Podcasts about pgy

As the academic year turns over, the Brown Surgery Podcast sits down with rising PGY-2 Charlotte Jackson,MD and rising PGY-3 Madison Camarlinghi, MD to discuss how to successfully navigate the challenges of intern year. From mastering early morning chart checks in Epic and efficiently triaging daily floor tasks to managing the constant stream of secure chats, our guests share their practical strategies for clinical excellence.The conversation also covers the art of trimming down consult presentations for senior residents, managing the anxiety of cross-cover on night float, and knowing exactly when to escalate clinical changes like tachycardia. Finally, Charlotte and Madison open up about maintaining an identity outside of the hospital—balancing ABSITE prep, family, and personal well-being—and offer their top pieces of advice for the incoming intern class

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

The vast majority of the time, “community standard of care” reflects evidence-based recommendations. This means that both the predominance of clinical data and what is clinically practice align one with another period but at times, clinical standard practice doesn't always align with what the data shows. How is this possible? This is exactly the case for home blood pressure monitoring in pregnancy (HBPM). This episode idea comes from an OB PGY-3, soon PGY-4, who asked his attending this brilliant question: “If the BUMP1 and BUMP2 clinical trials did not show a benefit with HBPM, why are we still doing it?” That is a complicated question that has a solid answer! Unsatisfied with his response, he asked for our opinion. Listen in for details.1. Tucker KL, et al. (2022). "Effect of self-monitoring of blood pressure on diagnosis of hypertension during higher-risk pregnancy: the BUMP 1 randomized clinical trial. JAMA2. Chappell LC, et al. (2022). "Effect of self-monitoring of blood pressure on blood pressure control in pregnant individuals with chronic or gestational hypertension: The BUMP 2 Randomized Clinical Trial. JAMA3. SMFM Special Statement (2023): Society for Maternal-Fetal Medicine Special Statement: Telemedicine in obstetrics—quality and safety considerations; AJOG

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

「牽起慢飛天使的手，用愛築起希望花園。」每個孩子都是獨特花朵。公益大使楊祐寧邀您響應伊甸「弱勢兒童服務計畫」，每月只要300元，就能讓慢飛天使在成長黃金期，獲得專業的協助，也能給予照顧者支持力量。 https://fstry.pse.is/8zs37s —— 以上為 Firstory Podcast 廣告 —— 美鳳姐天天喝的【補體素優蛋白EX】✅222增肌*關鍵：20g蛋白質、2倍**BCAA及維生素D✅義大利摩洛血橙：促進新陳代謝慶祝母親節，給爸媽正港ㄟ好體力

Blake Williamson, MD, MPH, and Gary Wörtz, MD, return for a new season of Ophthalmology off the Grid! This season, the hosts dive into the basics of training and education at the most prestigious programs in ophthalmology across the United States. In this episode, they invite Pavlina Kemp, MD, residency program director at the University of Iowa Department of Ophthalmology and Visual Sciences, and Samuel Tadros, MD, a PGY-4 ophthalmology resident, to share a state of the union on ophthalmology residency. They discuss what it takes to stand out during the application and interviewing process and find success in the field.

Send us Fan MailDr. Benny Rossner, PGY-2 pediatrics resident and veteran physician recruiter with 15 years of experience building clinical teams across the country, joins Ben and Rupa for a candid look at the neonatology workforce from a side of the conversation trainees rarely hear. He breaks down why demand for neonatologists is rising — sicker and younger patients, a shrinking APP pipeline into high-acuity specialties, and hospitals stretching budgets on locums before finally raising permanent salaries — and why fellows coming out of training have more negotiating power than they typically realize. He also shares practical advice on contract negotiations, non-competes, and why knowing the right people still matters enormously when it comes to landing the most competitive academic or metropolitan positions.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.Enjoy!

Hand injuries may look minor, but missed diagnoses can mean permanent disability. In this episode, EMRA*Cast host Maiya Smith, MD, is joined by PGY-3 Orthopedic Surgery resident Dr. Tyler Thorne to break down the high-yield hand exam and walk through can't-miss cases like Seymour fractures, central slip injuries, and perilunate dislocations.

This episode examines the potential benefits and pitfalls of early subspecialization in orthopaedic residency training, featuring trauma surgeon and AAOS Now deputy editor Doug Lundy, MD, MBA, FAAOS, Deputy Editor of AAOS Now and Chairman, Department of Orthopaedic Surgery and Senior Vice President of Medical Services at St. Luke's University Health Network. Dr. Lundy joins host Ellen Lutnick, MD, chair of the AAAOS Resident Assembly Executive Committee, for her inaugural episode of the AAOS Career Podcast.  Drawing on more than 27 years in trauma surgery, extensive experience in private practice and academics, and his tenure on the American Board of Orthopaedic Surgery (ABOS), Dr. Lundy defines early subspecialization and explores where the line falls between a helpful early interest and a narrowing of focus that limits a resident's growth. He discusses the importance of generalized training for board certification, the value of learning about multiple subspecialties throughout training, and why the PGY-3 year is often the sweet spot for identifying a subspecialty direction. Dr. Lundy emphasizes that the quality fellowship directors seek most is a teachable spirit — the willingness to learn rather than a demonstration of what a resident already knows. He also addresses the potential inequities early subspecialization can create within a program, the growing trend of dual fellowships, and which skills every resident should seek to take away from their training. Listeners gain candid, practical advice on navigating subspecialty decisions without limiting future opportunities, and Dr. Lundy leaves residents with a memorable guiding principle: Pursue the subspecialty you simply cannot live without. Guest: Doug Lundy, MD, MBA, FAAOS, Chairman, Department of Orthopaedic Surgery and Senior Vice President of Medical Services, St. Luke's University Health Network; AAOS Now Deputy Editor and AAOS Now Podcast host Host: Ellen Lutnick, MD, AAOS Resident Assembly Executive Committee Chair

In this episode of the Brown Surgery Podcast, PGY-4 general surgery resident Evan Mitchell sits down with a familiar face: Dr. Josh Cohen. Recently returning to the department as a surgical oncology attending, Dr. Cohen shares his journey from his residency training right here at Brown to his fellowship at Memorial Sloan Kettering, and what it's like starting his new practice.This conversation offers a grounded look into the realities of surgical oncology. Dr. Cohen discusses how to craft a career that balances broad operative skills with specialized cancer care, offering invaluable advice for medical students and residents trying to map out their futures.Key Topics Discussed:Choosing the Specialty: The unique appeal of head-to-toe operations, multidisciplinary care, and integrating complex cases with palliative care.Fellowship Nuances: The distinct differences in training and practice between Surgical Oncology and HPB fellowships.Advice for Trainees: Why you shouldn't stress about specializing too early, and the critical importance of finding a residency that builds a foundation as a strong general surgeon first.A Week in the Life: Managing a schedule dynamically split between the OR, clinic, and dedicated research time.Work-Life Balance & Dispelling Myths: Breaking down the misconception that surgical oncologists must have an intensely rigid personality, and how to maintain healthy boundaries while coordinating complex care across multiple specialties.Guest Bio:Dr. Josh Cohen completed his undergraduate studies at the University of Rochester and medical school at UMass. After completing his general surgery residency at Brown University, he pursued a fellowship at Sloan Kettering before returning to join the Brown surgical faculty.

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

What does it actually look like to get financially set up during residency? In this Milestones to Millionaire episode, we talk with a PGY-4 interventional radiology resident who is already building a strong financial foundation before becoming an attending. From maxing out Roth IRAs and opening a solo 401(k), to paying down debt and managing cash flow, this episode walks through a real-world example of doing the right things early. We also discuss one of the most important (and often overlooked) parts of financial success: how to communicate with your spouse about money and stay aligned on financial goals. If you're a medical student, resident, or early-career physician, this episode offers a practical look at how small, consistent decisions can set you up for long-term wealth. This podcast is sponsored by Bob Bhayani at Protuity. He is an independent provider of disability insurance planning solutions to the medical community in every state and a long-time white coat investor sponsor. He specializes in working with residents and fellows early in their careers to set up sound financial and insurance strategies. If you need to review your disability insurance coverage or to get this critical insurance in place, contact Bob at https://whitecoatinvestor.com/protuity today by email info@protuity.com or by calling (973) 771-9100. Celebrating your stories of success along the journey to financial freedom! Tune in every Monday to the Milestones to Millionaire Podcast, where we celebrate the financial achievements of our listeners and share practical tips for reaching your own milestones. We want to celebrate your milestones—no matter how big or small—and help inspire others to follow your lead. Every week, these episodes feature one listener who has recently achieved a milestone they are proud of and want to celebrate, and they give any advice they have for those who want to follow their example. Make sure to listen every Monday to be inspired by your fellow white coat investors. Celebrate YOUR Milestone on the Milestones to Millionaire Podcast: https://whitecoatinvestor.com/milestones  Website: https://www.whitecoatinvestor.com  YouTube: https://www.whitecoatinvestor.com/youtube  Student Loan Advice: https://studentloanadvice.com  TikTok: https://www.tiktok.com/@thewhitecoatinvestor  Facebook: https://www.facebook.com/thewhitecoatinvestor  Twitter: https://twitter.com/WCInvestor  Instagram: https://www.instagram.com/thewhitecoatinvestor  Subreddit: https://www.reddit.com/r/whitecoatinvestor  Online Courses: https://whitecoatinvestor.teachable.com  Newsletter: https://www.whitecoatinvestor.com/free-monthly-newsletter 

Episode 217: Testicular Cancer Dr. Arreaza: Welcome to Rio Bravo qWeek Podcast. Today we are discussing testicular cancer, a topic that may not appear frequently in primary care but is extremely important to recognize early. We are joined by Brandon Noorvash and Dr. Ebenezer Dadzie. Please introduce yourselves. Brandon: Thank you, Dr. Arreaza. My name is Brandon Noorvash. I am a third-year medical student at Western University of Health Sciences with a strong interest in urology. Ebenezer: Thank you for having us. My name is Dr. Ebenezer Dadzie, and I am a PGY-1 resident in the Clinica Sierra Vista Family Medicine Residency Program. Dr. Arreaza: Testicular cancer represents about 1-2% of cancers in men, but it is the most common cancer in men between the ages of 15 and 40. The good news is that it is also one of the most curable cancers in medicine, especially when detected early. Let's start with a quick question for our listeners. If a 25-year-old man presents with a painless lump in his testicle, what diagnosis should immediately come to your mind? Ebenezer: Testicular cancer should always be high on the differential. While benign conditions can cause scrotal swelling, a painless testicular mass should be considered cancer until proven otherwise. Dr. Arreaza: I agree. Especially if we perform a physical exam and find that the mass is attached to the testicle. Why is this such an important diagnosis for primary care physicians to recognize, what do you think, Brandon? Brandon: Testicular cancer typically affects young, otherwise healthy men, and early detection dramatically improves outcomes. Patients may delay seeking care because the lump is painless or because they feel embarrassed discussing symptoms. However, when diagnosed early, the 5-year survival rate exceeds 95%, and in localized disease it approaches 99%. Dr. Arreaza: Exactly, the survival is incredible and it gets even better with early detection. How common is testicular cancer? Ebenezer: In the United States, approximately 10,000 new cases are diagnosed each year, with around 500 deaths annually. The relatively low mortality reflects how effective current treatments are, especially chemotherapy for germ cell tumors. Dr. Arreaza: Let's talk about risk factors. What should clinicians know about risk factors for testicular cancer? Who is at risk? Brandon: The most important risk factor is cryptorchidism, or undescended testicle. Men with a history of cryptorchidism have about a 4-to-8-fold increased risk of developing testicular cancer. Ebenezer: Other risk factors include family history, personal history of testicular cancer, infertility, testicular atrophy, and certain genetic conditions such as Klinefelter syndrome. However, many patients who develop testicular cancer have no clear risk factors. Dr. Arreaza: Brandon, you recently saw a patient with testicular cancer during your rotation. Can you briefly tell us about that case? Protected health information is not being revealed, so patient confidentiality is being respected during this discussion. Dr. Arreaza: I think we all were pleasantly surprised to know that lung metastasis did not place the patient in a higher risk category. On the other hand, nonpulmonary visceral metastases (such as liver, bone, or brain) define poor-risk disease in nonseminoma and intermediate-risk disease in seminoma.  Dr. Arreaza: And of course, if the patient presents with sudden severe pain, we should always think about testicular torsion, which is a surgical emergency. What should clinicians focus on during the physical exam? Ebenezer: Testicular tumors typically feel firm, irregular, non-tender, and located within the testicle itself. Brandon: A helpful exam pearl is transillumination. Fluid-filled structures like hydroceles will transilluminate, whereas solid tumors do not. Dr. Arreaza: I have to admit I've never done a transillumination in a scrotum before.  Brandon/Ebenezer: I've done it. I had to clean my pen light afterwards. Arreaza: Once you suspect testicular cancer, what is the next step in evaluation? Ebenezer: The first diagnostic test is a scrotal ultrasound. Ultrasound is highly sensitive and can determine whether the mass is intratesticular, which is highly suspicious for malignancy. Dr. Arreaza: US and tumor markers. Let's talk a bit more about tumor markers. Why are they useful in testicular cancer? Brandon: Tumor markers help with diagnosis, staging, and monitoring response to treatment. Ebenezer: Alpha-fetoprotein, or AFP, is typically elevated in non-seminomatous germ cell tumors, particularly yolk sac tumors. An important point is that pure seminomas do not produce AFP. Brandon: Beta-hCG can be elevated in both seminomas and non-seminomatous tumors, although the levels are often higher in the non-seminomatous types. Ebenezer: LDH is less specific but can reflect tumor burden and disease activity, so it's useful for monitoring progression or response to treatment. Dr. Arreaza: So, tumor markers are not only diagnostic tools, but they also help guide staging and follow-up care. That's an important board question. Why don't we perform a biopsy in a testicular mass?  Ebenezer: Testicular masses suspicious of cancer are not biopsied because biopsy can disrupt lymphatic drainage and potentially spread tumor cells. Instead, the standard treatment is radical inguinal orchiectomy, which both removes the tumor and establishes the diagnosis. Dr. Arreaza: Brandon, can you briefly explain the two main categories of testicular cancer? Brandon: Let's start with the germ cell tumors. They are broadly divided into seminomas and non-seminomatous germ cell tumors (NSGCT). Seminomas tend to grow more slowly and are highly sensitive to radiation therapy. Ebenezer: Non-seminomatous tumors include embryonal carcinoma, yolk sac tumor, choriocarcinoma, and teratoma. These tumors tend to be more aggressive but are still highly responsive to treatment. Dr. Arreaza: How are patients staged once the diagnosis is made? Ebenezer: Staging typically includes a CT scan of the chest, abdomen, and pelvis to evaluate for metastasis, especially to the retroperitoneal lymph nodes, which are the most common site of spread. Dr. Arreaza: And how is testicular cancer managed? Brandon: The initial step is almost always radical inguinal orchiectomy. Depending on staging and tumor type, treatment may include active surveillance, chemotherapy, radiation therapy, or retroperitoneal lymph node dissection. Ebenezer: One reason outcomes are so favorable is that germ cell tumors respond extremely well to cisplatin-based chemotherapy. Dr. Arreaza: Let's talk about prognosis. Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _________________________________________ References: Honda K, Kawai T, Taguchi S, Shiratori T, Miyakawa J, Nakamura Y, Kaneko T, Suzuki K, Suda S, Kamei J, Kakutani S, Niimi A, Yamada Y, Urakami S, Fukuhara H, Nakagawa T, Kume H. Impact and Risk Factors of Diagnostic Delay in Patients With Testicular Cancer: A Multicenter Retrospective Study. Int J Urol. 2025 Nov;32(11):1593-1601. doi: 10.1111/iju.70187. Epub 2025 Jul 28. PMID: 40726135; PMCID: PMC12586796. https://pubmed.ncbi.nlm.nih.gov/40726135/ Singla N, Bagrodia A, Baraban E, Fankhauser CD, Ged YMA. Testicular Germ Cell Tumors: A Review. JAMA. 2025;333(9):793–803. doi:10.1001/jama.2024.27122 https://jamanetwork.com/journals/jama/article-abstract/2829847?utm_source=openevidence&utm_medium=referral Chavarriaga J, Nappi L, Papachristofilou A, Conduit C, Hamilton RJ. Testicular cancer. Lancet. 2025 Jul 5;406(10498):76-90. doi: 10.1016/S0140-6736(25)00455-6. Epub 2025 May 29. PMID: 40451233. https://pubmed.ncbi.nlm.nih.gov/40451233/ Tateo V, Thompson ZJ, Gilbert SM, Cortessis VK, Daneshmand S, Masterson TA, Feldman DR, Pierorazio PM, Prakash G, Heidenreich A, Albers P, Necchi A, Spiess PE. Epidemiology and Risk Factors for Testicular Cancer: A Systematic Review. Eur Urol. 2025 Apr;87(4):427-441. doi: 10.1016/j.eururo.2024.10.023. Epub 2024 Nov 13. PMID: 39542769. https://pubmed.ncbi.nlm.nih.gov/39542769/ Langn RC, Puente MEE. Scrotal Masses. Am Fam Physician. 2022 Aug;106(2):184-189. PMID: 35977130. https://pubmed.ncbi.nlm.nih.gov/35977130/ Xu P, Wang J, Abudurexiti M, Jin S, Wu J, Shen Y, Ye D. Prognosis of Patients With Testicular Carcinoma Is Dependent on Metastatic Site. Front Oncol. 2020 Jan 10;9:1495. doi: 10.3389/fonc.2019.01495. PMID: 31998648; PMCID: PMC6966605. https://pubmed.ncbi.nlm.nih.gov/31998648/

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

Welcome to Teeth & Titanium, Episode 64, “What is a Fellowship?” This episode features: Current Events-    Olympic hockey update-    The old foot on my chest bit-    Getting your FACS right Fan Mail-    LAST Feedback-    Orthognathic Deep dive-    Aura from the Harvard Unc-    The Match Debate-    Does your fellowship count?            Resident reminder            - Questions to ask when looking at a fellowship Journal Club-    The PGY-0: Why the Start of Training Doesn't Have to Wait Till Residency.-    Where Have the Resident Researchers Gone?-    The Value of Orthognathic Surgery Fellowships. Your personal finance drill from PWL Capital-    “Estate Freeze” by Brady Plunkett Senior Wealth Advisor Portfolio Manger, CFP, CIM Recommendations-    Pond rules-    A very long sunrise Be sure to subscribe so you never miss an episode! Apple / Spotify / Google / Online links Thanks to the CAOMS and PWL for their continued support of this podcast. https://www.caoms.com. PWL Capital; https://pwlcapital.com/ If you would like to contact us, be a guest, or would like to submit a topic for Resident Reminder or Journal club, please email us at: teethandtitaniumOMFS@gmail.com Hosted by Dr. Wendall Mascarenhas & Dr. Oscar DalmaoProduced by Dr. Brad W. Ray Articles/Books cited in this episode: Shivers PL, Goncalves PZ. The PGY-0: Why the Start of Training Doesn't Have to Wait Till Residency. J Oral Maxillofac Surg. 2026 Mar;84(3):287-288. Cillo JE Jr. Where Have the Resident Researchers Gone? J Oral Maxillofac Surg. 2026 Mar;84(3):285-286. Ritchie CA, Posnick JC, Kinard BE. The Value of Orthognathic Surgery Fellowships. J Oral Maxillofac Surg. 2026 Mar;84(3):289-290.

Robotic surgery has moved from novelty to norm, and in this episode of Behind the Knife, Drs. James Jung and Joey Lew sit down with urologic pioneer and Medtronic CMO Dr. Jim Porter to dissect how we got here, what the data really say about “the death of laparoscopy,” and where competing robotic platforms like Hugo may take the field next. From ergonomics and education to economics and global access, they tackle both the hype and the hard questions around robotics as the future of minimally invasive surgery.Hosts: ·      James Jung, MD, PhD, Assistant Professor of Surgery, Duke University·      Joey Lew, MD, MFA, Surgical resident PGY-3, Duke University, @lew__actuallyLearning Goals: By the end of this episode, listeners will be able to:·      Describe key clinical, ergonomic, and educational drivers behind the rapid adoption of robotic surgery in the United States and globally.·      Summarize current evidence comparing robotic and laparoscopic approaches for common procedures, including where outcomes are equivalent, inferior, or clearly superior.·      Explain how surgeon ergonomics, trainee experience, and video-based learning influence practice patterns and learning curves in minimally invasive surgery.·      Discuss the role of cost, reimbursement structures, and market competition (e.g., Medtronic Hugo vs da Vinci) in shaping robotic adoption across different health systems.·      Anticipate how next-generation, task- or organ-specific robotic platforms may further change standards of care in minimally invasive surgery.References:·      Violante T, Ferrari D, Novelli M, Larson DW. The Death of Laparoscopy - Volume 2: A Revised Prognosis. A retrospective study. Ann Surg. 2025 Jun 16. doi: 10.1097/SLA.0000000000006792. Epub ahead of print. PMID: 40518997. https://pubmed.ncbi.nlm.nih.gov/40518997/·      Yu Yoshida, Yoshiro Itatani, Takehito Yamamoto, Ryosuke Okamura, Koya Hida, Kazutaka Obama, Single-incision plus one robot-assisted surgery (SIPORS) using the Hugo robotic-assisted surgery (RAS) system for rectal cancer, Annals of Coloproctology, 10.3393/ac.2025.00787.0112, 41, 6, (586-591), (2025). https://pubmed.ncbi.nlm.nih.gov/41486916/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

In this episode, Lyell K. Jones Jr, MD, FAAN, speaks with Aaron L. Berkowitz, MD, PhD, FAAN, who served as the guest editor of the February 2026 Neurology of Systemic Disease issue. They provide a preview of the issue, which publishes on February 2, 2026. Dr. Jones is the editor-in-chief of Continuum: Lifelong Learning in Neurology® and is a professor of neurology at Mayo Clinic in Rochester, Minnesota. Dr. Berkowitz is a Continuum® Audio interviewer and a professor of neurology in the Department of Neurology at the University of California, San Francisco, in San Francisco, California. Additional Resources Read the issue: continuum.aan.com Subscribe to Continuum®: shop.lww.com/Continuum Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @LyellJ Guest: @AaronLBerkowitz Full episode transcript available here Dr Jones: The human nervous system is so complex. You can spend your whole career studying it and still have plenty to learn. But the human brain does not exist in isolation. It's intricately connected with and reliant on other bodily systems. When those systems go awry, sometimes the first sign is in the nervous system. Today we will speak with Dr Aaron Berkowitz, an expert on the neurology of systemic disease, and learn a little about how these disorders can present and what we can do about it. Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about subscribing to the journal, listening to verbatim recordings of the articles, and exclusive access to interviews not featured on the podcast. Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum: Lifelong Learning in Neurology. Today, I'm interviewing Dr Aaron Berkowitz, who is Continuum's guest editor for our latest issue of Continuum on the neurology of systemic disease. Dr Berkowitz is a professor of clinical neurology at the University of California, San Francisco, and he has an active practice as a neurohospitalist and in outpatient general neurology---and, importantly, as a clinician educator. In addition to numerous teaching awards, Dr Berkowitz has published several books and also serves on our editorial board for Continuum. Dr Berkowitz, welcome. Thank you for joining us. Why don't you introduce yourself to our listeners?  Dr Berkowitz: Thanks, Lyell. As you mentioned, I'm a general neurologist and neurohospitalist here in San Francisco, California at UCSF and very involved in resident education as well. And I was honored, flattered and a little bit frightened when I received the invitation to guest edit this massive issue on the neurology of systemic disease. But I've learned a ton, and it's been great to work with you and the incredible authors we recruited to write for us. And I'm excited to have the issue out in the world.  Dr Jones: Yeah, me too. And you and I have talked about it before: you're one of a very small group of people who have guest edited multiple issues on different topics, right?  Dr Berkowitz: That's right. I did the neuroinfectious disease issue in… was it 2020? 2021? Something like that.  Dr Jones: Yeah. So, congratulations, more people have walked on the moon than done what you've done. And I'm looking forward to chatting, Aaron, and really grateful for your work putting together a fantastic issue. I think our listeners will appreciate that the nervous system does not function in isolation. It's important to understand the neurologic manifestations of diseases that originate within the brain, spinal cord, nerves, muscles, etc., but also the manifestations of diseases that begin in other systems and, you know, may masquerade as a primary neurologic disorder. So, it's obviously an important topic for neurologists, since many of these patients are receiving care in another setting, perhaps from another specialist. I almost think of this issue of Continuum as a handbook for the consultant neurologist, inpatient or outpatient. I don't know. Do you think that's a fair characterization of the topic? Dr Berkowitz: Absolutely. I completely agree with you. I think, yeah, many of us go into neurology interested in our primary diseases, whether it's stroke or Parkinson's or neuropathy or particular interest in neurologic symptoms, whether they're cognitive, motor, sensory, visual. And we quickly learn in residency, right? As you said, a lot of what we see is neurologic manifestations of primary diseases. So, I don't know how similar this is to other training programs. But it seemed like, if I'm remembering correctly, my first year of residency was mostly on primary neurology services, general stroke, ICU. And we moved into the consultant role more in the PGY-3 year the next year. And I remember explaining to students rotating with us on the consult services, this is actually much more complex in a way, because the patient has some type of symptom in a much broader and much more complicated context of multiple things going on. And I call it "neurology in the wild." There's, like, neurology of, this patient's had a stroke and we know they have a stroke and we're trying to figure out why and treat it. That's all interesting. But our question here, is there a stroke needle buried in this haystack of all of these medical or surgical complications? And learning what I call neurology of X, which is really what this issue is; as you said, that there's a neurology of everything. There's a neurology of cardiac disease. There's a neurology of the peripartum. There's a neurology of rheumatologic disease. There's every new treatment that comes out in oncology has a neurology we learn, right? There's a neurology of everything.  Dr Jones: There's a lot of axes, right? There's the heart-brain axis and the kidney-brain axis. And… I think we cover everything except the spleen-brain axis, which maybe that's a thing, maybe not. I'll probably hear from all the spleen fans out there. So, I want to do a little bit of an experiment. We're going to do something new today on the podcast. Before we get into the questions, we're going to start with a Continuum Audio trivia question. So, this will be a first time ever. Dr Berkowitz, we all know that chronic hyperglycemia, or diabetes, can lead to many neurologic and systemic complications and that optimal glucose control is our goal. For our listeners, here's the question: what neurologic complication can occur from correcting hyperglycemia too quickly? What neurologic complication can occur from correcting hyperglycemia too quickly? Stick around to the end of our interview for the answer. So, Aaron, let's get right to it. You had a chance to review all the articles in this issue on the neurology of systemic disease. What do you think in all of those is the most exciting recent development for patients who fit into this category? Dr Berkowitz: Yeah, that's a great question. I think we talked about when we were putting this issue together, right, a lot of the Continuum subspecialty topics; there should have been updates on particular disease diagnostics, treatments, new phenotypes. Whereas here probably a lot less has changed in primary heart disease, primary cancer. As I'd like to say to our students trying to excite them about neurology, most specialties have new treatments, but I can name a large number of new diseases, right, that have been discovered since we've been out of training. So, a lot of the primary medicine stays the same, and the neurologic complications stay the same. But probably the thing that many readers will want to keep handy and will probably be much in need of update again in three years are the neurologic complications of all the new cancer treatments. So, if we think back to I finished training just over ten years ago when a lot of the fill-in-the-blank-umabs were coming out, CAR T therapy, and we were starting to see a lot of neurology, I remember, related to these and telling the oncologists and they said, oh, you just wait. We are seeing at the conferences that there's a lot of neurology to these. And I feel like that is always a moving target. And I think we are seeing a lot of those and it's hard to keep up with which treatments can cause which complications, which syndromes and which severities require holding the treatment when you can rechallenge longer-term complications of CAR T cell therapies now that we've learned more about the acute complications. So, Amy Pruitt from Penn has written us a fantastic article for this issue that covers a lot of the updates there. And I learned a lot from that. I feel like that's the one that just like every time the carnioplastic diseases are reviewed in Continuum, it seems like the table is another page longer from your colleagues there in Rochester teaching us about new antibodies. And I feel like, for this issue, that's one of the areas that felt like there was a lot of very new content to keep up with since last time.  Dr Jones: That's good news, right? It's good that we have new immunotherapies for cancer, but it does lead to neurologic catastrophes sometimes, and it is a moving target, really rapid. So, you mentioned that just over ten years ago you finished your training and now we see a lot more of these complex immunotherapy-related neurologic complications. What about in the other direction? Are there any things that you see less commonly now in your practice than you might have seen ten years ago right when you were finishing training?  Dr Berkowitz: I would say no, I think. I think we're seeing a lot of new stuff, and we're still seeing a high volume of the classic consults we tend to get, whether that's altered mental status in a patient who's systemically ill; weakness or difficulty reading from the ventilator in a patient who's critically ill; patient has endocarditis and has a stroke hemorrhage or mycotic aneurysm, what do we do? Yeah, one of the parts that was really fun and educational editing this issue is, I really wanted to ask the experts the questions I find that are really troubling and challenging and make sure we could understand their perspective on things like the endocarditis consult, which I always feel like each time there's some twist that even though the question is what do we do about this stroke and/or hemorrhage and/or aneurysm and is surgery safe? It seems like each time I always feel like I'm reinventing the wheel, trying to really sort out how to think about this. And we have a great article from Alvin Doss at Beth Israel and Steve Feskey from Boston Medical Center. It covers a lot of cardiology, as you know, in that article about a great section on endocarditis where every time it came back for review, I would say, but what about this? This comes up. What about this? Can you explain how you think about this for our readers? I don't know. I'd be curious to hear your perspective. It sounds like we agree on what has become more common. I don't think anything in neurology seems to become less… Dr Jones: Well, no, I guess we haven't really solved anything, I guess we haven't cured any problem. But that's okay, right? I mean, it's building on an established foundation of experience and history in our field. And you know, we mentioned earlier that in many ways this issue is kind of like a neurology consultant's handbook. We did something a little different with it in that sense. In addition to you serving as the guest editor, you have authored an article in the issue. It touches on something that we've talked about a couple of times, and I'd be interested to hear you talk through it with our listeners a little bit on how to approach the neurologic consultation. Tell us a little more about that and your article and how you approached it.  Dr Berkowitz: Oh, yeah, thanks. Well, thanks first of all for inviting me to think about a sort of introductory article to this issue. And I was trying to think about what to write about because, as you've said and we've been talking about, no one could know every neurologic complication of every medical disease, treatment, surgery, hospital context. Probably many of us don't even know all the muscle diseases, right, within neurology. So how could we know all this stuff? And we need some type of manual from our colleagues that can explain, okay, I know this patient has inflammatory bowel disease and they've had a stroke. Is that- are these related? Are these unrelated? And I thought the articles kind of answer all of these questions. What would I say beyond this patient has disease X and is on drug Y? Well, look up in this issue disease X and see what the neurology can be, common and rare and how often it's associated, how often it's the presenting feature, how often it means the treatment is failing, etc. I thought, I'm not sure there's much to say there. That's about a paragraph. And I thought, well, let's think even more broadly about neurologic consultation. And as you know, I like to think about diagnostic reasoning and clinical reasoning. And we talk a lot about framing bias right? And I think that is very common in consultative neurology because we'll be told in the consult or in the page or E-consult or whatever it is, this is a blank-year-old blank with a history of blank on treatment blank. And right away your mind is starting to say, oh, well, the patient just had heart disease, or, the patient is nine months pregnant, or, the patient is on an immune checkpoint inhibitor. And whether you want to do it or not, your mind is associating the patient's neurology with that. And it's- even if we know we're framing or anchoring, it's hard to kind of pull away from that. And most of the time, common things being common, a patient with cancer develops new neurology, It's probably the cancer, the treatment, or sometimes a paraneoplastic syndrome. But I've definitely found if you do a lot of inpatient neurology and a lot of consults that you're seeing so much and you have no choice but to apply these heuristics, because you're seeing a lot of volume quickly and the patients are in the hospital or they're being closely followed and outpatient setting by another specialist. You presume if you didn't get it quite right the first time, it's going to come back to you. And there's a little bit of difficulty figuring out, this is a case, actually, of all the altered mental status in acutely ill patients I got today, this is the one I should dig deeper in that I think this could turn out to be a stroke or encephalitis as opposed to delirium. I felt like that I really haven't approached that except knowing that it's easy to fall into traps. And so, I started to think about framing bias. You know, we talked about if we become aware of our biases, right, we're better at not falling prey to them. But it's subconscious. So, we might be applying it without even realizing, or even saying, I might be framing this case the wrong way, you can go right on framing it the wrong way. So, I want to kind of get a little more granular on what types of framing biases actually are relevant, specifically, to the console setting. And so, I tried to come up with a few more specific examples and try to think about ways that we could at least have a quick, if our knee-jerk is to associate primary disease X that the patient has or primary treatment X with neurologic symptom Y, what's at least a quick counter-knee jerk to say, what if it could be something else? So, for example, one of them I call "low signal-to-noise ratio bias." Altered mental status in the acutely ill hospitalized patient. What would you say, Lyell? 99 out of 100- 99.9 out of 100, it's not a primary neurologic disease. Is that fair to say? Dr Jones: Very high, yep. I agree. Dr Berkowitz: Yeah. But could it be a stroke? Could it be non-convulsive status epilepticus, meningitis encephalitis? So, how do we sort of counteract low signal-to-noise ratio bias, acknowledging it exists, acknowledging most of the time there is a low signal-to-noise, that it's not going to be neurology---to just for example, use the time course. This is pretty acute. Have I convinced myself this is not a stroke or a seizure or an acute neurologic infection? And if I'm not sure at the bedside, should I err on the side of more testing? Or the "curbside bias," as I call when your colleague just sends you a text message on your phone, No need to even open the chart, Dr Jones. Patient had a cerebellar stroke. Incidental. They're here for something else. Aspirin, right? Just like a super tentorial stroke. And you might reply thumbs up. And then imagine you open the CT scan and it's a huge cerebellar stroke with fourth ventricular compression- and patient can hide a lot of stroke back there, might just have a little ataxia. You were curbsided and that framed you to think, oh, they asked me, is aspirin okay for a cerebellar stroke and I said yes, without realizing actually the question should have been posed is, how do you manage a huge stroke with mass effect in the posterior fossa? So, these types of biases, I come up with five of them, I won't go through all of them. I'm in the article to sort of acknowledge for the reader, most of the time it's going to be what you look up in this issue, but how to think about the times where it might not be and how to be more precise about what framing is and different types of framing that occur specifically in the consultant arena. Dr Jones: And I think the longer we practice, the more of those low-frequency exceptions that you see. And, you know, and then it sticks in our mind and sometimes the bias swings the other way; people, you know, think primarily about the low frequency. And so, it's tricky. And what I really enjoyed about that article, we started talking about this probably more than a year ago, and more than a year ago, I would say relatively few clinicians were using a now widely popular large language model for clinical decision-making; we won't name the model. And now I think most clinicians are using it almost every day, right? And I think it puts a premium on how to think and how to engage with the patient, and less about the facts and the lists that a lot of conventional medical education really is derived from. So, I really appreciate that article. We can pat ourselves in the back. We had some foresight to put it in the issue, and I think it's a great addition to it. Dr Berkowitz: Thank you. Dr Jones: So, the list of potential topics when we think about the neurologic manifestations of systemic disease, we tend to break it down by organ systems, right? But the amount of things that could end up in the issue is almost infinite. Is there anything that, when you were putting this issue together---either in terms of the topics or editing the articles---is there anything that you wanted to include, but we just didn't have room? Dr Berkowitz: I certainly won't say we covered everything, but I will say we were able to recruit a fantastic team of authors. And as you and I also talked about at the beginning, although you could say, we're doing the movement disorders issue, let's find all the top movement disorders folks who are expert specialists in this field, there's not really a neurohematologist or a neurogastroenterologist out here. So, you and I put our heads together to think of phenomenal general neurologists in most cases, some subspecialists who know a lot about this but were also excited to read a lot more about it and assemble the existing knowledge by the practicing neurologist for the practicing neurologist. And I think with that approach and letting folks have kind of, you know, I asked some specific questions. These are topics I hope you'll cover. These are vexing questions in this area. I hope you'll find some answers to how often can this neurology be the primary feature of this rheumatologic disease with no systemic manifestations and when should we look or as we mentioned, the complicated endocarditis consult. I won't say we covered everything. This could be, and is, textbook-sized, and there are textbooks on this topic. But I think on the contrary, authors came back and had sections on things that I might not have thought to ask- to cover. Dr Sarah LaHue, my colleague here at UCSF, I asked for an article, as traditionally in this issue, on the neurology of pregnancy in the postpartum state and included, I think probably for the first time in Continuum, a fantastic review of neurologic considerations in patients in menopause, which I'm not sure has been covered before. So, things that I wouldn't have even thought to ask for. Our authors came back with some fantastic stuff. And the ICU article by Dr Shivani Ghoshal, instead of focusing just on altered mental status in the ICU, weakness in the ICU---those are all in there---I also asked her to discuss complications of procedures in the ICU. How often do procedures in the ICU cause local neuropathies or vascular injury, these types of things. Dr Jones: Yeah, me too. And I guess that's a great advertisement, that there probably are things that we didn't cover, but if there are, we can't think of them. We've done as best as we can. So now let's come back to our Continuum Audio trivia question for our listeners. And I'll repeat the question: what neurologic complication can occur from correcting hyperglycemia too quickly? And I actually think there might be two correct answers to this one. Dr Berkowitz, what do you think? Dr Berkowitz: Yeah, I was thinking of two things. I hope these are the things you're thinking of as well. One is what I think used to be referred to as insulin neuritis, sort of an acute painful small fiber neuropathy from after the initiation of insulin, I think also called treatment-induced diabetic neuropathy or something of that nature. And then the other one described, defined and classified by your colleagues there in Rochester, the diabetic lumbosacral radiculoplexis neuropathy or Bruns-Garland syndrome or a diabetic amyotropy, I think, can also---if I'm not mistaken---also occur in this context; you should have weight loss in association with diet treatment of diabetes. But how did I do? Dr Jones: Yeah, you win the prize, the first-ever prize. There's no monetary value to the prize, but pride, I think, is a good one. Yeah, those were the two I was thinking of. The treatment-induced neuropathy of diabetes is really nicely covered in Dr Rafid Mustafa's article on the neurologic complications of endocrine disorders. It's a rare condition characterized by the acute/subacute onset of diffuse neuropathic pain and some usually some autonomic dysfunction. And it occurs when you have rapid and substantial reductions in blood glucose levels. And you can almost map it out. There was a study from 2015 which is referenced in the article, which found that a drop in hemoglobin A1c of 2 to 3% over three months confers about a 20% absolute risk of developing this treatment-induced neuropathy of diabetes, and a drop of more than 4%, more than 80% risk. So, very substantial. And then in the other---we see this commonly in patients with diabetic lumbosacral radiculoplexis neuropathy---they have the subacute onset of usually asymmetric pain and weakness in the lower limbs that tends to occur more frequently in patients who have had recent better control of their sugar. We can also see it in the upper limbs too. So, you get a perfect score. Dr Berkowitz, well done. Again, I want to thank you. I want to thank you for such a great issue, a great article to kick off the issue, and a great discussion of the neurology of systemic disease. Today I learned a lot talking today, I learned a lot reading the issue. Really grateful for your leadership of putting it together, pulling together a really great author panel, and I think it will come in handy not just for our junior readers and listeners, but also our more experienced subscribers as well. Dr Berkowitz: Thank you so much. Like I said, it was a big honor to be invited to guest edit this issue. I've read it every three years since I started residency. It's always one of my favorite issues. As you said, a manual for consultative neurology, and I learned a ton from our authors and really appreciate the opportunity to work with you and the amazing Continuum team to bring this from an idea, as you said, probably over a year ago to a printed issue. So, thanks again, Lyell. Dr Jones: Thank you. And again, we've been speaking with Dr Aaron Berkowitz, guest editor of Continuum's most recent issue on the neurology of systemic disease. Please check it out, and thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. Thank you for listening to Continuum Audio.

In this mini series, we interview resident physicians to gain a deeper understanding into the responsibilities and challenges of their chosen specialty, and if their expectations as a medical student matched up with the realities of the field. Our guest, Dr. Shawn Choe, is passionate about neurosurgery. In this episode, he shares his journey to deciding a career in neurosurgery, what the training is like, and advice on being prepared for residency.Shawn Choe, MD is a PGY-3 in the Department of Neurological Surgery at Loyola University Medical Center. Originally born in Korea and transplanted to Chicago, he calls Chicago his new home. After completing his undergraduate education at the University of Illinois Urbana-Champaign, he obtained his Master's degree at Loyola University in Chicago and later his MD from the Stritch School of Medicine prior to starting his residency. While at Stritch, he was one of the producers for Medicus.Episode produced by: Angeli MittalEpisode recording date: 9/2/25www.medicuspodcast.com | medicuspodcast@gmail.com | Donate: http://bit.ly/MedicusDonate

Cold and flu season greetings from the Curious Clinicians! We hope you all are cold-free, but we were unfortunately under the weather this week. In honor of our "heme boards" series from Hannah's PGY-6 year, we decided to reboot this PGY-1 "intern question" that taught us all a new word. We will be back in 2 weeks with our regularly scheduled new episodes! Show notes for this episode are here!

“Always assume that everyone knows more than you do, and go into places with a lot of modesty.” – Brittany Brookner, MDIn this episode of the Kinked Wire, Virginia Tech Carilion medical student Aysha Alani hosts a discussion between PGY-2 Brittany Brookner, MD, and PGY-6 Chief Resident Neil Jain, MD, about their experiences, advice and absolute don'ts for away rotations. SIR thanks Medtronic for its generous support of the Kinked Wire.Contact us with your ideas and questions, or read more about interventional radiology in IR Quarterly magazine or SIR's Patient Center.Support the show Senior Editorial Manager, Hope Racine, explains the work she does at SIR.Support the show

In today's episode, we are joined by Dr. Alexandra Lawlor, a Florida native and PGY-1 dermatology resident, who shares her non-linear journey from public health consulting to matching into dermatology at HCA Florida Orange Park Hospital. We talk about following your passions, staying open-minded, and releasing the pressure of a fixed timeline. As the founder of If You're Reading This, Alex reflects on turning adversity into purpose and the power of staying authentically yourself throughout the process. We hope you enjoy! ---Connect with Dr. LawlorInstagram: @⁠dr.lawlorIfYoureReadingThis @ifyourereadingthismedWebsite: www.ifyourereadingthis.org ---DIGA Instagram: @⁠⁠⁠derminterest⁠⁠⁠Today's Host, Marissa: @⁠⁠⁠marissamarieruppe---For questions, comments, or future episode suggestions, please reach out to us via email at ⁠⁠⁠derminterestpod@gmail.com⁠⁠⁠ ---District Four by Kevin MacLeodLink: ⁠⁠⁠https://incompetech.filmmusic.io/song/3662-district-four⁠License: ⁠https://filmmusic.io/standard-license

Peripheral artery disease has been called the ‘silent circulatory crisis'—affecting millions, limiting mobility, and quietly raising the risk of heart attack, stroke, and limb loss. For decades, treatment focused on walking programs, aspirin, and sometimes a stent or bypass. But today, the landscape is changing. From PCSK9 inhibitors that drive cholesterol to record lows, to GLP-1 agonists like semaglutide improving walking distance, to novel antithrombotic strategies that balance bleeding and clotting—PAD care is entering a new era. In this episode, we'll explore the breakthroughs, the evidence behind them, and what they mean for patients who just want to keep moving forward." Hosted by the University of Michigan Department of Vascular Surgery: - Robert Beaulieu, Program Director - Frank Davis, Assistant Professor of Surgery - Luciano Delbono, PGY-5 House Officer - Andrew Huang, PGY-4 House Officer - Carolyn Judge, PGY-2 House Officer Learning objectives:  1.  Describe the current evidence-based recommendations for multifactorial medical management of peripheral artery disease (PAD), including lipid, glycemic, and antithrombotic strategies per 2024 SVS/AHA guidelines.  2. Interpret the clinical implications of the FOURIER trial regarding the role of PCSK9 inhibition in reducing cardiovascular events in patients with atherosclerotic disease, including PAD.  3.  Evaluate the emerging role of GLP-1 receptor agonists, such as semaglutide, in improving walking performance and quality of life among patients with diabetic PAD based on findings from the STRIDE trial. Sponsor URL: https://www.goremedical.com/ References:  H. L. Gornik et al., “2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease,” JACC, vol. 83, no. 24, pp. 2497–2604, June 2024, doi: 10.1016/j.jacc.2024.02.013. L. Mazzolai et al., “2024 ESC Guidelines for the management of peripheral arterial and aortic diseases: Developed by the task force on the management of peripheral arterial and aortic diseases of the European Society of Cardiology (ESC) Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS), the European Reference Network on Rare Multisystemic Vascular Diseases (VASCERN), and the European Society of Vascular Medicine (ESVM),” Eur Heart J, vol. 45, no. 36, pp. 3538–3700, Sept. 2024, doi: 10.1093/eurheartj/ehae179. https://pubmed.ncbi.nlm.nih.gov/40169145/ M. S. Sabatine et al., “Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease,” N Engl J Med, vol. 376, no. 18, pp. 1713–1722, May 2017, doi: 10.1056/NEJMoa1615664. https://pubmed.ncbi.nlm.nih.gov/28304224/ M. P. Bonaca et al., “Semaglutide and walking capacity in people with symptomatic peripheral artery disease and type 2 diabetes (STRIDE): a phase 3b, double-blind, randomised, placebo-controlled trial,” Lancet, vol. 405, no. 10489, pp. 1580–1593, May 2025, doi: 10.1016/S0140-6736(25)00509-4. https://pubmed.ncbi.nlm.nih.gov/40169145/ N. E. Hubbard, D. Lim, and K. L. Erickson, “Beef tallow increases the potency of conjugated linoleic acid in the reduction of mouse mammary tumor metastasis,” J Nutr, vol. 136, no. 1, pp. 88–93, Jan. 2006, doi: 10.1093/jn/136.1.88. https://pubmed.ncbi.nlm.nih.gov/16365064/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen Behind the Knife Premium: General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate 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-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

In this new mini series, we interview resident physicians to gain a deeper understanding into the responsibilities and challenges of their chosen specialty, and if their expectations as a medical student matched up with the realities of the field. Our guest, Dr. Farinoosh Dadrass, shares what life is like as a dermatology resident and surprises she has encountered in her training.Farinoosh Dadrass, MD is a PGY-3 dermatology resident at Loyola University Medical Center. She graduated from Loyola University Chicago Stritch School of Medicine, and completed a preliminary internal medicine year at the University of Illinois Chicago. To learn more about the field of dermatology and how to set yourself up for success to match into this specialty, please visit:https://www.aad.org/member/education/residents/medical-students https://www.aad.org/member/career/diversity/pathways/medical-students https://skinofcolorsociety.org/resources/student-resources/how-to-get-a-dermatology-residency Episode produced by: Rasa ValiaugaEpisode recording date: 11/25/25www.medicuspodcast.com | medicuspodcast@gmail.com | Donate: http://bit.ly/MedicusDonate

After the 2025 American Society of Hematology (ASH) Annual Meeting had passed, the  data were out, and the hematologist/oncologists of the world had time to digest the practice changes that awaited them upon their returns home. Rahul Banerjee, MD, FACP, and Brooke Adams, PharmD, BCOP, took part in an X Spaces discussion hosted by CancerNetwork® in collaboration with The American Society for Transplantation and Cellular Therapy (ASTCT) to highlight these potential changes. Adams and Banerjee discussed abstracts from the meeting, including the phase 3 MajesTEC-3 trial (NCT05083169), which evaluated teclistamab-cqyv (Tecvayli) plus daratumumab (Darzalex) in patients with relapsed/refractory multiple myeloma who progressed on at least 1 prior line of therapy.1 A significant progression-free survival benefit was observed with the experimental combination compared with standard of care in this population. They also discussed data from cohort A of the phase 2 IFM2021-01 trial (NCT05572229), which evaluated subcutaneous teclistamab in combination with subcutaneous daratumumab in patients with newly diagnosed multiple myeloma. Results demonstrated that the combination was effective and safe in the frontline treatment of patients who were ineligible for transplant.2 The discussion also covered the broader treatment landscape, as the experts compared the use of bispecific antibodies with BCMA-directed CAR T-cell therapies. Frontline bispecific strategies for transplant-ineligible populations were also topics of conversation, as well as post-transplant consolidation with bispecifics. Ultimately, they stated that multiple myeloma care is undergoing a paradigm shift toward deeper minimal residual disease negativity, possible treatment de‑escalation, and even serious use of the word “cure” for the disease. Banerjee is an assistant professor in the Clinical Research Division at the Fred Hutchinson Cancer Center, and Adams is a clinical pharmacist in the Department of Stem Cell Transplant and Cellular Therapy and coordinator of the PGY-2 Oncology Residency at Orlando Health. Both are also members of the ASTCT content committee. References Mateos M-V, Bahlis N, Perrot A, et al. Phase 3 randomized study of teclistamab plus daratumumab versus investigator's choice of daratumumab and dexamethasone with either pomalidomide or Bortezomib (DPd/DVd) in patients (Pts) with relapsed refractory multiple myeloma (RRMM): Results of majestec-3. Blood. 2025;146(suppl 2):LBA-6. doi:10.1182/blood-2025-LBA-6 Manier S, Lambert J, Marco M, et al. A phase 2 study of teclistamab in combination with daratumumab in elderly patients with newly diagnosed multiple myeloma: the IFM2021-01 teclille trial, cohort A. Blood. 2025;146(suppl 1):367. doi:10.1182/blood-2025-367

Welcome back for our series on AI for the clinician. This episode is a discussion about the ethical challenges and questions of AI in surgery, and there are often more questions than answers. Hosts: Ayman Ali, MD Ayman 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_TJ Ruchi Thanawala is an Associate Professor of Thoracic Surgery and Faculty in the Informatics Division at Oregon Health and Science University (tOHSU) and founder of Firefly, an AI-driven platform that is built for competency-based medical education. In addition, she directs the Surgical Data and Decision Sciences Lab for the Department of Surgery at OHSU.  Phillip Jenkins, MD: @PhilJenkinsMD Phil 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.  Steven Bedrick, PhD: @stevenbedrick Steven Bedrick is a machine learning researcher and an Associate Professor in Oregon Health and Science University's Division of Informatics, Clinical Epidemiology, and Translational Data Science. His research is focused on biomedical applications for speech and language technologies, with particular emphases on facilitating secondary use of electronic health record data and on supporting the diagnosis and management of language and communication disorders. Ryan Antiel, MD: @RyanAntiel Ryan Antiel is an Associate Professor of Pediatric Surgery at Duke Hospital and an associate director of the Trent Center for Bioethics, Humanities, and History of Medicine. His research addresses ethical challenges surrounding the care of seriously ill fetuses and neonates. He is also interested in the moral formation of surgical trainees.   Kayte Spector-Bagdady, JD: @KayteSB Kayte Spector-Bagdady is the Wantz Professor of Bioethics and Director of Michigan Bioethics at the University of Michigan Medical School. Her research focuses on increasing accessibility of health data for research and generalizability for diverse patient populations. She is also the former Associate Director for President Obama's bioethics commission. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen Behind the Knife Premium: General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate 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-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

In this episode of Behind the Knife, the minimally invasive surgery (MIS) team dives deep into the evolving field of common bile duct exploration (CBDE). From the historical context of laparoscopic approaches to the latest advances including robotic-assisted techniques, Drs. Shaina Eckhouse, James Jung, Zachary Weitzner, and Joey Lew discuss key evidence shaping modern practice. Listeners will learn about indications and anatomy guiding trans-cystic versus trans-choledochal approaches, practical tips for safe stone clearance, and critical considerations around learning curves and team coordination for robotic procedures. The episode also highlights important studies comparing single-stage laparoscopic CBDE with staged ERCP and cholecystectomy, emphasizing outcomes such as stone clearance, pancreatitis rates, and hospital length of stay. This comprehensive overview is a must-listen for MIS and acute care surgeons interested in optimizing the management of choledocholithiasis and streamlining patient care with minimally invasive techniques. Hosts:  - Shaina Eckhouse, MD, Bariatric Surgery Medical Director and Vice Chair of Clinical Operations, Department of Surgery, Duke University - James Jung, MD, PhD, Assistant Professor of Surgery, Duke University - Zachary Weitzner, MD, Minimally Invasive and Bariatric Surgery Fellow, Duke University, @ZachWeitznerMD - Joey Lew, MD, MFA, Surgical resident PGY-3, Duke University, @lew__actually Learning Goals:  By the end of this episode, listeners will be able to: -  Describe the historical approaches to managing choledocholithiasis, including staged interventions and the evolution toward single-stage laparoscopic common bile duct exploration (CBDE). -  Summarize key clinical evidence comparing CBDE and ERCP, including landmark studies and meta-analyses evaluating outcomes, complications, and trends over time.​ - Distinguish between transcystic and transcholedochal approaches to CBDE, explaining indications, contraindications, and technical nuances for each technique.​ -  Identify appropriate candidates for transcystic exploration based on cystic duct anatomy and stone characteristics.​ - Recognize the impact of newer surgical technologies—such as digital choledochoscopy, Spyglass, and robotic platforms—on CBDE practice, efficiency, and safety.​ - Discuss the importance of multidisciplinary teamwork, preparation, and perioperative planning for successful CBDE, particularly in complex or altered anatomy cases.​​ - Appraise the learning curve and quality of evidence for new CBDE procedures, outlining the need for mentorship, ongoing training, and knowing when to collaborate with GI or hepatopancreaticobiliary (HPB) surgery.​ - Outline approaches and bailout strategies for challenging cases, including patients with surgically altered anatomy and use of adjuncts such as intraoperative cholangiography (IOC), feeding tube placement, and Fanelli stents.​​ - Evaluate safety outcomes and limitations associated with robotic-assisted CBDE and single-stage management, incorporating recent data from population-based studies.​ -  Reflect on strategies for tailoring CBDE techniques to individual patient anatomy, surgeon experience, and available resources, advocating for evidence-based practice and continuous learning. References: -  Giurgiu DI, Margulies DR, Carroll BJ, et al. Laparoscopic Common Bile Duct Exploration: Long-term Outcome. Arch Surg. 1999;134(8):839-844. doi:10.1001/archsurg.134.8.839 https://pubmed.ncbi.nlm.nih.gov/10443806/ -  Lyu Y, Cheng Y, Li T, Cheng B, Jin X. Laparoscopic common bile duct exploration plus cholecystectomy versus endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for cholecystocholedocholithiasis: a meta-analysis. Surg Endosc. 2019;33(10):3275-3286. doi:10.1007/s00464-018-06613-w https://pubmed.ncbi.nlm.nih.gov/30511313/ - Bekheit M, Smith R, Ramsay G, Soggiu F, Ghazanfar M, Ahmed I. Meta‐analysis of laparoscopic transcystic versus transcholedochal common bile duct exploration for choledocholithiasis. BJS Open. 2019;3(3):242-251. doi:10.1002/bjs5.50132 https://pubmed.ncbi.nlm.nih.gov/31183439/ - Cironi K, Martin MJ. Reclaim the duct! Laparoscopic common bile duct exploration for the acute care surgeon. Trauma Surg Acute Care Open. 2025;10(Suppl 1). doi:10.1136/tsaco-2025-001821 https://pubmed.ncbi.nlm.nih.gov/40255986/ - Zhang C, Cheung DC, Johnson E, et al. Robotic Common Bile Duct Exploration for Choledocholithiasis. JSLS J Soc Laparosc Robot Surg. 2025;29(1):e2024.00075. doi:10.4293/JSLS.2024.00075 https://pubmed.ncbi.nlm.nih.gov/40144383/ - Kalata S, Thumma JR, Norton EC, Dimick JB, Sheetz KH. Comparative Safety of Robotic-Assisted vs Laparoscopic Cholecystectomy. JAMA Surg. 2023;158(12):1303-1310. doi:10.1001/jamasurg.2023.4389 https://pubmed.ncbi.nlm.nih.gov/37728932/ Ad Disclosure: 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/listen Behind the Knife Premium: General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate 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-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Walking into medical school without a roadmap hits differently when you are the first in your family to do it. No insider language, no built-in mentors, no one who can explain the difference between Step exams, clerkships, and the hidden curriculum everyone else seems to know. Kirsten Myers, PGY-3 in neurology, joins Lilly to talk about navigating medicine as a first-gen trainee—what it feels like, what it demands, and what it teaches you. They dig into the confusion, the pressure, and the unexpected strengths that come from forging your own path.

Top 5 Topics:- Truth About Becoming an Oral Surgeon: This You Haven't Heard About Before- 24-Hour Shifts, Zero Sleep, Real Trauma — The Brutal Reality of OMFS Residency- Study Hacks That Changed My Life Forever- Should You Specialize? The Honest Talk Every Dental Student Needs to Hear- 4-Year vs 6-Year OMFS: The Debate Quotes & Wisdom:[02:40–03:15] “Effective studying gets you A's; efficient studying gets you your life back.”[08:55–10:20] “If you can't see the change, you have to create it.”[16:40–17:40] “Just because you want your candle to shine brighter doesn't mean you have to put everyone else's candle out.”[19:11–20:05] “There will be time to study later. There won't be time to go on that trip or see family. Don't waste your gap year studying for the CBSE.”[20:05–20:55] “Whatever you study during your gap year, for the CBSE, will go in one ear and 90% out the other until you're in dental school.”[24:40–25:40] “When things are hard in residency, your routines — exercise, cooking, music, family — are what you rely on.”[41:50–43:00] “CBSE first, externships second, research third. But be self-aware. Comparison is the thief of joy.”[49:44–50:25] “There are so many rumors in dental school that aren't even true. Don't get distracted by them.”Questions:[05:13] – “What are the real differences between the 4-year and 6-year OMFS pathways, and what fellowships exist after training?”[13:31] – “How did you personally decide OMFS was right for you when there are so many specialties?”[18:40] – “Should I start studying for the CBSE during my gap year before dental school?”[22:11] – “How hard is the transition from dental school to OMFS residency, and what is PGY-1 actually like?”[30:22] – “How did you study for the CBSE, what resources did you use, and when did you take your last attempt?”[33:49] – “Can OMFS residents realistically moonlight to supplement income?”[41:28] – “As a D1 who wants OMFS, when should I start studying for the CBSE and how should I prioritize grades, research, and externships?”[44:23] – “What CBSE score should we aim for to be competitive in OMFS?”Now available on:- Dr. Gallagher's Podcast & YouTube Channel- Dose of Dental Podcast #198- 11.2025

Are you a med student with an upcoming away rotation? Get a head start with this episode of the BackTable ENT Podcast. Dr. Viraj Shah, a PGY-4 ENT resident at UT Southwestern and guest host Dr. Quynh-Chi Dang, PGY-1 at UC Davis Medical Center, discuss how to succeed on away rotations. --- SYNPOSIS They cover the basics of away rotations, factors to consider when applying, and effective strategies for excelling both in the operating room and within the residency team. Additionally, they delve into the importance of networking, securing recommendation letters, and making a positive impression through situational awareness and preparation. Personal anecdotes and practical tips make this a valuable listen for medical students gearing up for their rotations. --- TIMESTAMPS 00:00 Introduction 02:33 Diving into Away Rotations05:20 Factors to Consider for Away Rotations22:54 Handling Away Rotation Offers28:33 Succeeding in the OR34:30 Navigating OR Dynamics40:49 Securing Recommendation Letters46:11 Onsite Interviews: Preparation and Presentation50:48 Housing for Away Rotations56:03 Final Tips: Observing Team Dynamics and Being Proactive --- RESOURCES Chi Danghttps://health.ucdavis.edu/otolaryngology/our-team/residents.html Viraj Shah https://www.utsouthwestern.edu/departments/otolaryngology/education-training/residency-program/residents/

In this episode of the Brown General Surgery Podcast, PGY-4 resident Evan Mitchell sits down with two Brown Surgery faculty—one of our senior Trauma surgeons, Dr. Andrew Stephen, MD and one of our newest Trauma faculty Dr. Holden Spivak, MD (fresh off fellowships in Trauma/Critical Care at Shock Trauma and MIS at Stony Brook)—to explore the evolving role of robotics in trauma and acute care surgery.Key topics include:Why robotic surgery remains rare in acute trauma (hemodynamic instability, docking delays, and the risks of insufflation in unstable patients)Real-world exceptions: robotic splenectomy videos, liver laceration repairs, and selective use in stable obese patients with bowel injuriesThe nationwide decline in operative trauma since 1990 and the rebranding from “trauma surgeon” to “acute care surgeon”How emergency general surgery and elective MIS cases now sustain operative volumeTraining pathways: Is residency robotic experience now enough to skip a second fellowship year? Should future acute care surgeons pair a 1-year SCC fellowship with a dedicated MIS year?Will the classic 2-year AAST/ACS fellowship curriculum need to pivot toward more robotics and less ortho/neuro month-rotations?Job market realities: Being robotic-ready is nice, but sound decision-making (“when to operate and how”) remains the most valuable skillWhy open surgery will never become obsolete in a field driven by source control and hemorrhage controlAdvice for trainees: seek broad exposure, lean on mentors, prioritize supportive groups, and don't fear creative (even non-traditional) training routesWhether you're a med student eyeing surgical critical care, a resident deciding on fellowships, or a program director shaping tomorrow's curriculum, this candid conversation offers an honest look at where the field stands today—and where it's headed tomorrow.Tune in for practical insights from surgeons who are living the transition.

Stop powering through the pain! Surgery is a high-performance sport, yet surgeons often operate with minimal support, leading to chronic pain and potential career-ending injuries. This episode dives into the crucial topic of surgical ergonomics, explaining why your posture, instrument size, and even hydration impact your performance and longevity. Learn essential OR hacks—from adjusting monitor height and using micro-break stretches to strategic pre-case fueling—to mitigate the physical toll. We also share candid stories from surgeons who faced debilitating injuries, providing critical advice on acknowledging pain, seeking help, and treating recovery like a full-time job. It's time to invest in your physical health, because your hands and posture are your most vital instruments. Hosts:  Agnes Premkumar, MD (General Surgery Resident at Creighton University) @agnespremkumar  Steven Thornton, MD (General Surgery Resident at Duke University) @swthorntonjr Guests: Kathryn Coan, MD (Dignity Health, Phoenix) Anathea Powell, MD (Renown Health, Reno) Danielle Tanner, MD (Creighton University, Phoenix) Dr. Kathryn Coan is an endocrine surgeon, and associate professor at the Creighton University School of Medicine in Phoenix. Outside of the OR, she enjoys being active such as playing golf, hockey, and hiking. Dr. Anathea Powell is a colorectal surgeon working at Renown Health in Reno, Nevada and the University of Nevada, Reno. Outside of the OR, she has certifications in personal training as well as coaching for nutrition, sleep and recovery, mobility, and menopause. She is also a former All American in triathlon and aquabike (swim-bike). Dr. Danielle Tanner is a PGY-5 at Creighton University School of Medicine in Phoenix and aspires to be a rural general surgeon. Publications and Applications Discussed: Black Belt Academic Surgical Skills: https://bbass.org/ Epstein S, Sparer EH, Tran BN, Ruan QZ, Dennerlein JT, Singhal D, Lee BT. Prevalence of Work-Related Musculoskeletal Disorders Among Surgeons and Interventionalists: A Systematic Review and Meta-analysis. JAMA Surg. 2018 Feb 21;153(2):e174947. doi: 10.1001/jamasurg.2017.4947. Epub 2018 Feb 21. PMID: 29282463; PMCID: PMC5838584. https://pubmed.ncbi.nlm.nih.gov/29282463/ Sutton E, Irvin M, Zeigler C, Lee G, Park A. The ergonomics of women in surgery. Surg Endosc. 2014 Apr;28(4):1051-5. doi: 10.1007/s00464-013-3281-0. PMID: 24232047. https://pubmed.ncbi.nlm.nih.gov/24232047/ Patel VR, Stearns SA, Liu M, Tsai TC, Jena AB. Mortality Among Surgeons in the United States. JAMA Surg. 2025 Sep 1;160(9):1032-1034. doi: 10.1001/jamasurg.2025.2482. PMID: 40737024; PMCID: PMC12311820. https://pubmed.ncbi.nlm.nih.gov/40737024/ Lee MR, Lee GI. Does a robotic surgery approach offer optimal ergonomics to gynecologic surgeons?: a comprehensive ergonomics survey study in gynecologic robotic surgery. J Gynecol Oncol. 2017 Sep;28(5):e70. doi: 10.3802/jgo.2017.28.e70. Epub 2017 Jun 23. PMID: 28657231; PMCID: PMC5540729. https://pubmed.ncbi.nlm.nih.gov/28657231/ Berguer R. The application of ergonomics in the work environment of general surgeons. Rev Environ Health. 1997 Apr-Jun;12(2):99-106. doi: 10.1515/reveh.1997.12.2.99. PMID: 9273926. https://pubmed.ncbi.nlm.nih.gov/9273926/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen Behind the Knife Premium: General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate 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-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

In this episode of Voices of Otolaryngology, host Rahul K. Shah, MD, MBA, AAO-HNS/F EVP and CEO, sits down with brothers Michael Setzen, MD, and Gavin Setzen, MD, two private practice otolaryngologists who have shaped the specialty through decades of leadership and advocacy. Both Hall of Distinction Living Legends, the Setzen brothers share their journey from South Africa to building world-renowned practices in New York. Dr. Michael Setzen reveals an unconventional approach to work-life balance: never working Fridays and dedicating that time to golf, family, and Academy service. Dr. Gavin Setzen reflects on following his brother's footsteps into otolaryngology and the immigrant work ethic that drove both to become leaders in the Academy, American Rhinologic Society, and state societies—all while prioritizing wellness before it became a buzzword. The conversation explores how they built successful practices from scratch, knowing nobody when they started, and why they invested in Academy involvement from day one. The episode takes a special turn when Dr. Gavin Setzen's son, Sean Setzen, a PGY-1 ENT resident, joins as the podcast's first-ever guest host, sharing his optimism about the specialty's future and continuing the family legacy of otolaryngology leadership.

Septic shock remains a leading cause of pediatric mortality, but the choice of first-line vasoactive agent has long been debated. Dr Newton, a PGY-3, discusses this single-center retrospective cohort study comparing epinephrine and norepinephrine as initial infusions in children with septic shock. While the primary kidney outcome (MAKE30) showed no difference, epinephrine was linked to higher 30-day mortality in propensity-matched analysis. The findings are hypothesis-generating and highlight the need for prospective pediatric trials.

In the ED, your words can be as powerful as your meds. In this episode, PGY-3 Dr Kotel unpacks the science of placebo and nocebo, showing how communication shapes patient outcomes—and how small shifts in framing, empathy, and reassurance can turn talk into treatment.

Welcome back our series on AI for the clinician! In this episode, we go over some basics of machine learning statistics with the goal to help you read and analyze contemporary studies. Some of this will be a review, and parts will be technical, but by the end we hope reading these studies is less daunting.  Hosts: Ayman Ali, MD Ayman 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.  Julie Doberne, MD, PhD: @juliedoberne Julie Doberne is an Assistant Professor of Surgery, Assistant Professor of Medical Informatics and Clinical Epidemiology, cardiothoracic surgeon, and faculty member of the Surgical Data and Decision Sciences Lab at Oregon Health and Science University.  Phillip Jenkins, MD: @PhilJenkinsMD Phil 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.  Steven Bedrick, PhD: @stevenbedrick Steven Bedrick is a machine learning researcher and an Associate Professor in Oregon Health and Science University's Department of Medical Informatics and Clinical Epidemiology.  Shelby Willis, MD Shelby Willis is a general surgery PGY-4 at Oregon Health and Science University. She is currently in her research time in the Surgical Data and Decision Sciences lab at OHSU pursuing advanced training in informatics. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen BTK Fan Favorites:  General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

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Dr. Sean Teebagy is a PGY-2 resident at the University of Massachusetts Chan Medical School. Dr. Teebagy earned his medical degree from U Mass Chan Medical School after studying psychology at the College of The Holy Cross in Worcester, (woorster) Massachusetts. Dr. Teebagy's team recently won the Inaugural Eye Trauma 2025 Hackathon hosted by the American Society of Ophthalmic Trauma, as well as an award for best poster for his research in ocular trauma in Major League Baseball.

A silent danger lurks within the descending thoracic aorta. While most Type B aortic dissections are managed medically, up to half of these patients will either require life-saving surgery or die within just five years. So how do we separate those who will quietly recover from those on the edge of catastrophe? How do we protect the spinal cord, bowel, and limbs from the devastating consequences of malperfusion? Join the University of Michigan Department of Vascular Surgery as they tackle the high-stakes decisions behind managing this unpredictable disease—where timing is critical, interventions are evolving, and lives hang in the balance. Hosted by the University of Michigan Department of Vascular Surgery: ·       Robert Beaulieu, Program Director ·       Frank Davis, Assistant Professor of Surgery ·       Luciano Delbono, PGY-5 House Officer ·       Andrew Huang, PGY-4 House Officer ·       Carolyn Judge, PGY-2 House Officer Learning Objectives: 1.         Discuss general approach to diagnosis and management of TBAD. 2.         Identifying high-risk features in uncomplicated TBAD and understanding their role in determining the need for surgical management. 3.         Review endovascular techniques for managing malperfusion of the limbs, viscera, and spinal cord and discuss associated decision making. References:  Authors/Task Force Members, Czerny, M., Grabenwöger, M., Berger, T., Aboyans, V., Della Corte, A., Chen, E. P., Desai, N. D., Dumfarth, J., Elefteriades, J. A., Etz, C. D., Kim, K. M., Kreibich, M., Lescan, M., Di Marco, L., Martens, A., Mestres, C. A., Milojevic, M., Nienaber, C. A., … Hughes, G. C. (2024). EACTS/STS Guidelines for Diagnosing and Treating Acute and Chronic Syndromes of the Aortic Organ. The Annals of Thoracic Surgery, 118(1), 5–115. https://doi.org/10.1016/j.athoracsur.2024.01.021 de Kort, J. F., Hasami, N. A., Been, M., Grassi, V., Lomazzi, C., Heijmen, R. H., Hazenberg, C. E. V. B., van Herwaarden, J. A., & Trimarchi, S. (2025). Trends and Updates in the Management and Outcomes of Acute Uncomplicated Type B Aortic Dissection. Annals of Vascular Surgery, S0890-5096(25)00004-4. https://doi.org/10.1016/j.avsg.2024.12.060 Eidt, J. F., & Vasquez, J. (2023). Changing Management of Type B Aortic Dissections. Methodist DeBakey Cardiovascular Journal, 19(2), 59–69. https://doi.org/10.14797/mdcvj.1171 Lombardi, J. V., Hughes, G. C., Appoo, J. J., Bavaria, J. E., Beck, A. W., Cambria, R. P., Charlton-Ouw, K., Eslami, M. H., Kim, K. M., Leshnower, B. G., Maldonado, T., Reece, T. B., & Wang, G. J. (2020). Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) reporting standards for type B aortic dissections. Journal of Vascular Surgery, 71(3), 723–747. https://doi.org/10.1016/j.jvs.2019.11.013 MacGillivray, T. E., Gleason, T. G., Patel, H. J., Aldea, G. S., Bavaria, J. E., Beaver, T. M., Chen, E. P., Czerny, M., Estrera, A. L., Firestone, S., Fischbein, M. P., Hughes, G. C., Hui, D. S., Kissoon, K., Lawton, J. S., Pacini, D., Reece, T. B., Roselli, E. E., & Stulak, J. (2022). The Society of Thoracic Surgeons/American Association for Thoracic Surgery Clinical Practice Guidelines on the Management of Type B Aortic Dissection. The Annals of Thoracic Surgery, 113(4), 1073–1092. https://doi.org/10.1016/j.athoracsur.2021.11.002 Papatheodorou, N., Tsilimparis, N., Peterss, S., Khangholi, D., Konstantinou, N., Pichlmaier, M., & Stana, J. (2025). Pre-Emptive Endovascular Repair for Uncomplicated Type B Dissection—Is This an Option? Annals of Vascular Surgery, S0890-5096(25)00007-X. https://doi.org/10.1016/j.avsg.2025.01.003 Trimarchi, S., Gleason, T. G., Brinster, D. R., Bismuth, J., Bossone, E., Sundt, T. M., Montgomery, D. G., Pai, C.-W., Bissacco, D., de Beaufort, H. W. L., Bavaria, J. E., Mussa, F., Bekeredjian, R., Schermerhorn, M., Pacini, D., Myrmel, T., Ouzounian, M., Korach, A., Chen, E. P., … Patel, H. J. (2023). Editor's Choice - Trends in Management and Outcomes of Type B Aortic Dissection: A Report From the International Registry of Aortic Dissection. European Journal of Vascular and Endovascular Surgery: The Official Journal of the European Society for Vascular Surgery, 66(6), 775–782. https://doi.org/10.1016/j.ejvs.2023.05.015 Writing Committee Members, Isselbacher, E. M., Preventza, O., Hamilton Black Iii, J., Augoustides, J. G., Beck, A. W., Bolen, M. A., Braverman, A. C., Bray, B. E., Brown-Zimmerman, M. M., Chen, E. P., Collins, T. J., DeAnda, A., Fanola, C. L., Girardi, L. N., Hicks, C. W., Hui, D. S., Jones, W. S., Kalahasti, V., … Woo, Y. J. (2022). 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Journal of the American College of Cardiology, 80(24), e223–e393. https://doi.org/10.1016/j.jacc.2022.08.004 Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

Today, we're diving into a condition that's as fascinating as it is complex: Achalasia—where the esophagus stops playing nice, and swallowing becomes a daily challenge. We're breaking down the latest evidence, comparing POEM, pneumatic dilation, and Heller myotomy, and digging into what actually matters when deciding how to treat each achalasia subtype. Join show hosts Drs. Jake Greenberg, Dana Portenier, Zach Weitzner, and Joey Lew as they discuss the past, present, and future of Achalasia management. Whether you're a medical student or a seasoned attending, this episode will arm you with the tools to think critically about diagnosis, tailor your treatment strategy, and stay ahead of the curve on the future of achalasia care. Hosts:  ·      Jacob Greenberg, MD, EdM, MIS Division Chief and Vice Chair for Education, Duke University ·      Dana Portenier, MD, MIS Fellowship Director, Duke University ·      Zachary Weitzner, MD, Minimally Invasive and Bariatric Surgery Fellow, Duke University, @ZachWeitznerMD ·      Joey Lew, MD, MFA, Surgical resident PGY-3, Duke University, @lew__actually Learning Goals:  By the end of this episode, listeners will be able to: ·      Describe the pathophysiology and key diagnostic criteria for achalasia, including the role of manometry, EGD, and esophagram. ·      Differentiate between the three subtypes of achalasia based on the Chicago Classification and understand the clinical significance of each. ·      Compare treatment options for achalasia—pneumatic dilation, Lap Heller myotomy, and POEM—including indications, efficacy, and long-term outcomes. ·      Interpret landmark studies (e.g., European Achalasia Trial, JAMA POEM trial) and their impact on treatment decision-making. ·      Recognize patient-specific factors (age, comorbidities, achalasia subtype) that influence the choice of therapy. ·      Discuss evolving technologies and future directions in achalasia management, including endoluminal robotics, ARMS, and combined anti-reflux strategies. ·      Outline a basic treatment algorithm for newly diagnosed achalasia, incorporating diagnostic steps and tailored interventions. ·      Appreciate the multidisciplinary approach to achalasia care, including the roles of MIS surgeons, gastroenterologists, and emerging procedural skillsets. References: ·      Boeckxstaens G, Elsen S, Belmans A, Annese V, Bredenoord AJ, Busch OR, Costantini M, Fumagalli U, Smout AJPM, Tack J, Vanuytsel T, Zaninotto G, Salvador R; European Achalasia Trial Investigators. 10‑year follow-up results of the European Achalasia Trial: a multicentre randomised controlled trial comparing pneumatic dilation with laparoscopic Heller myotomy. Gut. 2024 Mar;73(4):582‑589. doi: 10.1136/gutjnl‑2023‑331374. PMID: 38050085 https://pubmed.ncbi.nlm.nih.gov/38050085/ ·      He J, Yin Y, Tang W, Jiang J, Gu L, Yi J, Yan L, Chen S, Wu Y, Liu X. Objective Outcomes of an Extended Anti‑reflux Mucosectomy in the Treatment of PPI‑Dependent Gastroesophageal Reflux Disease (with Video). J Gastrointest Surg. 2022 Aug;26(8):1566–1574. doi:10.1007/s11605‑022‑05396‑9. PMID: 35776296 https://pubmed.ncbi.nlm.nih.gov/35776296/ ·      Modayil RJ, Zhang X, Rothberg B, et al. Peroral endoscopic myotomy: 10-year outcomes from a large, single-center U.S. series with high follow-up completion and comprehensive analysis of long-term efficacy, safety, objective GERD, and endoscopic functional luminal assessment. Gastrointest Endosc. 2021;94(5):930-942. doi:10.1016/j.gie.2021.05.014. PMID: 33989646. https://pubmed.ncbi.nlm.nih.gov/33989646/ ·      Ponds FA, Fockens P, Lei A, Neuhaus H, Beyna T, Kandler J, Frieling T, Chiu PWY, Wu JCY, Wong VWY, Costamagna G, Familiari P, Kahrilas PJ, Pandolfino JE, Smout AJPM, Bredenoord AJ. Effect of peroral endoscopic myotomy vs pneumatic dilation on symptom severity and treatment outcomes among treatment-naive patients with achalasia: a randomized clinical trial. JAMA. 2019 Jul 9;322(2):134–144. doi:10.1001/jama.2019.8859. PMID: 31287522. https://pubmed.ncbi.nlm.nih.gov/31287522/ ·      Vaezi MF, Pandolfino JE, Yadlapati RH, Greer KB, Kavitt RT; ACG Clinical Guidelines Committee. ACG clinical guidelines: Diagnosis and management of achalasia. Am J Gastroenterol. 2020 Sep;115(9):1393–1411. doi:10.14309/ajg.0000000000000731. PMID: 32773454; PMCID: PMC9896940 https://pubmed.ncbi.nlm.nih.gov/32773454/ ·      West RL, Hirsch DP, Bartelsman JF, de Borst J, Ferwerda G, Tytgat GN, Boeckxstaens GE. Long term results of pneumatic dilation in achalasia followed for more than 5 years. Am J Gastroenterol. 2002;97(6):1346-1351. doi:10.1111/j.1572-0241.2002.05771.x. PMID:12094848. https://pubmed.ncbi.nlm.nih.gov/12094848/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

You have probably seen recent headlines that Microsoft has developed an AI model that is 4x more accurate than humans at difficult diagnoses. It's been published everywhere, AI is 80% accurate compared to a measly 20% human rate, and AI was cheaper too! Does this signal the end of the human physician? Is the title nothing more than clickbait? Or is the truth somewhere in-between? Join Behind the Knife fellow Ayman Ali and Dr. Adam Rodman from Beth Israel Deaconess/Harvard Medical School to discuss what this study means for our future.       Studies: Sequential Diagnosis with Large Language Models: https://arxiv.org/abs/2506.22405v1 METR study: https://metr.org/blog/2025-07-10-early-2025-ai-experienced-os-dev-study/ Hosts: Ayman Ali, MD Ayman Ali is a Behind the Knife fellow and general surgery PGY-4 at Duke Hospital in his academic development time where he focuses on applications of data science and artificial intelligence to surgery.  Adam Rodman, MD, MPH, FACP, @AdamRodmanMD Dr. Rodman is an Assistant Professor and a practicing hospitalist at Beth Israel Deaconess Medical Center. He's the Beth Israel Deaconess Medical Center Director of AI Programs. In addition, he's the co-director of the Beth Israel Deaconess Medical Center iMED Initiative. Podcast Link: http://bedside-rounds.org/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

RE-RELEASE This was first published in 2023 but it's so good we are running it back! Buckle up, PGY-1's! Intern year is starting whether you're ready or not. Don't fret, BTK has your back to make sure you dominate the first year of residency.  In this last episode of the intern bootcamp mini-series, we'll talk about tips & tricks as well as good habits to establish in order to dominate intern year. Hosts: Shanaz Hossain, Nina Clark Tips for New Interns:  GENERAL TIPS FOR SUCCESS ON THE WARDS Spend time with the patient! Trust, but verify. Be kind to everyone. Stay humble. Be flexible. Seek and apply feedback. HOW TO LEARN IN THE OR Double scrub as many cases as you can. Write down/record everything after a case. MAINTAIN YOUR PERSONAL SANITY Figure out your stress outlets and what brings you joy. Decompress after work. Maintain work/life boundaries. Keep in touch with loved ones. Vacations are meant for relaxation.Repeat after me: NO WORK ON VACATION! Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our new how-to video series on suture and knot-tying skills – https://behindtheknife.org/video-playlists/btk-suture-practice-kit-knot-tying-simulator-how-to-videos/

RE-RELEASE This was first published in 2023 but it's so good we are running it back! Buckle up, PGY-1's! Intern year is starting whether you're ready or not. Don't fret, BTK has your back to make sure you dominate the first year of residency. Today, we're hitting the wards and tackling some of the scary clinical scenarios you will see as an intern. Hosts: Shanaz Hossain, Nina Clark Tips for new interns: THINGS TO REMEMBER ·       BREATHE. In most cases, you have a little bit of time – at least enough to take a breath and calm down outside the room before heading into an emergency. Panic doesn't help anybody. ·       See the patient. Getting a bunch of pages? Worried about someone? Confused as to what's going on? Go see the patient and chat with the bedside team. ·       Know your toolbox. There are a ton of people around who can help you in the hospital, and knowing the basic labs/imaging studies and when to use them can help you to triage even the sickest patients. ·       Load the boat. You've heard this one from us all week! Loop senior level residents in early. HYPOTENSION ·       Differential: measurement error, patient's baseline, and don't miss – SHOCK.            - Etiologies of shock: hemorrhagic, hypovolemic, ·       On the phone: full set of vitals, accurate I/Os, ·       On the way: recent notes, PMH/PSH including from this hospital stay, and vitals/I&Os/studies from earlier in the day ·       In the room: ABCDs – rapidly gives you a sense of how high acuity the patient is ·       Get more info: labs, consider imaging, work up specific types of shock based on clinical concern. ·       Initial management: depends on etiology of hypotension; don't forget to consider peripheral or central access, foley catheterization for close monitoring of urine output, and level of care HYPOXEMIA ·       Differential: atelectasis, baseline pulmonary disease, pneumonia, PE, hemo/pneumothorax, volume overload ·       On the phone: full set of vitals, amount of supplemental oxygen required and delivery device, rate of escalation in oxygen requirement ·       On the way: review PMH/PSH, known injuries (known hemothorax/pneumothorax? Rib fractures? Chest tubes in already?), risk factors for DVT/PE, review I/Os for evidence of volume status, vitals and labs for evidence of infection ·       In the room: ABCDs, pulmonary and cardiac exam, volume status exam ·       Get more info: basic labs, ABG if worried about oxygenation, CXR, consider bedside US of the lungs/heart, if high suspicion for PE consider CTA chest ·       Initial Management: supplemental O2, higher level of care, consider intubation or other supplemental oxygenation adjuncts, additional management dependent on suspected etiology ·       ABG Vs VBG (IBCC): https://emcrit.org/ibcc/vbg/ ALTERED MENTAL STATUS ·       Differential: stroke, medication effect, hypoxemia or hypercarbia, toxic or medication effect, endocrine/metabolic, stroke or MI, psychiatric illness, or infections, delirium ·       On the way: review PMH/PSH, recent notes for evidence of altered mentation or agitation, or signs hinting at above etiologies ·       In the room: ABCDs, focal neuro deficits?, alert/oriented? Be sure the patient's mental status is adequate for airway protection! ·       Get more info: basic labs, blood gas/lactate, CT head noncontrast if concerned for stroke. ·       Initial management: rule out above; if concerned about delirium, optimize sleep/wake cycles, pain control, and lines/drains/tubes. OLIGURIA ·       Differential: prerenal due to hypovolemia or low effective circulating volume, intrinsic renal disease, post-renal obstruction ·       On the phone: clarify functional foley or bladder scan results, full set of vitals ·       On the way: review PMH/PSH, known injuries (known hemothorax/pneumothorax? Rib fractures? Chest tubes in already?), risk factors for DVT/PE, review I/Os for evidence of volume status, vitals and labs for evidence of infection ·       In the room: ABCDs, confirm functioning foley catheter ·       Get more info: basic labs, urine electrolytes, consider fluid challenge to evaluate responsiveness, consider adjuncts including renal US ·       Initial management: typically consider IVF bolus initially, but if patient not volume responsive, don't overload them -- look for other etiologies! TACHYCARDIA ·       Differential: sinus tachycardia (pain, hypovolemia, agitation, infection), cardiac arrhythmia, MI, PE ·       On the phone: full set of vitals, acuity of change in heart rate, updated I/Os ·       On the way: Review PMH/PSH, known cardiac history, cardiac and PE risk factors, volume resuscitation, signs concerning for infection, updated I/Os ·       In the room: ABCDs, cardiac/pulmonary exam, evaluate for any localizing signs for infection ·       Get more info: basic labs, EKG, consider CXR, troponins ·       Initial management: depends heavily on etiology Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our new how-to video series on suture and knot-tying skills – https://behindtheknife.org/video-playlists/btk-suture-practice-kit-knot-tying-simulator-how-to-videos/

RE-RELEASE This was first published in 2023 but it's so good we are running it back! Buckle up, PGY-1's! Intern year is starting whether you're ready or not. Don't fret, BTK has your back to make sure you dominate the first year of residency.  This episode, we'll talk about how to give and receive consults in the hospital like a pro. We'll also provide some tips on how to make those long call days a little more manageable. Hosts: Shanaz Hossain, Nina Clark Tips for New Interns:  GIVING CONSULTS Clear and Concise Question! Develop a script, such as: “Hi, this is XX with the general surgery team. We're calling to request an evaluation for a patient presenting with XX. I can give you the MRN whenever you are ready…” Follow this with a brief H&P. If you are asking another team to perform a procedure on your patient, be prepared with the following information: NPO Status Ability to Consent or Proxy Contact Blood Thinners Urgency of Procedure RECEIVING CONSULTS Make sure you are clear on what the team is asking of you as a consultant. Clarify if the patient is expecting to receive a surgery before talking to them about an operation! Quickly gather information about the patient and their hospital course from the consultant, electronic medical record, and, most importantly, the patient! Note the callback number on the primary team and call them with the plan after you have staffed the patient with your attending. If you are asked to perform a procedure as a consultant, clarify the following information: NPO Status Ability to Consent or Proxy Contact Blood Thinners Urgency of Procedure Develop a system to stay organized and keep track of your to-do list with consults! CALL SHIFTS Bring a survival bag with toothbrush/toothpaste, face wash, deodorant, change of clothes, etc to reset. Try to nap when you can, but: PM round to address non-urgent pages ahead of time Set alarms! Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our new how-to video series on suture and knot-tying skills – https://behindtheknife.org/video-playlists/btk-suture-practice-kit-knot-tying-simulator-how-to-videos/

RE-RELEASE This was first published in 2023 but it's so good we are running it back! Buckle up, PGY-1's! Intern year is starting whether you're ready or not. Don't fret, BTK has your back to make sure you dominate the first year of residency.  You've been a doctor for about 3.5 seconds, and suddenly that bright eyed, bushy-tailed medical student on service is looking to you for advice? Don't fret, in this episode we'll give you some tips for how to handle it. Hosts: Shanaz Hossain, Nina Clark Tips for new interns: REMEMBER HOW INTERNS DO AND DO NOT TEACH - Nobody, not even the med students, expect you to be an expert in everything or give a fully-planned formal lecture - You WILL however spend a ton of time working with students on your team – and via modeling and teachable moments, you can help them learn how it's done! MODELING - Remember how hard everything has been in the few days since you started residency? Think about all the information you've picked up, tips and tricks you're developing for efficiency, and best practices you're learning in the care of your patients. ALL of these are things you can pass on to students. - Presentations, case prep, answering questions from senior members of the team are ALL excellent opportunities to teach (and show students how you learn yourself, so they can do it independently). TEACHABLE MOMENTS - Find small topics that you know or are getting to know well – things like looking at a CXR, CT scan, etc. - Once you're getting more comfortable caring for specific disease processes, think about high yield lessons for students: - Acute trauma evaluation and management (ABCDE's), appendicitis, diverticulitis, benign biliary disease all make great 5 minute chalk talks that you can have in your back pocket IN THE OR - Watch students practice skills, and try to give some feedback and tips that you use (you learned knot tying and suturing more recently than ANYONE else in the OR and probably have some tips that you're still using to improve) - If you're not sure where or why the student is struggling with a particular skill (like tying a knot), model doing it yourself in slow motion while watching them do it – often the side by side comparison can help you identify where they're going astray BE THE RESIDENT YOU WISH YOU HAD - Refer to EVERYONE with respect - Model being a kind, conscientious, and curious physician - Try to find universal lessons and crossover topics that non-surgeons need to know - A great student makes their interns look even better – be explicit about how they can be successful, then advocate for them to have opportunities to show everything they're learning! Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more. If you liked this episode, check out our new how-to video series on suture and knot-tying skills – https://behindtheknife.org/video-playlists/btk-suture-practice-kit-knot-tying-simulator-how-to-videos/

RE-RELEASE This was first published in 2023 but it's so good we are running it back! Buckle up, PGY-1's! Intern year is starting whether you're ready or not. Don't fret, BTK has your back to make sure you dominate the first year of residency.  This episode, we'll tackle the resources that you should know about to support your own learning throughout residency. Hosts: Shanaz Hossain, Nina Clark Tips for new interns: STRUCTURE YOUR STUDYING - 2 things you need to do: (1) develop a knowledge base and (2) answer questions - Knowledge base Pick a level-appropriate textbook, read it (ideally all of it) yearly.  Ideally, lead a little bit every day - 10 pages/day is a good goal to start with and you may need to adjust.  - Questions Do some questions every week – 50/week is a good goal to start Plan to do more questions closer to ABSITE! Consider storing everything you learn in one place – either a notebook you carry with you or a cloud-based note app Share this with others, use it to take notes while reading, doing cases, getting feedback, or gaining experience while taking care of patients every day. SPECIFIC RESOURCES  - Textbooks Sabiston: big book, very dense, with a lot of great information. Schwartz: shorter chapters, clinically oriented, ideal for junior residents Cameron: shorter chapters, clinically oriented, ideal for senior residents - ABSITE review books Fiser: Classic, packed with facts but can be difficult to read, good for looking things up quickly BTK ABSITE Companion: https://www.amazon.com/Behind-Knife-ABSITE-Review-Companion-ebook/dp/B0CLBZ273F/ref=sr_1_2?crid=3382SFZ81ZHKA&keywords=absite+review+behind+the+knife&qid=1698106031&sprefix=absite+review+behind+the+knife%2Caps%2C64&sr=8-2 - Question banks TrueLearn: high quality, can be pricy depending on program  SCORE: written/edited by ABS, free for subscribing programs LEARN HOW TO OPERATE?? - Carry suture and a needle driver with you and practice basic moves - Consider a home suture kit for practice when you don't want to be in sim lab – BTK released one this year - Use VIDEOS to ensure learning things the correct way! Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our new how-to video series on suture and knot-tying skills – https://behindtheknife.org/video-playlists/btk-suture-practice-kit-knot-tying-simulator-how-to-videos/

RE-RELEASE This was first published in 2023 but it's so good we are running it back! Buckle up, PGY-1's! Intern year is starting whether you're ready or not. Don't fret, BTK has your back to make sure you dominate the first year of residency. First up, the first day of intern year. Hosts: Shanaz Hossain, Nina Clark Tips for new interns: BRING WHAT YOU NEED Name badge Scrubs, white coat, and extra clinic clothes Comfortable shoes - even on clinic days Pager Phone Pen Bonus stuff that's good to keep in your bag: Snacks, extras of everything, toothbrusth/toothpaste/deodorant, suture  STAY ORGANIZED Preround purposefully and systematically  Look at the same things in the same order every day on every patient Write data in the same physical location on your sheet so you can quickly find information on the fly  Keep track of to-do's from rounds Check box system:  Nina's system: empty = not done, half full = ordered/needs follow up, full = completely done and followed up on  Don't forget to look at the results of imaging studies, labs, or consults after they are entered!  Prioritize urgent/emergent things first, then consults and discharges, then routine orders, then notesAs you get more efficient, start drafting your notes as you pre-round – it will save you lots of time later in the afternoon!  OWN THE FLOOR  During the day, be ready to shift your priorities as urgent issues arise.  Develop a system for remembering what happened after rounds so you can quickly update seniors Shanaz's system: One color for AM rounds, a different color for afternoon events Load the boat! Your team is there to help you. If you are concerned about someone or have a question, ask. There is truly no better time than as an intern. Master the art of getting your seniors' attention in the OR - be conscientious, be clear in what you're asking, and be prepared to report back about urgent findings!  Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our new how-to video series on suture and knot-tying skills - https://behindtheknife.org/video-playlists/btk-suture-practice-kit-knot-tying-simulator-how-to-videos/

Join the Behind the Knife Surgical Oncology Team as we discuss the two key studies investigating optimal management strategies of neuroendocrine tumors of the small bowel. Hosts: - Timothy Vreeland, MD, FACS (@vreelant) is an Assistant Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center - Daniel Nelson, DO, FACS (@usarmydoc24) is Surgical Oncologist/HPB surgeon at Kaiser LAMC in Los Angeles. - Connor Chick, MD (@connor_chick) is a 2nd Year Surgical Oncology fellow at Ohio State University. - Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a 1st Year Surgical Oncology fellow at MD Anderson. - Beth (Elizabeth) Barbera, MD (@elizcarpenter16) is a PGY-6 General Surgery resident at Brooke Army Medical Center Learning Objectives: In this episode we review two important papers that discuss optimal management strategies of neuroendocrine tumors (NET) of the small bowel.  The first paper by Singh and colleagues discusses the NETTER-2 trial investigating the role of radioligand therapy for NET as a first-line treatment.  The second article by Maxwell et all challenges surgical dogma regarding optimal debulking cutoffs for debulking of NET. Links to Papers Referenced in this Episode: 1.     Singh S, Halperin D, Myrehaug S, Herrmann K, Pavel M, Kunz PL, Chasen B, Tafuto S, Lastoria S, Capdevila J, García-Burillo A, Oh DY, Yoo C, Halfdanarson TR, Falk S, Folitar I, Zhang Y, Aimone P, de Herder WW, Ferone D; all the NETTER-2 Trial Investigators. [177Lu]Lu-DOTA-TATE plus long-acting octreotide versus high‑dose long-acting octreotide for the treatment of newly diagnosed, advanced grade 2-3, well-differentiated, gastroenteropancreatic neuroendocrine tumours (NETTER-2): an open-label, randomised, phase 3 study. Lancet. 2024 Jun 29;403(10446):2807-2817. doi: 10.1016/S0140-6736(24)00701-3. Epub 2024 Jun 5. PMID: 38851203. https://pubmed.ncbi.nlm.nih.gov/38851203/ 2.     Maxwell JE, Sherman SK, O'Dorisio TM, Bellizzi AM, Howe JR. Liver-directed surgery of neuroendocrine metastases: What is the optimal strategy? Surgery. 2016 Jan;159(1):320-33. doi: 10.1016/j.surg.2015.05.040. Epub 2015 Oct 9. PMID: 26454679; PMCID: PMC4688152. https://pubmed.ncbi.nlm.nih.gov/26454679/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

Welcome back to our series on AI for the clinician! Large language models, like ChatGPT, have been taking the world by storm, and healthcare is no exception to that rule – your institution may already be using them! In this episode we'll tackle the fundamentals of how they work and their applications and limitations to keep you up to date on this fast-moving, exciting technology. Hosts: Ayman Ali, MD Ayman Ali is a Behind the Knife fellow and general surgery PGY-3 at Duke Hospital in his academic development time where he focuses on data science, artificial intelligence, and surgery. Ruchi Thanawala, MD: @Ruchi_TJ Ruchi Thanawala is an Assistant 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 directs the Surgical Data and Decision Sciences Lab for the Department of Surgery at OHSU.  Phillip Jenkins, MD: @PhilJenkinsMD Phil Jenkins is a general surgery PGY-3 at Oregon Health and Science University and a National Library of Medicine Post-Doctoral fellow pursuing a master's in clinical informatics. Steven Bedrick, PhD: @stevenbedrick Steven Bedrick is a machine learning researcher and an Associate Professor in Oregon Health and Science University's Department of Medical Informatics and Clinical Epidemiology. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

Welcome to our new series – the AI Journal Club! In this series, we'll cover some interesting studies and evidence-based applications of artificial intelligence in surgery in a case-based format. Surely AI can find a DVT by now … or can it? Stay tuned and find out! Hosts: - Ayman Ali, MD Ayman Ali is a Behind the Knife fellow and general surgery PGY-3 at Duke Hospital in his academic development time where he focuses on data science, artificial intelligence, and surgery. - Ruchi Thanawala, MD: @Ruchi_TJ Ruchi Thanawala is an Assistant 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 directs the Surgical Data and Decision Sciences Lab for the Department of Surgery at OHSU.  - Marisa Sewell, MD: @MarisaSewell Marisa Sewell is a general surgery PGY-4 at Oregon Health and Science University.  Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen