Behind The Knife: The Surgery Podcast

Join our OHSY Hernia team to review the current landscape of bioresorbable meshes and a conversation considering “are they worth it?"Hosts:  Dr. Maggie Bosley - @MBosleyMD Dr. Sean Orenstein - @OrensteinSean Dr. Amber Sandoval Dr. Peter Ferrin Institution: Oregon Health & Science UniversityReferences:- Long-Term, Prospective, Multicenter Study of Poly-4-Hydroxybutyrate Mesh (Phasix Mesh) for Hernia Repair in Cohort at Risk for Complication: 60-Month Follow-Uphttps://pubmed.ncbi.nlm.nih.gov/36102523/- Multicenter, Prospective, Longitudinal Study of the Recurrence, Surgical Site Infection, and Quality of Life After Contaminated Ventral Hernia Repair Using Biosynthetic Absorbable Mesh: The COBRA Studyhttps://pubmed.ncbi.nlm.nih.gov/28009747/- A prospective, multicenter trial of a long-term bioabsorbable mesh with Sepra technology in cohort of challenging laparoscopic ventral or incisional hernia repairs (ATLAS trial)https://pubmed.ncbi.nlm.nih.gov/34976385/- Biosynthetic mesh in hernia repair: A systematic review and meta-analysishttps://journals.lww.com/rhaw/fulltext/2024/07020/biosynthetic_mesh_in_hernia_repair__a_systematic.2.aspxPlease 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/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Circulating tumor DNA (ctDNA), a minimally invasive blood-based biomarker, has emerged as one of the most promising advances in cancer surveillance. Today, we will explore how ctDNA is transforming the management of colorectal cancer and anal squamous cell cancer across the disease continuum—from risk stratification and adjuvant therapy decision-making to surveillance and early detection of recurrence. Through landmark clinical trials, real-world applications, and emerging research, we will examine how ctDNA is helping move cancer care closer to the goal of truly personalized medicine.Hosts: ·       Dr. Janet Alvarez - General Surgery Resident at New York Medical College/Metropolitan Hospital Center·       Dr. Wini Zambare – General Surgery Resident at Weill Cornell Medical Center/New York Presbyterian·       Dr. Philip Bauer, Assistant Professor of Surgery, Division of Colon and Rectal Surgery, The Ohio State University Wexner Medical Center, Arthur G. James Cancer Hospital·       Dr. J. Joshua Smith MD, PhD, Chair, Department of Colon and Rectal Surgery at MD Anderson Cancer CenterGuests:Dr. Paul Romessor ·      Director of Colorectal and Anal Cancer, Department of Radiation Oncology·      Associate Attending Radiation OncologistMemorial Sloan Kettering Cancer CenterDr. Jeanne Tie ·      Medical Oncologist | Lower GI Unit ·      Lower GI Research Lead ·      Chair | Lower GI Working Party | GI Cancer TrialsPeter MacCallum Cancer Centre Dr. Takayuki Yoshino·      Professor, Global Center of Research Excellence for Advanced Medicine (G-CORE),Keio University School of Medicine·      Executive Advisor to Hospital East Director·      Director, Department of Global Oncology·      Chief, Department of Gastrointestinal OncologyNational Cancer Center Hospital EastLearning Objectives:·      Describe the biological basis and clinical applications of circulating tumor DNA (ctDNA) as a biomarker of minimal residual disease (MRD) in colorectal cancer.·      Interpret the prognostic significance of postoperative and longitudinal ctDNA testing and its role in predicting recurrence risk across stages of colorectal cancer.·      Evaluate evidence from landmark clinical trials, including DYNAMIC and GALAXY, supporting ctDNA-guided treatment de-escalation and escalation strategies in colorectal cancer.·      Discuss emerging applications of ctDNA monitoring in personalized cancer care, including surveillance, treatment response assessment, and future clinical trial directions. References:·      Ando, K. et al. (2026). Molecular Residual Disease and Recurrence in Rectal Cancer Patients Undergoing Upfront Surgery: A Prospective Cohort Study. Annals of Surgery. https://pubmed.ncbi.nlm.nih.gov/39854721/ (Note: If direct access is limited, the article is available via PMC: PMC12695342)·      Romesser, P. B. et al. (2026). Tumor-informed circulating tumor DNA stratifies recurrence risk and survival in anal squamous cell carcinoma. Nature Communications. https://pubmed.ncbi.nlm.nih.gov/38347209/·      Tie, J. et al. (2025). Circulating tumor DNA analysis guiding adjuvant therapy in stage II colon cancer: 5-year outcomes of the randomized DYNAMIC trial. Nature Medicine. https://pubmed.ncbi.nlm.nih.gov/39943485/·      Tie, J. et al. (2025). Circulating tumor DNA-guided adjuvant therapy in locally advanced colon cancer: the randomized phase 2/3 DYNAMIC-III trial. Nature Medicine. https://pubmed.ncbi.nlm.nih.gov/39974258/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/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Every spring for over 50 years, the Trauma, Critical Care, and Acute Care Surgery conference, best known simply as the MATTOX conference, is held in Las Vegas (https://www.trauma-criticalcare.com/).  The conference is unique in that it is entirely focused on practice-changing clinical education. It's a damn good time too!  A favorite feature is the annual debates.  Today, we are featuring a showdown between Drs. Bryan A. Cotton, MD, MPH and Marty A. Schreiber, MD, FACS, FCCM, FCRST (Hon), COL, MC, USAR as they debate REBOA as a Life-Saving Intervention in Hemorrhagic Shock.  You can listen on the podcast or watch the debate with accompanying slides on our website or app.  Let's get ready to RUMMMBLLLEEEE!  TRAUMA SURGERY VIDEO ATLAS: https://behindtheknife.org/premium/trauma-surgery-video-atlasPreparing for the deadliest injuries is challenging, and currently available resources are limited. That is why we created the Behind the Knife Trauma Surgery Video Atlas. Be ready for the most complex injuries, like penetrating trauma to the neck, audible bleeding from the IVC, and pelvic hemorrhage, with 24 scenarios. 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/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Every spring for over 50 years, the Trauma, Critical Care, and Acute Care Surgery conference, best known simply as the MATTOX conference, is held in Las Vegas (https://www.trauma-criticalcare.com/).  The conference is unique in that it is entirely focused on practice-changing clinical education. It's a damn good time too!  A favorite feature is the annual debates.  Today, we are featuring a showdown between Drs. Carlos V.R. Brown, MD, FACS and Katie W. Russell, MD as they debate WHETHER OR NOT PEDIATRIC PANCREATIC INJURIES CAN BE MANAGED NON-OPERATIVELY.  You can listen on the podcast or watch the debate with accompanying slides on our website or app.  Let's get ready to RUMMMBLLLEEEE!  TRAUMA SURGERY VIDEO ATLAS: https://behindtheknife.org/premium/trauma-surgery-video-atlasPreparing for the deadliest injuries is challenging, and currently available resources are limited. That is why we created the Behind the Knife Trauma Surgery Video Atlas. Be ready for the most complex injuries, like penetrating trauma to the neck, audible bleeding from the IVC, and pelvic hemorrhage, with 24 scenarios. 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/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Join us as we discuss research on mental health and wellbeing in the surgical workforce with Drs. Yang and Collins. The episode explores key findings from recent national surveys showing that nearly one in seven surgeons report suicidal ideation in the past year, with depression, anxiety, and PTSD affecting 15–20% of the surgical population. The conversation highlights protective factors—professional fulfillment, resilience, self-valuation, and connection—while distinguishing between healthy resilience and normalized suffering. Dr. Yang and Dr. Collins discuss systemic barriers including time constraints, out-of-pocket mental health costs, and persistent stigma, alongside actionable institutional interventions: protecting dedicated wellbeing time, establishing peer support and psychological first aid programs, ensuring free mental health access, and expanding research to understand what helps surgeons thrive. The episode emphasizes that self-care is essential to patient safety and invites listeners to become advocates, engage with the literature, and help drive culture change within their institutions. For more information about the AAS wellbeing survey, please email Dr. Yang at CJYANG@MGH.HARVARD.EDU.Host:   Steven Thornton, MD (General Surgery Resident at Duke University) Agnes Premkumar (General Surgery Resident at Creighton) Guests: Jeff Yang, MD (Massachusetts General Hospital) Reagan Collins, MD (University of Pennsylvania) Publications Discussed: Hughes TM, Collins RA, Cunningham CE. Depression and Suicide Among American Surgeons-A Grave Threat to the Surgeon Workforce. JAMA Surg. 2024 Jan 1;159(1):7-8. doi: 10.1001/jamasurg.2023.4658. PMID: 37792380. [https://pubmed.ncbi.nlm.nih.gov/37792380/] Collins RA, Herman T, Snyder RA, Haines KL, Stey A, Arora TK, Geevarghese SK, Phillips JD, Vicente D, Griggs CL, McElroy IE, Wall AE, Hughes TM, Sen S, Valinejad J, Alban A, Swan JS, Mercaldo N, Jalali MS, Chhatwal J, Gazelle GS, Rangel E, Yang CJ, Donelan K, Gold JA, West CP, Cunningham C. Unspoken Truths: Mental Health Among Academic Surgeons. Ann Surg. 2024 Mar 1;279(3):429-436. doi: 10.1097/SLA.0000000000006159. Epub 2023 Nov 23. PMID: 37991182. [https://pubmed.ncbi.nlm.nih.gov/37991182/]  Yaghmour NA, Bynum WE 4th, Hafferty FW, Könings KD, Richter T, Brigham TP, Nasca TJ. Causes of Death Among US Medical Residents. JAMA Netw Open. 2025 May 1;8(5):e259238. doi: 10.1001/jamanetworkopen.2025.9238. Erratum in: JAMA Netw Open. 2025 Jul 1;8(7):e2523489. doi: 10.1001/jamanetworkopen.2025.23489. PMID: 40366660; PMCID: PMC12079293. [https://pubmed.ncbi.nlm.nih.gov/40366660/] Nasca BJ, Hunt ML, Ramirez RT, Eng JS, Li RD, Agarwal G, Bilimoria KY, Hu YY. One is too many: suicidality among general surgery residents. Acad Med. 2025 Dec 24:wvaf105. doi: 10.1093/acamed/wvaf105. Epub ahead of print. PMID: 41819820. [https://pubmed.ncbi.nlm.nih.gov/41819820/] 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/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

INTRODUCING Behind the Knife OBGYN Oral Board Review!The oral boards aren't just about knowledge—they are about executing under pressure. This course is designed to give you the structure and confidence to command the room. We have curated 98 high-yield scenarios covering the "Big Three" of the exam: Obstetrics, Gynecology, and Office Practice. Whether it's a surgical emergency or a complex clinic workup, we will walk you through exactly how to articulate your plan, defend your decisions, and pass this exam.Each scenario includes 2 parts. The first part is a perfectly executed scenario.  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 are confident you will find this unique, dual format approach a highly effective way to prepare for the test.Please check out the preview episodes below that include Parts A and B, with and without commentary.This course includes access to our Oral Board Simulator.  Step into the hot seat and experience the pressure of the real exam and receive detailed, actionable feedback with the most advanced oral board prep available.   3-Month Purchase - 10 exams 6-Month Purchase - 22 exams 12-Month Purchase - 46 exams Learn More: https://behindtheknife.org/premium/obgyn-oral-board-reviewDOMINATE THE DAY!

Join Drs. Georgoff, Burke, and Premkumar in this episode of the EPA Playbook as they break down a practical, repeatable framework for managing patients in the trauma bay, one of the most high-pressure environments in surgical training. This episode focuses on the critical first minutes of evaluation, anchored in a structured primary survey. We emphasize how to recognize and immediately address life-threatening injuries, while maintaining situational awareness and clear communication with your team. From airway and hemorrhage control to adjuncts like FAST and early imaging, we highlight what matters most when time is critical. ***FREE EPA COURSE: https://behindtheknife.org/premium/epa-playbookSimply create an account on behindtheknife.org or our app and you the course will automatically show up in your Library.For additional information on EPAs, visit the American Board of Surgery EPA webpage: https://www.absurgery.org/get-certified/epas/. BTK Resources:Trauma Video Playlist (FAST, How to Read a CT, and more!)https://behindtheknife.org/video-playlists/trauma-videosBig T Trauma Podcastshttps://behindtheknife.org/podcast-series/big-t-traumaTrauma Surgery Video Atlas (Premium)https://behindtheknife.org/premium/trauma-surgery-video-atlas

Join Drs. Georgoff, Burke, and Premkumar in this episode of EPA Playbook, where we tackle the evaluation and management of small bowel obstruction. Through a realistic series of scenarios, we walk step-by-step through how junior residents can approach this diagnosis using an evidence-based approach.We break down the key components of the small bowel obstruction EPA, from rapid initial assessment and focused physical exam to early resuscitation, recognizing when to go straight to the OR, and post-operative care. Along the way, we highlight critical teaching points you'll actually use on call. Whether you're a new intern or an early resident looking to build confidence, this episode is designed to help you act decisively and move one step closer to entrustment. ***FREE EPA COURSE: https://behindtheknife.org/premium/epa-playbookSimply create an account on behindtheknife.org or our app and you the course will automatically show up in your Library.For additional information on EPAs, visit the American Board of Surgery EPA webpage: https://www.absurgery.org/get-certified/epas/.BTK Resources:Nasogastric Tube (NGT) Management Videohttps://behindtheknife.org/video/behind-the-knife-nasogastric-tube-ngt-managementNasogastric Tube (NGT) Placement Videohttps://behindtheknife.org/video/behind-the-knife-nasogastric-tube-ngt-placementOstomy Marking Videohttps://behindtheknife.org/video/behind-the-knife-ostomy-markingHow to Change an Ostomy Appliance Videohttps://behindtheknife.org/video/behind-the-knife-how-to-change-an-ostomy-applianceHow to Manage a Challenging Ostomy Videohttps://behindtheknife.org/video/behind-the-knife-how-to-manage-a-challenging-ostomyCited Studies: National prospective cohort study of the burden of acute small bowel obstruction https://doi.org/10.1002/bjs5.50136 Management and short-term outcomes of patients with small bowel obstruction in Denmark: a multicentre prospective cohort study https://doi.org/10.1007/s00068-022-02171-y Multi-institutional, prospective, observational study comparing the Gastrografin challenge versus standard treatment in adhesive small bowel obstruction https://doi.org/10.1097/ta.0000000000001499 Evaluation and management of small-bowel obstruction: an Eastern Association for the Surgery of Trauma practice management guideline https://doi.org/10.1097/ta.0b013e31827019de

In this episode of EPA Playbook, Drs. Jason Bingham, Emma Burke, and Agnes Premkumar discuss the evaluation and management of inguinal hernias through a case-based approach that reinforces key EPA concepts for surgical trainees. We specifically highlight the importance of a thorough history and physical exam, emphasize risk stratification, and indications for surgery versus watchful waiting. We briefly review a few postoperative considerations as well. ***FREE EPA COURSE: https://behindtheknife.org/premium/epa-playbookSimply create an account on behindtheknife.org or our app and you the course will automatically show up in your Library.For additional information on EPAs, visit the American Board of Surgery EPA webpage: https://www.absurgery.org/get-certified/epas/. Cited studies:Miserez M, et al. "Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients." Hernia. 2014;18(2):151-163. PubMed ID: 24504225Carrick MA, et al. "Smoking and anaesthesia." BJA Educ. 2019;19(1):1-6. PubMed ID: 33456860Amid PK, et al. "Local anesthesia for inguinal hernia repair step-by-step procedure." Ann Surg. 1994;220(6):735-737. PubMed ID: 7979603Huy TC, et al. "Reoperation for chronic postoperative inguinal pain." JAMA Surg. 2025;160(9):984-991. PubMed ID: 39855588

In this episode of EPA Playbook, Drs. Kevin Kniery, Emma Burke, and Agnes Premkumar discuss management of critically ill surgical patients, using case-based discussions to reinforce core principles of shock, resuscitation, and ICU care. We first review the four major types of shock. We then discuss two cases centered around managing a patient in septic shock and cardiogenic shock, delving into the nuances on how management differs between the two. Additionally, we underscore a physiology-driven approach to critical care, the importance of multidisciplinary collaboration, and the need to align treatment decisions with patient goals and values. ***FREE EPA COURSE: https://behindtheknife.org/premium/epa-playbookSimply create an account on behindtheknife.org or our app and you the course will automatically show up in your Library.For additional information on EPAs, visit the American Board of Surgery EPA webpage: https://www.absurgery.org/get-certified/epas/. 

Join Drs. Steele, Burke, & Premkumar in this episode of EPA Playbook, where we tackle a core general surgery EPA: the evaluation and management of benign and malignant colon disease. From common presentations like diverticulitis and lower GI bleeding to the diagnosis and workup of colon cancer, this episode provides a structured framework you can use on the wards, in clinic, and on call. Using case-based discussions, we walk through how to distinguishing benign from malignant processes, selecting appropriate imaging and endoscopy, and recognizing when a patient needs urgent intervention versus outpatient workup. We also cover key principles of colon cancer management, including staging, surgical planning, and multidisciplinary care, alongside high-yield management of benign conditions.***FREE EPA COURSE: https://behindtheknife.org/premium/epa-playbookSimply create an account on behindtheknife.org or our app and you the course will automatically show up in your Library.For additional information on EPAs, visit the American Board of Surgery EPA webpage: https://www.absurgery.org/get-certified/epas/. Cited Studies:Gustafsson, U.O., Scott, M.J., Hubner, M. et al. Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations: 2018. World J Surg 43, 659–695 (2019). https://doi.org/10.1007/s00268-018-4844-yBTK Resources:Ostomy Marking Videohttps://behindtheknife.org/video/behind-the-knife-ostomy-markingHow to Change an Ostomy Appliance Videohttps://behindtheknife.org/video/behind-the-knife-how-to-change-an-ostomy-applianceHow to Manage a Challenging Ostomy Videohttps://behindtheknife.org/video/behind-the-knife-how-to-manage-a-challenging-ostomy

Two years into the EPA era — are we actually training surgeons differently, or just checking new boxes? In this episode, Behind the Knife co-director and Duke Trauma Surgeon Dr. Patrick Georgoff and Behind the Knife surgical education fellows Dr. Agnes Premkumar and Dr. Emma Burke sit down with Dr. Ruchi Thanawala, thoracic surgeon at OHSU, informatician, and founder of Firefly Labs, to get an honest look at the state of competency-based surgical education. We dig into why surgery is uniquely hard to assess, what the data are actually showing (spoiler: significant skewing, and we're not ready to make promotion decisions off it yet), and why collecting assessments is only 25% of the work. If you've ever wondered whether EPAs are moving the needle or just adding noise, this one's for you***FREE EPA COURSE: https://behindtheknife.org/premium/epa-playbookSimply create an account on behindtheknife.org or our app and you the course will automatically show up in your Library.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/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

In this episode, we use the recent SAGES guidelines to tackle one of the most common and controversial questions in general surgery. Through a case-based discussion, our experts review the evidence for intraoperative biliary imaging, discuss strategies for difficult anatomy, and compare IOC with other imaging modalities. Join us as we translate the latest recommendations into practical lessons that can be applied in the operating room.Take Home Points:  Routine IOC is supported; however, this remains a conditional recommendation that should be individualized based on anatomy, surgeon experience, and available resources. Use a selective approach to IOC in special populations, including pediatric and pregnant patients, where risks and benefits may differ. Alternative imaging modalities including ICG fluorescence and laparoscopic ultrasound have complementary roles.  Routine IOC may help maintain surgeon and team proficiency, and trainees should learn both IOC performance and interpretation  Hosts:  Jason Bingham, MD – General and Bariatric Surgeon  Nicole L. Petcka, MD, MHPE – General Surgery Resident at Emory University Guests:  Emily Miraflor, MD – General and Colorectal Surgeon at UCSF East Bay, Senior Author on the SAGES Guidelines  Kevin El-Hayek, MD - HPB and Foregut Surgeon at MetroHealth and Professor of Surgery at Case Western Reserve School of Medicine, Chair of the SAGES HPB/Solid Organ Committee  Dena Shehata, MD - SAGES Guideline Fellow, Co-first author on the SAGES Guidelines  Resources: Kumar, S. K., Shehata, D. G., Cetrulo, L. N., Ignacio, R., Chiu, J., Davis, B. R., McDonald, M., Bloom, M. B., Ayloo, S., Kchaou, A., Orthopoulos, G., Pucher, P. H., Oliphant, U., Hallowell, P. T., Serrot, F., Overby, D., Moreno-Paquentin, E., Slater, B. J., & Miraflor, E. (2025). SAGES guidelines for the use of intraoperative imaging of the common bile duct. Surgical endoscopy, 39(11), 7091–7102. https://doi.org/10.1007/s00464-025-12142-0 SAGES Safe Cholecystectomy Program - https://www.sages.org/safe-cholecystectomy-program/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/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Join our Hernia Team for a review of the current controversy around preoperative optimization and the practical implications.Hosts: Dr. Maggie Bosley - @MBosleyMD Dr. Sean Orenstein - @OrensteinSean Dr. Amber Sandoval Dr. Peter Ferrin Institution: Oregon Health & Science UniversityReferences:Adverse Events after Ventral Hernia Repair: The Vicious Cycle of Complicationshttps://pubmed.ncbi.nlm.nih.gov/26206646/Risk factors for postoperative wound infections and prolonged hospitalization after ventral/incisional hernia repairhttps://pubmed.ncbi.nlm.nih.gov/24030572/lack of association between glycated hemoglobin and adverse outcomes in diabetic patients undergoing ventral hernia repair: an ACHQC studyhttps://pubmed.ncbi.nlm.nih.gov/35969297/Impact of preoperative haemoglobin A1c levels on postoperative outcomes in adults undergoing major noncardiac surgery: A systematic reviewhttps://pubmed.ncbi.nlm.nih.gov/38853752/Does active smoking really matter before ventral hernia repair? An AHSQC analysishttps://pubmed.ncbi.nlm.nih.gov/30220485/Abstinence from smoking reduces incisional wound infection: a randomized controlled trialhttps://pubmed.ncbi.nlm.nih.gov/12832959/The Association of Nicotine Replacement Therapy With Outcomes Among Smokers Hospitalized for a Major Surgical Procedurehttps://pubmed.ncbi.nlm.nih.gov/31790653/Is weight trajectory a better marker of wound complication risk than BMI in hernia patients with obesity?https://pubmed.ncbi.nlm.nih.gov/38082008/Gender, racial, and socioeconomic disparity of preoperative optimization goals in ventral hernia repairhttps://pubmed.ncbi.nlm.nih.gov/37658198/Limited or Lasting: Is Preoperative Weight Loss as Part of Prehabilitation Maintained after Open Ventral Hernia Repair?https://pubmed.ncbi.nlm.nih.gov/39907236/The impact of preoperative optimization for abdominal wall reconstruction on long-term glucose control and smoking cessationhttps://pubmed.ncbi.nlm.nih.gov/40739418/Watchful waiting as a treatment strategy for patients with a ventral hernia appears to be safehttps://pubmed.ncbi.nlm.nih.gov/26838293/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/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

As colorectal cancer rates rise among younger adults, surgeons are increasingly caring for patients with rectal cancer who are pregnant or hoping to preserve future fertility. With more individuals delaying childbearing, balancing effective cancer treatment with fertility preservation and maternal–fetal safety has become an important clinical challenge. This timely topic was recently highlighted by Dr. Sharon Suwanabol during a presentation at the American Society of Colon and Rectal Surgeons annual meeting 2026. In this episode, we explore the intersection of rectal cancer, fertility, and pregnancy through a multidisciplinary, case-based discussion. We review how surgery, chemotherapy, and pelvic radiation can affect fertility and sexual function in both men and women, and why early counseling and referral to reproductive endocrinology specialists are essential. The discussion also emphasizes that evaluation and treatment during pregnancy can often be performed safely, with care individualized based on tumor stage, gestational age, and the patient's goals and values. Hosts and discussants ·      Dr. Betelhem Yohannes, General surgery resident at the University of Washington ·      Dr. Griffen Allen, General surgery resident at the University of Washington  ·      Dr. Raga Siddharthan, Assistant Professor of Surgery in the Section of Colorectal Surgery at the University of Washington  ·      Dr. Stacey Cohen, Professor in the Division of Hematology and Oncology at the University of Washington and a gastrointestinal medical oncologist at Fred Hutch Cancer Center, specializing in colorectal and other GI cancers. Learning objectives ·      Describe the impact of rectal cancer surgery on fertility, sexual function, and future childbearing potential. ·      Review the effects of chemotherapy and pelvic radiation on reproductive health and fertility preservation. ·      Discuss available fertility preservation strategies and the importance of early pre-treatment counseling and referral. ·      Recognize the diagnostic challenges of rectal cancer during pregnancy, including overlapping gastrointestinal symptoms. ·      Review appropriate staging and workup considerations for suspected rectal cancer in pregnant patients. ·      Discuss multidisciplinary management strategies for rectal cancer during pregnancy, including individualized treatment sequencing. ·      Examine ethical and patient-centered considerations when balancing maternal cancer treatment and fetal outcomes. References  Siegel RL, Wagle NS, Star J, Kratzer TB, Smith RA, Jemal A. Colorectal cancer statistics, 2026. CA Cancer J Clin. 2026;76(2):e70067. doi:10.3322/caac.70067 [https://pubmed.ncbi.nlm.nih.gov/38240409/] Pregnancy at Age 35 Years or Older: ACOG Obstetric Care Consensus No. 11. Obstet Gynecol. 2022;140(2):348-366. doi:10.1097/AOG.0000000000004873 [https://pubmed.ncbi.nlm.nih.gov/35640237/] Stal J, YI SY, Cohen-Cutler S, et al. Fertility Preservation Discussions Between Young Adult Rectal Cancer Survivors and Their Providers: Sex-Specific Prevalence and Correlates. Oncologist. 2022;27(7):579-586. doi:10.1093/oncolo/oyac052 [https://pubmed.ncbi.nlm.nih.gov/35708892/] Druvefors E, Myrelid P, Andersson RE, Landerholm K. Female and Male Fertility after Colectomy and Reconstructive Surgery in Inflammatory Bowel Disease: A National Cohort Study from Sweden. J Crohns Colitis. 2023;17(10):1631-1638. doi:10.1093/ecco-jcc/jjad079 [https://pubmed.ncbi.nlm.nih.gov/37341355/] Ito M, Tsukada Y, Watanabe J, et al. Long-term survival and functional outcomes of laparoscopic surgery for clinical stage I ultra-low rectal cancers located within 5 cm of the anal verge: A prospective phase II trial (Ultimate trial). Ann Surg. Published online April 1, 2024. doi:10.1097/SLA.0000000000006290 [https://pubmed.ncbi.nlm.nih.gov/38629555/] Teh WT, Stern C, Chander S, Hickey M. The impact of uterine radiation on subsequent fertility and pregnancy outcomes. Biomed Res Int. 2014;2014:482968.  Johnson GGRJ, Park J, Helewa RM, Goldenberg BA, Nashed M, Hyun E. Total neoadjuvant therapy for rectal cancer: a guide for surgeons. Can J Surg. 2023 Apr 21;66(2):E196-E201. doi: 10.1503/cjs.005822. PMID: 37085291; PMCID: PMC10125160. [https://pubmed.ncbi.nlm.nih.gov/37085291/] Naren G, Guo J, Bai Q, Fan N, Nashun B. Reproductive and developmental toxicities of 5-fluorouracil in model organisms and humans. Expert Rev Mol Med. 2022 Jan 31;24:e9. doi: 10.1017/erm.2022.3. PMID: 35098910; PMCID: PMC9884763. [https://pubmed.ncbi.nlm.nih.gov/35098910/] National Comprehensive Cancer Network. (2026). NCCN Clinical Practice Guidelines in Oncology: Rectal Cancer (Version 2.2026). Retrieved from NCCN Guidelines for Rectal Cancer [https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1449] Oktay, Kutluk M.D., Ph.D.. Expert Commentary on Fertility Preservation in Colorectal Cancers: Current State and Practical Tips for the Cancer Practitioner. Diseases of the Colon & Rectum 63(6):p 726-727, June 2020. | DOI: 10.1097/DCR.0000000000001688 [https://pubmed.ncbi.nlm.nih.gov/32479532/] Stal J, YI SY, Cohen-Cutler S, et al. Fertility Preservation Discussions Between Young Adult Rectal Cancer Survivors and Their Providers: Sex-Specific Prevalence and Correlates. Oncologist. 2022;27(7):579-586. doi:10.1093/oncolo/oyac052 [https://pubmed.ncbi.nlm.nih.gov/35708892/] Gentile G, Ciccarone M. Management of fertility preservation in young female patients with gastrointestinal cancer: A case series and systematic literature review. Curr Probl Cancer. 2025;57:101221. doi:10.1016/j.currproblcancer.2025.101221 [https://pubmed.ncbi.nlm.nih.gov/39598263/] Saif MW. Management of colorectal cancer in pregnancy: a multimodality approach. Clin Colorectal Cancer. 2005;5(4):247-256. doi:10.3816/ccc.2005.n.035 [https://pubmed.ncbi.nlm.nih.gov/16183863/] Rogers JE, Dasari A, Eng C. The Treatment of Colorectal Cancer During Pregnancy: Cytotoxic Chemotherapy and Targeted Therapy Challenges. Oncologist. 2016 May;21(5):563-70. doi: 10.1634/theoncologist.2015-0362. Epub 2016 Mar 21. PMID: 27000464; PMCID: PMC4861360. [https://pubmed.ncbi.nlm.nih.gov/27000464/] Jiang Q, Hua H. Fertility in young-onset colorectal patients with cancer: a review. Oncologist. 2024;29(10):e1237-e1245. doi:10.1093/oncolo/oyae141 [https://pubmed.ncbi.nlm.nih.gov/39292850/] Dolmans MM, Hollanders de Ouderaen S, Demylle D, Pirard C. Utilization rates and results of long-term embryo cryopreservation before gonadotoxic treatment. J Assist Reprod Genet. 2015;32(8):1233-1237. doi:10.1007/s10815-015-0533-z [https://pubmed.ncbi.nlm.nih.gov/26162569/ Moawad NS, Santamaria E, Rhoton-Vlasak A, Lightsey JL. Laparoscopic Ovarian Transposition Before Pelvic Cancer Treatment: Ovarian Function and Fertility Preservation. J Minim Invasive Gynecol. 2017;24(1):28-35. doi:10.1016/j.jmig.2016.08.831 [https://pubmed.ncbi.nlm.nih.gov/27599763/] Fish R. Ovarian transposition in rectal cancer: uncertain benefit at a high price. Colorectal Dis. 2022;24(6):706-707. doi:10.1111/codi.16086 [https://pubmed.ncbi.nlm.nih.gov/35191146/] Ribeiro R, Baiocchi G, Moretti-Marques R, Linhares JC, Costa CN, Pareja R. Uterine transposition for fertility and ovarian function preservation after radiotherapy. Int J Gynecol Cancer. 2023;33(12):1837-1842. Published 2023 Dec 4. doi:10.1136/ijgc-2023-004723 [https://pubmed.ncbi.nlm.nih.gov/38104863/] Haggar F, Pereira G, Preen D, et al. Maternal and neonatal outcomes in pregnancies following colorectal cancer. Surg Endosc. 2013;27(7):2327-2336. doi:10.1007/s00464-012-2774-6 [https://pubmed.ncbi.nlm.nih.gov/23645367/] 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/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Why do millions of patients qualify for bariatric surgery, yet only a fraction ever make it to the operating room?Hosts·      Matthew Martin, trauma and bariatric surgeon at the University of Southern California/Los Angeles General Medical Center (Los Angeles, California)·      Adrian Dan, bariatric and MIS surgeon, program director for the advanced MIS bariatric and foregut fellowship at Summa Health System (Akron, Ohio)·      Crystal Johnson Mann, bariatric and foregut surgeon at the University of Florida (Gainesville, Florida)·      Katherine Cironi, general surgery resident at the University of Southern California/Los Angeles General Medical Center (Los Angeles, California)Learning objectives:This episode explores disparities in access to bariatric surgery through three key studies examining eligibility, referral patterns, and weight stigma.References: Article #1: Socioeconomic disparities in eligibility and access to bariatric surgery: a national population-based analysis (2010, Martin et al.) https://pubmed.ncbi.nlm.nih.gov/19782647/ Analyzed national U.S. datasets to compare patients eligible for bariatric surgery with those who underwent surgery.  Although more than 22 million Americans met criteria for bariatric surgery, only about 0.4% underwent surgery in 2006. Patients eligible for surgery were more likely to be female, uninsured, lower income, and from racial and ethnic minority groups, while those receiving surgery were disproportionately Caucasian women with private insurance.  This discussion highlights insurance coverage as one of the largest structural barriers to care. Article #2: Investigating racial disparities in bariatric surgery referrals (2019, Johnson-Mann et al.) https://pubmed.ncbi.nlm.nih.gov/30824334/ This study focused on referral patterns within a primary care network.  Among nearly 4,700 eligible patients, only 5% were referred to bariatric surgery.  Referral disparities were seen across sex, ethnicity, and insurance status. Hispanic patients were significantly less likely to be referred and were far more likely to be uninsured or self-pay.  The study emphasizes that disparities begin long before the operating room, often at the level of primary care referral and institutional access policies. Article #3: Assessing Weight Stigma Interventions: A Systematic Review of Randomized Controlled Trials (2025, Wang et al.) https://pubmed.ncbi.nlm.nih.gov/40227369/ Examined interventions designed to reduce weight stigma. Across 56 randomized controlled trials, most interventions demonstrated improvements in attitudes toward obesity.  Effective approaches included emphasizing the biologic and environmental causes of obesity, promoting weight-inclusive healthcare, fostering empathy through shared narratives, and using cognitive dissonance strategies to challenge implicit bias.  However, changing attitudes does not necessarily translate into improved clinical behavior or patient outcomes. Together, these studies demonstrate that disparities in bariatric surgery occur at multiple stages: eligibility, referral, access, and treatment. Structural barriers, provider bias, insurance limitations, and societal stigma all contribute to inequitable care. Herein, we emphasize the importance of expanding access pathways, improving provider education, and actively reducing weight stigma to ensure equitable surgical care for all eligible patients.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/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Prehospital blood is one of the hottest debates in trauma resuscitation — and the evidence just got a lot more interesting. In this episode, Drs. Patrick Georgoff and Ayman Ali sit down with Dr. Ed Barnard, UK defense professor of emergency medicine and author of the landmark SWIFT trial, and Dr. Juan De Chesney, trauma surgeon and pioneer in prehospital blood programs, to break down what we actually know about getting blood to patients before they hit the doors. The SWIFT trial — the largest prehospital whole blood RCT to date — found no superiority of whole blood over component therapy, but the story is far more nuanced than a negative headline suggests. From the logistics of carrying blood on a helicopter to the stark reality that only 1.8% of US ground EMS carries any blood products at all, this conversation exposes both the progress and the enormous gaps that remain. Hosts: Ayman Ali, MD: Ayman Ali is a Behind the Knife fellow and general surgery PGY-4 at Duke Hospital.  Patrick Georgoff, MD @georgoff: Patrick Georgoff is faculty in the Department of Surgery at the Duke University School of Medicine where he serves as an Associate Professor of Trauma, Acute, and Critical Care Surgery and Trauma Medical Director. He is a leading educator and creator for Behind the Knife, a premier digital education platform and podcast advancing surgical training through innovative, high-yield multimedia content. Juan Duchesne, MD: Juan Duchesne is a trauma surgeon and Professor of Surgery serving as the Trauma Medical Director and Division Chief at the University of Mississippi Medical Center. His pioneering contributions to the field—particularly in whole blood and balanced resuscitation practices—have been honored with numerous accolades.  Ed Barnard, PhD FRCEM FIMC RCSEd, @edbarn @DefProfEM: Ed Barnard is an emergency physician and UK Defence Professor of Emergency Medicine, RCEM/NIHR Associate Professor, and Affiliated Assistant Professor at the University of Cambridge. He has sub-specialty training in pre-hospital and academic emergency medicine and possesses extensive experience in trauma, anaesthesia, and critical care across both civilian and military settings. His contributions to the field have been honored with five national research awards and a PhD - undertaken with the US Army in San Antonio, TX. This episode was sponsored by Teleflex, a global provider of medical devices. Learn more at teleflex.com and at the Teleflex Trauma and Emergency Medicine LinkedIn page. 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/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Join the Behind the Knife Surgical Oncology Team as we discuss clinical challenges through case-based examples including the diagnosis, workup, and management of patients with cutaneous melanoma. Learning Objectives:In this episode, we review the workup and management of patients with cutaneous melanoma and both microscopic and macroscopic nodal disease. References used in the making of this episode: Reijers, I.L.M., Menzies, A.M., van Akkooi, A.C.J. et al. Personalized response-directed surgery and adjuvant therapy after neoadjuvant ipilimumab and nivolumab in high-risk stage III melanoma: the PRADO trial. Nat Med 28, 1178–1188 (2022). https://doi.org/10.1038/s41591-022-01851-x Christian U. Blank et al. Neoadjuvant nivolumab plus ipilimumab versus adjuvant nivolumab in macroscopic, resectable stage III melanoma: The phase 3 NADINA trial.. J Clin Oncol 42, LBA2-LBA2(2024). DOI:10.1200/JCO.2024.42.17_suppl.LBA2 Faries MB, Thompson JF, Cochran AJ, et al. Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma. N Engl J Med. 2017;376(23):2211-2222. doi:10.1056/NEJMoa1613210   https://pubmed.ncbi.nlm.nih.gov/28591523/ National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Cutaneous Melanoma. Version 1.2026. Accessed April 8, 2026. NCCN Guidelines PDF   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/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

A 25-year-old pregnant woman presents with a 1-day history of progressive pain and swelling. The foot is cold, pulseless and neurologic function is deteriorating by the hour. Imaging shows a massive iliofemoral DVT. Now both the limb and the pregnancy are threatened. Do you anticoagulate, thrombolyse or operate? Join us as we break down the management and decision making behind this rare but devastating case.Hosts:·      Christian Hadeed -PGY 4 General Surgery, Brookdale Hospital Medical Center·      Paul Haser -Division Chief, Vascular Surgery, Brookdale Hospital Medical Center·      Andrew Harrington, Vascular surgery, Brookdale Hospital Medical Center·      Lucio Flores, Vascular surgery, Brookdale Hospital Medical CenterLearning objectives:-       Recognize the clinical presentation and pathophysiology of phlegmasia cerulea dolens-       Describe how pregnancy affects decision making in patients with phlegmasia and venous thromboembolic disease-       Discuss the goals of treatment for patients with DVT's and identify when operative intervention is indicated-       Describe the sequelae of DVT's and how this relates to post thrombotic syndrome-       Review the indications, risks, and limitations of anticoagulation, catheter-directed thrombolysis, thrombectomy, and fasciotomy in the management of DVT and phlegmasia.-       Explain the role of IVUS in managing venous thromboembolic disease and May Thurner syndromeReferences:-       Vedantham, S., Goldhaber, S. Z., Julian, J. A., Kahn, S. R., Jaff, M. R., Cohen, D. J., Magnuson, E., Razavi, M. K., Comerota, A. J., Gornik, H. L., Murphy, T. P., Lewis, L., Duncan, J. R., Nieters, P., Derfler, M. C., Filion, M., Gu, C.-S., Kee, S., Schneider, J., … Kearon, C. (2017). Pharmacomechanical catheter-directed thrombolysis for deep-vein thrombosis. New England Journal of Medicine, 377(23), 2240–2252. https://doi.org/10.1056/NEJMoa1615066-       Gomes, M. S., Guimarães, M., & Montenegro, N. (2019). Thrombolysis in pregnancy: A literature review. Journal of Maternal-Fetal & Neonatal Medicine, 32(14), 2418–2428. https://doi.org/10.1080/14767058.2018.1438402-       Mangla, A., & Hamad, H. (2023). May-Thurner syndrome. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK554377/-       Bates, S. M., Rajasekhar, A., Middeldorp, S., McLintock, C., Rodger, M. A., James, A. H., et al. (2018). American Society of Hematology 2018 guidelines for management of venous thromboembolism: Venous thromboembolism in the context of pregnancy. Blood Advances, 2(22), 3317–3359. https://doi.org/10.1182/bloodadvances.2018024802-       Kahn, S. R., Comerota, A. J., Cushman, M., Evans, N. S., Ginsberg, J. S., Goldenberg, N. A., et al. (2014). The postthrombotic syndrome: Evidence-based prevention, diagnosis, and treatment strategies. Circulation, 130(18), 1636–1661. https://doi.org/10.1161/CIR.0000000000000130 https://pubmed.ncbi.nlm.nih.gov/25246013/Sponsor URL: https://www.goremedical.com/If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Get a behind-the-scenes look at one of the most anticipated sessions from the Association of Surgeons of Great Britain and Ireland Annual Conference: “Bad Day on Call.”In this session, expert surgeons from the United States, United Kingdom, and Canada work through challenging real-world acute care and trauma cases. As each case unfolds, the panel explores key decision points while highlighting both the similarities and differences in surgical management across healthcare systems.This year's panel featured an outstanding group of acute care and trauma surgeons, including Dr. Rob Lim, Dr. Courtney Collins, Dr. Michael Cripps, Dr. Caroline Reinke, Dr. Chris Schlachta, Mr. Christian Macutkiewicz, Mr. Adam Peckham-Cooper, Miss Kate Hancorn, and Mr. Dimitrios Damaskos. Hope you enjoy this engaging discussion filled with practical insights and international perspectives!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/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

It's hospital day five. The patient looked better yesterday… but now she's hypotensive, on vasopressors, acidotic, and spiraling toward multi-organ failure. The CT scan doesn't show perforation or megacolon, but your gut tells you this is going south. Do you keep pushing medical therapy… or is it time to operate?Join Drs. Rushabh Dev, Jeffrey Coughenour, Kevin Bartow, Raymond Okeke, and Desra Fletcher from the Emergency General Surgery team in Tiger Country at Mizzou as they tackle one of the deadliest and most challenging diseases acute care surgeons face: fulminant Clostridioides difficile infection. In this Clinical Challenges episode, the panel discusses diagnostic stewardship, ASCRS recommendations, timing of operative intervention and technique, subtotal colectomy versus diverting loop ileostomy with lavage, and physiology that should push surgeons toward definitive source control. Through a real-world high-risk case vignette, the team explores the hardest question in emergency general surgery: when to stop hoping medical therapy will work and pull the operative trigger.Hosts Dr. Rushabh Dev FACS (Moderator, Surgical Attending) – Assistant Professor of Surgery, Associate PD ACS & SCCM Fellowship, SICU Medical Director, Lieutenant Commander United States Navy Reserve  Dr. Jeffery Coughenour FACS (Surgical Attending) – Professor of Surgery and Emergency Medicine, Trauma Medical Director at the University of Missouri SOM Dr. Kevin Bartow FACS (Surgical Attending) –Professor of Surgery, Minimally Invasive Surgeon and General Surgery. Department of General Surgery at the University of Missouri SOM Raymond Okeke – Acute Care Surgery/Surgical Critical Care Fellow, University of Missouri School of Medicine  Desra Fletcher – PGY 3 General Surgery Resident, University of Missouri School of Medicine  Learning ObjectivesBy the end of this episode, listeners should be able to: Define the spectrum of Clostridioides difficile infection (CDI), including non-severe, severe, and fulminant disease, and recognize the physiologic implications of fulminant colitis.  Review contemporary diagnostic stewardship for CDI, including appropriate stool testing, pitfalls of PCR/NAAT interpretation, and the role and limitations of CT imaging in fulminant disease.  Describe evidence-based medical management of fulminant CDI, including high-dose enteral vancomycin, intravenous metronidazole, rectal vancomycin for ileus, and principles of antimicrobial stewardship.  Recognize the high-risk clinical features that should prompt urgent surgical evaluation, including worsening shock, vasopressor dependence, lactate elevation, organ failure, and evolving abdominal exam findings.  Discuss the operative indications and timing for surgery in fulminant CDI and understand why delayed intervention contributes to mortality.  Compare subtotal colectomy with end ileostomy versus diverting loop ileostomy with antegrade lavage, including current evidence, patient selection, limitations of the literature, and ASCRS recommendations.  Review practical operative strategies for subtotal colectomy in unstable patients, including damage-control principles and common technical pitfalls.  Apply clinical reasoning to a complex, high-risk case of fulminant CDI in a patient with decompensated cirrhosis, septic shock, and multi-organ dysfunction.  References ASCRS Clinical Practice Guidelines for *Clostridioides difficile* Infection (2021)  Surgical Management of *Clostridium difficile* Colitis — Neal et al., 2011 (Loop Ileostomy + Lavage Protocol)  Clinical Practice Guidelines for *Clostridioides difficile* Infection in Adults and Children (IDSA/SHEA, 2021 Update)  Adjunctive Hyperbaric Oxygen and Surgical Outcomes in Necrotizing Soft Tissue Infections (Background discussion of severe infection physiology)  Total Abdominal Colectomy Versus Diverting Loop Ileostomy for Fulminant CDI — Systematic Review & Meta-analysis  Current Status of Surgical Therapy for Fulminant *Clostridioides difficile* Colitis  Behind the Knife Episode 648 – Emergency General Surgery Journal Review: *Clostridioides difficile* Infection  Bottom line: Fulminant C. diff is one of the few EGS diseases where the hardest decision is not what operation to perform — it's recognizing when medical therapy has failed before the patient becomes unsalvageable.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/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

The majority of non-fatal gunshot wound survivors walk away with a bullet still inside them. Most are discharged without a removal attempt, without a surveillance plan, and without a conversation about what comes next. This episode fills that gap.Dr. Patrick Georgoff is joined by BIG T co-host Dr. Teddy Puzio (UT Houston), gun violence survivor and trauma surgeon Dr. Madhu Subramanian (Duke), and Dr. Tyler Simpson (Duke ACS Fellow) for a practical, honest conversation about one of trauma's most overlooked topics.What we cover: Epidemiology: how common retained fragments really are, and why the downstream burden is underappreciated When to remove (and when not to): a framework for both index hospitalization and delayed removal Forensic evidence: how to handle bullets in the OR without destroying their evidentiary value — and who to call when you don't know Lead toxicity: the rare but real complication that can surface a decade later, which blood lead levels should prompt action, and when to call hematology or toxicology The psychology: retained bullets are independently associated with depression and reduced return to work — and that belongs in the risk-benefit conversation DOMINATE THE DAYBIG T Trauma Full Series: https://behindtheknife.org/podcast-series/big-t-traumaThis episode of Big T Trauma was sponsored by Teleflex, a global provider of medical devices. Learn more at teleflex.com and at the Teleflex Trauma and Emergency Medicine LinkedIn page. 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/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

In this episode, hosts Drs. Maya Hunt, Nicole Santucci, Bryanna Stukes and Zoe Zhou explore the parallels between the literacy crisis in America and current challenges in surgical education, drawing insights from the podcast "Sold a Story." They discuss how both systems advance learners without true competency, blame struggling students rather than examining flawed teaching methods, and look to the promise of competency-based education as a path forward. Beyond surgical training, they examine how declining literacy rates will directly impact how we communicate with and care for our future patients.Episode Hosts:–Dr. Maya Hunt, Indiana Universitymayahunt@iu.edu-Dr. Nicole Santucci, Washington University in St. Louissnicole@wustl.edu-Dr. Bryanna Stukes, UT Southwesternbryanna.stukes@UTSouthwestern.edu-Dr. Nanruoyi (Zoe) Zhou, Weill Cornell Medicinezhoun1@mskcc.org–CoSEF: @surgedfellows, cosef.org References:1.        Sold A Story: How teaching kids to read went so wrong | podcast. Accessed February 22, 2026. https://features.apmreports.org/sold-a-story/.2.        2024-2025 Literacy Statistics. National Literacy Institute. Accessed February 22, 2026. https://www.thenationalliteracyinstitute.com/2024-2025-literacy-statistics.3.        Purdy AC, Smith BR, Amersi F, et al. Characteristics Associated With Outstanding General Surgery Residency Graduate Performance, as Rated by Surgical Educators. JAMA Surg. 2022;157(10):918-924. doi:10.1001/jamasurg.2022.3340 https://pubmed.ncbi.nlm.nih.gov/35947371/4.        Santosa KB, Lussiez A, Bellomo TR, et al. Identifying Strategies for Struggling Surgery Residents. J Surg Res. 2022;273:147-154. doi:10.1016/j.jss.2021.12.026 https://pubmed.ncbi.nlm.nih.gov/35085942/5.        Mattar SG, Alseidi AA, Jones DB, et al. General surgery residency inadequately prepares trainees for fellowship: results of a survey of fellowship program directors. Ann Surg. 2013;258(3):440-449. doi:10.1097/SLA.0b013e3182a191ca https://pubmed.ncbi.nlm.nih.gov/24022436/6.        George BC, Bohnen JD, Williams RG, et al. Readiness of US General Surgery Residents for Independent Practice. Ann Surg. 2017;266(4):582-594. doi:10.1097/SLA.0000000000002414 https://pubmed.ncbi.nlm.nih.gov/28742711/7.        Brasel KJ, Lindeman B, Jones A, et al. Implementation of Entrustable Professional Activities in General Surgery: Results of a National Pilot Study. Ann Surg. 2023;278(4):578-586. doi:10.1097/SLA.0000000000005991 https://pubmed.ncbi.nlm.nih.gov/37436883/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/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Ileocolic resection is one of the most common operations performed for Crohn's disease, yet the optimal approach to anastomotic construction and mesenteric management remains an active area of debate. From the configuration of the anastomosis to the extent of mesenteric excision, emerging evidence suggests that surgical technique may play a meaningful role in disease outcomes. Join Drs. Jared Hendren, Elissa Dabaghi, Joseph Trunzo, Ajaratu Keshinro, and David Rosen as they discuss methods for ileocolic anastomosis in Crohn's disease while reviewing the latest literature.Hosts: - Jared Hendren, MDInstitution: Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio- Elissa Dabaghi, MDInstitution: Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio- Joseph Trunzo, MDInstitution: Department of Colon and Rectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OhioX/Twitter @joseph_trunzo- Ajaratu Keshinro, MDInstitution: Department of Colon and Rectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OhioX/Twitter- @AJKesh- David Rosen, MDInstitution: Department of Colon and Rectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OhioX/Twitter- @davidrrosenmdLearning Objectives: By the end of this episode, listeners will be able to:1.     Evaluate the evidence for the Kono-S anastomosis in reducing postoperative recurrence after ileocolic resection for Crohn's disease2.     Describe the role of the mesentery in driving recurrence and discuss how mesenteric-targeting surgical approaches may influence outcomes3.     Interpret the results of recent randomized controlled trials on extended mesenteric excision and apply them to surgical decision-making in ileocolic resection for Crohn's diseasePlease 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/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

As cancer vaccines move into Phase II and III clinical trials, it isincreasingly important for surgeons to understand their role in thisevolving landscape. What exactly are these vaccines, how do they work,and what should the surgical community know about theirimplementation? Join BTK surgical education fellows Kara Button andMichelle LaBella as they sit down with Professor Robert Jones to breakdown the science of mRNA vaccines, the logistics of tissueprocurement, and the future of cancer care.Hosts:- Professor Robert Jones: Consultant Liver Surgeon, Liverpool UniversityHospitals; UK National Institute for Healthcare Research, Co-Lead forthe Cancer Vaccine Innovation Pathway, Bowel Cancer UK and RoyalCollege of Surgeons UK Lead for Research into Advanced Bowel Cancer,and UK Chief Investigator for the BNT122-01 trial.https://www.linkedin.com/in/robert-jones-6103722a/- Kara Button, DO: General Surgery Resident, Maine Medical Center;Behind the Knife Surgical Education Fellow.- Michelle LaBella, MD: General Surgery Resident; University of NorthCarolina; Behind the Knife Surgical Education Fellow.References:https://clinicaltrials.biontech.com/trials/BNT122-01Jones RP, Lee LYW, Corrie PG, et al. Individualized cancer vaccinesversus surveillance after adjuvant chemotherapy for surgicallyresected high-risk stage 2 and stage 3 colorectal cancer: protocol fora randomized trial. BJS. 2023;110(12):1883-1884.doi:10.1093/bjs/znad332https://pubmed.ncbi.nlm.nih.gov/37856683/Tie J, Wang Y, Loree JM, et al. Circulating tumor DNA-guided adjuvanttherapy in locally advanced colon cancer: the randomized phase 2/3DYNAMIC-III trial. Nat Med. 2025;31(12):4291-4300.doi:10.1038/s41591-025-04030-whttps://pubmed.ncbi.nlm.nih.gov/41115959/Rojas LA, Sethna Z, Soares KC, et al. Personalized RNA neoantigenvaccines stimulate T cells in pancreatic cancer. Nature.2023;618(7963):144-150. doi:10.1038/s41586-023-06063-yhttps://pubmed.ncbi.nlm.nih.gov/37165196/https://www.cancer.ox.ac.uk/research/lynchvax#:~:text=The%20LynchVax%20program%2C%20funded%20by,individuals%20with%20this%20genetic%20conditionPlease 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/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Can an algorithm actually give you your life back? A recent Stanford paper revealed that using large language models at home yields massive efficiency gains—up to 176%. For busy surgeons drowning in clinical duties and administrative bloat, every reclaimed second is priceless.In this episode of Behind the Knife, Ayman and Patrick sit down with Christian Péan—an orthopedic trauma surgeon, Duke's Executive Director of AI and IT Innovation, and the Founder/CEO of RevelAi Health. He's also a Core faculty member at the Duke-Margolis Institute for Health Policy. Dr. Péan breaks down how naturally skeptical surgeons can adopt AI to save time, shares his granular daily workflow, and discusses his mission to cure physician burnout through tech. Whether you are a tech enthusiast or a total skeptic, this episode gives you the practical playbook for integrating AI into your surgical career today.Hosts:- Ayman Ali, MDAyman Ali is a PGY-4 at Duke Hospital and current Behind the Knife fellow.- Patrick Georgoff, MD @georgoffPatrick Georgoff is faculty in the Department of Surgery at the Duke University School of Medicine where he serves as an Associate Professor of Trauma, Acute, and Critical Care Surgery and Trauma Medical Director. He is a leading educator and creator for Behind the Knife, a premier digital education platform and podcast advancing surgical training through innovative, high-yield multimedia content.- Christian Péan, MD @DrChristianPeanChristian Péan is faculty in the Department of Orthopaedic Surgery at the Duke University School of Medicine where he serves as Executive Director of AI and IT Innovation. He is the Founder and CEO of RevelAi Health, a health technology company advancing the transition to value-based care in musculoskeletal health with conversational AI. He is also author of the popular substack Techy Surgeon.  https://www.revelaihealth.com/https://techysurgeon.substack.com/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/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

What are the experts saying about thyroid cancer treatment in 2025?  Maybe it's time to discuss deescalation of aggressive surgical care for lower risk thyroid cancers.  We can accept that less surgery may be appropriate in select cases, including more thyroid lobectomies versus total thyroidectomies, consider less invasive approaches such as percutaneous ablation techniques, and utilize more observation with active surveillance.  Early assessment of treatment may allow appropriate reduction in use of radioactive iodine ablation and more relaxed routine monitoring can reduce surveillance burden to patients and providers. Hosts:  - Amanda Doubleday, DO, MBA, Assistant Professor, Waukesha Surgical Specialists, ProHealth Care.  Affiliated with University of Wisconsin School of Medicine and Public Health, Department of Surgery.  - Simon Holoubek, DO, MPH, Assistant Professor, University of Wisconsin School of Medicine and Public Health, Department of Surgery.  - Alexander Chiu, MD, Assistant Professor, University of Wisconsin School of Medicine and Public Health, Department of Surgery.  - Rebecca S Sippel, MD, FACS, Professor and Chair of Division of Endocrine Surgery, Vice Chair of Academic Affairs and Professional Development, University of Wisconsin School of Medicine and Public Health, Department of Surgery.  Learning Objectives:- Risk stratification system now includes 4 categories: low, low-intermediate, high-intermediate, and high-TSH suppression targets are simplified:  below the normal range if there is structural or biochemical disease and in the normal range if disease free. - Thyroid lobectomy is recommended for tumors < 2cm cT1N0 tumors and can be considered for tumors 2-4 cm. - Micro-Papillary Thyroid Carcinoma (

For decades, a tight carotid stenosis felt like a ticking time bomb — a plaque waiting to throw an embolus and cause the next stroke. We were taught that severe narrowing meant surgery, and trials like ACAS and ACST-1 seemed to prove it. But medicine has changed. Statins, antiplatelets, tighter blood pressure control, even PCSK9 and GLP-1 therapies have quietly slashed stroke risk, and now newer data from CREST-2 suggest that for many asymptomatic patients, the knife — or the stent — may not add much at all. So if modern medical therapy works better than ever… who actually benefits from intervention anymore? Today, we unpack the evidence, the controversies, and how to counsel the patient who feels perfectly fine but has high-grade stenosis.Hosts: Carolyn Judge, Andrew Huang, Luciano Delbono, Frank Davis, Robert BeaulieuInstitution: University of Michigan, Department of Surgery, Section of Vascular SurgeryLearning objectives: Describe how modern intensive medical therapy has transformed the natural history of asymptomatic carotid stenosis and explain why contemporary patients experience substantially lower annual stroke risk than those in earlier eras. Interpret and compare the results of landmark trials—including ACAS, ACST-1, and CREST-2—to assess the relative benefits of medical therapy, endarterectomy, and stenting. Apply current evidence and guideline recommendations to patient care by selecting which asymptomatic patients are most likely to benefit from carotid revascularization versus optimized medical therapy alone. References:SVS Guidelines:Brook, R. D., et al. (2022). Society for Vascular Surgery clinical practice guidelines for management of extracranial carotid artery disease. Journal of Vascular Surgery, 75(1), e1–e67. https://doi.org/10.1016/j.jvs.2021.09.031CREST (1)Brott, T. G., Hobson, R. W., Howard, G., et al. (2010). Stenting versus endarterectomy for treatment of carotid-artery stenosis. New England Journal of Medicine, 363(1), 11–23. https://doi.org/10.1056/NEJMoa0912321CREST-2Brott, T. G., Howard, G., Fong, P., et al. (2024). Randomized trial of carotid artery stenting or carotid endarterectomy vs best medical therapy for asymptomatic carotid stenosis: CREST-2 results. [Manuscript in preparation]. ClinicalTrials.gov Identifier: NCT02089217. Retrieved from https://clinicaltrials.gov/ct2/show/NCT02089217ACST-1Halliday, A., Mansfield, A., Marro, J., et al. (2004). Randomised trial of carotid artery surgery for asymptomatic stenosis. Lancet, 363(9420), 1491–1502. https://doi.org/10.1016/S0140-6736(04)16153-1ACST-2Halliday, A., Bulbulia, R., Bonati, L. H., et al. (2021). Carotid artery stenting versus carotid endarterectomy in patients with asymptomatic carotid stenosis (ACST-2): A randomised trial. Lancet, 398(10291), 1065–1073. https://doi.org/10.1016/S0140-6736(21)01980-1ACASExecutive Committee for the Asymptomatic Carotid Atherosclerosis Study. (1995). Endarterectomy for asymptomatic carotid stenosis. JAMA, 273(18), 1421–1428. https://doi.org/10.1001/jama.1995.03520420033036Sponsor URL: https://www.goremedical.com/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/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

In this episode, our expert panel dives into the critical, historically debated topic of early burn wound excision using a real-world case of a patient with massive surface area burns. We explore the dramatic shift from the pre-1970s "wait and watch" approach to the modern standard of early source control, backed by landmark literature showing reduced mortality and shorter hospital stays. The discussion also highlights the nuances of this timeline, covering specific scenarios where delaying surgery is actually safer due to physiologic instability, uncertain burn depths, or mass casualty events. Tune in to hear the evidence behind these clinical decisions and learn why modern burn surgeons believe that removing necrotic eschar early is the best way to dominate the day!Hosts: - Kathleen Romanowski – University of California Davis Hospital, Shriners Hospital Sacramento- Laura Johnson – Grady Memorial Hospital- Lauren Nosanov – Grady Memorial Hospital-  Victoria Miles – Louisiana State University Health Science Center, University Medical Center New OrleansLearning Objectives:- Review the historical development of early burn excision and understand how these studies shaped modern burn surgical practice.-  Evaluate contemporary evidence on the timing of burn excision.- Apply current evidence and clinical principles to operative decision-making, identifying key patient and injury factors that influence the timing of excision and grafting in patients with major thermal injury.References:- Thompson P, Herndon DN, Abston S, Rutan T. Effect of early excision on patients with major thermal injury. J Trauma. 1987 Feb;27(2):205-7. doi: 10.1097/00005373-198702000-00019. PMID: 3820353. https://pubmed.ncbi.nlm.nih.gov/3820353/-  Gray DT, Pine RW, Harnar TJ, Marvin JA, Engrav LH, Heimbach DM. Early surgical excision versus conventional therapy in patients with 20 to 40 percent burns. A comparative study. Am J Surg. 1982 Jul;144(1):76-80. doi: 10.1016/0002-9610(82)90605-5. PMID: 7046487. https://pubmed.ncbi.nlm.nih.gov/7046487/- De La Tejera G, Corona K, Efejuku T, Keys P, Joglar A, Villarreal E, Gotewal S, Wermine K, Huang L, Golovko G, El Ayadi A, Palackic A, Wolf SE, Song J. Early wound excision within three days decreases risks of wound infection and death in burned patients. Burns. 2023 Dec;49(8):1816-1822. doi: 10.1016/j.burns.2023.06.003. Epub 2023 Jun 15. PMID: 37369613; PMCID: PMC10721718. https://pubmed.ncbi.nlm.nih.gov/37369613/- Ramsey WA, O'Neil CF Jr, Corona AM, Cohen BL, Lyons NB, Meece MS, Saberi RA, Gilna GP, Satahoo SS, Kaufman JI, Schulman CI, Namias N, Proctor KG, Pizano LR. Burn excision within 48 hours portends better outcomes than standard management: A nationwide analysis. J Trauma Acute Care Surg. 2023 Jul 1;95(1):111-115. doi: 10.1097/TA.0000000000003951. Epub 2023 Apr 11. PMID: 37038260. https://pubmed.ncbi.nlm.nih.gov/37038260/- Hayashi K, Sasabuchi Y, Matsui H, Nakajima M, Otawara M, Ohbe H, Fushimi K, Ono K, Yasunaga H. Does early excision or skin grafting of severe burns improve prognosis? A retrospective cohort study. Burns. 2023 May;49(3):554-561. doi: 10.1016/j.burns.2023.01.013. Epub 2023 Feb 3. PMID: 36774244. https://pubmed.ncbi.nlm.nih.gov/36774244/- Janzekovic Z. Once upon a time ... how west discovered east. J Plast Reconstr Aesthet Surg. 2008;61(3):240-4. doi: 10.1016/j.bjps.2008.01.001. Epub 2008 Feb 1. PMID: 18243082. https://pubmed.ncbi.nlm.nih.gov/18243082/

This episode includes a full, sample cardiothoracic scenario pulled directly from our Cardiothoracic Surgery Oral Board Review Course. Listen in and test your clinical pathways in real-time as we walk through the perfect answers and provide high-yield commentary to help you pass the "hot seat."About our Cardiothoracic Surgery Oral Board Review Course: 43 High-Yield Scenarios Dual-Format Learning: Each case includes "Part A" (a straight run-through of the perfect exam response) and "Part B" (the same scenario packed with expert tips, tricks, and commentary). Free Simulator Access: Every purchase of the course includes access to our new AI-powered Oral Board Simulator, allowing you to practice your verbal responses under pressure. Resources: Cardiothoracic Surgery Oral Board Review Course: https://app.behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review Oral Board Simulator: https://app.behindtheknife.org/oral-board-simulator Download the BTK App on iOS and Android for on-the-go studying. DOMINATE THE DAY!

This mini-series on Behind the Knife delves into the technical aspects of the Operative Standards for Cancer Surgery, developed through the American College of Surgeons Cancer Research Program and Cancer Surgery Standards Program. This episode highlights sentinel lymph node biopsy for breast cancer.Hosts:- Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a Surgical Oncology fellow at MD Anderson Cancer Center.- Lauren Postlewait, MD, FACS, is an Associate Professor of Surgery at Emory University School of Medicine and is the Medical Director of the Breast Center at Grady Memorial Hospital in Atlanta, GA.- Chantal Reyna, MD, FACS (@kprgrl3) is a Breast surgical oncologist at Loyola University Medical Center in Chicago, IL and serves as the oncology clinical lead for the breast service line.Guest:- Susan E. Pories, MD, FACS (@SusanPoriesMD) is a professor of surgery, vice chair for quality and safety, and director of the Rutger's Breast Center at the University hospital. Learning Objectives: -       Understand the definition and identification of axillary sentinel lymph node. -       Understand the technique for injecting tracer or dye to perform sentinel lymph node biopsy. -       Understand the importance of preincision drainage evaluation and transcutaneous localization.-       Understand techniques to minimize seroma formation.Links to Papers Referenced in this EpisodeOperative Standards for Cancer Surgery, Volume 1: Breast, Lung, Pancreas, Colonhttps://www.facs.org/quality-programs/cancer-programs/cancer-surgery-standards-program/operative-standards-for-cancer-surgery/purchase/Kindle edition:https://www.amazon.com/Operative-Standards-Cancer-Surgery-Section-ebook/dp/B07MWSNFSBSentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial Lancet Oncol. 2010 Oct;11(10):927-33.https://pubmed.ncbi.nlm.nih.gov/20863759/Improved Axillary Evaluation Following Neoadjuvant Therapy for Patients With Node-Positive Breast Cancer Using Selective Evaluation of Clipped Nodes: Implementation of Targeted Axillary Dissection J Clin Oncol. 2016 Apr 1;34(10):1072-8.https://pubmed.ncbi.nlm.nih.gov/26811528/The false-negative rate of sentinel node biopsy in patients with breast cancer: a meta-analysis World J Surg. 2012 Sep;36(9):2239-51. https://pubmed.ncbi.nlm.nih.gov/22569745/Effect of lymphoscintigraphy drainage patterns on sentinel lymph node biopsy in patients with breast cancer Am J Surg. 2005 Oct;190(4):557-62.https://pubmed.ncbi.nlm.nih.gov/16164919/Sentinel Lymph Node Biopsy vs No Axillary Surgery in Patients With Small Breast Cancer and Negative Results on Ultrasonography of Axillary Lymph Nodes: The SOUND Randomized Clinical Trial JAMA Oncol. 2023 Nov 1;9(11):1557-1564.https://pubmed.ncbi.nlm.nih.gov/37733364/Choosing Wisely GuidelinesSociety of Surgical Oncology. Released 2016 July 12; last updated 2020 November 13. Choosing Wisely: Five Things Physicians and Patients Should Question.https://surgonc.org/wp-content/uploads/2020/11/SSO-5things-List_2020-Updates-11-2020.pdfPlease 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/listenBehind the Knife Premium:General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewOral Board Simulator: https://app.behindtheknife.org/oral-board-simulatorTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

This episode includes two full, sample vascular scenarios pulled directly from our Vascular Surgery Oral Board Review Course. Listen in and test your clinical pathways in real-time as we walk through the perfect answers and provide high-yield commentary to help you pass the "hot seat."Sample Scenarios Included in This Episode: Case 22: Aortoenteric Fistula (AEF). A 78-year-old woman presents to the ER with a massive upper GI bleed and a history of an open AAA repair 10 years ago. We walk you through the immediate stabilization, CTA evaluation, and the definitive operative management—including axillobifemoral bypass, aortic stump closure, and duodenal repair. Case 27: Acute Mesenteric Ischemia. A 79-year-old woman with a history of atrial fibrillation presents with abdominal pain out of proportion to her physical exam. Test your decision-making on systemic heparinization, SMA embolectomy versus stenting (ROMS), and how to appropriately evaluate bowel viability with a second-look laparotomy. About our Vascular Surgery Oral Board Review Course: 72 High-Yield Scenarios: Covering everything from carotid stump syndrome to a AAA with a horseshoe kidney. Dual-Format Learning: Each case includes "Part A" (a straight run-through of the perfect exam response) and "Part B" (the same scenario packed with expert tips, tricks, and commentary). Free Simulator Access: Every purchase of the course includes access to our new AI-powered Oral Board Simulator, allowing you to practice your verbal responses under pressure. Resources: Vascular Surgery Oral Board Review Course: https://app.behindtheknife.org/premium/vascular-surgery-oral-board-audio-review Oral Board Simulator: https://app.behindtheknife.org/oral-board-simulator Download the BTK App on iOS and Android for on-the-go studying. DOMINATE THE DAY!

In response to increasing surgeon burnout, unsustainable clinical demands, and ongoing loss of surgeon autonomy in the setting of employee-based models, the American College of Surgeons is speaking out. In this episode, hosts Dr. Steven Thornton and Dr. Emma Burke sit down with Dr. Douglas Wood, Chair of Surgery at the University of Washington and Dr. Thomas Varghese, Editor-in-Chief of the Journal of the American College of Surgeons, to discuss the new ACS Workplace Standards Framework. The conversation covers how this initiative grew out of discussions around unionization, what domains the framework addresses — from call intensity and OR block access to administrative burden and inpatient census limits — and how specialty-specific guidelines can be developed and implemented at the local level. Dr. Wood and Dr. Varghese also reflect on the culture of "unlimited endurance" that has long defined surgery, why meaningful systems-level change is both necessary and achievable, and how improving workplace sustainability could transform the pipeline of future surgeons for generations to come.Hosts: Emma Burke and Steven ThorntonGuests: Dr. Douglas Wood & Dr. Thomas Varghese Jr.Papers Discussed:1. Wood DE, Wolinsky PR, Dodgion CM, et al. Developing Specialty-Specific Workplace Standards for Surgeons: A Framework to Support Sustainable Surgical Careers. Journal of the American College of Surgeons, 2026. DOI: 10.1097/XCS.0000000000001880 https://pubmed.ncbi.nlm.nih.gov/41773743/2. Varghese TK Jr. Toward Sustainable Surgical Practice: Defining Workplace Standards for the Modern Era. J Am Coll Surg. 2026 Mar 3. doi: 10.1097/XCS.0000000000001888. Epub ahead of print. PMID: 41773737. https://pubmed.ncbi.nlm.nih.gov/41773737/***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6Please 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/listenBehind the Knife Premium:General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewOral Board Simulator: https://app.behindtheknife.org/oral-board-simulatorTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

The House Judiciary Committee just dropped a 47-page report calling the National Residency Match Program a hiring monopoly that harms patients, doctors, and the public — and the surgical community is talking. In this episode, Dr. Patrick Georgoff is joined by BTK surgical education fellows Dr. Emma Burke and Dr. Agnes Prem Kumar, along with special guest Dr. Brian Carmody (aka the Sheriff of Sodium), a pediatric nephrologist and one of the sharpest analysts of medical education policy working today. Together, they break down the report's central claims: that the NRMP exercises monopolistic control over residency hiring, suppresses resident wages, and strips trainees of bargaining power — and they separate what the report gets right from where its rhetoric badly outruns its evidence. From the history of Section 207 and the antitrust lawsuit that nearly brought down academic medicine, to the real economics of GME funding, resident unionization, and what a match-free world would actually look like — this is the context you need to understand one of the most consequential debates in graduate medical education in years. Don't miss Dr. Carmody's six-part YouTube series on the match, linked in the show notes.Congressional Report: https://judiciary.house.gov/media/press-releases/new-report-exposes-how-medical-residency-hiring-monopoly-harms-patients-andThe Match 6-Part Video Series: https://www.youtube.com/playlist?list=PLc36yFQWkuG1sXk62A3zeRWB8aoK5SISPThe Sodium Sheriff Blog:  https://thesheriffofsodium.com/***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6Please 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/listenBehind the Knife Premium:General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewOral Board Simulator: https://app.behindtheknife.org/oral-board-simulatorTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

A career in surgery has a profound impact on those who practice the craft. High rates of poor mental health are well described but incompletely understood. One potential mechanism for advancing our understanding of surgeon well-being is studying surgeons' emotional experiences. Shame, a self-conscious emotion reflecting how an individual feels about themselves, could be a particularly powerful lens. In this series on shame in surgery, we explore what we know about shame in surgery and what shame can tell us about learning and working as surgeons.In this third episode, we talk with Drs. Sheina Theodore and Tejal Brahmbhatt about their study examining the relationship between internalized shame states and burnout among surgery residents. They make a compelling case that addressing the well-being crisis in surgery requires looking beyond external stressors to the internal experience of shame: the quiet, invisible voice that tells residents they aren't good enough, and ask what role the culture of surgery plays in that internal monologue. Host: Steven ThorntonGuests:1.    Sheina Theodore (Assistant Professor of Surgery, Boston University)2.    Tejal Brahmbhatt (Associate Professor of Surgery, Cedars Sinai Medical Center) Publications Discussed:1.    Smith SM, Kobzeva-Herzog A, McGillen P, Castagne-Charlotin M, Davies J, Sanchez SE, Dechert T, Brahmbhatt TS, Theodore S. Internalized Shame Experiences and Burnout in General Surgery Residents. J Surg Educ. 2025 Apr;82(4):103447. doi: 10.1016/j.jsurg.2025.103447. Epub 2025 Feb 6. PMID: 39919584. https://pubmed.ncbi.nlm.nih.gov/39919584/***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6Please 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/listenBehind the Knife Premium:General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewOral Board Simulator: https://app.behindtheknife.org/oral-board-simulatorTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

A career in surgery has a profound impact on those who practice the craft. High rates of poor mental health are well described but incompletely understood. One potential mechanism for advancing our understanding of surgeon well-being is studying surgeons' emotional experiences. Shame, a self-conscious emotion reflecting how an individual feels about themselves, could be a particularly powerful lens. In this series on shame in surgery, we explore what we know about shame in surgery and what shame can tell us about learning and working as surgeons. In this second episode, we talk with Dr. ElAbd and Dr. Zammit about their study examining the relationship between shame-based learning, grit, and burnout across surgical specialties. Their findings highlight how grit may both protect against burnout and mediate whether residents go on to shame others. Host: Steven ThorntonGuests:1.    Rawan ElAbd (Plastic Surgery Resident, McGill University)2.    Dino Zammit (Assistant Professor of Plastic Surgery, McGill University)Publications Discussed:1.    ElAbd R, Pu L, Esmonde-White C, ElHawary H, Vorstenbosch J, Zammit D. Association of Grit and Shame Based Learning on Burnout in Surgical Training: A Single Institution Analysis. J Surg Educ. 2025 Sep;82(9):103583. doi: 10.1016/j.jsurg.2025.103583. Epub 2025 Jun 27. PMID: 40580606.https://pubmed.ncbi.nlm.nih.gov/40580606/***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6Please 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/listenBehind the Knife Premium:General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewOral Board Simulator: https://app.behindtheknife.org/oral-board-simulatorTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

A career in surgery has a profound impact on those who practice the craft. High rates of poor mental health are well described but incompletely understood. One potential mechanism for advancing our understanding of surgeon well-being is studying surgeons' emotional experiences. Shame, a self-conscious emotion reflecting how an individual feels about themselves, could be a particularly powerful lens. In this series on shame in surgery, we explore what we know about shame in surgery and what shame can tell us about learning and working as surgeons.In this first episode, we talk with Dr. Will Bynum and Professor Luna Dolezal about how they understand shame in medicine, why it's so hard to see even when it's everywhere, and how developing what they call "shame competence" might be one of the most important steps we can take toward humanizing surgical training.Host: Steven ThorntonGuests: Will Bynum (Associate Professor of Family Medicine, Duke University) Luna Dolezal (Professor of Philosphy and Medical Humanities, Exeter University) Publications Discussed: Dolezal L, Bynum W. Shame competence: addressing the effects of shame in health care. Lancet. 2024 Oct 19;404(10462):1514-1515. doi: 10.1016/S0140-6736(24)02269-4. PMID: 39426826. https://pubmed.ncbi.nlm.nih.gov/39426826/ The Nocturnists. Shame in Medicine: The Lost Forest [podcast series]. The Nocturnists; 2022. https://thenocturnists.org/shameinmedicine Nguyen LN, Bynum WE 4th. When I Say…self-conscious emotions. Med Educ. 2021 Mar;55(3):291-292. doi: 10.1111/medu.14425. Epub 2020 Dec 23. PMID: 33289140. https://pubmed.ncbi.nlm.nih.gov/33289140/ Tracy, J. L., Robins, R. W., & Tangney, J. P. (Eds.). (2007). The self-conscious emotions: Theory and research. The Guilford Press. ***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6Please 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/listenBehind the Knife Premium:General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewOral Board Simulator: https://app.behindtheknife.org/oral-board-simulatorTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Welcome back to the AI journal club! In this episode, we bring you a deep dive into a game-changing paper from The Lancet -- the MASAI study. This is the first randomized controlled trial to evaluate the use of artificial intelligence in breast cancer screening and we're so excited to discuss it.We'll break down the study's impressive findings on interval cancer rates, sensitivity, and massive workload reductions for radiologists. Beyond the data, we'll tackle the big-picture questions and some sensational recent headlines. Are we deploying AI too fast? Or is it time to go faster? Hosts: - Ayman Ali, MDAyman Ali is a Behind the Knife fellow and general surgery PGY-4 at Duke Hospital in his academic development time where he focuses on data science, artificial intelligence, and surgery. - Ruchi Thanawala, MD: @Ruchi_TJRuchi Thanawala is an Associate Professor of Informatics and Thoracic Surgery at Oregon Health and Science University (OHSU) and founder of Firefly, an AI-driven platform that is built for competency-based medical education. In addition, she is the Director of the Surgical Data and Decision Sciences Lab for the Department of Surgery at OHSU and Associate Program Director for the Clinical Informatics Sub-specialty Fellowship. - Phillip Jenkins, MD: @PhilJenkinsMDPhil Jenkins is a general surgery PGY-4 at Oregon Health and Science University and a National Library of Medicine Post-Doctoral fellow pursuing a master's in clinical informatics.***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6Please 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/listenBehind the Knife Premium:General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewOral Board Simulator: https://app.behindtheknife.org/oral-board-simulatorTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Join the Johns Hopkins Thoracic Surgery Subspecialty team on this rapid research review revealing how investigative efforts have changed the way we view and use Veno-venous (VV) ECMO therapy in the pre-lung transplant patient population working to avoid ventilator dependence and the associated morbidity while facilitating continued ambulation and preoperative optimization. Hosts:- Dr. Alfred J. Casillan, MD, PhDAttending Thoracic Surgeon Johns Hopkins Hospital - Kyla Rakoczy, MD Johns Hopkins General Surgery ResidentReferences:Awake ECMO as Bridge to Lung Transplantation Fuehner T, Kuehn C, Hadem J, Wiesner O, Gottlieb J, Tudorache I, et al. Extracorporeal membrane oxygenation in awake patients as bridge to lung transplantation. American Journal of Respiratory and Critical Care Medicine. 2012;185(7):763–768. PMID: 22268135 Link: https://pubmed.ncbi.nlm.nih.gov/22268135/Predictors of Successful ECMO Bridging Tipograf Y, Salna M, Minko E, Grogan EL, Sonett JR, Bacchetta MD. Outcomes of extracorporeal membrane oxygenation as a bridge to lung transplantation. Annals of Thoracic Surgery. 2019;107(5):1456–1463. PMID: 30790550 Link: https://pubmed.ncbi.nlm.nih.gov/30790550/Intubation Status and ECMO Bridging Outcomes Zhou AL, Jennings MR, Akbar AF, et al. Utilization and outcomes of nonintubated extracorporeal membrane oxygenation as a bridge to lung transplant. Journal of Heart and Lung Transplantation. 2025;44(4):661–669. PMID: 39486773 Link: https://pubmed.ncbi.nlm.nih.gov/39486773/ECMO Duration and Waitlist Mortality Shou BL, Kalra A, Zhou AL, et al. Impact of extracorporeal membrane oxygenation bridging duration on lung transplant outcomes. Annals of Thoracic Surgery. 2024;118(2):496–503. PMID: 38740080 Link: https://pubmed.ncbi.nlm.nih.gov/38740080/Mechanical Ventilation as a Risk Marker Mason DP, Thuita L, Alster JM, Murthy SC, Budev MM, Mehta AC, et al. Lung transplantation in recipients requiring mechanical ventilation: outcomes and risk factors. Journal of Thoracic and Cardiovascular Surgery. 2010;139(1):114–119. PMID: 19931096 Link: https://pubmed.ncbi.nlm.nih.gov/19931096/***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6Please 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/listenBehind the Knife Premium:General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewOral Board Simulator: https://app.behindtheknife.org/oral-board-simulatorTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Welcome back to Behind the Knife with Cody, Patrick, Jason, and Ayman. Today, we are tackling a defining professional ritual for every surgical trainee: the Morbidity and Mortality (M&M) Conference. We are providing a practical roadmap to help you build clear, high-quality presentations that facilitate real learning for the entire room. Whether you are a junior resident preparing for your first case or an attending looking to moderate effectively, this episode covers exactly what to include, what to leave out, and how to properly frame a complication.Hosts: Cody Mullens, MD Patrick Georgoff, MD Jason Bingham, MD Ayman Ali, MD ***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6Surgical Instrument Flashcard Course: https://app.behindtheknife.org/premium/surgical-instrument-flashcardsPlease 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/listenBehind the Knife Premium:General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Xenotransplantation—the use of organs from other species to treat human disease—has long existed at the intersection of science fiction and surgical innovation. While early efforts were marked by limited success and ethical controversy, recent advances in genetic engineering, immunosuppression, and organ preservation have brought the field closer than ever to clinical reality.In this episode of Behind the Knife, we are joined by Dr. Joshua Mezrich to explore the history, science, and future of xenotransplantation. Through a narrative lens, we trace the evolution of transplantation from its earliest experimental days to the modern era of gene-edited porcine organs, highlighting key breakthroughs, ethical challenges, and the pioneers who shaped the field. We also examine the current state of clinical trials and what xenotransplantation may mean for the future of organ availability and transplant practice.Hosts - Madeline Cloonan, MD PhD, General Surgery Resident, University of Nebraska Medical Center, @maddie_cloonan  - Joshua Mezrich, MD, Professor, University of Wisconsin School of Medicine and Public HealthLearning Objectives By the end of this episode, listeners will be able to:- Describe the historical evolution of xenotransplantation, including the primate and early porcine eras - Explain the key immunologic and biologic barriers to xenotransplantation, including hyperacute rejection and the role of natural antibodies - Summarize major scientific advances that enabled modern xenotransplantation, including cloning and CRISPR-based gene editing - Discuss recent clinical experiences and ongoing trials of xenotransplantation in humans -  Evaluate the ethical considerations and societal implications of xenotransplantation - Consider the potential role of xenotransplantation in addressing organ shortage and reshaping transplant eligibility and allocationCheck out Dr. Mezrich's new book! https://www.amazon.com/Every-Living-Creature-Xenotransplantation-Change-ebook/dp/B0FH14LF6K***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6***Surgical Instrument FlashCards: https://app.behindtheknife.org/premium/surgical-instrument-flashcards 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/listenBehind the Knife Premium:General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

INTRODUCING Behind the Knife OBGYN Oral Board Review!The oral boards aren't just about knowledge—they are about executing under pressure. This course is designed to give you the structure and confidence to command the room. We have curated 98 high-yield scenarios covering the "Big Three" of the exam: Obstetrics, Gynecology, and Office Practice. Whether it's a surgical emergency or a complex clinic workup, we will walk you through exactly how to articulate your plan, defend your decisions, and pass this exam.Each scenario includes 2 parts. The first part is a perfectly executed scenario.  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 are confident you will find this unique, dual format approach a highly effective way to prepare for the test.Please check out the preview episodes below that include Parts A and B, with and without commentary.This course includes access to our Oral Board Simulator.  Step into the hot seat and experience the pressure of the real exam and receive detailed, actionable feedback with the most advanced oral board prep available.   3-Month Purchase - 10 exams 6-Month Purchase - 22 exams 12-Month Purchase - 46 exams Learn More: https://app.behindtheknife.org/premium/obgyn-oral-board-reviewDOMINATE THE DAY!

In this episode, we explore the grueling realities of the general surgery preliminary year—a high-stakes, one-year audition for surgical trainees operating without a safety net. We sit down with a program director, a former IMG prelim turned attending, and a recently successful SOAP applicant to uncover exactly what it takes to survive the scramble and excel clinically. Listen in to learn actionable strategies for navigating hospital expectations, securing vital mentorship, and ultimately turning your preliminary position into a secured categorical spot.Hosts:Ayman Ali, MDDr. Ayman Ali is a Behind the Knife fellow and general surgery PGY-4 at Duke Hospital. Kevin Naresh Shah, MDDr. Kevin Shah is an Assistant Professor of Hepatobiliary Surgery at the Duke University School of Medicine and Program Director of General Surgery. Katharine Louise Jackson, MBBSDr. Louise Jackson is an Assistant Professor of Colon and Rectal Surgery at the Duke University School of Medicine and the Medical Student Clerkship Director. Rafael Felix Tiongco, MDDr. Rafael Tiongco is a first-year resident at Penn State College of Medicine.Sponsor Disclaimer: Visit goremedical.com/btkpod to learn more about GORE® SYNECOR Biomaterial, including supporting references and disclaimers for the presented content.  Refer to Instructions for Use at eifu.goremedical.com for a complete description of all applicable indications, warnings, precautions and contraindications for the markets where this product is available. Rx only ***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6Please 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/listenBehind the Knife Premium:General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Identification of pancreatic cystic lesions has become increasingly common due to improved resolution and increased utilization of cross-sectional imaging. However, there are many types of pancreatic cysts, each with varying degrees of malignant potential. In this episode from the HPB team at Behind the Knife, listen in as we discuss the clinical presentation, diagnostic work-up, and management strategies for various pancreatic cysts: Pseudocysts, Serous Cystadenomas, Mucinous Cystic Neoplasms, and IPMNs, amongst others. HostsAnish J. Jain MD (@anishjayjain) is a current PGY4 General Surgery resident at Stanford University and a former T32 Research Fellow at the University of Texas MD Anderson Cancer Center.Jon M. Harrison MD is a Hepatobiliary & Pancreatic (HPB) surgeon at the Massachusetts General Hospital in Boston, MA and a former HPB Surgery fellow at Stanford University. Learning Objectives·      Develop an understanding of the clinical presentation, diagnostic work-up, and treatment of benign pancreatic cysts·      Develop an understanding of the clinical presentation, diagnostic work-up, and treatment of pre-malignant pancreatic cysts·      Develop an understanding of when surveillance is appropriate for management of pancreatic cysts, and the criteria involved in making that determination·      Develop an understanding of the prognostic utility of PancSeq for IPMNsReferences: Paniccia A, Polanco PM, Boone BA, et al. Prospective, Multi-Institutional, Real-Time Next-Generation Sequencing of Pancreatic Cyst Fluid Reveals Diverse Genomic Alterations That Improve the Clinical Management of Pancreatic Cysts. Gastroenterology. 2023 Jan;164(1):117-133.e7.PubMed Link: https://pubmed.ncbi.nlm.nih.gov/36209796/ Ohtsuka T, Fernandez-Del Castillo C, Furukawa T, et al. International evidence-based Kyoto guidelines for the management of intraductal papillary mucinous neoplasm of the pancreas. Pancreatology. 2024 Mar;24(2):255-270.PubMed Link: https://pubmed.ncbi.nlm.nih.gov/38182527/ Zelga P, Hernandez-Barco YG, Qadan M, et al. Number of Worrisome Features and Risk of Malignancy in Intraductal Papillary Mucinous Neoplasm. J Am Coll Surg. 2022 Jun 1;234(6):1021-1030.PubMed Link: https://pubmed.ncbi.nlm.nih.gov/35703792/ Ciprani D, Weniger M, Qadan M, et al. Risk of malignancy in small pancreatic cysts decreases over time. Pancreatology. 2020 Sep;20(6):1213-1217.PubMed Link: https://pubmed.ncbi.nlm.nih.gov/32819844/ ***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6Sponsor Disclaimer: Visit goremedical.com/btkpod to learn more about GORE® SYNECOR Biomaterial, including supporting references and disclaimers for the presented content.Refer to Instructions for Use at eifu.goremedical.com for a complete description of all applicable indications, warnings, precautions and contraindications for the markets where this product is available. Rx only 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/listenBehind the Knife Premium:General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

With the increasing incidence of colorectal cancer in those less than 50 years of age, one must wonder how many patients present with a Stage IV diagnosis. Take a deep dive with us discussing the management of metastatic colorectal cancer by joining our team and guests, Drs. Cathy Eng, Michael D'Angelica, and Nina Sanford.Hosts: - Dr. Janet Alvarez - General Surgery Resident at New York Medical College/Metropolitan Hospital Center- Dr. Wini Zambare – General Surgery Resident at Weill Cornell Medical Center/New York Presbyterian- Dr. Philip Bauer, Assistant Professor of Surgery, Division of Colon and Rectal Surgery, The Ohio State University Wexner Medical Center, Arthur G. James Cancer Hospital-  Dr. J. Joshua Smith MD, PhD, Chair, Department of Colon and Rectal Surgery at MD Anderson Cancer Center Guest Speakers:- Dr. Michael D'Angelica MD, FACS – Hepatopancreatobiliary Surgery, Memorial Sloan Kettering Cancer Center, Enid A. Haupt Chair in Surgery, Vice Chair, Education- Dr. Cathy Eng MD, FACP - Division of Hematology and Oncology, Vanderbilt-Ingram Cancer Center, David H. Johnson Endowed Chair in Surgical and Medical Oncology, Professor of Medicine, Hematology and Oncology, VICC Associate Director for Strategic Relations and Research Partnerships, Executive Director, Young Adult Cancers Program - Dr. Nina Sanford, MD – Radiation Oncology, UT Southwestern Medical Center, Chief of Gastrointestinal Radiation Oncology Service, Associate Professor Learning Objectives:1.     Review the epidemiology, prognosis, and common metastatic patterns of metastatic colorectal cancer (mCRC).2.     Discuss the role of systemic chemotherapy and targeted therapies in the first- and subsequent-line treatment of mCRC, including the impact of molecular biomarkers such as MSI/MMR, RAS, BRAF, and HER2.3.     Evaluate the indications and timing of surgical and locoregional therapies for metastatic colorectal cancer, particularly in patients with liver-limited or oligometastatic disease.4.     Describe the multidisciplinary management of mCRC, including the roles of radiation therapy, systemic therapy sequencing, and palliative interventions to optimize outcomes and quality of life.References:Singh, M., Morris, V. K., Bandey, I. N., Hong, D. S. & Kopetz, S. Advancements in combining targeted therapy and immunotherapy for colorectal cancer. Trends Cancer 10, 598–609 (2024). PubMed Link: https://pubmed.ncbi.nlm.nih.gov/38821852/Napolitano, S. et al. BRAFV600E mutant metastatic colorectal cancer: Current advances in personalized treatment and future perspectives. Cancer Treat. Rev. 134, (2025). PubMed Link: https://pubmed.ncbi.nlm.nih.gov/40009904/Ciardiello, F. et al. Clinical management of metastatic colorectal cancer in the era of precision medicine. CA. Cancer J. Clin. 72, 372–401 (2022). PubMed Link: https://pubmed.ncbi.nlm.nih.gov/35472088/Kim, S. Y. & Kim, T. W. Current challenges in the implementation of precision oncology for the management of metastatic colorectal cancer. ESMO Open 5, e000634 (2020). PubMed Link: https://pubmed.ncbi.nlm.nih.gov/32188714/Biller, L. H. & Schrag, D. Diagnosis and Treatment of Metastatic Colorectal Cancer: A Review. JAMA 325, 669–685 (2021). PubMed Link: https://pubmed.ncbi.nlm.nih.gov/33591350/Smith, J. J. et al. Genomic stratification beyond Ras/B-Raf in colorectal liver metastasis patients treated with hepatic arterial infusion. Cancer Med. 8, 6538–6548 (2019). PubMed Link: https://pubmed.ncbi.nlm.nih.gov/31503397/Saadat, L. V. et al. Hepatic Artery Infusion Chemotherapy Compared to Transarterial Radioembolization For Unresectable Colorectal Liver Metastases. Ann. Surg. 10.1097/SLA.0000000000006851 doi:10.1097/SLA.0000000000006851. PubMed Link: https://pubmed.ncbi.nlm.nih.gov/?term=10.1097/SLA.0000000000006851 (Linked via DOI search as the direct PMID is still indexing)Xiao, A. & Fakih, M. KRAS G12C Inhibitors in the Treatment of Metastatic Colorectal Cancer. Clin. Colorectal Cancer 23, 199–206 (2024). PubMed Link: https://pubmed.ncbi.nlm.nih.gov/38825433/André, T. et al. Pembrolizumab in Microsatellite-Instability–High Advanced Colorectal Cancer. N. Engl. J. Med. 383, 2207–2218 (2020). PubMed Link: https://pubmed.ncbi.nlm.nih.gov/33264544/Morris, V. K. et al. Treatment of Metastatic Colorectal Cancer: ASCO Guideline. J. Clin. Oncol. 41, 678–700 (2023). PubMed Link: https://pubmed.ncbi.nlm.nih.gov/36252154/Xu, Z. et al. Treatments for Stage IV Colon Cancer and Overall Survival. J. Surg. Res. 242, 47–54 (2019). PubMed Link: https://pubmed.ncbi.nlm.nih.gov/31071604/Smith, J. J. & D'Angelica, M. I. Surgical Management of Hepatic Metastases of Colorectal Cancer. Hematol. Oncol. Clin. North Am. 29, 61–84 (2015). PubMed Link: https://pubmed.ncbi.nlm.nih.gov/25475573/Strickler, J. H. et al. Tucatinib plus trastuzumab for chemotherapy-refractory, HER2-positive, RAS wild-type unresectable or metastatic colorectal cancer (MOUNTAINEER): a multicentre, open-label, phase 2 study. Lancet Oncol. 24, 496–508 (2023). PubMed Link: https://pubmed.ncbi.nlm.nih.gov/37142372/Kruijssen, D. E. W. van der et al. Upfront resection versus no resection of the primary tumor in patients with synchronous metastatic colorectal cancer: the randomized phase III CAIRO4 study conducted by the Dutch Colorectal Cancer Group and the Danish Colorectal Cancer Group. Ann. Oncol. 35, 769–779 (2024). PubMed Link: https://pubmed.ncbi.nlm.nih.gov/38852675/Hitchcock, K. E., Romesser, P. B. & Miller, E. D. Local Therapies in Advanced Colorectal Cancer. Hematol. Oncol. Clin. North Am. 36, 553–567 (2022). PubMed Link: https://pubmed.ncbi.nlm.nih.gov/35562258/Hitchcock, K. E. et al. Alliance for clinical trials in Oncology (Alliance) trial A022101/NRG-GI009: a pragmatic randomized phase III trial evaluating total ablative therapy for patients with limited metastatic colorectal cancer: evaluating radiation, ablation, and surgery (ERASur). BMC Cancer 24, 201 (2024). PubMed Link: https://pubmed.ncbi.nlm.nih.gov/38350888/Adam, R. et al. Liver transplantation plus chemotherapy versus chemotherapy alone in patients with permanently unresectable colorectal liver metastases (TransMet): results from a multicentre, open-label, prospective, randomised controlled trial. The Lancet 404, 1107–1118 (2024). PubMed Link: https://pubmed.ncbi.nlm.nih.gov/39306468/Elez, E. et al. Encorafenib, Cetuximab, and mFOLFOX6 in BRAF-Mutated Colorectal Cancer. N. Engl. J. Med. 392, 2425–2437 (2025). PubMed Link: https://pubmed.ncbi.nlm.nih.gov/40444708/***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6Please 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/listenBehind the Knife Premium:General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

In the final installment of the Healthcare Econ 101 miniseries, Dr. Christopher Childers and Dr. Nina Clark demystify the "black box" of medical billing and coding. This episode breaks down the two essential components of every medical bill: ICD codes, which identify the patient's diagnosis (the "why"), and CPT codes, which describe the specific services or procedures performed (the "what"). The discussion emphasizes that surgeons are legally and ethically responsible for the accuracy of these codes, regardless of whether a professional coder or an automated system handles the data entry. Listeners will gain insights into the "Global Period," the pitfalls of illegal "unbundling," and how to use modifiers—such as the -22 for increased procedural services—to accurately reflect the complexity of a case.***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6Please 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/listenBehind the Knife Premium:General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Ever wonder why a complex gallbladder surgery only nets the surgeon about $350, while the hospital collects thousands? In this episode, Dr. Christopher Childers and Dr. Nina Clark pull back the curtain on how the money actually flows in medicine. From the birth of the RVU to the "Two Midnight Rule," we're breaking down the math behind your paycheck.Next Step: Ready to make sure you're actually getting credit for the work you do? Join us for Episode 3, where we dive into the "Black Box" of Coding and Billing. ***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6Sponsor Disclaimer: Visit goremedical.com/btkpod to learn more about GORE® SYNECOR Biomaterial, including supporting references and disclaimers for the presented content.  Refer to Instructions for Use at eifu.goremedical.com for a complete description of all applicable indications, warnings, precautions and contraindications for the markets where this product is available. Rx only 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/listenBehind the Knife Premium:General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Ever feel like you're fluent in medical jargon but totally illiterate when it comes to the business side of surgery? You're not alone. In this series premiere, Dr. Christopher Childers (Surgical Oncologist and health policy expert) joins Dr. Nina Clark to demystify the "second world" of medicine: healthcare finance. We're breaking down the basic vocabulary every surgeon needs to advocate for themselves and their patients.Next Step: Ready to see how this translates to your paycheck? In Episode 2, we dive into Physician and Hospital Compensation, RVUs, and the flow of funds.***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6Please 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/listenBehind the Knife Premium:General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

The high-stakes world of surgical oral boards just got a high-tech upgrade. In this episode, the Behind the Knife team dives deep into the 2026 evolution of their AI Oral Board Simulator. With over 10,000 exams completed and a 99% recommendation rate from recent examinees, we're showing you how AI is leveling the playing field for residents everywhere.Join Drs. Georgoff, Swenson, and Ali as they break down the new features designed to mimic the modern, non-linear, and "rapid branching" style of the American Board of Surgery. Whether you're a junior resident honing your consult skills or a chief preparing for the "hot seat," this is the ultimate guide to dominating your boards without breaking the bank.Simulator: behindtheknifeoralboardsimulator.org

In surgery, when we think of research, often we picture randomized controlled trials, meta-analyses, and big data sets. But have you ever considered what we might miss by limiting our research programs to quantitative inquiry? What if you want to understand the culture or identity of your department or your training program? Or, what If you want to understand the values, priorities, and lived experiences of your patients? Some of the most meaningful insights about how we teach, learn, and practice surgery come from talking to people. Their words, their stories, and their experiences, and that's where qualitative research comes in. In this episode we dive into the “why” and “how” of qualitative research with leaders in the space, Professor Nicole Perez and Dr. Maya Hunt.Host:  Steven Thornton, MD (General Surgery Resident at Duke University)Guests: Nicole Perez (Assistant Professor of Medical Education, University of Illinois Chicago) Maya Hunt (General Surgery Resident, Indiana University) Publications Discussed: Bosk CL. Forgive and Remember: Managing Medical Failure. The University of ChicagoPress; 2011.  Liang et al 2019 Why do women leave surgical training? A qualitative and feminist study, doi: https://doi.org/10.1016/S0140-6736(18)32612-6 Jenkins TM. Doctors' Orders: the Making of Status Hierarchies in an Elite Profession. Columbia University Press; 2020.  Yosso, T. J. (2005). Whose culture has capital? A critical race theory discussion of community cultural wealth. Race Ethnicity and Education, 8(1), 69–91. https://doi.org/10.1080/1361332052000341006 ***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6Please 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/listenBehind the Knife Premium:General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Surgical quality is a term that is often thrown around in surgical practice. We have multiple quality improvement projects, metrics and benchmarks that motivate us to do better, and of course the ever expanding patient reviews to possibly “reflect” the type of surgical care provided. But what does quality actually mean? What metrics can we use to understand the type of care being provided by ourselves, our colleagues, and the health system at large. Today, we delve into these questions to understand how quality is currently understood within surgery and how we hope it to evolve in the future. Joining BTK fellow Agnes Premkumar and ASGBI hosts Jared Wohlgemut and Gita Lingam are two fantastic guests - Dr. Mark Cheetham, joining us from the UK, has deep experience in national audits and system-level quality improvement. Dr. Cheetham is a colorectal surgeon and the National Clinical Lead for General Surgery at the Getting it Right First Time Programme in NHS England, or GIRFT. Dr. Alexander Perez is representing the US; he is a board-certified general surgeon and minimally invasive surgeon at Baylor St. Luke's Medical Center. He has worked extensively with institutional quality programs and is the current assistant Dean for patient safety, simulation, and process improvement at the Baylor College of Medicine. Resources: Institute for Healthcare Improvement: https://www.ihi.org/library/tools/quality-improvement-essentials-toolkit NSQIP: https://www.facs.org/quality-programs/data-and-registries/acs-nsqip/ Getting it right first time (UK): https://gettingitrightfirsttime.co.uk/ ***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6Please 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/listenBehind the Knife Premium:General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US