Our “Training the Rural Surgeon” miniseries continues as Dr. Randy Lehman and Jacob Steffen are joined by Dr. Frank Wood from the University of Oklahoma and Dr. Barclay Stewart from the University of Washington to examine how residency programs are building the next generation of rural surgeons.

Dr. Wood explains why Oklahoma created a dedicated rural surgery track, how residents train in Lawton, and why broad clinical exposure, culture fit, and teamwork remain essential for long term success in rural practice. The discussion also explores the workforce challenges facing rural Oklahoma as experienced surgeons retire and communities work to maintain local surgical care.

Dr. Stewart outlines the University of Washington's PROGRESS program and the WWAMI model, connecting rural and global surgery training across the Pacific Northwest. He discusses flexible training pathways, regional partnerships, and how residents gain experience in diverse care environments while preparing for broad scope surgical practice.

For medical students and residents interested in rural surgery, this episode offers two distinct approaches to developing surgeons who can serve rural, remote, and frontier communities.

0:00 Intro

00:55 Oklahoma's Rural Surgery Track

08:08 What Programs Look for in Applicants

13:51 Teamwork and Culture Fit

18:53 Training Philosophy and Resident Development

24:51 Case Volume and Early Operative Experience

27:59 The WWAMI and PROGRESS Model

33:51 Broad Scope Training Across Rural Sites

38:35 Flexible Training Pathways

43:28 Learning Care Delivery in Different Environments

49:47 Matching and Program Structure

University of Oklahoma General Surgery Residency Programs

https://medicine.ouhsc.edu  

University of Washington Department of Surgery

https://uwsurgery.org/ 

🌐 Connect with The Rural American Surgeon:

https://www.theruralamericansurgeon.com/ 

Join us on Facebook:

https://facebook.com/profile.php?id=61564305936854

Our “Training the Rural Surgeon” miniseries continues as Dr. Randy Lehman and Jacob Steffen are joined by Dr. Mariela Rivera, Program Director at Mayo Clinic in Rochester, Minnesota. They discuss how Mayo Clinic’s rural general surgery track equips residents for the broad scope of rural surgical practice.

The conversation explores the structure of the rural track, training across Mayo Clinic Health System sites, flexible rotations, endoscopy, OBGYN, subspecialty exposure, and the balance between tertiary care training and high-volume community surgery experience.

Dr. Rivera also explains what she values in applicants, including adaptability, emotional intelligence, ownership, strong patient relationships, and a demonstrated commitment to rural practice.

For medical students and residents interested in rural surgery, this episode offers an inside look at Mayo Clinic’s approach to training surgeons for the clinical breadth, autonomy, and responsibilities of independent rural practice.

0:00 Intro

06:53 Key Strengths and Structure of the Residency Program

10:51 Qualities of a Successful Rural Track Applicant

13:58 Intern Case Volumes and One-on-One Surgical Mentorship

17:23 Surgery Olympics: Simulation-Based Skill Assessments 

Resources Mentioned:

Mayo Clinic Residency Programs

https://college.mayo.edu 

🌐 Connect with The Rural American Surgeon:

https://www.theruralamericansurgeon.com/ 

Join us on Facebook:

https://www.facebook.com/profile.php?id=61564305936854

Our “Training the Rural Surgeon” miniseries begins with Dr. Randy Lehman joined by medical student Jacob Steffen, Dr. Mel Johnson from Gundersen, and Dr. Lauren Dudas from WVU to examine how residency programs prepare surgeons for broad scope rural practice. The discussion covers operative volume, subspecialty exposure, rural rotations, and why some programs intentionally train residents in urology, ENT, OBGYN, and critical access environments where specialist backup may not exist.They also discuss signaling, mentorship, interview strategy, and the qualities program directors consistently look for in future rural surgeons.For students considering rural surgery, this episode offers a practical look at how different programs approach autonomy, breadth, and long term preparation for rural practice.0:00 Intro05:01 Broad Scope Rural Surgery with Dr. Mel Johnson11:14 Applicant Fit and Program Mission17:11 Research and Rural Surgery Mentorship23:50 Surgical Case Volume29:05 Finding Rural Surgery Programs32:17 Rural Surgery Training at WVU with Dr. Lauren Dudas41:40 Grit and Independent Learning46:39 Resident Case Mix49:21 Program Resources Resources Mentioned:Gundersen Foundation General Surgery Residency Program:https://gundersenhealth.orgWVU General Surgery Residency Program:https://medicine.hsc.wvu.edu/surgeryWVU Surgery Instagram:https://instagram.com/wvusurgeryNorth American Rural Surgical Society:https://ruralsurgery.orgAmerican College of Surgeons Rural Surgery Advisory Council:

https://facs.org🌐 Connect with The Rural American Surgeon:https://www.theruralamericansurgeon.com/ Join us on Facebook:https://www.facebook.com/profile.php?id=61564305936854

The operating room rewards preparation long before it rewards confidence.

In Part Two of this conversation, Dr. Randy Lehman continues mentoring medical student Jacob Steffen through the realities of surgical training: knot tying, OR etiquette, retraction, camera driving, tube placement, handling responsibility, and earning trust inside a surgical team.

Dr. Lehman explains why great surgical residents often separate themselves early by mastering small technical details before anyone asks them to.

The conversation also explores entitlement, situational awareness, humility, preparation, reputation, and the compounding effect of discipline over time.

They discuss why some residents continue getting more opportunities while others remain stuck at the same level, and why surgery ultimately favors the people willing to prepare before they feel ready.

This episode is about learning before the pressure arrives.

0:00 Intro

00:34 Practical Skills Students Should Already Know

08:50 First Responsibilities Inside the OR

11:34 Knot Tying and Technical Repetition

21:55 OR Etiquette and Sterile Field Awareness

31:21 Biggest Mistakes Medical Students Make

43:09 Career Advice and Personal Growth in Surgery

Resources Mentioned:

🌐 Mayo Clinic

https://www.mayoclinic.org/

🌐 Medscape

https://www.medscape.com/

🌐 Ethicon Knot Tying Manual / Surgical Education

https://www.jnjmedtech.com/en-US/companies/ethicon

🌐 Connect with The Rural American Surgeon:

https://www.theruralamericansurgeon.com/ 

Join us on Facebook:

https://www.facebook.com/profile.php?id=61564305936854

In surgery, responsibility comes before confidence.Medical students entering a Sub I are expected to manage patients, present clearly, stay organized, and earn trust before they feel fully comfortable doing it.In this Part One episode, Dr. Randy Lehman mentors medical student Jacob Steffen through rounds, presentations, list management, tube management, and operating room etiquette.Jacob explains why the students who stand out are not the ones pretending to know everything. They’re the ones who are reliable, honest, teachable, and willing to take ownership under pressure.They also discuss the Dunning-Kruger effect in surgical training, the danger of overconfidence, and why credibility matters more than performance.Confidence is built by carrying responsibility before you feel ready for it.0:00 Intro02:09 What a Sub I Actually Is10:13 How I Do It: Rounds, Lists, and Daily Workflow20:07 Managing Tasks and Running the List35:09 Physical Exam and Tube Management40:50 The Dunning-Kruger Effect50:04 Professionalism and Operating Room Etiquette Resources Mentioned:🌐 Mayo Clinic:https://www.mayoclinic.org/Epic:https://www.epic.com/🌐 Connect with The Rural American Surgeon:https://www.theruralamericansurgeon.com/ Join us on Facebook:https://www.facebook.com/profile.php?id=61564305936854

Today Dr. Lehman sits down with the most special guest, his daughter Charlotte. 

And this time, she’s in the host seat asking the hard-hitting questions!

She covers everything from fear in the operating room to money, parenting, and of course, the grossest thing dad’s ever seen in surgery.

🌐 Connect with The Rural American Surgeon:https://www.theruralamericansurgeon.com/ 

Join us on Facebook:https://www.facebook.com/profile.php?id=61564305936854

Locums surgery is often treated as temporary coverage, but many rural hospitals rely on it to maintain consistent access to care. Surgeons step in without relocating, often filling roles that cannot support full time hires.

Megan Hoot, a physician recruiter at CompHealth, has spent over eight years placing surgeons into roles that often become long-term solutions. She has worked closely with Dr. Randy Lehman across multiple assignments and brings a clear view of how these arrangements develop.

In this episode, Megan and Dr. Hoot break down how locums works in practice, including licensing, privileges, malpractice coverage, and how surgeons are selected and paid. They also address common misconceptions about ease and competition.

For rural surgeons, locums becomes a way to maintain coverage while building flexibility without sacrificing continuity.

0:00 Intro

01:54 Megan Hoot’s Background

11:14 Why Rural Surgery?

16:31 How I Do It: Locums Setup and Entry

39:44 Financial Corner: Locums Rates

58:55 Resources for the Busy Rural Surgeon

Resources Mentioned:

Book a call with Megan:

https://snshqsc.co/uVf0y3

CompHealth:

https://www.comphealth.com/

🌐 Connect with The Rural American Surgeon:

https://www.theruralamericansurgeon.com/

Join us on Facebook:

https://www.facebook.com/profile.php?id=61564305936854

In rural surgery, there’s no “waiting until you feel ready.” There’s only action, because sometimes you’re the only one.

Dr. Scott Nelson, a colorectal surgeon in Grants Pass, Oregon, built a solo practice after losing his partner early in his career. What followed was years of figuring it out in real time, often without backup.

In this episode, Dr. Randy Lehman and Dr. Nelson break down what it actually looks like to grow into responsibility: managing cases outside your training, making decisions without a safety net, and learning through repetition, not confidence.

They also walk through practical approaches to common perianal disease, including hemorrhoids, fistulas, abscesses, and fissures in a rural setting.

From handling GI bleeds without formal training to building a full colorectal practice in isolation, this conversation highlights a core reality of rural medicine:

Competence often comes after you accept responsibility.

If you’re early in your career (or stepping into situations where you feel unprepared) this episode will shift how you interpret that feeling.

0:00 Intro

01:54 Dr. Nelson’s Background

04:23 Why Rural Surgery Is Special to You

14:26 How I Do It: Managing Perianal Disease

48:03 Financial Corner

53:31 Resources for the Busy Rural Surgeon

Resources Mentioned:

North American Rural Surgical Society:

https://www.northamericanrss.org/

🌐 Connect with The Rural American Surgeon:

https://www.theruralamericansurgeon.com/

Join us on Facebook:

https://www.facebook.com/profile.php?id=61564305936854

In rural surgery, not everyone fits the environment the same way.

The work doesn’t slow down, and the community expects you to stay, serve, and carry responsibility without backup.

Today Dr. Randy Lehman speaks with Dr. Jesse Van Maanen, a rural general surgeon practicing near where he grew up. They examine why surgeons with rural roots or early commitment tend to integrate more naturally, and why moving rural to escape a busy system often fails.

The discussion centers on how that fit shows up in practice, from handling complex cases with limited staff to using robotics as a tool for control rather than convenience, and building trust through direct, honest patient conversations.

Rural surgeons will leave with practical takeaways: choose the environment intentionally, understand what the community expects of you, and build your practice around those realities rather than trying to reshape them.

0:00 Intro

00:50 Dr. Van Maanen’s Background

05:54 Why Rural Surgery Is Special to You

16:56 How I Do It: Robotics in Rural Practice

44:39 Financial Corner

46:36 Classic Rural Surgery Stories

54:39 Resources for the Busy Rural Surgeon

Resources Mentioned:

North American Rural Surgical Society:

https://www.northamericanrss.org/

🌐 Connect with The Rural American Surgeon:

https://www.theruralamericansurgeon.com/

Join us on Facebook:

https://www.facebook.com/profile.php?id=61564305936854

A complex operation only works if it can be executed reliably inside the system you have.

In this Part Two episode, Dr. Randy Lehman continues with Dr. Cate Straub, focusing on how pancreatic surgery is actually performed without consistent teams, subspecialty backup, or standardized support structures.

She walks through operative sequencing, vascular decision making, and how technique changes when you cannot rely on experienced assistance or ideal exposure.

The discussion ties technical execution back to responsibility in rural practice, where outcomes depend on adapting the operation to the environment, not the other way around.

0:00 Intro

00:07 How I Do It: Whipple

40:08 Financial Corner

42:43 Resources for the Busy Rural Surgeon

Resources Mentioned:

WWAMI program:

https://www.uwmedicine.org/school-of-medicine/md-program/wwami

SAGES:

https://www.sages.org/

American College of Surgeons:

https://www.facs.org

🌐 Connect with The Rural American Surgeon:

https://www.theruralamericansurgeon.com/

Join us on Facebook:

https://www.facebook.com/profile.php?id=61564305936854