The Intentional Surgeon with Sharon L. Stein, MD

Surgery is a team sport, yet many departments operate as isolated individuals sharing a call schedule. In this episode of The Intentional Surgeon, Dr. Sharon Stein welcomes Dr. Faisal Aziz (Chief of Vascular Surgery at Penn State Health) to discuss how his division built a true "one team" culture where surgeons stay long-term and support each other at 2 AM.

Key Discussion Points:

• The Recruitment Post That Sparked the Call: Why Penn State’s group stands out as a unified team rather than a collection of independent contractors.
• Culture Eats Strategy: Applying Peter Drucker's rule and Jim Collins’ Good to Great framework to surgical leadership.
• Hiring for Character First: Why technical skills can be taught, but integrity and humility cannot.
• Uncovering True Culture: Practical strategies for applicants to assess a department's real culture—from observing how staff are treated to Dr. Julie Freischlag’s "3-second pause" technique.
• Vulnerability in the OR: How senior leaders asking for help builds psychological safety, breaks down ego, and improves patient care.
• Cross-Generational Skill Exchange: Bridging the gap between open-operative mastery and modern endovascular/robotic techniques through mutual mentorship.

Featured Quote:

"I can teach surgeons how to do complicated operations. What I cannot teach is how to be kind, or how to have character and integrity. It is much easier to hire for character and invest in technical growth than to hire competence without integrity." — Dr. Faisal Aziz

Thank you and chat tomorrow!

Technical prowess and clinical knowledge are the bedrock of any surgical career, but they are only two pieces of the puzzle. The third—and arguably most impactful—element is communication. Despite its outsized influence on resident evaluations, operating room efficiency, and patient outcomes, intentional communication is rarely explicitly taught in medical school or residency programs.

In this episode of The Intentional Surgeon, Dr. Sharon Stein breaks down why communication isn't just a "soft skill," but a critical clinical tool. Dr. Stein also introduces The Launchpad, a new program designed to empower graduating residents with the communication, prioritization, and negotiation skills needed to navigate high-stakes career decisions.

In This Episode:

• The Communication Gap: Why attendings often complain about consults or presentations due to formatting and communication disconnects rather than a lack of clinical knowledge.
• Decoding Communication Styles:
  • The Punchline First: High-yield communicators who need the core verdict up front (e.g., Do I need to check a box, get out of bed to operate, or listen closely to offer expertise?).
  • The Logical Processors: Thinkers who require a structured, step-by-step chronology.
  • The Relational Communicators: Team members who build rapport through personal connection before diving into clinical details.
• The Power of the Open-Ended Intake: Why asking new patients "In your own words, what is going on with you?" unlocks crucial insights into both their communication style and their baseline understanding of their diagnosis.
• Building Trust Through Airtime: How allowing patients and colleagues to speak uninterrupted for the first minute fosters psychological safety and accelerates clinical trust.
• Mirroring to Meet Needs: How recognizing a patient’s need to process information slowly allows you to adapt your delivery style, reducing anxiety around difficult diagnoses.
• Continuous Skill Acquisition: Why seasoned surgeons can and should learn new communication models just as they learned laparoscopic or robotic techniques mid-career.
• The Launchpad: A dedicated 6-month program equipping graduating residents and fellows with essential tools in communication, prioritization, and negotiation as they navigate their first job search and career launch.

Key Takeaway:

"We spend years perfecting our technical craft, yet so much of our daily success hinges on how effectively we communicate. When you learn to deliver information in a way that aligns with how the other person’s brain processes it, you transform your relationships with your residents, your OR teams, and your patients. Communication isn't a fixed personality trait—it's a learnable surgical skill." — Dr. Sharon Stein

Resources:

• The Launchpad Program: A 6-month, interactive coaching initiative starting this September for graduating residents and fellows looking for their first surgical position. Learn how to identify your priorities, master negotiation, and communicate effectively to land in a practice environment where you will thrive. Register here.

Surgeons operate in a high-stakes, highly penalized environment where mistakes carry immediate, human consequences. As a result, surgical culture has traditionally been deeply risk-averse, favoring short-term event tracking over long-term process evolution. But in an era driven by generative AI, non-linear thinking, and shifting generational values, how do we advance the craft without compromising safety?

In this episode, Dr. Sharon Stein sits down with Dr. Julio Mayol, Professor of Surgery at the University of Madrid, Chief of General Surgery at Hospital Clínico San Carlos, and Scientific Director of the San Carlos Health Research Institute. Dr. Mayol pulls back the curtain on his "crazy ideas" for surgery, explaining why the future of the field relies not on doing more volume, but on mastering the hard skill of communication, fostering organizational trust, and embracing simulation over fear.

In This Episode:

• The Fear of Innovation: Why surgeons are trained to reduce variance and noise, making the profession hesitant to re-evaluate established practices even when long-term outcomes remain unknown.
• Overcoming Inertia with Generative AI: How advanced simulation tools allow surgeons to test complex, non-linear realities before stepping into the operating room—drawing parallels to how aerospace engineers test aircrafts.
• Cognitive Biases and M&M Culture: Moving away from punitive "find the guilty party" morbidity and mortality conferences to evaluating near-misses, structural complexity, and systemic learning opportunities.
• The Myth of the "Soft Skill": Why communication is actually the single hardest clinical skill in surgery, acting as a crucial filter against cognitive overload and a prerequisite for medical trust.
• Redefining Professional Incentives: Challenging the "industrial revolution" mindset where volume, RVUs, and paper counts define success, and shifting toward metrics based on patient-reported outcomes, social capital, and collaborative networks.
• The "If It's Difficult, You're Doing It Wrong" Philosophy: Examining how alignment, clarity, and deep, deliberate thinking eliminate unnecessary friction in surgical education and clinical practice.
• Humanities as Table Stakes: Why treating surgery merely as a technical, reproducible task leaves clinicians vulnerable to automation, whereas embracing the deeply human aspects of medicine protects both patient and surgeon well-being.

Key Takeaways:

"Healing starts with communication. Communication is not a soft skill—it is the hardest skill for surgeons. When we operate solely as technical machines doing reproducible tasks, we miss the entire point of our craft. If we act like machines, we should be replaced by machines. Medicine is deeply human, and we must measure our value by how we transform practice and improve lives, not just by how much volume we accumulate." — Dr. Julio Mayol

Key Concepts:

• Trust isn't created by saying "yes" to everything; it's built on coherence—doing what you say, saying what you do, and clearly explaining the "why" when you must say "no."
• Healthy clinical and research teams actively include voices that challenge authority and question established norms to prevent groupthink.
• Recognizing when an administrative or clinical role no longer provides growth (often around the 6–8 year mark) and stepping aside to foster new talent and build collaborative networks.

What does it take to train a modern surgeon? For decades, residency has relied on the "see one, do one, teach one" model. But according to one of the field's leading innovators, technical skill is only a tiny fraction of the job.

In this episode, Dr. Sharon Stein sits down with Dr. Patrick Jackson, Chief of General Surgery and the Robert A. Altman Endowed Chair of Surgical Education at MedStar Georgetown University Hospital. Backed by a historic $10 million grant funded by Lynda Carter and the Robert Altman Foundation, Dr. Jackson outlines his vision to dismantle and rebuild surgical training around four core pillars.

In This Episode:

• Residency as a Leadership Track: Why the operating room requires training clinicians to execute irreversible decisions using incomplete data under extreme uncertainty.
• Recruiting for Character over Research: The five core attributes Dr. Jackson filters for: integrity, compassion, communication skills, work ethic, and team adaptability.
• The Four Pillars of the Institute:
  1. Technical Training: Blending traditional craftsmanship with simulators, Virtual Reality (VR), and AI.
  2. Humanistic Leadership: Shifting medicine away from commoditization and "RVU generators" back to human-to-human care.
  3. Educational Research: Eliminating fear as a motivator and studying systemic training inefficiencies.
  4. Community & Global Engagement: Democratizing surgical access globally while investing directly in local community outcomes.
• The "Lane Assist" Future of Robotics: How upcoming AI software will mimic vehicle lane assistance—providing real-time haptic and visual feedback to prevent structural errors during complex dissections.
• Tailored, Flexible Residencies: Proposing a hybrid model where senior residents can customize their rotations—such as deep pelvic work with gynecologists or specialized rural training.
• NASCAR and Bartenders: Why surgical culture should look outside the medical bubble to learn team efficiency from elite pit crews and human connection from bartenders.

Key Takeaway:

"The operating room is a place where we're making irreversible decisions based on incomplete data... As medicine has become commoditized, we have started to lose the aspect that you are taking care of another human being. We have to reinvest in human-to-human contact. The only fear a surgical trainee should have is that they aren't going to do their patient well." — Dr. Patrick Jackson

Physician burnout is often treated as a personal failure—a symptom of missing a meditation session or a hospital pizza party. But true burnout isn't about how much you suck; it’s about the rigid institutional matrix in which you operate.

In this episode, Dr. Sharon Stein sits down with Dr. Najjia Mahmoud, Chief of Colon and Rectal Surgery at University of Pennsylvania and past president of the American Society of Colon and Rectal Surgery, to dive into the clinical anatomy of burnout and what the antidote may be:

In This Episode:

• Exploring the three domains of burnout: cynicism, emotional exhaustion, and a low sense of personal accomplishment and how it differs from depression.
• Why, despite advancement in your career, you may continue to feel a loss of control over your day-to-day.
• Dr. Mahmoud’s structural pillars of resilience: guarding physical health, cultivating self-awareness, maintaining connection outside of medicine, and practicing radical optimism.

Building Blocks of Resilience:

1. Physical Health: Guarding the baseline triage of nutrition, sleep, and exercise.
2. Self-Awareness: Actively tracking internal thoughts, emotional triggers, and daily coping strategies.
3. Flexibility: Intentionally regulating internal expectations to navigate rigid environments.
4. Connection: Staying anchored to values, community, and peer support groups separate from work.
5. Optimism: Holding an active belief that structural, positive change within systems is always possible.

Key Takeaway:

"One resource in healthcare seems infinite and free: the professionalism of caregivers. Mistakenly, many health systems operate under the framework that burnout is solely the responsibility of the individual. That is junk. True structural resilience requires meaning, mastery, and autonomy." — Dr. Najjia Mahmoud

Recommended Reading: Man’s Search for Meaning by Viktor Frankl.

In rural, underserved areas of Kenya, a lack of access to timely cesarean sections leaves young women vulnerable to the trauma of obstructed labor. Beyond the tragic loss of the child, the resulting prolonged pressure on pelvic organs causes severe tissue necrosis and the formation of vesicovaginal and rectovaginal fistulas. Leaking urine and stool continuously, these women are often heavily stigmatized and ostracized by their communities.

In this episode, Dr. Sharon L. Stein sits down with Dr. Anna Spivak, Section Chief of Pelvic Floor Surgery at the Cleveland Clinic, to discuss Campaign 52—an international medical relief initiative providing free, life-altering surgical care to these vulnerable women.

Unlike top-down, Western-driven mission trips, Campaign 52 operates at the explicit request and direction of local Kenyan surgeons. Dr. Spivak shares how this collaborative, local-first framework allows a specialized task force of colorectal, gynecologic, and urologic surgeons to tackle an overwhelming backlog of complex pelvic floor conditions, directly target the exact procedural needs of the community, and systematically build lasting hospital infrastructure.

Global Surgery Best Practices:

For residents, fellows, and surgeons looking to participate in humanitarian work overseas, Dr. Spivak outlines a foundational rulebook:

1. Do not establish a short-term camp without locked-in, long-term, perpetual aftercare. Campaign 52 ensures close, local, long-term clinical checkups, pelvic floor physical therapy tracking, and remote communication via the Fistula Foundation.
2. Front-load your schedule. Round on 100+ triage patients on day one, and position the highly complex, multi-hour operations early in the week so patients have adequate time to recover safely before the traveling team departs.
3. Do not show up to enforce what you think a population needs. Identify local clinical hubs seeking discrete clinical education or structural backlog reduction.

Key Takeaway for Listeners:

"In the United States, some equipment would be in the garbage a long time ago. Because they have very little, they truly utilize everything they have. Limitation begets creativity. When Dr. Mabeya fixes these complex fistulas, he is truly saving souls. He's giving these women a chance to be alive, to take care of themselves, and to contribute to their society." — Dr. Anna Spivak

Learn More and Get Involved:

• Read the Research: Dive into the three-part series documenting the logistics and outcomes of Campaign 52 published in Diseases of the Colon & Rectum (DC&R).
• Follow the Work: Connect with the team via @Campaign_52 on Instagram and Facebook to donate unused clinic supplies or join the surgical task force.
• Explore Global Relief: Learn more about broader international surgical placements through the American College of Surgeons' Operation Giving Back initiative.

If the global healthcare sector were a country, it would be the fifth-worst greenhouse gas emitter on the planet! Within hospitals, the operating room generates a staggering one-third of that entire carbon footprint.

In this episode, Dr. Sharon Stein sits down with Dr. Patricia Sylla (System Chief of Colon and Rectal Surgery at Mount Sinai Health System) and Dr. Shaneeta Johnson (Chair of Surgery at Meharry Medical College School of Global Health). Together, they discuss the massive environmental toll of the OR, from volatile anesthetics to single-use plastics, and map out a collaborative blueprint for a more sustainable future.

In This Episode, They Discuss:

• Climate, Access, and Disparities: Dr. Johnson shares her experience providing medical aid in the Bahamas after Hurricane Dorian, illustrating how climate change causes extreme weather which directly disrupts healthcare access, particularly for vulnerable communities.
• The Surgical Carbon Footprint: Dr. Sylla details why waste is only one small piece of the problem. True environmental impact spans energy expenditure, water usage, and the relentless stream of single-use materials hitting landfills.
• The Threat of Volatile Anesthetics: Why a transition to a zero-desflurane policy across health systems can dramatically drop carbon emissions overnight.
• The Supply Chain "Hotspots": Examining Life Cycle Analysis (LCA) data which reveals that up to 60% of a laparoscopic cholecystectomy's environmental footprint stems directly from disposable instrumentation.

Top 3 Actions for Surgeons Today:

1. Lean the Instrument Trays: Standardize trays down to tools used in 70% or more of cases. Pack the remaining 30% separately and keep them unopened on the back table until explicitly needed.
2. Stop Automated Openings: Instruct OR staff to stop opening specialized devices automatically. Wait until you are ready to use them to avoid creating unnecessary landfill waste.
3. Appoint a Green Champion: Build an institutional team bridging surgeons, anesthesia, central processing (SPD), and supply chain stakeholders together just like we did when starting enhanced recovery programs!

Resources

• The Carbon Footprint of a Laparoscopic Cholecystectomy
• SAGES: Sustainability in Surgical Practice

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As surgeons, we’ve all been told the same lie: The only way to get ahead in your career is to say yes to everything. We are conditioned to believe that if we turn down a single opportunity, committee, or research project, the powers that be will stop asking, and our academic or clinical careers will stall.

In this episode on the Intentional Surgeon, Dr. Sharon L. Stein dispels this toxic surgical myth. Drawing from her own unconventional path, including the time her mentors told her she was committing "academic suicide" by dropping to a four-day work week, Sharon shares how learning to say yes selectively actually accelerated her success as a busy clinician, professor, and national society president.

In This Episode, I Discuss:

• Why saying no to the wrong things doesn’t kill your career—it actually makes your time more valuable.
• A hard truth for perfectionist surgeons: doing a job badly is significantly worse than not doing it at all.
• The Opportunity Framework: Before accepting any new role, filter it through these five metrics to ensure it aligns with your short- or long-term goals:Skills: Will it teach you a new technical technique or leadership capability?Networking: Who will you be working alongside, and can you learn from them?Goodwill: Is it building social capital with your chief or the hospital CFO?Advancement: Is this a necessary rung on your path to chair or society president?Control: Will this role give you more autonomy over your schedule or resources?Bonus: Fun! Don't discount an invitation simply because it sounds enjoyable or involves travel to a great culture.

• The "Negotiated Yes": How to protect your plate when your boss forces an assignment on you. Sharon breaks down the four ways to negotiate constraints:

• Time-limiting: offering a 6-month term instead of a year.
• Scope-limiting: writing the proposal but passing off the board presentation.
• Effort-limiting: accepting that some hospital paperwork only needs "B-grade" work, not an A-plus treatise.
• Additional Assistance: demanding administrative or clinical support to get the job done.

• The Three Ways to Deliver a Respectful "No": How to turn down an invitation while preserving the relationship, including the power of sponsorship—passing the opportunity to a junior colleague or fellow to help build their CV.

Key Takeaway for Listeners:

"Saying yes to everything is not the answer to anything. Truly effective and successful surgeons aren't doing it all — they are incredibly focused on what they love and what they are good at, which means they are saying 'no' to a whole lot else." — Dr. Sharon Stein

Challenge for the Week:

Pull out a sticky note and audit your week. Track how many times you say "yes" to an add-on patient, a meeting, or a schedule change versus how many times you protect your time with a "no." If you are sitting on a committee playing Tetris on your phone just to have a line on your CV, it might be time to take something off your platter.

Connect with Sharon:

Do you disagree? Has saying "no" ever backfired in your department? Sharon wants to hear your stories.

• Website: www.intentionalsurgeon.com

We often treat surgical culture as an immovable force of nature, something we simply have to survive. But what if the norms we pride ourselves on, the "win-at-all-costs" mentality and the "show no weakness" rule, are actually holding us back from our true potential?

In this episode, Dr. Sharon L. Stein welcomes Dr. Katrina Monton, an organizational psychologist and former professional athlete. Katrina bridges the worlds of high-performance sport and medicine to unpack Masculinity Contest Culture and the deep structures that shape how surgeons work, lead, and suffer.

We Discuss:

• High Performance vs. High Stakes: Defining the environments where visibility is high, margins for error are low, and the pressure is constant.
• The Four Norms of Masculinity Contest Culture: Katrina breaks down the framework that defines many high-stakes workplaces:

1. Show No Weakness: The psychological demand to suppress vulnerability or mental health struggles.
2. Strength and Stamina: Valorizing the 80-hour work week and physical endurance as a measure of worth.
3. Put Work First: The prioritization of the profession over self, family, and personal identity.
4. Dog-Eat-Dog: A culture of constant comparison and hyper-competitiveness.

• The "Olympic Shelf Life": Why high-pressure cultures work for short-term gains (like a 4-year Olympic cycle) but lead to attrition and burnout in a 30-year surgical career.
• Invisible Architecture: Why we are still following rules and norms created for a workforce that no longer exists, and how to navigate the "clash" between tradition and a diverse, modern society.
• Brave Space vs. Safe Space: Why growth requires discomfort. Katrina explains how to lean into "controversy with civility" and the courage to act even when you're scared.
• Micro-Interactions for Macro-Change: How leadership isn't about grand mandates, but about small, daily choices—like soliciting feedback, using first names, or simply saying hello.
• The "F-Word" in High Performance: Why the most successful teams in high-stakes environments (like Speed Skating Canada) actually prioritize fun and joy as fuel for excellence.

Featured Guest:

Katrina Monton, PhD is an organizational psychologist and a former member of the Canadian Women's National Water Polo team. Her research focuses on the impact of culture on physician outcomes and how to build human capacity in high-stakes environments.

Key Takeaway:

"I’m not in the business of removing challenge. I’m in the business of building up human capacity so that the human being can withstand more. If we can build people up instead of breaking them down, they can achieve more than we ever imagined." — Dr. Katrina Monton

Join the Conversation:

Do you recognize the "Dog-Eat-Dog" norm in your department? What is one "micro-behavior" you can change today to build a braver space for your team?

Connect with Dr. Sharon L. Stein: www.intentionalsurgeon.com

In our surgical training, we are masters of the clinical and the technical. We know the anatomy, the indications, and the surgical techniques. But there is a missing pillar in our education — one that often accounts for 70% of the problems residency directors and surgical chairs face.

In this episode, Dr. Sharon Stein dives into the "Soft Skills" of surgery: communication, negotiation, emotional intelligence, and team building. Often dismissed or ignored, these skills are actually the bedrock of effective leadership, whether you are leading a committee or simply leading a patient through a life-changing diagnosis in the clinic.

In This Episode, We Discuss:

• Why the term isn't about being "soft" or "weak," but about the non-physical skills that the military has long prioritized as essential for leadership.
• Why professional development is the third, often ignored, leg of the surgical stool.
• Leadership in the "Just a Surgeon" Role: Why every surgeon is a leader — from convincing a patient to accept a necessary stoma to managing a team with mismatched priorities in the OR.
• The "One-and-Done" Course Problem: Why weekend leadership retreats often fail to stick and why we need longitudinal, consistent practice to build these "muscles."
• A Lesson in Communication Styles: Sharon shares a personal story of a "messy" interaction with a colleague and how understanding the difference between "speaking-to-think" and "thinking-to-speak" changed her team’s dynamic.
• How to recognize when a conflict isn't about who is right or wrong, but about whose values are at play, and how to find a solution that honors both.
• Launching the Next Generation: Sharon also discusses her passion for teaching graduating residents and fellows how to negotiate and prioritize early, with the goal of reducing the 50% turnover rate for first surgical jobs.

Key Takeaway for Listeners:

"We are smart enough to learn how to do complex surgery; we are certainly smart enough to learn leadership. But first, we have to prioritize it. Most of the problems we deal with aren't technical — they’re interpersonal." — Dr. Sharon Stein

Connect with Sharon:

• The Surgeons Launchpad: Coaching for Residents & Fellows: Are you graduating soon? Learn the skills to get your first job and retain those skills for life... Learn more on how to launch your career with intention here.
• Institutional Workshops: Does your division have recurring conflict? Sharon works with departments to embed these soft skills into the culture through longitudinal programs.
• Website: www.intentionalsurgeon.com