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It’s 2 a.m. and a patient with a GSW to the thigh is rolling into the trauma bay. He’s hypotensive, tachycardic, and has a tourniquet in place. Do you get a CTA or go straight to the OR? What do you do with the tourniquet? Join us as we work through this and two other cases of extremity vascular trauma and break down the literature to answer these questions and discuss how we should approach these challenging injuries. Hosts:·      Christian Hadeed - PGY 5 General Surgery, Brookdale Hospital Medical Center·      Paul Haser -Division Chief, Vascular Surgery, Brookdale Hospital Medical Center·      Andrew Harrington – Division Chief, Vascular surgery, Richmond University Medical Center·      Lucio Flores - Vascular surgery, Brookdale Hospital Medical Center Learning Objectives:·      Apply the X-ABCDE approach to patients with extremity vascular trauma, including the role of early hemorrhage control and tourniquets.·      Recognize the hard and soft signs of extremity arterial injury and determine when additional vascular imaging is indicated.·      Describe the role of the ankle-brachial index, CT angiography, and conventional angiography in the evaluation of suspected extremity vascular injury.·      Discuss the principles of operative management of extremity vascular injuries, including temporary shunting, vascular repair, and restoration of limb perfusion.·      Briefly discuss mangles extremities and when saving the limb may not be appropritate References:·      American College of Surgeons Committee on Trauma. (2025). Advanced trauma life support (ATLS®) student course manual (11th ed.). American College of Surgeons.·      Lynch, K., & Johansen, K. (1991). Can Doppler pressure measurement replace “exclusion” arteriography in the diagnosis of occult extremity arterial trauma? Annals of Surgery, 214(6), 737–741. https://doi.org/10.1097/00000658-199112000-00016·      Inaba, K., Branco, B. C., Reddy, S., Park, J. J., Green, D., Plurad, D., Talving, P., Lam, L., & Demetriades, D. (2011). Prospective evaluation of multidetector computed tomography for extremity vascular trauma. Journal of Trauma, 70(4), 808–815. https://doi.org/10.1097/TA.0b013e3182118384·      Polcz, J. E., White, J. M., Ronaldi, A. E., Dubose, J. J., Grey, S., Bell, D., White, P. W., & Rasmussen, T. E. (2021). Temporary intravascular shunt use improves early limb salvage after extremity vascular injury. Journal of Vascular Surgery, 73(4), 1304–1313. https://doi.org/10.1016/j.jvs.2020.08.137·      Asensio, J. A., Kessler, J. J., Miljkovic, S. S., Kotaru, T. R., Dabestani, P. J., Kalamchi, L. D., Wenzl, F. A., Sanford, A. P., & Rowe, V. L. (2020). Brachial artery injuries: Operative management and predictors of outcome. Annals of Vascular Surgery, 69, 146–157. https://doi.org/10.1016/j.avsg.2020.05.049·      Barnes, C. J., Pietrobon, R., & Higgins, L. D. (2002). Does the pulse examination in patients with traumatic knee dislocation predict a surgical arterial injury? A meta-analysis. Journal of Trauma, 53(6), 1109–1114. https://doi.org/10.1097/00005373-200212000-00013·      Mills, W. J., Barei, D. P., & McNair, P. (2004). The value of the ankle-brachial index for diagnosing arterial injury after knee dislocation: A prospective study. Journal of Trauma, 56(6), 1261–1265. https://doi.org/10.1097/01.TA.0000068995.63201.0B·      Weinberg, D. S., Scarcella, N. R., Napora, J. K., & Vallier, H. A. (2016). Can vascular injury be appropriately assessed with physical examination after knee dislocation? Clinical Orthopaedics and Related Research, 474, 1453–1458. https://doi.org/10.1007/s11999-016-4730-6Sponsor URL: https://www.goremedical.com/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-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-reviewOBGYN Oral Board Review Course: https://behindtheknife.org/course/obgyn-oral-board-reviewSurgical Critical Care Review: https://behindtheknife.org/premium/surgical-critical-care-reviewABSITE Question Bank: https://behindtheknife.org/premium/absite-question-bankEPA Playbook: https://behindtheknife.org/course/epa-playbookSurgical Instrument Flashcards: https://behindtheknife.org/course/surgical-instrument-flashcardsABSITE Review: https://behindtheknife.org/course/absite-2026-exam-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

This mini-series on Behind the Knife will discuss 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 total mesorectal excision for rectal cancer. Host: Jason Lizalek, MD (@JasonLizalekMD) is a Surgical Oncology fellow at Moffitt Cancer Center in Tampa, FL.Guests: Sean J Langenfeld, MD, FACS, FASCRS (@seanlangenfeld) is a professor of surgery and the chief of the division of colon and rectal surgery at the University of Nebraska Medical Center in Omaha, NE Larissa Temple, MD, FACS, FASCRS is a professor of surgery and the chief of colon and rectal surgery at the University of Rochester in Rochester, NY. Learning Objectives: -       Understand the relevant pelvic anatomy that makes TME challenging.-       Develop a step-by-step approach to TME that avoids major pitfalls and allows for a sfe low pelvic anastomosis.-       Learn tips and tricks for exposure and progress in the more difficult cases. Links to Papers Referenced in this Episode:Operative Standards for Cancer Surgery, Volume 1: Breast, Lung, Pancreas, Colonhttps://www.facs.org/quality-programs/cancer-programs/cancer-surgery-standards-program/operative-standards-for-cancer-surgery/purchase/Kindle edition:https://www.amazon.com/Operative-Standards-Cancer-Surgery-Section-ebook/dp/B07MWSNFSBThe American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Rectal Cancer 2023 Supplementhttps://pubmed.ncbi.nlm.nih.gov/37647138/NCCN Guidelines for Rectal Cancerhttps://www.nccn.org/guidelines/guidelines-detail?category=1&id=1461 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-reviewOBGYN Oral Board Review Course: https://behindtheknife.org/course/obgyn-oral-board-reviewSurgical Critical Care Review: https://behindtheknife.org/premium/surgical-critical-care-reviewABSITE Question Bank: https://behindtheknife.org/premium/absite-question-bankEPA Playbook: https://behindtheknife.org/course/epa-playbookSurgical Instrument Flashcards: https://behindtheknife.org/course/surgical-instrument-flashcardsABSITE Review: https://behindtheknife.org/course/absite-2026-exam-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

It’s postoperative day four after surgery for a perforated colon. The source appears controlled, but the patient is still intubated, the white count is eighteen, and nobody feels comfortable stopping piperacillin–tazobactam. Is four days really enough? Does the ICU buy another four—or is it time to ask what we’re missing? Join Drs. Rushabh Dev, Skye Shultz, Kelly Ray, Desra Fletcher, and Brycen Ratcliffe from the Emergency General Surgery team in Tiger Country at Mizzou as they revisit STOP-IT and examine what more than a decade of evidence has added to the management of complicated intra-abdominal infection. In this EGS Journal Review, the team appraises the landmark trial, explores its subgroup analyses and limitations, and puts contemporary SIS, IDSA, AAST, and Surviving Sepsis guidance into context. The discussion moves from source control and antibiotic duration to resistant organisms, cultures, de-escalation, ICU dosing, and the role of procalcitonin. For most complicated intra-abdominal infections, approximately four days after adequate source control remains the default. Persistent illness should prompt a search for failed source control, ineffective therapy, or another diagnosis before simply extending the stop date. Hosts Dr. Rushabh Dev, MD, FACS – Moderator and Acute Care Surgeon, University of Missouri Dr. Skye Shultz – Surgical Critical Care Fellow, University of Missouri Dr. Kelly Ray – General Surgery Resident; STOP-IT appraisal and antimicrobial selection Dr. Desra Fletcher – General Surgery Resident, University of Missouri; post-STOP-IT evidence and implementation Dr. Brycen Ratcliffe – General Surgery Resident; society guidance and microbiology Learning ObjectivesBy the end of this episode, listeners should be able to:·       Describe the design, principal results, strengths, and limitations of STOP-IT, including why adequate source control is essential to applying its findings.·       Apply short-course therapy after adequate operative or percutaneous source control and explain why sepsis alone, obesity, or diabetes does not automatically require a longer course.·       Distinguish the four-day default from the weaker SIS recommendation supporting up to eight days in selected critically ill patients after adequate source control.·       Recognize persistent or worsening illness that warrants reassessment of source control, drain function, microbiology, drug exposure, or alternative diagnoses.·       Differentiate the treatment scope of SIS guidance from the diagnostic and microbiology focus of IDSA 2024, the AAST surgical ICU consensus, and broader sepsis and antimicrobial-resistance guidance.·       Select and de-escalate antimicrobials using infection setting, resistance risk, cultures, local susceptibility data, and patient-specific dosing considerations.·       Explain the limited adjunctive role of procalcitonin in antibiotic discontinuation when duration remains uncertain, including the implications of ADAPT-Sepsis. References 1.     Sawyer RG, et al. Trial of short-course antimicrobial therapy for intraabdominal infection. N Engl J Med. 2015;372:1996–2005. STOP-IT. Article / guideline2.     Huston JM, et al. The Surgical Infection Society Guidelines on the Management of Intra-Abdominal Infection: 2024 Update. Surg Infect. 2024;25:419–435. Article / guideline3.     Rattan R, et al. Patients with complicated intra-abdominal infection presenting with sepsis do not require longer duration of antimicrobial therapy. J Am Coll Surg. 2016;222:440–446. Article / guideline4.     Rattan R, et al. Percutaneously drained intra-abdominal infections do not require longer duration of antimicrobial therapy. J Trauma Acute Care Surg. 2016;81:108–113. Article / guideline5.     Montravers P, et al. Short-course antibiotic therapy for critically ill patients treated for postoperative intra-abdominal infection: the DURAPOP randomized clinical trial. Intensive Care Med. 2018;44:300–310. Article / guideline6.     IDSA. 2024 Guideline Update on Complicated Intra-Abdominal Infections: Risk Assessment, Diagnostic Imaging, and Microbiological Evaluation. Article / guideline7.     Nohra E, et al. Fever and infections in surgical intensive care: an AAST Critical Care Committee clinical consensus document. Trauma Surg Acute Care Open. 2024;9:e001303. Article / guideline8.     IDSA. 2026 Guidance on the Treatment of Antimicrobial-Resistant Gram-Negative Infections. Article / guideline9.     Prescott HC, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026. Crit Care Med. 2026. Article / guideline10.  Dark P, et al. Biomarker-guided antibiotic duration for hospitalized patients with suspected sepsis: the ADAPT-Sepsis randomized clinical trial. JAMA. 2025;333:682–693. Article / guidelineAfter adequate source control, most complicated intra-abdominal infections need approximately four days of antibiotics. If the patient is not improving, reassess the source and the treatment—not just the calendar.Sponsor 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/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-reviewOBGYN Oral Board Review Course: https://behindtheknife.org/course/obgyn-oral-board-reviewSurgical Critical Care Review: https://behindtheknife.org/premium/surgical-critical-care-reviewABSITE Question Bank: https://behindtheknife.org/premium/absite-question-bankEPA Playbook: https://behindtheknife.org/course/epa-playbookSurgical Instrument Flashcards: https://behindtheknife.org/course/surgical-instrument-flashcardsABSITE Review: https://behindtheknife.org/course/absite-2026-exam-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

Enlace del curso: https://behindtheknife.org/premium/repaso-para-el-examen-de-certificaci-n-en-cirug-a-general Behind the Knife es el podcast quirúrgico líder en el mundo y una plataforma de educación quirúrgica. Nuestra misión es crear contenido innovador de educación quirúrgica que sea accesible para todos. Estamos muy emocionados de expandirnos al público hispanohablante y ofrecerles 4 episodios de muestra de nuestro Curso de Repaso para el examen de certificación de Cirugía General. Hoy, escucharás un caso de muestra de este curso de repaso en audio, que incluye 100 escenarios. El curso tiene un formato emocionante y completamente único. Cada uno de los 100 caso consta de dos partes. La primera parte es un caso oral perfectamente ejecutado que imita la realidad. Cada caso tiene una duración de cinco a siete minutos e incluye una variedad de tácticas y estilos. Si logras alcanzar este nivel de desempeño en tu preparación, seguramente aprobarás el examen de certificación con éxito. La segunda parte introduce comentarios de alto rendimiento para cada escenario. Estos comentarios incluyen consejos y trucos para ayudarte a dominar los escenarios más desafiantes, además de una enseñanza práctica y fácil de entender que cubre los temas más confusos que enfrentamos como cirujanos generales. Estamos seguros de que encontrarás este enfoque único de doble formato como una forma altamente efectiva de prepararte para el examen. Nuestro contenido está disponible en nuestras aplicaciones para iOS y Android y en nuestro sitio web (behindtheknife.org). Por favor, consulta las notas del programa para más información. Nos encantaría escuchar tus comentarios sobre este episodio enviando un correo electrónico a [email protected] y apreciamos tu ayuda para difundir la palabra entre tus colegas si disfrutas del material. Este contenido incluye 97 descripciones operatorias para todos los procedimientos comunes —y la mayoría de los poco comunes— incluidos en el Currículo de Cirugía General SCORE. Cada descripción está diseñada para ayudar a los candidatos a prepararse de manera eficaz para el Examen de Certificación en Cirugía General. presentadores de podcast: - Auri P. Garcia Gonzalez, MD PhD nació en San Juan, Puerto Rico, y se trasladó a los Estados Unidos en el 2012 para sus estudios graduados. Actualmente, es estudiante de post-grado en cirugía general en Duke University. - Diego Schaps, MD, MPH es un residente de cirugía general en Duke y nació en Miami, en el estado de la Florida. Sus padres nacieron en El Salvador. Disclaimer: Los productos de contenido de Behind the Knife son únicamente para fines educativos. No diagnosticamos, tratamos ni ofrecemos consejos específicos para pacientes. ------Behind the Knife is the world's leading surgical podcast and surgical education platform.  Our mission is to create innovative surgical education content that is accessible to all.  We are very excited to expand into the spanish audience and bring you 4 sample episodes of our General Surgery Oral Board Review Course which will be released over the course of the next week. Today, you'll hear a sample scenario from this comprehensive audio review course which includes 100 scenarios.  The course has an exciting and entirely unique format. Each of the 100 scenarios includes two parts. The first part is a perfectly executed oral board scenario that mimics the real thing. Scenarios are five to seven minutes long and include a variety of tactics and styles. If you're able to achieve this level of performance in your preparation, you are sure to pass the oral exam with flying colors. The second part introduces high yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy to understand teaching that covers the most confusing topics that we face as general surgeons. We are confident you will find this unique dual format approach a highly effective way to prepare for the test. The course contains crisp, concise operative descriptions that cover all SCORE common topics and and most SCORE uncommon topics. Our content is available on our iOS and Android apps and website (behindtheknife.org).  Please check the show notes for more information. We would love to hear your feedback by emailing [email protected] and appreciate your help spreading the word to your colleagues if you enjoy the material. Hosts:- Auri P. Garcia Gonzalez, MD PhD was born and raised in San Juan, Puerto Rico and moved to the US in 2012 for graduate studies. At present, she is a surgical resident at Duke University.- Diego Schaps, MD, MPH is a general surgery resident at Duke and was born in Miami, Florida. His parents were born in El Salvador.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

Calcified peripheral artery disease (PAD) remains one of the most challenging problems in endovascular intervention. Calcium limits vessel expansion, increases the risk of dissection and procedural failure, and can ultimately lead to bailout stenting. The Disrupt PAD III program provided important evidence for a different approach: intravascular lithotripsy (IVL) as a vessel-preparation strategy. In this episode, we examine the randomized Disrupt PAD III trial published by Tepe and colleagues and the large, real-world observational analysis led by Armstrong and colleagues. Together, these studies explore whether IVL can make treatment of heavily calcified lesions more predictable, reduce the need for stenting, and support a “leave-nothing-behind” strategy. Hosts: Dr. Robert Beaulieu Dr. Frank Davis Dr. Luciano Delbono Dr. Andrew Huang Dr. Carolyn Judge Learning ObjectivesBy the end of this episode, listeners should be able to: Explain the challenges posed by moderate to severe vascular calcification during peripheral endovascular intervention and the rationale for dedicated vessel-preparation strategies. Describe the design, patient population, endpoints, and primary findings of the randomized Disrupt PAD III trial comparing IVL with conventional PTA. Interpret the procedural and longer-term outcomes associated with IVL, including residual stenosis, dissection rates, bailout stenting, and primary patency. Evaluate how the Disrupt PAD III observational study complements the randomized trial by examining IVL in a larger, more complex, real-world population and across multiple vascular beds. Identify the practical implications, limitations, and remaining unanswered questions surrounding IVL, including its role relative to other calcium-modification strategies such as atherectomy. References Tepe G, Brodmann M, Werner M, et al. Intravascular Lithotripsy for Peripheral Artery Calcification: 30-Day Outcomes From the Randomized Disrupt PAD III Trial. JACC Cardiovasc Interv. 2021;14(12):1352-1361. doi:10.1016/j.jcin.2021.04.010. https://pubmed.ncbi.nlm.nih.gov/34167675/ Tepe G, Brodmann M, Bachinsky W, et al. Intravascular Lithotripsy for Peripheral Artery Calcification: Mid-term Outcomes From the Randomized Disrupt PAD III Trial. J Soc Cardiovasc Angiogr Interv. 2022. https://pubmed.ncbi.nlm.nih.gov/39131928/ Armstrong EJ, Adams G, Soukas PA, et al. Intravascular Lithotripsy for Peripheral Artery Calcification: 30-Day Outcomes From the Disrupt PAD III Observational Study. J Endovasc Ther. 2026;33(2):853-862. doi:10.1177/15266028241283716. https://pubmed.ncbi.nlm.nih.gov/39422234/ Sponsor URL: https://www.goremedical.com/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-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-reviewOBGYN Oral Board Review Course: https://behindtheknife.org/course/obgyn-oral-board-reviewSurgical Critical Care Review: https://behindtheknife.org/premium/surgical-critical-care-reviewABSITE Question Bank: https://behindtheknife.org/premium/absite-question-bankEPA Playbook: https://behindtheknife.org/course/epa-playbookSurgical Instrument Flashcards: https://behindtheknife.org/course/surgical-instrument-flashcardsABSITE Review: https://behindtheknife.org/course/absite-2026-exam-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

Breast cancer risk varies widely across patients, and surgeons play a central role in recognizing elevated risk and guiding appropriate management. In this episode, we review the spectrum of breast cancer risk and discuss practical strategies for risk assessment and risk reduction. We’ll cover surveillance, lifestyle interventions, risk-reducing medications, high-risk breast lesions, and prophylactic surgery—with an emphasis on translating the available evidence into individualized clinical care. Hosts:- Rashmi Kumar, MD, PhDResident, University of Michigan General Surgery Residency ProgramTwitter/X: @RashmiJKumar- Melissa Pilewskie, MDAttending Breast Surgical Oncologist, Co-Director of the Weiser Family Center for Breast Cancer, Michigan Medicine Twitter/X: @MPilewskie- Stephanie Downs-Canner, MDAttending Breast Surgical Oncologist & Physician-Scientist, Memorial Sloan Kettering Cancer Center, Program Director of the Breast Surgical Oncology Fellowship Training Program Twitter/X: @SDownsCanner Learning Objectives: Identify major modifiable and nonmodifiable breast cancer risk factors, including genetic predisposition, family history, breast density, high-risk lesions, prior chest radiation, and lifestyle factors. Select and interpret commonly used breast cancer risk-assessment tools—including the Gail, Tyrer-Cuzick, and BCSC models—while recognizing their important limitations. Recommend appropriate risk-management strategies based on a patient’s risk level, including enhanced surveillance, lifestyle interventions, genetic evaluation, and endocrine risk-reducing therapy. Explain the indications, benefits, limitations, and tradeoffs of managing high-risk breast lesions and pursuing risk-reducing surgery, including bilateral mastectomy and salpingo-oophorectomy. References:Risk-Assessment Tools National Cancer Institute. Breast Cancer Risk Assessment Tool.https://bcrisktool.cancer.gov/ National Breast Cancer Foundation. What is the Tyrer-Cuzick model?https://www.nationalbreastcancer.org/blog/tyrer-cuzick-model/ Breast Cancer Surveillance Consortium. BCSC Breast Cancer Risk Calculator.https://tools.bcsc-scc.ucdavis.edu/BC5yearRisk/#/ Chemoprevention Guideline Bevers TB, Ward JH, Arun BK, et al. Breast cancer risk reduction, version 2.2015. J Natl Compr Canc Netw. 2015;13(8):880-915. doi:10.6004/jnccn.2015.0105CDC Overview of Risk Factors Centers for Disease Control and Prevention. Breast cancer risk factors. https://www.cdc.gov/breast-cancer/risk-factors/index.html Emerging Techniques in Risk Assessment Breastcancer.org. Polygenic risk score may help predict invasive breast cancer risk. https://www.breastcancer.org/news/polygenic-risk-score-invasive-cancer-risk Breast Cancer Research Foundation. Clairity Breast: The first FDA-authorized AI platform to predict breast cancer risk from a mammogram. https://www.bcrf.org/blog/clairity-breast-ai-artificial-intelligence-mammogram-approved/ Risk reduction Pilewskie ML, Dimick JB. Bariatric Surgery for Breast Cancer Risk Reduction—Benefit May Not Be One Size Fits All. JAMA Surg. 2023;158(6):641–642. doi:10.1001/jamasurg.2023.0534 https://pubmed.ncbi.nlm.nih.gov/37043229/ Boraka Ö, Klintman M, Rosendahl AH. Physical Activity and Long-Term Risk of Breast Cancer, Associations with Time in Life and Body Composition in the Prospective Malmö Diet and Cancer Study. Cancers (Basel). 2022 Apr 13;14(8):1960. doi: 10.3390/cancers14081960. PMID: 35454864; PMCID: PMC9025884. https://pubmed.ncbi.nlm.nih.gov/35454864/ Tzenios N, Tazanios ME, Chahine M. The impact of BMI on breast cancer - an updated systematic review and meta-analysis. Medicine (Baltimore). 2024 Feb 2;103(5):e36831. doi: 10.1097/MD.0000000000036831. PMID: 38306546; PMCID: PMC10843423. https://pubmed.ncbi.nlm.nih.gov/38306546/ Hartmann LC, Schaid DJ, Woods JE, et al. Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. New England Journal of Medicine 1999; 340(2):77-84. https://pubmed.ncbi.nlm.nih.gov/9887158/ Domchek SM, Friebel TM, Singer CF, et al. Association of risk-reducing surgery in BRCA1 or BRCA2 mutation carriers with cancer risk and mortality. JAMA 2010; 304(9):967–975. https://pubmed.ncbi.nlm.nih.gov/20810374/ Rebbeck TR, Friebel T, Lynch HT, et al. Bilateral prophylactic mastectomy reduces breast cancer risk in BRCA1 and BRCA2 mutation carriers: The PROSE Study Group. Journal of Clinical Oncology 2004; 22(6):1055-1062. https://pubmed.ncbi.nlm.nih.gov/14981104/ Matteo Lazzeroni et al. Randomized Placebo Controlled Trial of Low-Dose Tamoxifen to Prevent Recurrence in Breast Noninvasive Neoplasia: A 10-Year Follow-Up of TAM-01 Study. J Clin Oncol 41, 3116-3121(2023). Elizabeth S. McDonald et al. GLP-1 Agonists Are Associated With a Significant Reduction in Breast Cancer Incidence in Women. JCO Oncol Pract 22, 1341-1348(2026). 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-reviewOBGYN Oral Board Review Course: https://behindtheknife.org/course/obgyn-oral-board-reviewSurgical Critical Care Review: https://behindtheknife.org/premium/surgical-critical-care-reviewEPA Playbook: https://behindtheknife.org/course/epa-playbookSurgical Instrument Flashcards: https://behindtheknife.org/course/surgical-instrument-flashcardsABSITE Review: https://behindtheknife.org/course/absite-2026-exam-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Ever wonder how a mountain of clinical data transforms into a clinical practice guideline, or whether deviating from one puts you at legal risk? Join us as we pull back the curtain on guidelines methodology, decode the fine print, and put the evidence into practice.  Hosts:  Scott Steele, MD, MBA – Colon and Rectal Surgeon at Cleveland Clinic   Nicole L. Petcka, MD, MHPE – General Surgery Resident at Emory University Guests:  Bethany Slater, MD – Pediatric Surgeon at Mount Siani, SAGES Guidelines Committee Chair  Francesco Palazzo, MD – Minimally Invasive Surgeon at Jefferson Health, SAGES Guidelines Committee Co-chair  Elisa Calabrese, MD – General Surgery Resident at UCSF-East Bay, SAGES/RACS Guidelines Fellow  Resources: Kumar, S. S., Collings, A. T., Wunker, C., Athanasiadis, D. I., DeLong, C. G., Hong, J. S., Ansari, M. T., Abou-Setta, A., Oliver, E., Berghella, V., Alli, V., Hassan, I., Hollands, C., Sylla, P., Slater, B. J., & Palazzo, F. (2024). SAGES guidelines for the use of laparoscopy during pregnancy. Surgical endoscopy, 38(6), 2947–2963. https://doi.org/10.1007/s00464-024-10810-1Please 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-reviewOBGYN Oral Board Review Course: https://behindtheknife.org/course/obgyn-oral-board-reviewSurgical Critical Care Review: https://behindtheknife.org/premium/surgical-critical-care-reviewEPA Playbook: https://behindtheknife.org/course/epa-playbookSurgical Instrument Flashcards: https://behindtheknife.org/course/surgical-instrument-flashcardsABSITE Review: https://behindtheknife.org/course/absite-2026-exam-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

You stayed late again, the service is still short-staffed, and when you finally say something, the answer is: you just need to be more efficient. More resilient. That's the go-to explanation for almost everything hard about residency — but what if the problem isn't your resilience at all? In the finale of Beyond the Match, Mckenzie Roebuck, Carl Engelke, Michael Brinton, and Omer Hassan of CoSEF look downstream at what happens after residents match: working conditions, culture and mental health, the practical barriers that make transferring so difficult, why residents may not trust existing reporting systems, and what real accountability and resident voice would require. Hosts:  Dr. Mckenzie Roebuck, CoSEF BTK Lead, Inova Fairfax Medical Campus, [email protected] Dr. Carl Engelke, The Ohio State University, [email protected]  Dr. Michael Brinton, Medical College of Wisconsin, [email protected]   Dr. Omer Hassan, University of Calgary/Alberta Children's Hospital, [email protected] CoSEF: X @surgedfellows, cosef.org  Learning objectives: Summarize the real problems the congressional report identifies in working conditions, mistreatment reporting, and resident mental health Distinguish necessary difficulty in residency training from preventable system dysfunction, and describe its relationship to resident well-being and reporting Explain the practical barriers to resident mobility, including position availability, training requirements, funding, visa status, professional risk, and stigma Describe local and national accountability mechanisms — including program reporting, GMECs, ACGME pathways, and unions — and the limitations of each Identify strategies to strengthen resident voice, psychological safety, anti-retaliation protections, and institutional accountability rather than relying on individual resilience alone.  References: House Committee on the Judiciary. Medical Mis-Match: How a Residency Hiring Monopoly Harms Patients, Doctors, and the American Public. Published online March 27, 2026. Gianakos AL, Freischlag JA, Mercurio AM, et al. Bullying, Discrimination, Harassment, Sexual Harassment, and the Fear of Retaliation During Surgical Residency Training: A Systematic Review. World J Surg. 2022;46(7):1587-1599. doi:10.1007/s00268-021-06432-6PubMed Link: https://pubmed.ncbi.nlm.nih.gov/35006329/ Mata DA, Ramos MA, Bansal N, et al. Prevalence of Depression and Depressive Symptoms Among Resident Physicians: A Systematic Review and Meta-analysis. JAMA. 2015;314(22):2373-2383. doi:10.1001/jama.2015.15845PubMed Link: https://pubmed.ncbi.nlm.nih.gov/26647259/ Malone TL, Zhao Z, Liu TY, Song PXK, Sen S, Scott LJ. Prediction of Suicidal Ideation Risk in a Prospective Cohort Study of Medical Interns. PLoS One. 2021;16(12):e0260620. doi:10.1371/journal.pone.0260620PubMed Link: https://pubmed.ncbi.nlm.nih.gov/34855821/ Drolet BC, Schwede M, Bishop KD, Fischer SA. Compliance and Falsification of Duty Hours: Reports From Residents and Program Directors. J Grad Med Educ. 2013;5(3):368-373. doi:10.4300/JGME-D-12-00375.1PubMed Link: https://pubmed.ncbi.nlm.nih.gov/24404298/ National Resident Matching Program. The Match Agreement. Accessed August 2026. https://www.nrmp.org/intro-to-the-match/the-match-agreement/. Intealth (ECFMG). J-1 Physicians Training in the US (infographic). Accessed August 2026. https://www.intealth.org/pdfs/J-1_US_Infographic.pdf. (Note: Institutional PDF; no PubMed entry available). Foote DC, Rosenblatt AE, Amortegui D, et al. Experiences With Unionization Among General Surgery Resident Physicians, Faculty, and Staff. JAMA Netw Open. 2024;7(7):e2421676. doi:10.1001/jamanetworkopen.2024.21676PubMed Link: https://pubmed.ncbi.nlm.nih.gov/39018072/ Accreditation Council for Graduate Medical Education. Report an Issue. https://www.acgme.org/residents-and-fellows/report-an-issue/?utm_source. 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-reviewOBGYN Oral Board Review Course: https://behindtheknife.org/course/obgyn-oral-board-reviewSurgical Critical Care Review: https://behindtheknife.org/premium/surgical-critical-care-reviewEPA Playbook: https://behindtheknife.org/course/epa-playbookSurgical Instrument Flashcards: https://behindtheknife.org/course/surgical-instrument-flashcardsABSITE Review: https://behindtheknife.org/course/absite-2026-exam-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

You matched into your dream program... but only after submitting 80 applications, spending thousands of dollars, and losing sleep wondering if anyone was even reading yours. Meanwhile, on the other side of the screen, a program director is staring down a thousand applications for six spots, trying to figure out who's actually serious about coming. Sound familiar? Join Mckenzie Roebuck, Milanie Milan, Sarah Lund, and Bryanna Stukes of CoSEF as they unpack the residency application arms race: why uncertainty drives overapplication, what preference signaling and application caps actually solve, the trade-offs of virtual versus in-person interviews, and how better transparency, advising, holistic review, and even AI might help applicants and programs find the right fit.  Hosts: Dr. Mckenzie Roebuck, CoSEF BTK Lead, Inova Fairfax Medical Campus, [email protected], insta @mrowemd, X @mrowemd1  Dr. Milanie Milan, Cleveland Clinic, [email protected], insta @m.mdgram Dr. Sarah Lund, Mayo Clinic, [email protected], X @DrSarahLund Dr. Bryanna Stukes, UT Southwestern [email protected] CoSEF: X @surgedfellows, cosef.org Learning objectives: Explain how uncertainty across the residency selection process drives overapplication and distinguish the Match algorithm from the broader application ecosystem Describe how preference signaling, application caps, and interview format affect applicant and program behavior, including equity trade-offs Identify ways programs can improve both competitiveness and program-level transparency Discuss how investment in holistic review and mission-specific selection criteria may improve application review while introducing new challenges.  References: House Committee on the Judiciary. Medical Mis-Match: How a Residency Hiring Monopoly Harms Patients, Doctors, and the American Public. Published online March 27, 2026. National Resident Matching Program. Advance Data Tables: 2026 Main Residency Match. NRMP. Published March 20, 2026. Accessed August 2026. https://www.nrmp.org/match-data/2026/03/advance-data-tables-2026-main-residency-match/. Ulin L, Bernstein SA, Nunes JC, et al. Improving Transparency in the Residency Application Process: Survey Study. JMIR Form Res. 2023;7:e45919. doi:10.2196/45919PubMed Link: https://pubmed.ncbi.nlm.nih.gov/38145482/ American Medical Association. Transparency in the Resident Physician Application Process (Issue Brief). Published online November 2023. Accessed August 2026.https://www.ama-assn.org/system/files/cme-issue-brief-resident-application-process.pdf. Nilsen K, Walling A, Callaway P, et al. "The End Game" — Students' Perspectives of the National Residency Matching Program: A Focus Group Study. Med Sci Educ. 2018;28(4):729-737. doi:10.1007/s40670-018-0627-1PubMed Link: https://pubmed.ncbi.nlm.nih.gov/34646549/ Weissbart SJ, Kim SJ, Feinn RS, Stock JA. Relationship Between the Number of Residency Applications and the Yearly Match Rate: Time to Start Thinking About an Application Limit? J Grad Med Educ. 2015;7(1):81-85. doi:10.4300/jgme-d-14-00270.1PubMed Link: https://pubmed.ncbi.nlm.nih.gov/26217439/ Angus SV, Williams CM, Kwan B, et al. Drivers of Application Inflation: A National Survey of Internal Medicine Residents. Am J Med. 2018. doi:10.1016/j.amjmed.2018.01.002PubMed Link: https://pubmed.ncbi.nlm.nih.gov/29355512/ Lund S, Santucci NM, Zarate Rodriguez J, et al. Message Received? Applicant Insights on Preference Signals in General Surgery Residency Recruitment. J Surg Educ. 2026;83(9):104096. doi:10.1016/j.jsurg.2026.104096PubMed Link: https://pubmed.ncbi.nlm.nih.gov/42418854/ Woodward JM, Gan CY, Foote DC, et al. Thanks for the Signal—Now What? Program Director Perspectives on How Preference Signals Are Shaping General Surgery Residency Recruitment. J Surg Educ. 2026;83(9):104061. doi:10.1016/j.jsurg.2026.104061PubMed Link: https://pubmed.ncbi.nlm.nih.gov/42418853/ Mullens CL, Picart JK, Dualeh SHA, et al. A Practical Approach for Implementing Holistic Review for General Surgery Resident Recruitment. J Surg Educ. 2026;83(9):104069. doi:10.1016/j.jsurg.2026.104069PubMed Link: https://pubmed.ncbi.nlm.nih.gov/42436210/ 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-reviewOBGYN Oral Board Review Course: https://behindtheknife.org/course/obgyn-oral-board-reviewSurgical Critical Care Review: https://behindtheknife.org/premium/surgical-critical-care-reviewEPA Playbook: https://behindtheknife.org/course/epa-playbookSurgical Instrument Flashcards: https://behindtheknife.org/course/surgical-instrument-flashcardsABSITE Review: https://behindtheknife.org/course/absite-2026-exam-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 say about a training system when childcare can eat up almost half a resident’s monthly salary — and the physicians doing essential clinical work have almost no ability to negotiate their pay or benefits? A recent House Judiciary Committee report argues that the Match suppresses resident compensation and bargaining power. But if the Match disappeared tomorrow, would residents actually get paid more? Join Mckenzie Roebuck, Maya Hunt, Nicole Santucci, and Michael Kabbash of CoSEF as they unpack resident pay and benefits, where GME funding actually goes, why residency is not a normal labor market, and where real leverage for change might come from. Hosts: Dr. Mckenzie Roebuck, CoSEF BTK Lead, Inova Fairfax Medical Campus, [email protected], insta @mrowemd, X @mrowemd1  Dr. Maya Hunt, Indiana University, [email protected]  Dr. Nicole Santucci, Washington University in St. Louis, [email protected]  Dr. Michael Kabbash, University of Florida, [email protected], X @MichaelKabbash CoSEF: X @surgedfellows, cosef.org Learning objectives: Summarize the congressional report’s arguments about resident compensation and bargaining power  Explain how GME funding supports residency and why federal GME dollars do not map directly onto resident salaries  Describe how salary and benefit structures affect residents’ financial well-being, family planning, and quality of life  Identify institutional, policy, and collective strategies to strengthen resident compensation and bargaining power.  References: House Committee on the Judiciary. Medical Mis-Match: How a Residency Hiring Monopoly Harms Patients, Doctors, and the American Public. Published online March 27, 2026. Association of American Medical Colleges. AAMC Survey of Resident/Fellow Stipends and Benefits. https://www.aamc.org/data-reports/students-residents/report/aamc-survey-resident/fellow-stipends-and-benefits.  Centers for Medicare and Medicaid Services. Direct Graduate Medical Education (DGME). https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/direct-graduate-medical-education-dgme.  Foote DC, Rosenblatt AE, Amortegui D, et al. Experiences With Unionization Among General Surgery Resident Physicians, Faculty, and Staff. JAMA Netw Open. 2024;7(7):e2421676. doi:10.1001/jamanetworkopen.2024.21676 https://pubmed.ncbi.nlm.nih.gov/39018072/ Tomei KL, Selby LV, Kirk LM, et al. Beyond Training the Next Generation of Physicians: The Unmeasured Value Added by Residents to Teaching Hospitals and Communities. Acad Med. 2022;97(11):1592-1596. https://pubmed.ncbi.nlm.nih.gov/35731593/ doi:10.1097/ACM.0000000000004792 Accreditation Council for Graduate Medical Education. Common Program Requirements. Accessed August 2026.https://www.acgme.org/programs-and-institutions/programs/common-program-requirements/. Rigged or Right? The Residency Match Under Fire | podcast. Behind the Knife. https://behindtheknife.org/podcast/rigged-or-right-the-residency-match-under-fire.  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-reviewOBGYN Oral Board Review Course: https://behindtheknife.org/course/obgyn-oral-board-reviewSurgical Critical Care Review: https://behindtheknife.org/premium/surgical-critical-care-reviewEPA Playbook: https://behindtheknife.org/course/epa-playbookSurgical Instrument Flashcards: https://behindtheknife.org/course/surgical-instrument-flashcardsABSITE Review: https://behindtheknife.org/course/absite-2026-exam-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Introducing Behind the Knife Surgical Critical Care Review!DOMINATE THE ICU with our comprehensive course that includes audio + simulator + question bank.Master the management of the critically ill patient with Behind the Knife's all-new Surgical Critical Care Review. Built for high-yield, real-world application, this comprehensive multimedia program gives residents, fellows, and practicing surgeons everything they need to confidently manage the sickest patients in the hospital. What's included: 38 High-Yield Podcasts — Expert-led discussions spanning the full SCORE curriculum for Surgical Critical Care. AI Case Simulator — Test your judgment against our one-of-a-kind interactive simulator, built to recreate the pressure of high-stakes clinical scenarios. 110 simulator credits included with purchase. Comprehensive Question Bank — Rigorous, board-style multiple-choice questions to sharpen your performance on rounds and on exam day. Get Instant Access Here: https://behindtheknife.org/premium/surgical-critical-care-reviewEnjoy this sample episode from the course.

Introducing Behind the Knife Surgical Critical Care Review!DOMINATE THE ICU with our comprehensive course that includes audio + simulator + question bank.Master the management of the critically ill patient with Behind the Knife's all-new Surgical Critical Care Review. Built for high-yield, real-world application, this comprehensive multimedia program gives residents, fellows, and practicing surgeons everything they need to confidently manage the sickest patients in the hospital. What's included: 38 High-Yield Podcasts — Expert-led discussions spanning the full SCORE curriculum for Surgical Critical Care. AI Case Simulator — Test your judgment against our one-of-a-kind interactive simulator, built to recreate the pressure of high-stakes clinical scenarios. 110 simulator credits included with purchase. Comprehensive Question Bank — Rigorous, board-style multiple-choice questions to sharpen your performance on rounds and on exam day. Get Instant Access Here: https://behindtheknife.org/premium/surgical-critical-care-reviewEnjoy this sample episode from the course.

Introducing Behind the Knife Surgical Critical Care Review!DOMINATE THE ICU with our comprehensive course that includes audio + simulator + question bank.Master the management of the critically ill patient with Behind the Knife's all-new Surgical Critical Care Review. Built for high-yield, real-world application, this comprehensive multimedia program gives residents, fellows, and practicing surgeons everything they need to confidently manage the sickest patients in the hospital. What's included: 38 High-Yield Podcasts — Expert-led discussions spanning the full SCORE curriculum for Surgical Critical Care. AI Case Simulator — Test your judgment against our one-of-a-kind interactive simulator, built to recreate the pressure of high-stakes clinical scenarios. 110 simulator credits included with purchase. Comprehensive Question Bank — Rigorous, board-style multiple-choice questions to sharpen your performance on rounds and on exam day. Get Instant Access Here: https://behindtheknife.org/premium/surgical-critical-care-reviewEnjoy this sample episode from the course.

Introducing Behind the Knife Surgical Critical Care Review! DOMINATE THE ICU with our comprehensive course that includes audio + simulator + question bank.Master the management of the critically ill patient with Behind the Knife's all-new Surgical Critical Care Review. Built for high-yield, real-world application, this comprehensive multimedia program gives residents, fellows, and practicing surgeons everything they need to confidently manage the sickest patients in the hospital. What's included: 38 High-Yield Podcasts — Expert-led discussions spanning the full SCORE curriculum for Surgical Critical Care. AI Case Simulator — Test your judgment against our one-of-a-kind interactive simulator, built to recreate the pressure of high-stakes clinical scenarios. 110 simulator credits included with purchase. Comprehensive Question Bank — Rigorous, board-style multiple-choice questions to sharpen your performance on rounds and on exam day. Get Instant Access Here: https://behindtheknife.org/premium/surgical-critical-care-review Enjoy this sample episode from the course.

This episode offers a practical, case-based approach to one of the most common intraoperative challenges in GI surgery: constructing a stoma that just won't cooperate. The discussion covers preoperative marking and stoma siting in the obese and non-elective patient, technical maneuvers to gain length and reduce tension on the stoma, strategies for the foreshortened small bowel mesentery, and considerations for maturing a stoma in a massively dilated, thick-walled colon. Join Drs. Elissa Dabaghi, Jared Hendren, Joseph Trunzo, Ajaratu Keshinro, and David Rosen as they discuss this clinical challenge in colorectal surgery. Hosts: ·      Elissa Dabaghi, MD, Institution: Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio ·      Jared Hendren, MD, Institution: Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio ·      Joseph Trunzo, MD, Institution: Department of Colon and Rectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio, X/Twitter @joseph_trunzo ·      Ajaratu Keshinro, MD, Institution: Department of Colon and Rectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio, X/Twitter- @AJKesh ·      David Rosen, MD, Institution: Department of Colon and Rectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio, X/Twitter- @davidrrosenmd Learning Objectives: By the end of this episode, listeners will be able to: 1.     Describe preoperative marking strategies and intraoperative technical adaptations for stoma siting and construction in obese and non-elective patients.2.     Apply strategies for managing a foreshortened small bowel mesentery when constructing an end or loop ileostomy.3.     Recognize technical considerations for maturing a stoma in a massively dilated, thick-walled colon and identify associated long-term risks Sponsor Disclaimer: Visit https://www.goremedical.com/btkpod to learn more about GORE® SYNECOR Biomaterial, including supporting references and disclaimers for the presented content. Refer to Instructions for Use at eifu.goremedical.com for a complete description of all applicable indications, warnings, precautions and contraindications for the markets where this product is available. Rx only  Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium: 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-reviewOBGYN Oral Board Review Coures: https://behindtheknife.org/course/obgyn-oral-board-reviewEPA Playbook: https://behindtheknife.org/course/epa-playbookSurgical Instrument Flashcards: https://behindtheknife.org/course/surgical-instrument-flashcardsABSITE Review: https://behindtheknife.org/course/absite-2026-exam-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