Join the University of Washington Surgical Palliative Care Team for their final episode of this series — a dual journal review and clinical challenges discussion on assessing medical decision-making capacity. Using Dr. Paul Applebaum’s foundational framework, the team outlines the four key criteria for evaluating capacity and brings the topic to life through two contrasting standardized patient scenarios. This episode highlights why capacity assessment is not only relevant but essential for surgeons navigating complex, high-stakes decisions. 

Dr. Katie O’Connell (@katmo15) is an associate professor of surgery at the University of Washington. She is a trauma surgeon, palliative care physician, director of surgical palliative care, and founder of the Advance Care Planning for Surgery clinic at Harborview Medical Center, Seattle, WA.

Dr. Ali Haruta is an assistant professor of surgery at the University of Washington. She is a trauma and emergency general surgeon and palliative care physician. Ali recently completed fellowships in palliative care at the University of Washington and Trauma and Critical Care at Parkland. 

Dr. Lindsay Dickerson (@lindsdickerson1) is a PGY6 general surgery resident at the University of Washington with an interest in surgical oncology.  

Dr. Virginia Wang is a PGY3 general surgery resident at the University of Washington.

1.        Decipher the distinction between the terms “capacity” and “competence”.  

2.        Describe the four criteria for assessing medical decision-making capacity presented in Dr. Paul Applebaum’s article “Assessment of Patients’ Competence to Consent to Treatment.”

3.        Apply the capacity assessment framework to real-world clinical scenarios in surgical practice. 

1.        Applebaum, PS. Assessment of Patients’ Competence to Consent to Treatment. New England Journal of Medicine 2007; 357(18):1834-1840. https://pubmed.ncbi.nlm.nih.gov/17978292/

2.        Special thank you to Mr. Mark Fox for his acting contribution to this episode.

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In their last Behind the Knife episode, the Hernia Content Team from Carolinas Medical Center discusses quality improvement in abdominal wall reconstruction (AWR). The complexity of AWR patients makes this discipline a perfect match for quality improvement efforts. The group review two papers published by their group: one that tracks patient outcomes over time and then another that reviews a specific quality improvement initiative (penicillin allergy protocol). 

Hosts:

·      Dr. Sullivan “Sully” Ayuso, Minimally Invasive Surgery, Endeavor Health (Evanston, IL), @SAyusoMD (Twitter)

·      Dr. Monica Polcz, Assistant Professor, University of South Florida (Tampa, FL)

·      Dr. Vedra Augenstein, Professor of Surgery, Carolinas Medical Center (Charlotte, NC), @VedraAugenstein (Twitter)

·      Dr. Todd Heniford, Chief of GI & MIS, Carolinas Medical Center (Charlotte, NC), @THeniford (Twitter)

Learning Objectives:

-       Define Quality Improvement and its Importance in Surgical Practice

-       Identify Key Strategies and Examples of Quality Improvement Initiatives in Abdominal Wall Reconstruction

-       Explain the Process of Implementing and Evaluating a Quality Improvement Project

-       Recognize the Value of Multidisciplinary Collaboration in Quality Improvement

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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. 

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It is the final episode of our Challenging Cases in Emergency General Surgery series and we’re diving into another dreaded topic: the complex abdominal wall. This structure is a daily partner to the general surgeon—but when things go wrong, it can quickly become our biggest challenge. In this episode, we’ll walk through the emergency presentation of a patient with multiple prior hernia repairs and mesh placements, and how these complicate diagnosis and management. From imaging pearls to OR decision-making and post-op dilemmas, this episode covers it all.  We round things off with a fun game (as always!) and some hot takes on abdominal wall strategies in emergency general surgery. Whether you’re an EGS surgeon, trainee, or surgical enthusiast, this episode is packed with practical insights, decision-making frameworks, and real-world nuance.

Hosts:

- Dr. Ashlie Nadler

- Dr. Jordan Nantais

- Dr. Graham Skelhorne-Gross

Learning Objectives:

- Identify key factors to assess in patients presenting with complex abdominal wall problems, including detailed surgical history, hernia characteristics, and signs of complications.

- Discuss the role of imaging, particularly CT scans, in evaluating patients with ventral hernias and bowel obstruction, with a focus on identifying transition points and signs of strangulation.

- Outline the surgical approach to incarcerated incisional ventral hernias, including pre-operative considerations, operative techniques, and management of threatened bowel.

- Recognize the importance of patient-specific factors and interdisciplinary collaboration in the management of complex abdominal wall cases, including the role of pre-habilitation and hernia specialists.

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We got the gang together (minus John, who is on mission).  Today, we are talking about diverticulitis with super expert Scott Steele.  Scott walks Jason, Patrick, and Kevin through the nuances of modern-day management of diverticulitis.   We cover laparoscopic lavage, review decision making for surgical resection after drainage, and discuss the evolving role of antibiotics in uncomplicated cases. Surgical techniques, including resection boundaries and the consideration of diverting ostomies in emergent situations, are also reviewed.  DOMINATE THE COLON!

Hosts

Scott Steele, MD: @ScottRSteeleMD

Scott is the Rupert B. Turnbull MD Endowed Chair in Colorectal Surgery and Chairman of Colorectal Surgery at Cleveland Clinic in Cleveland, OH. A graduate of the United States Military Academy at West Point, he was an active duty Army officer for over 20 years, serving as the Chief of Colorectal Surgery at Madigan Army Medical Center. He also received his MBA from Case Western University Weatherhead School of Business and Management.

Patrick Georgoff, MD: @georgoff

Patrick Georgoff is an Acute Care Surgeon at Duke University.  He went to medical school at the University of Pennsylvania, completed General Surgery residency and Surgical Critical Care fellowship at the University of Michigan, and a Trauma Surgery fellowship at the University of Texas in Houston.  His clinical practice includes the full spectrum of Acute Care Surgery in addition to elective hernia surgery.  Patrick is the Associate Program of the General Surgery Residency and associate Trauma Medical Director at Duke.

Kevin Kniery, MD: @Kniery_Bird

Kevin is a vascular surgeon at Brooke Army Medical Center. He completed his undergraduate degree at the United States Military Academy in West Point, medical school at Tulane University, general surgery residency at Madigan Army Medical Center, and vascular fellowship at Cornell and Columbia.

Jason Bingham, MD: @BinghamMd

Jason is a general and bariatric surgeon at Madigan Army Medical Center. He also serves as the Director of Research and Associate Program Director for the general surgery residency program. He received his undergraduate degree from New York University and medical degree at the Uniformed Services University of Health Sciences. He is a medical officer in the US Army with several combat deployments under his belt. Jason’s research efforts focus on the management of hemorrhagic shock, trauma induced coagulopathy, and ischemia-reperfusion injury.

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In our recent episode on global burn surgery with Dr. Barclay Stewart and Dr. Manish Yadav, we discussed several cases at Kirtipur Hospital in Nepal to illustrate the global burden of burns and similarities and differences in treating burns at Harborview Medical Center, a level 1 trauma and ABA verified burn center in Seattle, WA and Kirtipur Hospital (Nepal Cleft and Burn Center) in Kathmandu, Nepal. In this episode Dr. Stewart and Dr. Yadav return for an interview by UW Surgery Resident, Paul Herman, sharing insights on how to get involved in global surgery with an emphasis on sustainable participation.

Hosts: 

Manish Yadav, Kirtipur Hospital, Nepal

Barclay Stewart, UW/Harborview Medical Center

Paul Herman, UW/Harborview General Surgery Resident, @paul_herm 

Tam Pham, UW/Harborview Medical Center (Editor)

1.     Approaches to global surgery 

a.     Describe historical perspectives on global health and global surgery reviewing biases global surgery inherits from global health due to the history of colonialism, neo-colonialism and systemic inequalities

b.     Review a recently published framework and evaluation metrics for sustainable global surgery partnerships (GSPs) as described by Binda et al., in Annals of Surgery in March 2024.

c.      Provide examples of this framework from a successful global surgery partnership

d.     Define vertical, horizontal and diagonal global surgery approaches

e.     Share tips for initial engagement for individuals interested in getting involved in global surgery

1.     Gosselin, R., Charles, A., Joshipura, M., Mkandawire, N., Mock, C. N. , et. al. 2015. “Surgery and Trauma Care”. In: Disease Control Priorities (third edition): Volume 1, Essential Surgery, edited by H. Debas, P. Donkor, A. Gawande, D. T. Jamison, M. Kruk, C. N. Mock. Washington, DC: World Bank.

2.     Qin R, Alayande B, Okolo I, Khanyola J, Jumbam DT, Koea J, Boatin AA, Lugobe HM, Bump J. Colonisation and its aftermath: reimagining global surgery. BMJ Glob Health. 2024 Jan 4;9(1):e014173. doi: 10.1136/bmjgh-2023-014173. PMID: 38176746; PMCID: PMC10773343.

https://pubmed.ncbi.nlm.nih.gov/38176746/

3.     Binda CJ, Adams J, Livergant R, Lam S, Panchendrabose K, Joharifard S, Haji F, Joos E. Defining a Framework and Evaluation Metrics for Sustainable Global Surgical Partnerships: A Modified Delphi Study. Ann Surg. 2024 Mar 1;279(3):549-553. doi: 10.1097/SLA.0000000000006058. Epub 2023 Aug 4. PMID: 37539584; PMCID: PMC10829902.

 https://pubmed.ncbi.nlm.nih.gov/37539584/

4.     Jedrzejko N, Margolick J, Nguyen JH, Ding M, Kisa P, Ball-Banting E, Hameed M, Joos E. A systematic review of global surgery partnerships and a proposed framework for sustainability. Can J Surg. 2021 Apr 28;64(3):E280-E288. doi: 10.1503/cjs.010719. PMID: 33908733; PMCID: PMC8327986.

https://pubmed.ncbi.nlm.nih.gov/33908733/

5.     Frenk J, Gómez-Dantés O, Knaul FM: The health systems agenda: prospects for the diagonal approach. The handbook of global health policy. 2014 Apr 24; pp. 425–439

6.     Davé DR, Nagarjan N, Canner JK, Kushner AL, Stewart BT; SOSAS4 Research Group. Rethinking burns for low & middle-income countries: Differing patterns of burn epidemiology, care seeking behavior, and outcomes across four countries. Burns. 2018 Aug;44(5):1228-1234. doi: 10.1016/j.burns.2018.01.015. Epub 2018 Feb 21. PMID: 29475744.

https://pubmed.ncbi.nlm.nih.gov/29475744/

7.     Strain, S., Adjei, E., Edelman, D. et al. The current landscape of global international surgical rotations for general surgery residents in the United States: a survey by the Association for Program Directors in Surgery’s (APDS) global surgery taskforce. Global Surg Educ 3, 77 (2024). https://doi.org/10.1007/s44186-024-00273-2

8.     Francalancia S, Mehta K, Shrestha R, Phuyal D, Bikash D, Yadav M, Nakarmi K, Rai S, Sharar S, Stewart BT, Fudem G. Consumer focus group testing with stakeholders to generate an enteral resuscitation training flipbook for primary health center and first-level hospital providers in Nepal. Burns. 2024 Jun;50(5):1160-1173. doi: 10.1016/j.burns.2024.02.008. Epub 2024 Feb 15. PMID: 38472005; PMCID: PMC11116054.

https://pubmed.ncbi.nlm.nih.gov/38472005/

9.     Shrestha R, Mehta K, Mesic A, Dahanayake D, Yadav M, Rai S, Nakarmi K, Bista P, Pham T, Stewart BT. Barriers and facilitators to implementing enteral resuscitation for major burn injuries: Reflections from Nepalese care providers. Burns. 2024 Oct 28;51(1):107302. doi: 10.1016/j.burns.2024.107302. Epub ahead of print. PMID: 39577105.

https://pubmed.ncbi.nlm.nih.gov/39577105/

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Surgical conferences are a forum of the profession–where we all gather to socialize, share clinical experiences, promote academic work, and learn from each other. But what goes into putting these conferences together? In this next installment of the BTK/ASGBI collaborative series, Jon Williams and ASGBI co-hosts Kellie Bateman and Jared Wohlgemut welcome Mr. Dimitrios Damaskos from Edinburgh and Dr. Anne Lidor from the University of Wisconsin to take a look behind the scenes of conference planning. We’ll cover logistics, program selection, how surgical societies strive to support their members and trainees, and much more!

Mr Dimitrios Damaskos, initially from Greece, he came to the UK for his fellowship and is a UGI and Emergency General Surgical Consultant with an interest in abdominal wall surgery based in The Royal Infirmary Edinburgh. He is the current Director of Scientific Programme for ASGBI and responsible for organising our main International Congress which this year happens to be in Edinburgh. He has also held numerous other events for surgical societies including the British Hernia Society.

Dr. Lidor serves as the program chair for the Society for American Gastrointestinal and Endoscopic Surgeons (i.e. SAGES), which is a wide-reaching US-based international surgical society that encompasses many facets of general surgery. The SAGES Annual Meeting was just last month, and is a great opportunity for surgeons to convene and share clinical experiences, academic work, and professionally connect. Dr. Lidor completed medical school at the New York Medical College, and then moved on to George Washington University for general surgery residency training. Following residency, she moved to Baltimore to Johns Hopkins where she completed her MIS/Bariatric Surgery fellowship and subsequently stayed on as a faculty surgeon. After years at Hopkins during which she held many education leadership roles both at the medical school and as fellowship director, she moved to the University of Wisconsin to become Chief of Minimally Invasive and Bariatric Surgery, a role she continues to hold today. 

If you enjoyed this episode, stay tuned for more upcoming BTK/ASGBI collaborative content. If you have any questions or comments, please feel free to reach out to us at [email protected]. 

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Hey APPs - Are you ready to DOMINATE surgery?  Well let's go!  Perform at the highest level on day one of your rotation using our easy to navigate text, tables, flashcards, podcasts, and videos.  Go beyond rote memorization and learn what really matters.  We are talking practical, high-yield, and engaging content all available at your fingertips.  Get the information you need to know FAST.  Whether it's learning how to two-hand tie, work up a patient with a colon mass, or organizing yourself for rounds, Behind the Knife has got you covered.   

Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation Course Link: https://app.behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation

Hey APPs - Are you ready to DOMINATE surgery?  Well let's go!  Perform at the highest level on day one of your rotation using our easy to navigate text, tables, flashcards, podcasts, and videos.  Go beyond rote memorization and learn what really matters.  We are talking practical, high-yield, and engaging content all available at your fingertips.  Get the information you need to know FAST.  Whether it's learning how to two-hand tie, work up a patient with a colon mass, or organizing yourself for rounds, Behind the Knife has got you covered.   

Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation Course Link: https://app.behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation

Hey APPs - Are you ready to DOMINATE surgery?  Well let's go!  Perform at the highest level on day one of your rotation using our easy to navigate text, tables, flashcards, podcasts, and videos.  Go beyond rote memorization and learn what really matters.  We are talking practical, high-yield, and engaging content all available at your fingertips.  Get the information you need to know FAST.  Whether it's learning how to two-hand tie, work up a patient with a colon mass, or organizing yourself for rounds, Behind the Knife has got you covered.   

Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation Course Link: https://app.behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation