Behind The Knife: The Surgery Podcast

The grind of surgical training has been celebrated in the past, but to what end? With mounting evidence that supports a high prevalence of burnout in the surgical community, surgical educators and leaders are often called to develop initiatives to address the detrimental and potentially irreversible effects on trainees’ wellness during surgical training. We invite Dr. David Rogers, who has personally experienced burnout, to share his insight and expertise in improving workplace wellness. Spoiler: it’s not as easy as group yoga sessions and daily donuts.
Hosts:
Dr. David Rogers
Dr. Jeremy Lipman
Dr. Judith French
Dr. Amy Han
Learning Objectives
1. Listeners will be able to define wellness in the context of surgical training.
2. Listeners will be able to better characterize and recognize signs of burnout among surgeons and surgical trainees.
3. Listeners will be able identify strategies for overcoming burnout.
4. Listeners will be able to apply conceptual frameworks from workplace wellness outside of medicine that can guide developing effective programs that promote wellness in surgical education community.
References:
Torres-Landa S, Moreno K, Brasel KJ, Rogers DA. Identification of Leadership Behaviors that Impact General Surgery Junior Residents' Well-being: A Needs Assessment in a Single Academic Center. J Surg Educ. 2022;79(1):86-93. doi:10.1016/j.jsurg.2021.07.017
Coverdill JE, Bittner IV JG, Park MA, Pipkin WL, Mellinger JD. Fatigue as impairment or educational necessity? Insights into surgical culture. Acad Med. 2011;86:S69-72.
Dyrbye LN, Thomas MR, Harper W, et al. The learning environment and medical student burnout: a multicentre study. Med Educ. 2009;43(3):274-282. doi:10.1111/j.1365-2923.2008.03282.x
Dyrbye L, Shanafelt T. A narrative review on burnout experienced by medical students and residents. Med Educ. 2016;50(1):132-149. doi:10.1111/medu.12927
Bordage G. Conceptual frameworks to illuminate and magnify. Med Educ. 2009;43(4):312 319. doi:10.1111/j.1365-2923.2009.03295.x
Bakker AB, de Vries JD. Job Demands–Resources theory and self-regulation: New explanations and remedies for job burnout. Anxiety, Stress, & Coping. 2021;34: 1-21.
Georgiadis F. Author Dr Amit Sood: Rising Through Resilience; Five Things You Can Do To Become More Resilient. Medium. https://medium.com/authority-magazine/author-dr-amit-sood-rising-through-resilience-five-things-you-can-do-to-become-more-resilient-673b0a1e9f2a. Published 2020. Accessed May 10, 2022.
Gino F. Are You Too Stressed to Be Productive? Or Not Stressed Enough? Harvard Business Review. Published October 5, 2017. https://hbr.org/2016/04/are-you-too-stressed-to-be-productive-or-not-stressed-enough

Goleman D. Primal Leadership, with a New Preface by the Authors : Unleashing the Power of Emotional ... Intelligence.Harvard Bus Review Press; 2016.
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

It’s 1AM and the emergency department is calling about *insert terrifying foregut problem you haven’t seen since you were an intern here* and you wake up in a cold sweat to realize it was just a dream...this time. Tune in to this clinical challenge episode for some tips and tricks for managing foregut nightmares with Drs. Mike Weykamp, Nicole White, Andrew Wright, and Nick Cetrulo from the University of Washington’s Minimally Invasive Surgery team.
Referenced articles and videos:
1. Rodriguez-Garcia HA, Wright AS, Yates RB. Managing obstructive gastric volvulus: challenges and solutions. Open Access Surgery. 2017
https://www.dovepress.com/getfile.php?fileID=35414
2. Yates RB. Giant PEH: Management Principles for Unique Clinical Circumstances. 2017 SAGES Annual Meeting. Houston, TX. 2017
https://www.youtube.com/watch?v=vq6cZL2-pho
3. Millet I, Orliac C, Alili C, Guillon F, Taourel P. Computed tomography findings of acute gastric volvulus. Eur Radiol. 2014.
https://pubmed.ncbi.nlm.nih.gov/25278244/
4. Mazaheri P, Ballard DH, Neal KA, Raptis DA, Shetty AS, Raptis CA, Mellnick VM. CT of Gastric Volvulus: Interobserver Reliability, Radiologists' Accuracy, and Imaging Findings. AJR Am J Roentgenol. 2019.
https://pubmed.ncbi.nlm.nih.gov/30403524/
5. Barmparas G, Alhaj Saleh A, Huang R, Eaton BC, Bruns BR, Raines A, Bryant C, Crane CE, Scherer EP, Schroeppel TJ, Moskowitz E, Regner JL, Frazee R, Campion EM, Bartley M, Mortus JR, Ward J, Margulies DR, Dissanaike S. Empiric antifungals do not decrease the risk for organ space infection in patients with perforated peptic ulcer. Trauma Surg Acute Care Open. 2021.
https://pubmed.ncbi.nlm.nih.gov/34079912/
6. Horn CB, Coleoglou Centeno AA, Rasane RK, Aldana JA, Fiore NB, Zhang Q, Torres M, Mazuski JE, Ilahi ON, Punch LJ, Bochicchio GV. Pre-Operative Anti-Fungal Therapy Does Not Improve Outcomes in Perforated Peptic Ulcers. Surg Infect (Larchmt). 2018.
https://pubmed.ncbi.nlm.nih.gov/30036134/
7. Wee JO. Gastric Volvulus in Adults. In: UpToDate, Louie BE (Ed), UpToDate, Waltham, MA. (Accessed on May 15, 2022.)
https://www.uptodate.com/contents/gastric-volvulus-in-adults
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

Acute limb ischemia is simultaneous one of the most fun but frustrating diseases to treat in vascular surgery. In this episode of Behind the Knife, the vascular surgery team gives a concise overview of the diagnosis/workup and treatment of patients with acute limb ischemia and talks about some of the difficult decision making regarding treatment modality given all the exciting technology available today.
Dr. Nicholas Osborne is an Associate Professor of Vascular Surgery at the University of Michigan and the Chief of Vascular Surgery at the Ann Arbor Veteran’s Affairs Healthcare System.
Dr. Frank Davis is a Chief Resident in the Integrated Vascular Surgery program at the University of Michigan.
Dr. Craig Brown is a PGY-6 in the General Surgery program at the University of Michigan.
Papers discussed in this Episode:
AHA/ACC/SVS, etc Guidelines on the Management of Patients with Lower Extremity Peripheral Artery Disease
https://pubmed.ncbi.nlm.nih.gov/27851992/
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

In this episode from the Endocrine Surgery team at BTK we invited Dr. Kepal Patel to join us to discuss two endocrine surgery cases while discussing pertinent literature. We discuss the work-up and surgical decision making for a case of medullary thyroid cancer and a Bethesda III thyroid nodule.
Dr. Kepal Patel is the Chief of the Division of Endocrine Surgery and a Professor of Surgery, Otolaryngology and Biochemistry at NYU Langone Health.
Dr. Michael Yeh is a Professor of Surgery at UCLA and serves as Section Chief of the UCLA Endocrine Surgery program which he established.
Dr. Masha Livhits is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department
Dr. James Wu is an Assistant Professor of Surgery at UCLA and works in the Endocrine Surgery Department
Dr. Vivek Sant is an Endocrine Surgery Fellow at UCLA in his first year of fellowship
Dr. Rivfka Shenoy is a PGY-5 General Surgery Resident at UCLA who has completed two years of research
Dr. Max Schumm is a PGY-5 General Surgery Resident at UCLA who has completed two years of research. He is a future endocrine surgeon.
Important Papers
Miyauchi, A., Matsuzuka, F., Hirai, K., Yokozawa, T., Kobayashi, K., Ito, Y., ... & Yamaguchi, K. (2002). Prospective trial of unilateral surgery for nonhereditary medullary thyroid carcinoma in patients without germline RET mutations. World journal of surgery, 26(8), 1023-1028.
Cibas, E. S., Baloch, Z. W., Fellegara, G., LiVolsi, V. A., Raab, S. S., Rosai, J., ... & Alexander, E. K. (2013). A prospective assessment defining the limitations of thyroid nodule pathologic evaluation. Annals of internal medicine, 159(5), 325-332.
Papazian, M. R., Dublin, J. C., Patel, K. N., Oweity, T., Jacobson, A. S., Brandler, T. C., & Givi, B. (2022). Repeat Fine-Needle Aspiration With Molecular Analysis in Management of Indeterminate Thyroid Nodules. Otolaryngology–Head and Neck Surgery, 01945998221093527.
Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

How do we actually improve wellness? How do surgery trainees advocate for themselves as both learners and employees? In this final surgical education episode with Matt Chia MD MS and Karl Bilimoria MD MS, we review two articles discussing unions and wellness in surgical training. We’re joined by Meg Smith MD MS, Brian Brajcich MD MS, and Darci Foote MD MS to tackle this difficult topic and open the discussion for what’s next in surgical education.
Learning Objectives:

· Identify potential benefits and limitations of unionization in surgery training
· Describe strategies used by program leadership to improve wellness in surgery
References:

National Evaluation of the Association Between Resident Labor Union Participation and Surgical Resident Well-being https://doi.org/10.1001/jamanetworkopen.2021.23412
How Program Directors Understand General Surgery Resident Wellness - https://doi.org/10.1016/j.jsurg.2022.07.022
Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.
If you liked this episode, check out other surgical education episodes here: https://behindtheknife.org/podcast-category/surgical-education/