Behind The Knife: The Surgery Podcast

Join the Behind the Knife Surgical Oncology Team as we discuss the PRADO and NADINA randomized control trials regarding neoadjuvant therapy in Stage III melanoma with macroscopic nodal disease!
Hosts:
Timothy Vreeland, MD, FACS (@vreelant) is an Assistant Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center.
Daniel Nelson, DO, FACS (@usarmydoc24) is Surgical Oncologist/HPB surgeon at Kaiser LAMC in Los Angeles.
Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a 2ndYear Surgical Oncology fellow at MD Anderson.
Beth (Elizabeth) Barbera, MD (@elizcarpenter16) is a General Surgery physician in the United States Air Force station at RAF Lakenheath.
Joe (Joseph) Broderick, MD, MA (@joebrod5) is a General Surgery research resident between his second and third year at Brooke Army Medical Center.
Galen Gist, MD (@gistgalen) is a General Surgery research resident between his second and third year at Brooke Army Medical Center.
 Learning Objectives:

-       Evaluate the role of Completion Lymph Node Dissection (CLND) in patients with positive sentinel lymph nodes, specifically citing the lack of melanoma-specific survival benefit vs. the improvement in regional disease control demonstrated in the MSLT-II trial.
-       Determine the appropriate surgical excision margins for primary cutaneous melanoma, comparing the outcomes of 1 cm versus 2 cm margins as analyzed in the MINT trial (Lancet 2019).
-       Analyze the impact of adjuvant systemic therapy (Anti-PD1/Immunotherapy) on recurrence-free survival in patients with resected high-risk Stage III melanoma.
References:

Reijers, I.L.M., Menzies, A.M., van Akkooi, A.C.J. et al. Personalized response-directed surgery and adjuvant therapy after neoadjuvant ipilimumab and nivolumab in high-risk stage III melanoma: the PRADO trial. Nat Med 28, 1178–1188 (2022). https://doi.org/10.1038/s41591-022-01851-x

Christian U. Blank et al. Neoadjuvant nivolumab plus ipilimumab versus adjuvant nivolumab in macroscopic, resectable stage III melanoma: The phase 3 NADINA trial.. J Clin Oncol 42, LBA2-LBA2(2024). DOI:10.1200/JCO.2024.42.17_suppl.LBA2
*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.  
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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
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Research years. Professional development time. Career exploration.
Whatever you call it, stepping out of clinical residency can feel confusing, intimidating, and oddly hard to plan for. 

In this episode of Behind the Knife, our BTK Surgical Education Fellows Drs. Elizabeth Maginot, Nicole Petcka, Agnes Premkumar, Kara Button, Emma Burke, and Michelle LaBella sit down with Dr. Daniel Nussbaum, Associate Professor of Surgery at Duke University and leader in the Duke Residency Research Fellowship Program, to unpack dedicated resident profressional development time really looks like, who it helps, who it doesn’t, and how to make the most of it if you choose to step out of clinical training.

Together, the group tackles:
·       Why “research years” are often better thought of as professional development time
·       Whether taking time out of residency is actually necessary for fellowship or an academic career
·       How to find the right mentor—and why there’s rarely a “perfect” project
·       Practical advice on setting boundaries, saying yes (and no), and managing unstructured time
·       A clear, resident-level overview of funding options, including:
- NIH T32 and F32 grants
- NIH Loan Repayment Program (LRP)
- Society, foundation, and departmental funding
·       What faculty and program leadership look for when supporting resident research
·       Lessons the panel wishes they’d known before starting research time
Whether you’re a medical student curious about residency structure, a resident debating whether to step out, or faculty mentoring trainees through career development, this episode offers candid insight, real examples, and reassurance that there’s more than one “right” path.

High-Yield Takeaway: You don’t need research time to be a great surgeon—but if you want to grow skills outside the OR, this may be the rare window to do it thoughtfully (and even enjoy it).

Resources & Links Mentioned:
NIH Funding & Training Programs
·       NIH RePORTER – Explore active NIH-funded grants and training programs
https://reporter.nih.gov/#/
·       NIH T32 Institutional Training Grants
https://grants.nih.gov/funding/activity-codes/T32
·       NIH F32 Individual Postdoctoral Fellowship
https://grants.nih.gov/funding/activity-codes/F32
·       NIH Loan Repayment Program (LRP)
https://grants.nih.gov/funding/funding-categories/lrp
·        Foundational & Society Grants
(Not a comprehensive list; examples discussed in the episode)
·       Association of Program Directors in Surgery (APDS) Job Board 
https://apds.careerwebsite.com/jobs/? 
·       American College of Surgeons (ACS) – Resident research funding
https://www.facs.org/for-medical-professionals/professional-growth-and-wellness/scholarships-fellowships-and-awards/resident/resident-research/
·       Association for Academic Surgery (AAS) – Resident research funding primer
https://www.aasurg.org/resident-research-funding-primer/
·       American Surgical Association (ASA) – Research awards & fellowships
https://americansurgical.org/awards_Fellowship.cgi
·       Society of University Surgeons (SUS) – Resident Research Scholar Awards 
https://www.susweb.org/resident-scholar-research-awards/? 
·       American Association for the Surgery of Trauma (AAST) – Scholarships & grants
https://www.aast.org/professional-development/scholarships.html
·       Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) – Research grants
https://www.sages.org/research/research-grants/

Helpful Application Resources
·       NIH Biosketch Format & Instructions
https://grants.nih.gov/grants-process/write-application/forms-directory/biosketch

Sponsor Link: Medical Education master's program at the University of Pennsylvania Graduate School of Education - https://www.gse.upenn.edu/btk
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
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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
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Abdominal organ procurement is a high-stakes operation that blends anatomy, speed, and coordinated teamwork. In this Behind the Knife episode, the UNMC transplant team walks through the practical “how-to” of deceased donor abdominal recovery—covering OR roles and logistics, key anatomic maneuvers, cannulation/flush troubleshooting, and the workflow differences that matter most between donation after brain death (DBD) and donation after circulatory death (DCD).
Hosts
Madeline Cloonan, MD PhD – General Surgery Resident, University of Nebraska Medical Center (@maddie_cloonan)
 
Evelyn Waugh, MD – Transplant Surgery Fellow, University of Nebraska Medical Center
 
Jacqueline Dauch, MD – Abdominal Transplant Surgeon, University of Nebraska Medical Center
 
Alex Maskin, MD – Kidney & Pancreas Transplant Surgeon, University of Nebraska Medical Center
Learning Objectives

Compare DBD vs DCD donor workflow and define total vs functional warm ischemia.
 

Identify key OR roles and the ethical/legal separation of death declaration from procurement teams. 

Outline the core steps of abdominal procurement, including exposure, cannulation, cross-clamp, and organ removal sequence.
 

Apply a practical troubleshooting approach when flush flow is inadequate

References

 Englesbe MJ, Mulholland MW. Operative Techniques in Transplantation Surgery. Philadelphia, PA: Wolters Kluwer; 2018.

Tullius SG, Rabb H. Improving the supply and quality of deceased-donor organs for transplantation. N Engl J Med. 2018;378(20):1924–1933. doi:10.1056/NEJMra1708700. https://pubmed.ncbi.nlm.nih.gov/29768153/

Croome KP, Barbas AS, Whitson B, et al. American Society of Transplant Surgeons recommendations on best practices in donation after circulatory death organ procurement. Am J Transplant. 2023;23(2):171–179. doi:10.1016/j.ajt.2022.10.009. https://pubmed.ncbi.nlm.nih.gov/36695685/

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
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What happens when the world of GLP-1s collides with the operating room? Today, we’re diving into the new era of obesity care. 
Hosts
·       Matthew Martin, trauma and bariatric surgeon at the University of Southern California/Los Angeles General Medical Center (Los Angeles, California) @docmartin2
·       Adrian Dan, bariatric and MIS surgeon, program director for the advanced MIS bariatric and foregut fellowship at Summa Health System (Akron, Ohio) @DrAdrianDan
·       Crystal Johnson Mann, bariatric and foregut surgeon at the University of Florida (Gainesville, Florida) @crys_noelle_
·       Katherine Cironi, general surgery resident at the University of Southern California/Los Angeles General Medical Center (Los Angeles, California) @cironimacaroni
Learning objectives
1.          Understand the evolving role of OMMs in bariatric surgical practice
·       Recognize how widespread GLP-1 and dual-incretin therapies have reshaped patient presentations, expectations, and referral patterns.
·       Appreciate current evidence comparing surgery to GLP-1 therapy, including the JAMA Surgery study out of Allegheny Health (2025), noting:
o   Superior weight loss with bariatric surgery (~28% TBWL vs ~10% with GLP-1s)
o   Higher health-care utilization and cost in GLP-1–treated patients.
·       Frame OMMs not as alternatives but as complementary tools within a chronic disease model when treating obesity.
2.           Review pharmacologic classes and their expected efficacy
·       Surgeons should be able to articulate the mechanisms, efficacy, and limitations of:
o   GLP-1 receptor agonists – incretin-based satiety; 5–12% TBWL.
o   Dual GIP/GLP-1 agonists – most potent agents; 15–22% TBWL.
o   Sympathomimetics – norepinephrine-driven appetite suppression; 3–7% TBWL.
o   Combination agents (bupropion-naltrexone, phentermine-topiramate) – 5–12% TBWL depending on regimen.
o   Emerging therapies – retatrutide, maritide, oral GLP-1s, with promising TBWL in phase 2 trials
3.          Apply OMMs strategically in the preoperative phase
·       Integrate OMMs without compromising surgical eligibility—OMM-related weight loss does not negate the indication for surgery.
·       Counsel patients that medication response does not equal disease resolution; surgery remains the most durable intervention.
·       Manage delayed gastric emptying and aspiration risk:
o   Pause weekly GLP-1 or dual agonists for ≥1 week pre-op (longer if symptomatic).
o   Collaborate closely with the anesthesia/OR teams
·       Screen for nutritional depletion before surgery, especially protein deficits exacerbated by appetite suppression.
·       Navigate insurance barriers that may paradoxically approve surgery but deny medication continuation.
4.          Implement postoperative OMMs safely and effectively
·       Establish criteria for OMM introduction:
o   Typical initiation at 6–12 months, once the diet stabilizes and the physiologic curve flattens.
o   Earlier initiation (4–6 weeks) may be appropriate in pediatric or select high-risk populations.
·       Recognize altered pharmacokinetics after sleeve and bypass:
o   Injectables may be preferred due to altered absorption of oral agents.
·       Prevent postoperative nutritional compromise:
o   Monitor protein intake, hydration, and micronutrient status (including iron, B12, and fat-soluble vitamins).
o   Titrate doses slowly to minimize nausea/vomiting that can precipitate malnutrition.
·       Frame OMM use as a tool for disease persistence (plateau/regain), not as a marker of failure.
5.          Identify systems-level barriers and the implementation of coordinated care
·       Understand insurance inconsistencies—coverage for surgery is often not paired with coverage for long-term medical therapy.
·       Clearly document disease persistence and medical necessity when appealing denials.
·       Avoid fragmented care: establish shared-care pathways between bariatric surgery, obesity medicine, and primary care.
·       Use patient-centered language emphasizing complementary therapy, not hierarchy or competition between surgery and medications.
6.          Counsel patients ethically and accurately within a chronic disease model
·       Set expectations: sustained success requires surgery + medication + behavioral change.
·       Educate patients that postoperative OMM use does not imply surgical failure.
·       Normalize long-term multimodal management of obesity, analogous to diabetes or hypertension models.
*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
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In surgical residency, cases are long, expectations are high, and patient care always comes first. But then you become a parent, and suddenly you’re navigating pregnancy risk, parental leave, and lactation logistics in a system that wasn’t built for it. We’ve made meaningful progress over the past decade, but too many trainees still face becoming parents in residency without clear, consistent support. 
In this episode, join Dr. Kara Button with Dr. Arielle Kanters and Dr. Sarah Shubeck as they ask: How do we build a surgical workforce that’s skilled, resilient—and genuinely supported as surgeon-parents? They’ll share practical, evidence-based steps programs can take to make parental support the norm—not the exception.
Hosts:
Kara Button, DO — General Surgery Resident, Maine Medical Center; Behind the Knife Surgical Education Fellow
Arielle Kanters, MD — Colorectal Surgeon; Associate Program Director, Colorectal Surgery Fellowship, Cleveland Clinic
Dr. Sarah Shubeck, MD — Assistant Professor of Surgery; Breast Surgical Oncologist, University of Chicago
References:
Bamdad MC, Hughes DT, Englesbe M. Safe and supported pregnancy: A call to action for surgery chairs and program directors: A call to action for surgery chairs and program directors. Ann Surg. 2022;275(1):e1-e2. doi:10.1097/SLA.0000000000005181 https://pubmed.ncbi.nlm.nih.gov/34433187/

Castillo-Angeles M, Atkinson RB, Easter SR, et al. Pregnancy during surgical training: Are residency programs truly supporting their trainees? J Surg Educ. 2022;79(6):e92-e102. doi:10.1016/j.jsurg.2022.06.011 https://pubmed.ncbi.nlm.nih.gov/35842402/

Castillo-Angeles M, Smink DS, Rangel EL. Perspectives of general surgery program directors on paternity leave during surgical training. JAMA Surg. 2022;157(2):105-111. doi:10.1001/jamasurg.2021.6223 https://pubmed.ncbi.nlm.nih.gov/34851404/

Kanters AE, Shubeck SP. The importance of parental leave and lactation support for surgeons. Clin Colon Rectal Surg. 2023;36(5):333-337. doi:10.1055/s-0043-1764288 https://pubmed.ncbi.nlm.nih.gov/37564351/

Kling SM, Slashinski MJ, Green RL, Taylor GA, Dunham P, Kuo LE. Parental leave experiences for the non-childbearing general surgery resident parent: A qualitative analysis. Surgery. 2024;176(5):1320-1326. doi:10.1016/j.surg.2024.04.035 https://pubmed.ncbi.nlm.nih.gov/38910045/

Mann H, Glazer T. Current state of safe pregnancy policies for the US surgical trainee. OTO Open. 2024;8(3):e172. doi:10.1002/oto2.172 https://pubmed.ncbi.nlm.nih.gov/39036338/

Rangel EL, Smink DS, Castillo-Angeles M, et al. Pregnancy and motherhood during surgical training. JAMA Surg. 2018;153(7):644-652. doi:10.1001/jamasurg.2018.0153 https://pubmed.ncbi.nlm.nih.gov/29562068/

Rangel EL, Castillo-Angeles M, Easter SR, et al. Incidence of infertility and pregnancy complications in US female surgeons. JAMA Surg. 2021;156(10):905-915. doi:10.1001/jamasurg.2021.3301 https://pubmed.ncbi.nlm.nih.gov/34319353/

https://www.nytimes.com/2019/12/20/science/doctors-surgery-motherhood-medical-school.html

https://behindtheknife.org/podcast/family-leave-during-surgical-training-a-discussion-with-abs-president-dr-jo-buyske

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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