rectal cancer using neoadjuvant chemoradiotherapy and local excision (ACOSOG Z6041): results of an open-label, single-arm, multi-institutional, phase 2 trial. Lancet Oncol. 2015 Nov;16(15):1537-1546. doi: 10.1016/S1470-2045(15)00215-6. Epub 2015 Oct 22. PMID: 26474521; PMCID: PMC4984260.
Friel CM, Cromwell JW, Marra C, Madoff RD, Rothenberger DA, Garcia-Aguílar J. Salvage radical surgery after failed local excision for early rectal cancer. Dis Colon Rectum. 2002 Jul;45(7):875-9. doi: 10.1007/s10350-004-6320-z. PMID: 12130873.
Nascimbeni R, …
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Doctor Cure Thyself: An Interview With Dr. David Fajgenbaum
9 maart 2023 · 36 min
DO NOT MISS THIS EPISODE! Need a little inspiration? Tune in for Dave's story. Links from the show: Lees meer
Chasing My Cure: https://chasingmycure.com/ CDCN: https://cdcn.org/
Every Cure: https://everycure.org/
AMF: https://healgrief.org/actively-moving-forward/young-adult-grief/David Fajgenbaum, MD, MBA, MSc, FCPP, is an Assistant Professor of Medicine in Translational Medicine & Human Genetics at the University of Pennsylvania, Founding Director of the Center for Cytokine Storm Treatment & Laboratory (CSTL), Associate Director, Patient Impact of the Penn Orphan Disease Center, and Co-Founder/President of the Castleman Disease Collaborative Network (CDCN) and co-founder of Every Cure. He is also the national bestselling author of 'Chasing My Cure: A Doctor's Race to Turn Hope Into Action' and a patient battling idiopathic multicentric Castleman disease (iMCD). He is in his longest remission ever thanks to a precision treatment that he identified, which had never been used before for iMCD. He has also identified and/or advanced 9 other treatment approaches for iMCD and cancer.
One of the youngest individuals ever appointed to the faculty at Penn Medicine and in the top 1 percent youngest awardees of an NIH R01 grant, Fajgenbaum has published scientific papers in high-impact journals such as the New England Journal of Medicine, Journal of Clinical Investigation, and Lancet, been recognized with awards such as the 2016 Atlas Award along with then Vice President Joe Biden, and profiled in a cover story by The New York Times as well as by Good Morning America, CNN, Forbes 30 Under 30, and the Today Show. An authority on cytokine storms and their treatment, Fajgenbaum currently leads over 20 translational research studies including the CORONA Project, which is the world’s largest effort to identify, track, and advance COVID-19 treatments. He also serves on the Board of Directors for the Reagan-Udall Foundation for the FDA, co-Chair of the Advisory Board for the CURE Drug Re…
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Journal Review in Surgical Education: Unions and Wellness
6 maart 2023 · 42 min
How do we actually improve wellness? How do surgery trainees advocate for themselves as both learners and employees? In this final surgical education episode with Matt Chia MD MS and Karl Bilimoria MD MS, we review two articles discussing unions and wellness in surgical training. We’re joined by Meg Smith MD MS, Brian Brajcich MD MS, and Darci Foote MD MS to tackle this difficult topic and open the discussion for what’s next in surgical education. Lees meer
Learning Objectives:
· Identify potential benefits and limitations of unionization in surgery training
· Describe strategies used by program leadership to improve wellness in surgery
References:
National Evaluation of the Association Between Resident Labor Union Participation and Surgical Resident Well-being https://doi.org/10.1001/jamanetworkopen.2021.23412
How Program Directors Understand General Surgery Resident Wellness - https://doi.org/10.1016/j.jsurg.2022.07.022
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/
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Journal Review in Hepatobiliary Surgery: Intraductal Papillary Mucinous Neoplasm IPMN
2 maart 2023 · 45 min
Join the Behind the Knife HPB team as we dive deeper into the complex world of IPMNs with a journal article review of a recent JAMA Surgery publication and the first author of the article! Lees meer
Learning Objectives: In this episode, we discuss the article, “Progression vs Cyst Stability of Branch-Duct Intraductal Papillary Mucinous Neoplasms After Observation and Surgery.” This article describes a multicenter retrospective study of centers in Italy, Korea, Singapore, and the US that specifically assessed what dynamic variables are associated with malignant progression in pathologically proven IMPNs under at least a year of initial surveillance.
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 CenterDaniel 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-6 General Surgery resident at Brooke Army Medical Center
Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a PGY-5 General Surgery resident at Brooke Army Medical Center
Beth Carpenter, MD (@elizcarpenter16) is a PGY-4 General Surgery resident at Brooke Army Medical Center
Guest:
Dr. Giovanni Marchegiani is a pancreas surgeon within the department of general and pancreatic surgery at the University of Verona in Italy. His research interests include exocrine and cystic neoplasms of the pancreas. He is the first author of the study discussed in the episode in addition to over 100 additional scientific, peer-reviewed articles.Journal Article:
1. Marchegiani G, Pollini T, Andrianello S, et al. Progression vs Cyst Stability of Branch-Duct Intraductal Papillary Mucinous Neoplasms After Observation and Surgery. JAMA Surg. 2021;156(7):654–661. doi:10.1001/jamasurg.2021.1802Please visit https://beh…
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BTK Vascular Surgery Oral Board Review – Sample Episode 2 - Lower Extremity Trauma
27 februari 2023 · 27 min
Our Vascular Surgery Oral Board Audio Review includes 72 high-yield scenarios that cover the majority of the VSCORE topics designed for Vascular Surgeons by Vascular Surgeons.
Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as vascular surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test. Lees meerLearn more about the full set of 72 scenarios here: https://behindtheknife.org/premium/vascular-surgery-oral-review/
Our Vascular Surgery Oral Board Book is available on Amazon here: https://www.amazon.com/Vascular-Surgery-Oral-Board-Review/dp/0578382296/ref=sr_1_4?crid=VUNDNTCJOH8M&keywords=behind+the+knife&qid=1675087641&sprefix=behind+the+knif%2Caps%2C82&sr=8-4&ufe=app_do%3Aamzn1.fos.f5122f16-c3e8-4386-bf32-63e904010ad0
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
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BTK Vascular Surgery Oral Board Review – Sample Episode 1 - Fem and Pop Aneurysm
23 februari 2023 · 23 min
Our Vascular Surgery Oral Board Audio Review includes 72 high-yield scenarios that cover the majority of the VSCORE topics designed for Vascular Surgeons by Vascular Surgeons. Lees meer
Scenarios are 5 to 7 minutes long and include a variety of tactics and styles. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics we face as vascular surgeons. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.
Learn more about the full set of 72 scenarios here: https://behindtheknife.org/premium/vascular-surgery-oral-review/
Our Vascular Surgery Oral Board Book is available on Amazon here: https://www.amazon.com/Vascular-Surgery-Oral-Board-Review/dp/0578382296/ref=sr_1_4?crid=VUNDNTCJOH8M&keywords=behind+the+knife&qid=1675087641&sprefix=behind+the+knif%2Caps%2C82&sr=8-4&ufe=app_do%3Aamzn1.fos.f5122f16-c3e8-4386-bf32-63e904010ad0
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
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Clinical Challenges in Minimally Invasive Surgery: Ergonomics
20 februari 2023 · 32 min
Surgery is a contact sport and can cause injuries that prevent us from taking care of our patients and even threaten our careers. Join Drs. Mike Weykamp, Nicole White, Nick Cetrulo, and Andrew Wright for a discussion on the ergonomic challenges of open, laparoscopic, and robotic surgery as well as some tips, tricks, and resources on how to protect yourself and your practice. Lees meer
*We apologize for some distracting background noise throughout the episode.*
Referenced Articles & Websites:
1. Wells, A. C., Kjellman, M., Harper, S. J., Forsman, M., & Hallbeck, M. S. (2019). Operating hurts: a study of EAES surgeons. Surgical endoscopy, 33, 933-940.
2. Davis, W. T., Fletcher, S. A., & Guillamondegui, O. D. (2014). Musculoskeletal occupational injury among surgeons: effects for patients, providers, and institutions. Journal of surgical research, 189(2), 207-212.
3. Wright, A.S. Ergonomic Injury and Surgery: The Hidden Epidemic. Harkins Symposium at The University of Washington. October 21, 2022. https://www.youtube.com/watch?v=o1G1qGj4WaA
4. The Society of Surgical Ergonomics. https://www.societyofsurgicalergonomics.org/
5. OR Stretch. https://www.mayo.edu/research/labs/human-factors-engineering/or-stretch/or-stretch-videosPlease visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other MIS episodes here: https://behindtheknife.org/podcast-category/minimally-invasive/
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Journal Review in Vascular Surgery: Introduction to Endovascular Surgery – A Primer
16 februari 2023 · 37 min
Vascular surgery is full of awesome anatomy and big open vessel exposures, but endovascular surgery is here to stay and can be hard to get into, particularly as a learner. The basics of endovascular surgery share very little with the basics of open surgery and getting up to speed can be a big challenge. This episode is an introduction to all things endovascular surgery, from wires, catheters and sheaths to balloons and stents. Take a listen to get up to speed quickly in prep for an upcoming vascular rotation and skip the pain of trying to follow your attendings words so you can instead pay attention to the actual case. Lees meer
Dr. Frank Davis is an Assistant Professor of Vascular Surgery at the University of Michigan.
Dr. Craig Brown is a PGY-7 in the General Surgery program and the upcoming 2023 vascular surgery fellow at the University of Michigan.
Check out the accompanying video for this episode available here: https://behindtheknife.org/video-playlists/podcast-clips/
Ad referenced in episode: A team at the Brooke Army Medical Center is working to better define proficiency-based metrics for competency in commonly performed robotic general surgery procedures. If you are a general surgery resident or practicing surgeon who performs robotic assisted cholecystectomies or inguinal hernia repairs, reach out to the PI, Robert Laverty, MD, at rblaverty@gmail.com for more information on how you could be compensated $500 per video submitted of each (up to $1000 per surgeon).
To check out our Vascular Surgery Oral Board Audio Review and Book, please visit: https://behindtheknife.org/premium/
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
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Dominate the Match – Episode 4: "Rank and Match"
13 februari 2023 · 32 min
Interview season is over! There’s just one last hurdle in this residency application process to overcome- ranking and matching! Join our education fellow, Dr. Jessica Millar, and Dr. Charles Friel as they pull back the curtain on the ranking process and discuss how tooptimize your success in the match! Lees meer
Guest:
Charles Friel, MD- Professor of Colorectal Surgery, Surgical Director - Digestive Center of Excellence, Chief - Section of Colon & Rectal Surgery, and General Surgery Residency Program Director- University of Virginia, Charlottesville, VA“How the NRMP Matching Algorithm Works”: https://www.youtube.com/watch?v=kvgfgGmemdA&list=PLr0LH_NifZSpvQTwTqXVYn9jXfUKOTFN6&index=11
Important Dates
1. Ranking opens 2/1 at 12PM
2. Rank lists are due 3/1 at 9PM
3. Match status available 3/13 at 10AM
4. Match day results available 3/17 at 12PM ESTPlease visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out the rest of our “Dominate the Match Series” here: https://behindtheknife.org/podcast-series/medical-student-and-intern-survival-guide/
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Journal Review in Trauma Surgery: Blood Transfusions
9 februari 2023 · 24 min
In this episode, our team discusses the recent paper from JAMA Surgery Association of Whole Blood With Survival Among Patients Presenting With Severe Hemorrhage in US and Canadian Adult Civilian Trauma Centers. Join us as we explore some of the history of blood transfusions, how we got to where we are today, and the role whole blood transfusion may play going forward Lees meer
Hosts:
Elliott R. Haut, MD, PhD, 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) and editor-in-chief of Trauma Surgery and Acute Care Open.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 Masters in Education in the Health Professions from Johns Hopkins.
David Sigmon, MD, MMEd, a PGY-7 resident at the University of Illinois at Chicago who will be a fellow at Lincoln Medical Center in the Bronx next year. 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
Torres CM, Kent A, Scantling D, Joseph B, Haut ER, Sakran JV. Association of whole blood with survival among patients presenting with severe hemorrhage in US and Canadian adult civilian trauma centers. JAMA Surg. Published online January 18, 2023.
https://pubmed.ncbi.nlm.nih.gov/36652255/Sperry JL, Guyette FX, Brown JB, et al. Prehospital plasma during air medical transport in trauma patients at risk for hemorrhagic shock. N Engl J Med. 2018;379(4):315-326.
https://pubmed.ncbi.nlm.nih.gov/30044935/Moore HB, Moore EE, Chapman MP, et al. Plasma-first resuscitation to treat haemorrhagic shock during emergency ground transportation in an urban area: a randomised trial. Lancet. 2018;392(10144):283-291.
https://pubmed.ncbi.nlm.nih.gov/30032977/Cannon JW, Khan MA, Raja AS, et al. Damage cont…
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JOIN THE BTK TEAM!
7 februari 2023 · 2 min
**Specialty team application link - https://forms.gle/DwrRcMYDaP3a3LaQA Please email hello@behindtheknife.org with any questions.
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The King and Queen of Medical Comedy: Up Close and Personal with Dr. and Lady Glaucomflecken
6 februari 2023 · 42 min
Join Patrick Georgoff and Kevin Kniery for a special conversation with the king and queen of medical comedy Dr. Will Flanary, aka Dr. Glaucomflecken (@drglaucomflecken), and Kristin Flanary, aka Lady Glaucomflecken (@Lglaucomflecken). Lees meer
Will is a practicing ophthalmologist and social media personality with over 4 million followers. During his 3rd year of medical school, he was diagnosed with testicular cancer, and he began using humor as a coping mechanism. Following a second bout with cancer three years into his medical career, he created a Twitter account under the pseudonym "Dr. Glaucomflecken"— because it is arguably the funniest word in ophthalmology. A cardiac event and near-death experience in 2020 only fueled his creativity. Kristin is formally trained in cognitive neuroscience and social psychology and now works in marketing and communications. Kristin is best known internationally as her social media alter ego, “Lady Glaucomflecken,” where she shares stories from her unique perspective of the healthcare system. She has been a patient, "married to medicine" through the entire medical training journey and beyond, a lay responder and CPR provider to her husband, and a caregiver and "co-survivor" of his two cancer occurrences and a sudden cardiac arrest. And, if that’s not enough, they also have a brand-new podcast called Knock, Knock – Hi! where they discuss quirky and unexpectedly hilarious medical stories. Check out their website here: https://glaucomflecken.com/
**Specialty team application link - https://forms.gle/DwrRcMYDaP3a3LaQA Please email hello@behindtheknife.org with any questions.
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out our library of episodes here: https://behindtheknife.org/listen/
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EAST Papers That Should Change Your Practice
2 februari 2023 · 43 min
Did you miss this year’s Eastern Association for the Surgery of Trauma meeting? Don’t sweat it! Behind the Knife has got you covered. In this episode we discuss “Scientific Papers that Should Change Your Practice” with EAST manuscript and literature committee members Drs. Laura Brown (@laurarbrownMD), Brittany Bankhead (@bbankheadMD), and Julia Coleman (@juliacolemanMD). Lees meer
Universal blunt cerebrovascular screening? Early renal replacement therapy? Artificial intelligence in emergency general surgery? This episode is PACKED with high-yield material.
To learn more about all the good things happening at EAST visit www.east.org.
Papers discussed:
1. Do not forget the platelets: The independent impact of red blood cell to platelet ratio on mortality in massively transfused trauma patients (https://pubmed.ncbi.nlm.nih.gov/35313325/)
2. The 35-mm rule to guide pneumothorax management: Increases appropriate observation and decreases unnecessary chest tubes (https://pubmed.ncbi.nlm.nih.gov/35125448/)
3. Timing of thromboprophylaxis in patients with blunt abdominal solid organ injuries undergoing nonoperative management (https://pubmed.ncbi.nlm.nih.gov/33048907/)
4. Universal screening for blunt cerebrovascular injury (https://pubmed.ncbi.nlm.nih.gov/33502144/)
5. A three-step support strategy for relatives of patients during in the intensive care unit: a cluster randomized trial (https://pubmed.ncbi.nlm.nih.gov/35065008/)
6. Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest (https://pubmed.ncbi.nlm.nih.gov/34133859/)
7. Timing of Initiation of Renal-Replacement Therapy in Acute Kidney Injury (https://pubmed.ncbi.nlm.nih.gov/32668114/)
8. Disparities in Spatial Access to Emergency Surgical Services in the US (https://pubmed.ncbi.nlm.nih.gov/36239953/)
9. Validation of the AI-based Predictive Optimal Trees in Emergency Surgery Risk (POTTER) Calculator in Patients 65 Years and Older (https://pubmed.ncbi.nlm.nih.gov/33378309/)
10. Accuracy of Risk Estimation…