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Two years into the EPA era — are we actually training surgeons differently, or just checking new boxes? In this episode, Behind the Knife co-director and Duke Trauma Surgeon Dr. Patrick Georgoff and Behind the Knife surgical education fellows Dr. Agnes Premkumar and Dr. Emma Burke sit down with Dr. Ruchi Thanawala, thoracic surgeon at OHSU, informatician, and founder of Firefly Labs, to get an honest look at the state of competency-based surgical education. We dig into why surgery is uniquely ha...
In this episode, we use the recent SAGES guidelines to tackle one of the most common and controversial questions in general surgery. Through a case-based discussion, our experts review the evidence for intraoperative biliary imaging, discuss strategies for difficult anatomy, and compare IOC with other imaging modalities. Join us as we translate the latest recommendations into practical lessons that can be applied in the operating room. Take Home Points: Routine IOC is supported; however, this re...
Join our Hernia Team for a review of the current controversy around preoperative optimization and the practical implications. Hosts: Dr. Maggie Bosley - @MBosleyMD Dr. Sean Orenstein - @OrensteinSean Dr. Amber Sandoval Dr. Peter Ferrin Institution: Oregon Health & Science University References: Adverse Events after Ventral Hernia Repair: The Vicious Cycle of Complications https://pubmed.ncbi.nlm.nih.gov/26206646/ Risk factors for postoperative wound infections and prolonged hospitalization a...
As colorectal cancer rates rise among younger adults, surgeons are increasingly caring for patients with rectal cancer who are pregnant or hoping to preserve future fertility. With more individuals delaying childbearing, balancing effective cancer treatment with fertility preservation and maternal–fetal safety has become an important clinical challenge. This timely topic was recently highlighted by Dr. Sharon Suwanabol during a presentation at the American Society of Colon and Rectal Surgeons an...
Why do millions of patients qualify for bariatric surgery, yet only a fraction ever make it to the operating room? Hosts · Matthew Martin, trauma and bariatric surgeon at the University of Southern California/Los Angeles General Medical Center (Los Angeles, California) · Adrian Dan, bariatric and MIS surgeon, program director for the advanced MIS bariatric and foregut fellowship at Summa Health System (Akron, Ohio) · Crystal Johnson Mann, bariatric and foregut surgeon at the University of Florid...
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 pr...
Join the Behind the Knife Surgical Oncology Team as we discuss clinical challenges through case-based examples including the diagnosis, workup, and management of patients with cutaneous melanoma. Learning Objectives: In this episode, we review the workup and management of patients with cutaneous melanoma and both microscopic and macroscopic nodal disease. References used in the making of this episode: Reijers, I.L.M., Menzies, A.M., van Akkooi, A.C.J. et al. Personalized response-directed surger...
A 25-year-old pregnant woman presents with a 1-day history of progressive pain and swelling. The foot is cold, pulseless and neurologic function is deteriorating by the hour. Imaging shows a massive iliofemoral DVT. Now both the limb and the pregnancy are threatened. Do you anticoagulate, thrombolyse or operate? Join us as we break down the management and decision making behind this rare but devastating case. Hosts: · Christian Hadeed -PGY 4 General Surgery, Brookdale Hospital Medical Center · P...
Get a behind-the-scenes look at one of the most anticipated sessions from the Association of Surgeons of Great Britain and Ireland Annual Conference: “Bad Day on Call.” In this session, expert surgeons from the United States, United Kingdom, and Canada work through challenging real-world acute care and trauma cases. As each case unfolds, the panel explores key decision points while highlighting both the similarities and differences in surgical management across healthcare systems. This year’s pa...
It’s hospital day five. The patient looked better yesterday… but now she’s hypotensive, on vasopressors, acidotic, and spiraling toward multi-organ failure. The CT scan doesn’t show perforation or megacolon, but your gut tells you this is going south. Do you keep pushing medical therapy… or is it time to operate? Join Drs. Rushabh Dev, Jeffrey Coughenour, Kevin Bartow, Raymond Okeke, and Desra Fletcher from the Emergency General Surgery team in Tiger Country at Mizzou as they tackle one of the d...
The majority of non-fatal gunshot wound survivors walk away with a bullet still inside them. Most are discharged without a removal attempt, without a surveillance plan, and without a conversation about what comes next. This episode fills that gap. Dr. Patrick Georgoff is joined by BIG T co-host Dr. Teddy Puzio (UT Houston), gun violence survivor and trauma surgeon Dr. Madhu Subramanian (Duke), and Dr. Tyler Simpson (Duke ACS Fellow) for a practical, honest conversation about one of trauma's most...
In this episode, hosts Drs. Maya Hunt, Nicole Santucci, Bryanna Stukes and Zoe Zhou explore the parallels between the literacy crisis in America and current challenges in surgical education, drawing insights from the podcast "Sold a Story." They discuss how both systems advance learners without true competency, blame struggling students rather than examining flawed teaching methods, and look to the promise of competency-based education as a path forward. Beyond surgical training, they examine ho...
Ileocolic resection is one of the most common operations performed for Crohn's disease, yet the optimal approach to anastomotic construction and mesenteric management remains an active area of debate. From the configuration of the anastomosis to the extent of mesenteric excision, emerging evidence suggests that surgical technique may play a meaningful role in disease outcomes. Join Drs. Jared Hendren, Elissa Dabaghi, Joseph Trunzo, Ajaratu Keshinro, and David Rosen as they discuss methods for il...
As cancer vaccines move into Phase II and III clinical trials, it is increasingly important for surgeons to understand their role in this evolving landscape. What exactly are these vaccines, how do they work, and what should the surgical community know about their implementation? Join BTK surgical education fellows Kara Button and Michelle LaBella as they sit down with Professor Robert Jones to break down the science of mRNA vaccines, the logistics of tissue procurement, and the future of cancer...
Join hosts Ayman Ali and Patrick Georgoff with Dr. Christian Péan, a leading expert in AI and IT innovation in healthcare, as they demystify artificial intelligence for busy surgeons. This discussion redefines AI from a search engine to a powerful "thought partner" for knowledge work, offering practical advice on choosing and utilizing frontier LLMs like Claude and Gemini. Dr. Péan and the hosts share specific use cases, from automating literature reviews and resident coaching to streamlining administrative duties and improving clinical documentation with ambient scribes, aiming to combat physician burnout.
What are the experts saying about thyroid cancer treatment in 2025? Maybe it’s time to discuss deescalation of aggressive surgical care for lower risk thyroid cancers. We can accept that less surgery may be appropriate in select cases, including more thyroid lobectomies versus total thyroidectomies, consider less invasive approaches such as percutaneous ablation techniques, and utilize more observation with active surveillance. Early assessment of treatment may allow appropriate reduction in use...
For decades, a tight carotid stenosis felt like a ticking time bomb — a plaque waiting to throw an embolus and cause the next stroke. We were taught that severe narrowing meant surgery, and trials like ACAS and ACST-1 seemed to prove it. But medicine has changed. Statins, antiplatelets, tighter blood pressure control, even PCSK9 and GLP-1 therapies have quietly slashed stroke risk, and now newer data from CREST-2 suggest that for many asymptomatic patients, the knife — or the stent — may not add...
In this episode, our expert panel dives into the critical, historically debated topic of early burn wound excision using a real-world case of a patient with massive surface area burns. We explore the dramatic shift from the pre-1970s "wait and watch" approach to the modern standard of early source control, backed by landmark literature showing reduced mortality and shorter hospital stays. The discussion also highlights the nuances of this timeline, covering specific scenarios where delaying surg...
This episode includes a full, sample cardiothoracic scenario pulled directly from our Cardiothoracic Surgery Oral Board Review Course. Listen in and test your clinical pathways in real-time as we walk through the perfect answers and provide high-yield commentary to help you pass the "hot seat." About our Cardiothoracic Surgery Oral Board Review Course: 43 High-Yield Scenarios Dual-Format Learning: Each case includes "Part A" (a straight run-through of the perfect exam response) and "Part B" (the...
This mini-series on Behind the Knife delves into the technical aspects of the Operative Standards for Cancer Surgery, developed through the American College of Surgeons Cancer Research Program and Cancer Surgery Standards Program. This episode highlights sentinel lymph node biopsy for breast cancer. Hosts : - Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a Surgical Oncology fellow at MD Anderson Cancer Center. - Lauren Postlewait, MD, FACS, is an Associate Professor of Surgery at Emory Unive...
This episode includes two full, sample vascular scenarios pulled directly from our Vascular Surgery Oral Board Review Course. Listen in and test your clinical pathways in real-time as we walk through the perfect answers and provide high-yield commentary to help you pass the "hot seat." Sample Scenarios Included in This Episode: Case 22: Aortoenteric Fistula (AEF). A 78-year-old woman presents to the ER with a massive upper GI bleed and a history of an open AAA repair 10 years ago. We walk you th...
Hosts Dr. Thornton and Dr. Burke speak with Dr. Wood and Dr. Varghese about the new American College of Surgeons Workplace Standards Framework. They explore how this initiative arose from growing surgeon burnout and discussions around unionization, aiming to define reasonable expectations for call, OR access, and administrative burden. The conversation emphasizes the need for systems-level change, moving beyond a culture of "unlimited endurance" to create more sustainable and attractive surgical careers for generations to come, while also highlighting the practical implementation challenges and benefits.
The House Judiciary Committee just dropped a 47-page report calling the National Residency Match Program a hiring monopoly that harms patients, doctors, and the public — and the surgical community is talking. In this episode, Dr. Patrick Georgoff is joined by BTK surgical education fellows Dr. Emma Burke and Dr. Agnes Prem Kumar, along with special guest Dr. Brian Carmody (aka the Sheriff of Sodium), a pediatric nephrologist and one of the sharpest analysts of medical education policy working to...
A career in surgery has a profound impact on those who practice the craft. High rates of poor mental health are well described but incompletely understood. One potential mechanism for advancing our understanding of surgeon well-being is studying surgeons' emotional experiences. Shame, a self-conscious emotion reflecting how an individual feels about themselves, could be a particularly powerful lens. In this series on shame in surgery, we explore what we know about shame in surgery and what shame...
A career in surgery has a profound impact on those who practice the craft. High rates of poor mental health are well described but incompletely understood. One potential mechanism for advancing our understanding of surgeon well-being is studying surgeons' emotional experiences. Shame, a self-conscious emotion reflecting how an individual feels about themselves, could be a particularly powerful lens. In this series on shame in surgery, we explore what we know about shame in surgery and what shame...
A career in surgery has a profound impact on those who practice the craft. High rates of poor mental health are well described but incompletely understood. One potential mechanism for advancing our understanding of surgeon well-being is studying surgeons’ emotional experiences. Shame, a self-conscious emotion reflecting how an individual feels about themselves, could be a particularly powerful lens. In this series on shame in surgery, we explore what we know about shame in surgery and what shame...
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...
Join the Johns Hopkins Thoracic Surgery Subspecialty team on this rapid research review revealing how investigative efforts have changed the way we view and use Veno-venous (VV) ECMO therapy in the pre-lung transplant patient population working to avoid ventilator dependence and the associated morbidity while facilitating continued ambulation and preoperative optimization. Hosts: - Dr. Alfred J. Casillan, MD, PhD Attending Thoracic Surgeon Johns Hopkins Hospital - Kyla Rakoczy, MD Johns Hopkins ...
Welcome back to Behind the Knife with Cody, Patrick, Jason, and Ayman. Today, we are tackling a defining professional ritual for every surgical trainee: the Morbidity and Mortality (M&M) Conference. We are providing a practical roadmap to help you build clear, high-quality presentations that facilitate real learning for the entire room. Whether you are a junior resident preparing for your first case or an attending looking to moderate effectively, this episode covers exactly what to include,...
Xenotransplantation—the use of organs from other species to treat human disease—has long existed at the intersection of science fiction and surgical innovation. While early efforts were marked by limited success and ethical controversy, recent advances in genetic engineering, immunosuppression, and organ preservation have brought the field closer than ever to clinical reality. In this episode of Behind the Knife, we are joined by Dr. Joshua Mezrich to explore the history, science, and future of ...
