AI is likely to change the way that medical and surgical education happens over the next decade. We needed to find out how, and Dr. Samir Grover joined us on this episode to talk about it. 

Dr. Samir Grover is a gastroenterologist, clinician-educator, and education researcher whose career has been defined by building the simulation and technology-enhanced learning infrastructure that trains the next generation of physicians, and by translating that work into national and international practice. He serves as Executive Vice-President, Academics at Scarborough Health Network (SHN), where he holds the hospital's inaugural Pialis Family Chair in Education.

Samir and the Grover lab have really pivoted to study the impact of AI on medical education. In this episode, we take a deep dive into the implications of AI on medicine. Samir also talks to us about his current AI stack and how we might immediately start to use AI in our own practice.

Links:

1. Samir C. Grover | About | University of Toronto
2. Samir Grover Substack:  Samir C. Grover, MD | Substack
3. AI empathy:  AI empathy is artificial. But could that possibly be better.
4. AI stack for med students or residents:  The AI stack for the medical student or resident
5. Neverskilling:  Neverskilling - Samir C. Grover, MD
6. Grover Lab:  Grover Lab | Dr. Samir C. Grover | AI in Medical Education

Jeremy Heffner is a trauma and acute care surgeon at Lima Memorial Health System in Ohio. He is also the Chief Operating Officer of SurgeON, a social media company dedicated to surgeons. Heffner was also previously a bioengineer who worked at NIH. He has been incredibly open about his journey and struggles with PTSD as a surgeon, and how those struggles ultimately caused his breakdown. Sadly, Dr. Heffner's story is not unique, and we brought him on the podcast to hear his insights about how many surgeons struggle with PTSD. 

What is unique is Dr. Heffner's approach to dealing with his PTSD. His approach is outlined in his recently released book, Proof of the Impossible. Dr. Heffner used AI to try to find answers to many of the questions he had while struggling with burnout and PTSD. He had some very strange and unusual conversations with AI, including a moment where he felt the AI was having a "misalignment event", defined as when "AI acts in ways that go against human intent, safety, or core instructions". 

Our discussion spanned the gamut of PTSD in surgery, and how AI may or may not be a tool that can help with mental health and burnout. For me, the most powerful message Jeremy had for us was the power of human connection and also that the only way to deal with the hard things is to face them.

We would just like to warn listeners that we do discuss some pretty traumatic things that Dr. Heffner experienced, and some of the description is pretty graphic. Also, we would always recommend professional help if you are dealing with mental illness, burnout, or suicidal ideation. 

We would love to hear your thoughts - do you think there is a role for AI in providing empathy to humans? Send us your feedback at [email protected]. 

 Links:

1. Source: LinkedIn https://share.google/yBOCofBF9BhotNeWh
2. Pre-Order "Proof of the Impossible"  https://share.google/w0jGPSiz9WLBstaqU
3. SurgeON with Mark Soliman interview:  https://open.spotify.com/episode/3znH6DkcDDcg7Zqyca2YSb?si=p3zoYYb_RCiNvL5hkX4l9g&utm_source=copy-link&sci=spotify%3Acard-config%3A0qjrdqA8ITGkKr0375x09R

This week's guest is Dr. Bishal Gyawali. Bishal is an oncologist at Queen's University and a policy researcher. His focus as a researcher has been both sensational and at the same time extremely fundamental. Bishal has been asking questions around how we decide which drugs are approved for funding by the government, as well as how we might best allocate resources to help cancer patients around the world. Bishal has been an integral part of the "Common Sense Oncology" movement, which will promote interventions that measurably improve the lives of patients, promoting effective treatments but  also challenging interventions that might cause more harm than good.

Our conversation focused around Bishal's training, how he became interested in cancer health policy and his thoughts around the idea of value in cancer care. We also discussed Bishal's thoughtful use of technology, blogs, and social media.

Links:

1. Grounded in Groundshot Podcast – Dr. Bishal Gyawali
   
   
2. BG lab: Dr. Bishal Gyawali
   
   
3. Common Sense Oncology: Home - Common Sense Oncology
   
   
4. Mittal A, Kim MS, Dunn S, Wright K, Gyawali B. Frequently asked questions on surrogate endpoints in oncology-opportunities, pitfalls, and the way forward. EClinicalMedicine. 2024 Sep 13;76:102824. doi: 10.1016/j.eclinm.2024.102824. PMID: 39764569; PMCID: PMC11701476.

5. Surrogate Endpoints: The 15 Most Common Misunderstandings in Oncology
   
   
6. Cancer groundshot: Access to proven treatments must parallel development of new therapies
   
   
7. Do Oncology Board Exams Make Us Better Doctors?
   
   
8. Ending Medical Reversal: Ending Medical Reversal | Hopkins Press
   
   

In 2013, when I was a medical student, I wrote an essay entitled, #nomoretextbooks? for the Canadian Undergraduate Surgical Education Committee essay competition. In the essay I wrote, “Tomorrow, I start my vascular surgery rotation. Before bed tonight, I will watch a YouTube video of a femoral-popliteal bypass surgery, review the surgical anatomy from Zollinger’s Atlas of Surgical Operations on my iPad while waiting for my car tires to be changed, listen to a podcast on peripheral vascular disease while riding my exercise bike, and perhaps tweet about my new rotation.” At the time, I really felt strongly that the future of surgical textbooks would be virtual. 

To explore that future, I spoke with Tanner Schrank, the head of impact for the Journal of Medical Insight (also called JOMI). JOMI is a website that showcases a wide range of operations across multiple disciplines. What I really like about JOMI is the in-depth interviews that are done with surgeons before the operation, where the surgeon will describe their thought process and indications for the operation. The videos are also extraordinarily well filmed, often from multiple camera angles and with great detail. JOMI clearly offers a fantastic resource for residents and attendings to learn new surgical techniques.

Tanner and I discuss the implications for a transition to a “virtual” textbook that is more reliant on video than an actual written textbook. I must caveat this episode by saying that I think there is pretty good evidence that reading something and actively trying to absorb information is more effective than passively viewing it. In other words, I am not totally convinced that you can effectively learn something by passively watching video. I think it’s important, especially for trainees, to learn actively.  As the great expert on performance, Anders Ericsson said, deliberate practice, not just practice, is required to really acquire mastery. However, there is no question in my mind that video needs to augment the learning that we do as surgeons. At Queen’s, we use video review on a weekly basis to give residents and fellows feedback on how they can improve their technique. 

We would love to hear your thoughts. Do you think videos are the way of the future for surgical textbooks? Shoot us an email at [email protected]. 

Links:

1. AMBOSS: Beyond the Textbook: amboss.com/int/internationalpodcast
2. JOMI: https://jomi.com/
3. #nomoretextbooks: https://www.canjsurg.ca/content/57/4/E119 

In honor of National Nursing Week in Canada, which is May 11th to May 17th, we are re-releasing an early episode with Lauren Kiwan, nurse clinician for general surgery at the Foothills Medical Centre. Lauren shares what surgeons can do to improve the OR. 
Revisit this important episode with us.

___

Lauren Kirwan is the nurse clinician for general surgery at the Foothills Medical Centre. She is currently finishing up her nurse practitioner degree. 

We wanted to ask Lauren her thoughts about what it means to be an OR nurse and what she wishes surgeons would do to make the OR environment better. We also hear about the impact of COVID19 on our nursing colleagues. We’d love to hear from our nurse listeners – what are some things that make your day or make you mad in the operating room? Email us at [email protected] with your thoughts and comments. 

Links:

1. Melinda Davis on the Anesthetist - Surgeon relationship: https://soundcloud.com/cjs-podcast/e40-melinda-davis-on-career-counseling-and-the-anesthetist-surgeon-relationship

2.  Atul Gawande paper on Safe Surgery Checklist implementation in South Carolina. Perception of Safety of Surgical Practice Among Operating Room Personnel From Survey Data Is Associated With All-cause 30-day Postoperative Death Rate in South Carolina. https://journals.lww.com/annalsofsurgery/Abstract/2017/10000/Perception_of_Safety_of_Surgical_Practice_Among.14.aspx

I have a confession to make. I kind of felt that to talk about money or to be really into financial planning was akin to being the Wolf of Wall Street, where the only real principle was how much money I could make. After this week’s conversation with Dr. Mark Soth, I think of financial planning in a completely different way. In fact, I would argue that Dr. Soth provided on this episode some of the best advice on how to live in a truly fulfilling way.

Dr. Soth is an intensivist at McMaster University. He has done significant work in the space of physician financial independence. He has a website called The Loonie Doctor as well as a limited run podcast called The Money Scope podcast. In this episode I basically ask Mark all the finance related questions I could think of, ranging from the utility of professional corporations in 2026 to tools for financial tracking. Most importantly, Mark explores how financial planning can help us all to life “the good life”. 

Check out all the resources and links from Mark in the show notes. 

Links:

1. The Wealthy Barber
2. The Money Scope Podcast 
3. The Loonie Doctor's Bookshelf : Mark’s favorite finance books
4. beyond MD podcast with Dr. Yatin Chadha
5. Breaking Bad Debt - Dr. Steph - YouTube
6. Reboot Your Portfolio by Dan Bortolotti

While we hope that none of  us “botch a surgery”, medico-legal concerns are issues that affect most surgeons at some point in their careers. Previously on the podcast, Dr. Richard Mimeault and Liise Honey spoke to us about the landscape of medico-legal concerns in surgery, and the anatomy of a lawsuit. In this episode, we talk about the CMPA's innovative approach to try to prevent errors from happening in the first place. Richard Mimeault and Elisabeth Normand join us to talk about "Theatre Arts", a workshop developed by the CMPA to help OR teams improve the quality of the care, and most importantly, improve the culture and dynamics of the team. In this episode we talk about the Theatre Arts workshop and how improving culture may have profound impacts on patient safety and satisfaction. 

Links:

1. Theatre Arts workshop: https://www.cmpa-acpm.ca/en/education-events/workshops/workshop-theatre-arts
2. CMPA x Cold Steel on Medicolegal risks for surgeons: https://www.youtube.com/watch?v=7Mkw68prEP0
3. CMPA x Cold Steel – the Anatomy of a Lawsuit: https://www.youtube.com/watch?v=LRUh95LauFw 
4. Contact the CMPA: https://www.cmpa-acpm.ca/en/connect/contact-us
   
   

Dr. Varun Kapila is a vascular surgeon in Brampton, Ontario. He is the author of “Six Lessons for Everyday Leadership: From the Operating Room Into Everyday Life, What Surgery Taught Me About Leadership That Can Be Applied by Everyone”. In this episode we delve into Dr. Kapila’s thoughts on leadership and why everyone can be a leader in their own lives.

Links:

1. https://www.amazon.ca/Six-Lessons-Everyday-Leadership-Operating-ebook/dp/B0GQWHNYFS 
2. https://learn.hms.harvard.edu/insights/learner-stories/driving-system-level-change-through-surgical-leadership 
3. https://ontariohealth.ca/clinical/cardiac-stroke-vascular/abdominal-aortic-aneurysm-program
4. https://www.cmaj.ca/content/196/4/E112 
5. https://www.thestar.com/news/hes-not-young-hes-my-doctor/article_bcec69e9-2822-54cf-bed1-c2322cefc558.html 

For a newly graduated surgical resident, one of the most interesting and perplexing question that many folks have to deal with is a surprisingly simple one: what should a full-time surgical job look like? For many of us, we simply looked at what our predecessors job looked like, and modeled our own careers after them. This meant ensuring that our schedules were jam-packed with clinical activities every day, without much consideration for other aspects of our career (such as call and research, for example).

At the beginning of March, the American College of Surgeons released a framework of standards of what they think reasonable expectations are for a surgeon’s job. We have the link to the paper in the shownotes. The ACS is the one of the largest surgical organizations in North America, and this standard framework they have put out is really a statement on what they think is necessary to ensure that surgeons have a sustainable career. They put out standards for call, access to the OR, access to clinic, resource access, inpatient census, clinical support, and even fatigue mitigation.

Dr. Pat Murphy, trauma and acute care surgeon at the Medical College of Wisconsin, was a previous guest on the show to talk about his work trying to define what a full time acute care surgeon should look like. He actually brought this framework to our attention, and we invited him to join us once again on Cold Steel to discuss the implications of such a framework.
We would love to hear your thoughts. Send us an email at [email protected], or find us on X (@colsteelpod, @ameerfarooq & @pbatesmurphy)

Resources from this episode:

1. Wood, Douglas E MD, FACS, FRCSEd; Wolinsky, Philip R MD, FACS2; Dodgion, Christopher M MD, MSPH, MBA, FACS3; Farmer, Diana Lee MD4; Gantt, Nancy L MD, FACS5; Napolitano, Lena M MD, FACS, MAMSE6; Timmons, Shelly D MD, PhD, FACS. FAANS7; Welsh, David J MD, MBA, FACS8; Winfield, Robert D MD, FACS9; Bura, Connie BA10; Essig, Rachael MD11; Turner, Patricia L MD, MBA, FACS10. Developing Specialty-Specific Workplace Standards for Surgeons: A Framework to Support Sustainable Surgical Careers. Journal of the American College of Surgeons ():10.1097/XCS.0000000000001880, March 03, 2026. | DOI: 10.1097/XCS.0000000000001880
2. https://www.facs.org/for-medical-professionals/news-publications/news-and-articles/acs-brief/march-3-2026-issue/acs-releases-workplace-standards-framework-to-support-sustainable-surgical-careers/
3. Pat Murphy on Cold Steel: https://www.canjsurg.ca/content/e184-pat-murphy-workforce-planning-acute-care-surgery
4. https://calnewport.com/

Paul Fedak is a cardiac surgeon and translational scientist at the University of Calgary. He has written and spoken about what it means to pursue excellence and what it might cost us. Dr. Fedak unexpectedly had to cut short his clinical career as a surgeon due to spinal cord issues. The result has been a powerful exploration about identity, meaning, burnout and the pursuit of excellence. This is a conversation about that pursuit.

Bio: https://profiles.ucalgary.ca/paul-fedak 

Links:

1. https://www.theglobeandmail.com/opinion/article-as-a-heart-surgeon-i-chased-excellence-it-cost-me-my-body-and-my-mind/
2. http://paulfedak.com/
3. https://www.ted.com/talks/paul_fedak_beyond_mastery_how_a_heart_surgeon_found_his_own_heart
4. https://calgaryherald.com/opinion/columnists/opinion-the-mountain-decides-who-goes-and-who-stays