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 can tell us about learning and working as surgeons.

In this third episode, we talk with Drs. Sheina Theodore and Tejal Brahmbhatt about their study examining the relationship between internalized shame states and burnout among surgery residents. They make a compelling case that addressing the well-being crisis in surgery requires looking beyond external stressors to the internal experience of shame: the quiet, invisible voice that tells residents they aren't good enough, and ask what role the culture of surgery plays in that internal monologue. 

Host: Steven Thornton

Guests:
1.    Sheina Theodore (Assistant Professor of Surgery, Boston University)
2.    Tejal Brahmbhatt (Associate Professor of Surgery, Cedars Sinai Medical Center)

Publications Discussed:

1.    Smith SM, Kobzeva-Herzog A, McGillen P, Castagne-Charlotin M, Davies J, Sanchez SE, Dechert T, Brahmbhatt TS, Theodore S. Internalized Shame Experiences and Burnout in General Surgery Residents. J Surg Educ. 2025 Apr;82(4):103447. doi: 10.1016/j.jsurg.2025.103447. Epub 2025 Feb 6. PMID: 39919584. https://pubmed.ncbi.nlm.nih.gov/39919584/

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In this second episode, we talk with Dr. ElAbd and Dr. Zammit about their study examining the relationship between shame-based learning, grit, and burnout across surgical specialties. Their findings highlight how grit may both protect against burnout and mediate whether residents go on to shame others. 

Host: Steven Thornton

Guests:
1.    Rawan ElAbd (Plastic Surgery Resident, McGill University)
2.    Dino Zammit (Assistant Professor of Plastic Surgery, McGill University)

Publications Discussed:
1.    ElAbd R, Pu L, Esmonde-White C, ElHawary H, Vorstenbosch J, Zammit D. Association of Grit and Shame Based Learning on Burnout in Surgical Training: A Single Institution Analysis. J Surg Educ. 2025 Sep;82(9):103583. doi: 10.1016/j.jsurg.2025.103583. Epub 2025 Jun 27. PMID: 40580606.
https://pubmed.ncbi.nlm.nih.gov/40580606/

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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 can tell us about learning and working as surgeons.

In this first episode, we talk with Dr. Will Bynum and Professor Luna Dolezal about how they understand shame in medicine, why it's so hard to see even when it's everywhere, and how developing what they call "shame competence" might be one of the most important steps we can take toward humanizing surgical training.

Host: Steven Thornton

Guests:

***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6

Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  
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Welcome back to the AI journal club! In this episode, we bring you a deep dive into a game-changing paper from The Lancet -- the MASAI study. This is the first randomized controlled trial to evaluate the use of artificial intelligence in breast cancer screening and we're so excited to discuss it.

We'll break down the study's impressive findings on interval cancer rates, sensitivity, and massive workload reductions for radiologists. Beyond the data, we'll tackle the big-picture questions and some sensational recent headlines. Are we deploying AI too fast? Or is it time to go faster? 

Hosts: 
- Ayman Ali, MD
Ayman Ali is a Behind the Knife fellow and general surgery PGY-4 at Duke Hospital in his academic development time where he focuses on data science, artificial intelligence, and surgery. 

- Ruchi Thanawala, MD: @Ruchi_TJ
Ruchi Thanawala is an Associate Professor of Informatics and Thoracic Surgery at Oregon Health and Science University (OHSU) and founder of Firefly, an AI-driven platform that is built for competency-based medical education. In addition, she is the Director of the Surgical Data and Decision Sciences Lab for the Department of Surgery at OHSU and Associate Program Director for the Clinical Informatics Sub-specialty Fellowship. 

- Phillip Jenkins, MD: @PhilJenkinsMD
Phil Jenkins is a general surgery PGY-4 at Oregon Health and Science University and a National Library of Medicine Post-Doctoral fellow pursuing a master’s in clinical informatics.

***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6

Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen
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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 General Surgery Resident

References:
Awake ECMO as Bridge to Lung Transplantation Fuehner T, Kuehn C, Hadem J, Wiesner O, Gottlieb J, Tudorache I, et al. Extracorporeal membrane oxygenation in awake patients as bridge to lung transplantation. American Journal of Respiratory and Critical Care Medicine. 2012;185(7):763–768. PMID: 22268135 Link: https://pubmed.ncbi.nlm.nih.gov/22268135/

Predictors of Successful ECMO Bridging Tipograf Y, Salna M, Minko E, Grogan EL, Sonett JR, Bacchetta MD. Outcomes of extracorporeal membrane oxygenation as a bridge to lung transplantation. Annals of Thoracic Surgery. 2019;107(5):1456–1463. PMID: 30790550 Link: https://pubmed.ncbi.nlm.nih.gov/30790550/

Intubation Status and ECMO Bridging Outcomes Zhou AL, Jennings MR, Akbar AF, et al. Utilization and outcomes of nonintubated extracorporeal membrane oxygenation as a bridge to lung transplant. Journal of Heart and Lung Transplantation. 2025;44(4):661–669. PMID: 39486773 Link: https://pubmed.ncbi.nlm.nih.gov/39486773/

ECMO Duration and Waitlist Mortality Shou BL, Kalra A, Zhou AL, et al. Impact of extracorporeal membrane oxygenation bridging duration on lung transplant outcomes. Annals of Thoracic Surgery. 2024;118(2):496–503. PMID: 38740080 Link: https://pubmed.ncbi.nlm.nih.gov/38740080/

Mechanical Ventilation as a Risk Marker Mason DP, Thuita L, Alster JM, Murthy SC, Budev MM, Mehta AC, et al. Lung transplantation in recipients requiring mechanical ventilation: outcomes and risk factors. Journal of Thoracic and Cardiovascular Surgery. 2010;139(1):114–119. PMID: 19931096 Link: https://pubmed.ncbi.nlm.nih.gov/19931096/

***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6

Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
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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, what to leave out, and how to properly frame a complication.

Hosts:

***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6

Surgical Instrument Flashcard Course: https://app.behindtheknife.org/premium/surgical-instrument-flashcards

Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  
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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 xenotransplantation. Through a narrative lens, we trace the evolution of transplantation from its earliest experimental days to the modern era of gene-edited porcine organs, highlighting key breakthroughs, ethical challenges, and the pioneers who shaped the field. We also examine the current state of clinical trials and what xenotransplantation may mean for the future of organ availability and transplant practice.

Hosts 
- Madeline Cloonan, MD PhD, General Surgery Resident, University of Nebraska Medical Center, @maddie_cloonan  
- Joshua Mezrich, MD, Professor, University of Wisconsin School of Medicine and Public Health

Learning Objectives 
By the end of this episode, listeners will be able to:
- Describe the historical evolution of xenotransplantation, including the primate and early porcine eras 
- Explain the key immunologic and biologic barriers to xenotransplantation, including hyperacute rejection and the role of natural antibodies 
- Summarize major scientific advances that enabled modern xenotransplantation, including cloning and CRISPR-based gene editing 
- Discuss recent clinical experiences and ongoing trials of xenotransplantation in humans 
-  Evaluate the ethical considerations and societal implications of xenotransplantation 
- Consider the potential role of xenotransplantation in addressing organ shortage and reshaping transplant eligibility and allocation

Check out Dr. Mezrich’s new book!
 https://www.amazon.com/Every-Living-Creature-Xenotransplantation-Change-ebook/dp/B0FH14LF6K

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Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  
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INTRODUCING Behind the Knife OBGYN Oral Board Review!

The oral boards aren't just about knowledge—they are about executing under pressure. This course is designed to give you the structure and confidence to command the room. We have curated 98 high-yield scenarios covering the "Big Three" of the exam: Obstetrics, Gynecology, and Office Practice. Whether it’s a surgical emergency or a complex clinic workup, we will walk you through exactly how to articulate your plan, defend your decisions, and pass this exam.

Each scenario includes 2 parts. The first part is a perfectly executed scenario.  If you are 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. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.

Please check out the preview episodes below that include Parts A and B, with and without commentary.

This course includes access to our Oral Board Simulator.  Step into the hot seat and experience the pressure of the real exam and receive detailed, actionable feedback with the most advanced oral board prep available.  

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DOMINATE THE DAY!

In this episode, we explore the grueling realities of the general surgery preliminary year—a high-stakes, one-year audition for surgical trainees operating without a safety net. We sit down with a program director, a former IMG prelim turned attending, and a recently successful SOAP applicant to uncover exactly what it takes to survive the scramble and excel clinically. Listen in to learn actionable strategies for navigating hospital expectations, securing vital mentorship, and ultimately turning your preliminary position into a secured categorical spot.

Hosts:

Ayman Ali, MD
Dr. Ayman Ali is a Behind the Knife fellow and general surgery PGY-4 at Duke Hospital. 

Kevin Naresh Shah, MD
Dr. Kevin Shah is an Assistant Professor of Hepatobiliary Surgery at the Duke University School of Medicine and Program Director of General Surgery. 

Katharine Louise Jackson, MBBS
Dr. Louise Jackson is an Assistant Professor of Colon and Rectal Surgery at the Duke University School of Medicine and the Medical Student Clerkship Director. 

Rafael Felix Tiongco, MD
Dr. Rafael Tiongco is a first-year resident at Penn State College of Medicine.

Sponsor Disclaimer: Visit goremedical.com/btkpod to learn more about GORE® SYNECOR Biomaterial, including supporting references and disclaimers for the presented content.  Refer to Instructions for Use at eifu.goremedical.com for a complete description of all applicable indications, warnings, precautions and contraindications for the markets where this product is available. Rx only

***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6

Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
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Learning Objectives
·      Develop an understanding of the clinical presentation, diagnostic work-up, and treatment of benign pancreatic cysts
·      Develop an understanding of the clinical presentation, diagnostic work-up, and treatment of pre-malignant pancreatic cysts
·      Develop an understanding of when surveillance is appropriate for management of pancreatic cysts, and the criteria involved in making that determination
·      Develop an understanding of the prognostic utility of PancSeq for IPMNs

References:

***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6

Sponsor Disclaimer: Visit goremedical.com/btkpod to learn more about GORE® SYNECOR Biomaterial, including supporting references and disclaimers for the presented content.

Refer to Instructions for Use at eifu.goremedical.com for a complete description of all applicable indications, warnings, precautions and contraindications for the markets where this product is available. Rx only 

Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  
If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen
Behind the Knife Premium:
General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas
Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship
Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation
Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
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