In this episode, hosts Drs. Maya Hunt, Nicole Santucci, Bryanna Stukes and Zoe Zhou explore the parallels between the literacy crisis in America and current challenges in surgical education, drawing insights from the podcast "Sold a Story." They discuss how both systems advance learners without true competency, blame struggling students rather than examining flawed teaching methods, and look to the promise of competency-based education as a path forward. Beyond surgical training, they examine how declining literacy rates will directly impact how we communicate with and care for our future patients.

Episode Hosts:
–Dr. Maya Hunt, Indiana University
[email protected]

References:
1.        Sold A Story: How teaching kids to read went so wrong | podcast. Accessed February 22, 2026. https://features.apmreports.org/sold-a-story/.

2.        2024-2025 Literacy Statistics. National Literacy Institute. Accessed February 22, 2026. https://www.thenationalliteracyinstitute.com/2024-2025-literacy-statistics.

3.        Purdy AC, Smith BR, Amersi F, et al. Characteristics Associated With Outstanding General Surgery Residency Graduate Performance, as Rated by Surgical Educators. JAMA Surg. 2022;157(10):918-924. doi:10.1001/jamasurg.2022.3340 https://pubmed.ncbi.nlm.nih.gov/35947371/

4.        Santosa KB, Lussiez A, Bellomo TR, et al. Identifying Strategies for Struggling Surgery Residents. J Surg Res. 2022;273:147-154. doi:10.1016/j.jss.2021.12.026 https://pubmed.ncbi.nlm.nih.gov/35085942/

5.        Mattar SG, Alseidi AA, Jones DB, et al. General surgery residency inadequately prepares trainees for fellowship: results of a survey of fellowship program directors. Ann Surg. 2013;258(3):440-449. doi:10.1097/SLA.0b013e3182a191ca https://pubmed.ncbi.nlm.nih.gov/24022436/

6.        George BC, Bohnen JD, Williams RG, et al. Readiness of US General Surgery Residents for Independent Practice. Ann Surg. 2017;266(4):582-594. doi:10.1097/SLA.0000000000002414 https://pubmed.ncbi.nlm.nih.gov/28742711/

7.        Brasel KJ, Lindeman B, Jones A, et al. Implementation of Entrustable Professional Activities in General Surgery: Results of a National Pilot Study. Ann Surg. 2023;278(4):578-586. doi:10.1097/SLA.0000000000005991 https://pubmed.ncbi.nlm.nih.gov/37436883/

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Ileocolic resection is one of the most common operations performed for Crohn's disease, yet the optimal approach to anastomotic construction and mesenteric management remains an active area of debate. From the configuration of the anastomosis to the extent of mesenteric excision, emerging evidence suggests that surgical technique may play a meaningful role in disease outcomes. Join Drs. Jared Hendren, Elissa Dabaghi, Joseph Trunzo, Ajaratu Keshinro, and David Rosen as they discuss methods for ileocolic anastomosis in Crohn's disease while reviewing the latest literature.

Hosts: 
- Jared Hendren, MD
Institution: Department of General Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio

- Elissa Dabaghi, 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.     Evaluate the evidence for the Kono-S anastomosis in reducing postoperative recurrence after ileocolic resection for Crohn's disease
2.     Describe the role of the mesentery in driving recurrence and discuss how mesenteric-targeting surgical approaches may influence outcomes
3.     Interpret the results of recent randomized controlled trials on extended mesenteric excision and apply them to surgical decision-making in ileocolic resection for Crohn's disease

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As cancer vaccines move into Phase II and III clinical trials, it is
increasingly important for surgeons to understand their role in this
evolving landscape. What exactly are these vaccines, how do they work,
and what should the surgical community know about their
implementation? Join BTK surgical education fellows Kara Button and
Michelle LaBella as they sit down with Professor Robert Jones to break
down the science of mRNA vaccines, the logistics of tissue
procurement, and the future of cancer care.

Hosts:

- Professor Robert Jones: Consultant Liver Surgeon, Liverpool University
Hospitals; UK National Institute for Healthcare Research, Co-Lead for
the Cancer Vaccine Innovation Pathway, Bowel Cancer UK and Royal
College of Surgeons UK Lead for Research into Advanced Bowel Cancer,
and UK Chief Investigator for the BNT122-01 trial.
https://www.linkedin.com/in/robert-jones-6103722a/

- Kara Button, DO: General Surgery Resident, Maine Medical Center;
Behind the Knife Surgical Education Fellow.

- Michelle LaBella, MD: General Surgery Resident; University of North
Carolina; Behind the Knife Surgical Education Fellow.

References:

https://clinicaltrials.biontech.com/trials/BNT122-01

Jones RP, Lee LYW, Corrie PG, et al. Individualized cancer vaccines
versus surveillance after adjuvant chemotherapy for surgically
resected high-risk stage 2 and stage 3 colorectal cancer: protocol for
a randomized trial. BJS. 2023;110(12):1883-1884.
doi:10.1093/bjs/znad332
https://pubmed.ncbi.nlm.nih.gov/37856683/

Tie J, Wang Y, Loree JM, et al. Circulating tumor DNA-guided adjuvant
therapy in locally advanced colon cancer: the randomized phase 2/3
DYNAMIC-III trial. Nat Med. 2025;31(12):4291-4300.
doi:10.1038/s41591-025-04030-w
https://pubmed.ncbi.nlm.nih.gov/41115959/

Rojas LA, Sethna Z, Soares KC, et al. Personalized RNA neoantigen
vaccines stimulate T cells in pancreatic cancer. Nature.
2023;618(7963):144-150. doi:10.1038/s41586-023-06063-y
https://pubmed.ncbi.nlm.nih.gov/37165196/

https://www.cancer.ox.ac.uk/research/lynchvax#:~:text=The%20LynchVax%20program%2C%20funded%20by,individuals%20with%20this%20genetic%20condition

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Can an algorithm actually give you your life back? A recent Stanford paper revealed that using large language models at home yields massive efficiency gains—up to 176%. For busy surgeons drowning in clinical duties and administrative bloat, every reclaimed second is priceless.
In this episode of Behind the Knife, Ayman and Patrick sit down with Christian Péan—an orthopedic trauma surgeon, Duke’s Executive Director of AI and IT Innovation, and the Founder/CEO of RevelAi Health. He’s also a Core faculty member at the Duke-Margolis Institute for Health Policy. Dr. Péan breaks down how naturally skeptical surgeons can adopt AI to save time, shares his granular daily workflow, and discusses his mission to cure physician burnout through tech. Whether you are a tech enthusiast or a total skeptic, this episode gives you the practical playbook for integrating AI into your surgical career today.

Hosts:
- Ayman Ali, MD
Ayman Ali is a PGY-4 at Duke Hospital and current Behind the Knife fellow.
- Patrick Georgoff, MD @georgoff
Patrick Georgoff is faculty in the Department of Surgery at the Duke University School of Medicine where he serves as an Associate Professor of Trauma, Acute, and Critical Care Surgery and Trauma Medical Director. He is a leading educator and creator for Behind the Knife, a premier digital education platform and podcast advancing surgical training through innovative, high-yield multimedia content.
- Christian Péan, MD @DrChristianPean
Christian Péan is faculty in the Department of Orthopaedic Surgery at the Duke University School of Medicine where he serves as Executive Director of AI and IT Innovation. He is the Founder and CEO of RevelAi Health, a health technology company advancing the transition to value-based care in musculoskeletal health with conversational AI. He is also author of the popular substack Techy Surgeon.  
https://www.revelaihealth.com/
https://techysurgeon.substack.com/

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What are the experts saying about thyroid cancer treatment in 2025?  Maybe it’s time to discuss deescalation of aggressive surgical care for lower risk thyroid cancers.  We can accept that less surgery may be appropriate in select cases, including more thyroid lobectomies versus total thyroidectomies, consider less invasive approaches such as percutaneous ablation techniques, and utilize more observation with active surveillance.  Early assessment of treatment may allow appropriate reduction in use of radioactive iodine ablation and more relaxed routine monitoring can reduce surveillance burden to patients and providers. 

Hosts:  
- Amanda Doubleday, DO, MBA, Assistant Professor, Waukesha Surgical Specialists, ProHealth Care.  Affiliated with University of Wisconsin School of Medicine and Public Health, Department of Surgery.  
- Simon Holoubek, DO, MPH, Assistant Professor, University of Wisconsin School of Medicine and Public Health, Department of Surgery.  
- Alexander Chiu, MD, Assistant Professor, University of Wisconsin School of Medicine and Public Health, Department of Surgery.  
- Rebecca S Sippel, MD, FACS, Professor and Chair of Division of Endocrine Surgery, Vice Chair of Academic Affairs and Professional Development, University of Wisconsin School of Medicine and Public Health, Department of Surgery.  

Learning Objectives:
- Risk stratification system now includes 4 categories: low, low-intermediate, high-intermediate, and high
-TSH suppression targets are simplified:  below the normal range if there is structural or biochemical disease and in the normal range if disease free. 
- Thyroid lobectomy is recommended for tumors < 2cm cT1N0 tumors and can be considered for tumors 2-4 cm. 
- Micro-Papillary Thyroid Carcinoma (<1cm) can be managed with active surveillance and/or percutaneous ablation 
- Central compartment lymph node dissection includes levels 6-7. 
- RAI is strongly not recommended for low risk cancers.   Can be considered in low-intermediate and high-intermediate cancers.  It is routinely recommended in high risk cancers. 

References: 
Ringel MD, Sosa JA, Baloch Z, Bischoff L, Bloom G, Brent GA, Brock PL, Chou R, Flavell RR, Goldner W, Grubbs EG, Haymart M, Larson SM, Leung AM, Osborne JR, Ridge JA, Robinson B, Steward DL, Tufano RP, Wirth LJ. 2025 American Thyroid Association Management Guidelines for Adult Patients with Differentiated Thyroid Cancer. Thyroid. 2025 Aug;35(8):841-985. doi: 10.1177/10507256251363120. Erratum in: Thyroid. 2025 Nov;35(11):1350. doi: 10.1177/10507256251387671. PMID: 40844370.
https://pubmed.ncbi.nlm.nih.gov/40844370/

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For decades, a tight carotid stenosis felt like a ticking time bomb — a plaque waiting to throw an embolus and cause the next stroke. We were taught that severe narrowing meant surgery, and trials like ACAS and ACST-1 seemed to prove it. But medicine has changed. Statins, antiplatelets, tighter blood pressure control, even PCSK9 and GLP-1 therapies have quietly slashed stroke risk, and now newer data from CREST-2 suggest that for many asymptomatic patients, the knife — or the stent — may not add much at all. So if modern medical therapy works better than ever… who actually benefits from intervention anymore? Today, we unpack the evidence, the controversies, and how to counsel the patient who feels perfectly fine but has high-grade stenosis.

Hosts: Carolyn Judge, Andrew Huang, Luciano Delbono, Frank Davis, Robert Beaulieu

Institution: University of Michigan, Department of Surgery, Section of Vascular Surgery

Learning objectives:

References:
SVS Guidelines:
Brook, R. D., et al. (2022). Society for Vascular Surgery clinical practice guidelines for management of extracranial carotid artery disease. Journal of Vascular Surgery, 75(1), e1–e67. https://doi.org/10.1016/j.jvs.2021.09.031

CREST (1)
Brott, T. G., Hobson, R. W., Howard, G., et al. (2010). Stenting versus endarterectomy for treatment of carotid-artery stenosis. New England Journal of Medicine, 363(1), 11–23. https://doi.org/10.1056/NEJMoa0912321

CREST-2
Brott, T. G., Howard, G., Fong, P., et al. (2024). Randomized trial of carotid artery stenting or carotid endarterectomy vs best medical therapy for asymptomatic carotid stenosis: CREST-2 results. [Manuscript in preparation]. ClinicalTrials.gov Identifier: NCT02089217. Retrieved from https://clinicaltrials.gov/ct2/show/NCT02089217

ACST-1
Halliday, A., Mansfield, A., Marro, J., et al. (2004). Randomised trial of carotid artery surgery for asymptomatic stenosis. Lancet, 363(9420), 1491–1502. https://doi.org/10.1016/S0140-6736(04)16153-1

ACST-2
Halliday, A., Bulbulia, R., Bonati, L. H., et al. (2021). Carotid artery stenting versus carotid endarterectomy in patients with asymptomatic carotid stenosis (ACST-2): A randomised trial. Lancet, 398(10291), 1065–1073. https://doi.org/10.1016/S0140-6736(21)01980-1

ACAS
Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. (1995). Endarterectomy for asymptomatic carotid stenosis. JAMA, 273(18), 1421–1428. https://doi.org/10.1001/jama.1995.03520420033036

Sponsor URL: https://www.goremedical.com/
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In this episode, our expert panel dives into the critical, historically debated topic of early burn wound excision using a real-world case of a patient with massive surface area burns. We explore the dramatic shift from the pre-1970s "wait and watch" approach to the modern standard of early source control, backed by landmark literature showing reduced mortality and shorter hospital stays. The discussion also highlights the nuances of this timeline, covering specific scenarios where delaying surgery is actually safer due to physiologic instability, uncertain burn depths, or mass casualty events. Tune in to hear the evidence behind these clinical decisions and learn why modern burn surgeons believe that removing necrotic eschar early is the best way to dominate the day!

Hosts: 

- Kathleen Romanowski – University of California Davis Hospital, Shriners Hospital Sacramento
- Laura Johnson – Grady Memorial Hospital
- Lauren Nosanov – Grady Memorial Hospital
-  Victoria Miles – Louisiana State University Health Science Center, University Medical Center New Orleans

Learning Objectives:
- Review the historical development of early burn excision and understand how these studies shaped modern burn surgical practice.
-  Evaluate contemporary evidence on the timing of burn excision.
- Apply current evidence and clinical principles to operative decision-making, identifying key patient and injury factors that influence the timing of excision and grafting in patients with major thermal injury.

References:

- Thompson P, Herndon DN, Abston S, Rutan T. Effect of early excision on patients with major thermal injury. J Trauma. 1987 Feb;27(2):205-7. doi: 10.1097/00005373-198702000-00019. PMID: 3820353. https://pubmed.ncbi.nlm.nih.gov/3820353/
-  Gray DT, Pine RW, Harnar TJ, Marvin JA, Engrav LH, Heimbach DM. Early surgical excision versus conventional therapy in patients with 20 to 40 percent burns. A comparative study. Am J Surg. 1982 Jul;144(1):76-80. doi: 10.1016/0002-9610(82)90605-5. PMID: 7046487. https://pubmed.ncbi.nlm.nih.gov/7046487/
- De La Tejera G, Corona K, Efejuku T, Keys P, Joglar A, Villarreal E, Gotewal S, Wermine K, Huang L, Golovko G, El Ayadi A, Palackic A, Wolf SE, Song J. Early wound excision within three days decreases risks of wound infection and death in burned patients. Burns. 2023 Dec;49(8):1816-1822. doi: 10.1016/j.burns.2023.06.003. Epub 2023 Jun 15. PMID: 37369613; PMCID: PMC10721718. https://pubmed.ncbi.nlm.nih.gov/37369613/
- Ramsey WA, O'Neil CF Jr, Corona AM, Cohen BL, Lyons NB, Meece MS, Saberi RA, Gilna GP, Satahoo SS, Kaufman JI, Schulman CI, Namias N, Proctor KG, Pizano LR. Burn excision within 48 hours portends better outcomes than standard management: A nationwide analysis. J Trauma Acute Care Surg. 2023 Jul 1;95(1):111-115. doi: 10.1097/TA.0000000000003951. Epub 2023 Apr 11. PMID: 37038260. https://pubmed.ncbi.nlm.nih.gov/37038260/
- Hayashi K, Sasabuchi Y, Matsui H, Nakajima M, Otawara M, Ohbe H, Fushimi K, Ono K, Yasunaga H. Does early excision or skin grafting of severe burns improve prognosis? A retrospective cohort study. Burns. 2023 May;49(3):554-561. doi: 10.1016/j.burns.2023.01.013. Epub 2023 Feb 3. PMID: 36774244. https://pubmed.ncbi.nlm.nih.gov/36774244/
- Janzekovic Z. Once upon a time ... how west discovered east. J Plast Reconstr Aesthet Surg. 2008;61(3):240-4. doi: 10.1016/j.bjps.2008.01.001. Epub 2008 Feb 1. PMID: 18243082. https://pubmed.ncbi.nlm.nih.gov/18243082/

This episode includes a full, sample cardiothoracic scenario pulled directly from our Cardiothoracic Surgery Oral Board Review Course. Listen in and test your clinical pathways in real-time as we walk through the perfect answers and provide high-yield commentary to help you pass the "hot seat."

About our Cardiothoracic Surgery Oral Board Review Course:

This mini-series on Behind the Knife delves into the technical aspects of the Operative Standards for Cancer Surgery, developed through the American College of Surgeons Cancer Research Program and Cancer Surgery Standards Program. This episode highlights sentinel lymph node biopsy for breast cancer.

Hosts:
- Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a Surgical Oncology fellow at MD Anderson Cancer Center.
- Lauren Postlewait, MD, FACS, is an Associate Professor of Surgery at Emory University School of Medicine and is the Medical Director of the Breast Center at Grady Memorial Hospital in Atlanta, GA.
- Chantal Reyna, MD, FACS (@kprgrl3) is a Breast surgical oncologist at Loyola University Medical Center in Chicago, IL and serves as the oncology clinical lead for the breast service line.

Guest:
- Susan E. Pories, MD, FACS (@SusanPoriesMD) is a professor of surgery, vice chair for quality and safety, and director of the Rutger’s Breast Center at the University hospital. 

Learning Objectives: 
-       Understand the definition and identification of axillary sentinel lymph node. 
-       Understand the technique for injecting tracer or dye to perform sentinel lymph node biopsy. 
-       Understand the importance of preincision drainage evaluation and transcutaneous localization.
-       Understand techniques to minimize seroma formation.

Links to Papers Referenced in this Episode
Operative Standards for Cancer Surgery, Volume 1: Breast, Lung, Pancreas, Colon
https://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/B07MWSNFSB

Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial Lancet Oncol. 2010 Oct;11(10):927-33.
https://pubmed.ncbi.nlm.nih.gov/20863759/

Improved Axillary Evaluation Following Neoadjuvant Therapy for Patients With Node-Positive Breast Cancer Using Selective Evaluation of Clipped Nodes: Implementation of Targeted Axillary Dissection J Clin Oncol. 2016 Apr 1;34(10):1072-8.
https://pubmed.ncbi.nlm.nih.gov/26811528/

The false-negative rate of sentinel node biopsy in patients with breast cancer: a meta-analysis World J Surg. 2012 Sep;36(9):2239-51. 
https://pubmed.ncbi.nlm.nih.gov/22569745/

Effect of lymphoscintigraphy drainage patterns on sentinel lymph node biopsy in patients with breast cancer Am J Surg. 2005 Oct;190(4):557-62.
https://pubmed.ncbi.nlm.nih.gov/16164919/

Sentinel Lymph Node Biopsy vs No Axillary Surgery in Patients With Small Breast Cancer and Negative Results on Ultrasonography of Axillary Lymph Nodes: The SOUND Randomized Clinical Trial JAMA Oncol. 2023 Nov 1;9(11):1557-1564.
https://pubmed.ncbi.nlm.nih.gov/37733364/

Choosing Wisely Guidelines
Society of Surgical Oncology. Released 2016 July 12; last updated 2020 November 13. Choosing Wisely: Five Things Physicians and Patients Should Question.
https://surgonc.org/wp-content/uploads/2020/11/SSO-5things-List_2020-Updates-11-2020.pdf

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This episode includes two full, sample vascular scenarios pulled directly from our Vascular Surgery Oral Board Review Course. Listen in and test your clinical pathways in real-time as we walk through the perfect answers and provide high-yield commentary to help you pass the "hot seat."

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