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ACS
Podcast

The Operative Word

Clinical implications for the practicing surgeon

The Operative Word

In this podcast series, hosts Jamie Coleman, MD, FACS, and Dante Yeh, MD, FACS, speak with recently published authors about the motivation behind their latest research and the clinical implications it has for the practicing surgeon. Spread the word on social media by using the hashtag #JACSOperativeWord.

The Operative Word is available on , , , , or wherever you listen to your podcasts.

Latest Episodes

Episode 17: Novel Form of Breast Intraoperative Radiation Therapy with CT-Guided High-Dose-Rate Brachytherapy: Interim Results of a Prospective Phase II Clinical Trial

In this episode, Dr. Jamie Coleman is joined by Shayna Showalter, MD, from the University of Virginia School of Medicine, Charlottesville, VA. They discuss Dr. Showalter’s recent evaluating precision breast intraoperative radiation therapy (PB-IORT), which uses customized CT-based treatment plans for high-dose-rate (HDR) brachytherapy. Interim results show that PB-IORT has an acceptable breast cancer recurrence rate, minimal side effects, and excellent cosmetic outcomes.

Disclosure Information: Drs. Coleman and Showalter have nothing to disclose.

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Episode 16: Comprehensive Cost Implications of Commercially Available Noninvasive Colorectal Cancer Screening Modalities

In this episode, Dr. Dante Yeh is joined by Casey Allen, MD, from the Institute of Surgery, Division of Surgical Oncology, Allegheny Health Network, Pittsburgh, Pennsylvania. They discuss Dr. Allen’s recent study, which found that widespread adoption of the fecal immunochemical test for noninvasive colorectal cancer screening could lead to substantial cost savings. This carries major value implications for a large population health system.

Episode 15: Operationalizing the Culture of Burnout and Well-Being: Multicenter Study of Value Congruence and Flourishing in General Surgery Residency

In this episode, Dr. Jamie Coleman is joined by Carter Lebares, MD, FACS, from the Department of Surgery, University of California San Francisco. They discuss Dr. Lebares’ recent at 16 academic general surgery training programs, in which residents indicated a perceived lack of value congruence with leadership regarding occupational well-being. Program directors expressed variable alignment with these perceptions. Value congruence was significantly associated with individual resident global well-being.

Epiosde 14: Leadership and Impostor Syndrome in Surgery

In this episode, Dr. Dante Yeh is joined by Lola Fayanju, MD, MA, MPHS, FACS, from the University of Pennsylvania, Philadelphia, PA. They discuss Dr Fayanju’s recent on impostor syndrome, an internalized sense of incompetence and not belonging. The study found that female physicians were more likely to experience impostor syndrome than male physicians, regardless of specialty or leadership role. While several identity-based gaps persist in leadership, impostor syndrome among racially minoritized groups may not be a significant contributor.

Episode 13: Quantifying the Prognostic Value of Preoperative Surgeon Intuition: Comparing Surgeon Intuition and Clinical Risk Prediction as Derived from the 鶹ý NSQIP Risk Calculator

In this episode, Dr. Dante Yeh is joined by Gabriel Brat, MD, FACS, MPH, and Jayson Marwaha, MD, MBI, from Beth Israel Deaconess Medical Center, Boston, MA. They discuss their recent , which compared the predictive utility of preoperative surgeon intuition and surgical risk calculators and found that, while preoperative surgeon intuition alone is an independent predictor of patient outcomes, traditional risk calculators are more robust predictors of postoperative complication.

Episode 12: COVID Vaccination Status and Operative Outcomes after Kidney Transplantation

In this episode, Dr. Jamie Coleman is joined by Bradley Kushner, MD, from the Washington University School of Medicine, St Louis. They discuss Dr. Kushner’s , which found that patients who are unvaccinated against COVID-19 have worse compliance and healthcare follow-up after a kidney transplant compared with those who were preoperatively vaccinated.

Episode 11: Severe Increase in Nursing Labor Cost and Effect on Surgical Department Financial Margins at an Academic, Tertiary Medical Center

In this episode, Dr. Jamie Coleman is joined by Clayton Brinster, MD, FACS, from Ochsner Health. They discuss his , which demonstrates a significant increase in surgical nursing labor cost, with a resultant decrease in department of surgery financial margins. This nationwide, precarious trend is not sustainable, and fiscal recovery will require sustained, strategic workforce allocation.

Disclosure Information: Drs Brinster and Coleman have nothing to disclose.

Episode 10: Truth of Colorectal Enhanced Recovery Programs: Process Measure Compliance in 151 Hospitals

In this episode, Dr. Dante Yeh is joined by Tejen Shah, MD, from The Ohio State University Wexner Medical Center. They discuss his , which shows that contrary to published enhanced recovery program (ERP) literature, most study hospitals had difficulty improving process compliance, with 80% not achieving substantial improvement. ERP bundles should be implemented in a more deliberate manner with better-planned, pragmatic, and informed strategies.

Disclosure Information: Dr. Shah has nothing to disclose. Dr. Yeh receives author royalties from UpToDate, advisory panel/training honoraria from Takeda Pharmaceuticals, and advisory panel honoraria from Baxter, Eli Lilly, and Fresenius Kabi.

Episode 9: Fluoroscopic Intraoperative Breast Neoplasm and Node Detection

In this episode, Dr. Jamie Coleman is joined by Roi Weiser, MD, from the University of Texas MD Anderson Cancer Center, and Suzanne Klimberg, MD, PhD, MSHCT, FACS, from the Division of Surgical Oncology at the University of Texas Medical Branch. They discuss their , which shows that fluoroscopic intraoperative neoplasm and node detection (FIND) can be used to localize the biopsy clip marking a non-palpable breast or axillary lesion, obviating the need for an additional procedure to insert a localization device. Furthermore, FIND shows promising results, with decreased margin positivity and re-excision rate compared with wire localization.

Disclosure Information: Dr. Klimberg receives book royalties from Elsevier, Springer, and Saunders. Drs Coleman and Weiser have nothing to disclose.

Episode 8: Cost-Effectiveness of Universal Screening for Blunt Cerebrovascular Injury: A Markov Analysis

In this episode, Dr. Dante Yeh is joined by Sharven Taghavi, MD, MPH, MS, FACS, from the Tulane University School of Medicine. They discuss his on blunt cerebrovascular injury (BCVI), which is a significant cause of morbidity and mortality in patients with blunt trauma. Using a Markov decision analysis, the authors found that universal screening for cerebrovascular injury using CT angiography in blunt trauma victims was the optimal strategy.

Disclosure Information: Nothing to disclose.

Disclosures outside the scope of this work: Dr. Taghavi receives funding from the CDC. Dr. Yeh receives author royalties from UpToDate, advisory panel/training honoraria from Takeda Pharmaceuticals, and advisory panel honoraria from Baxter, Eli Lilly, and Fresenius Kabi.

To earn0.25 AMA PRA Category 1 Credits™for this episode of the J鶹ýOperative Word Podcast,to register for the course and complete the evaluation.

Episode 7: Disparity-Sensitive Measures in Surgical Care: A Delphi Panel Consensus

In this episode, Dr. Jamie Coleman is joined by Elzerie de Jager, MBBS(Hons), PhD, from the University of Vermont and the Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School and Harvard TH Chan School of Public Health; and LD Britt MD, MPH, FACS, from the Department of Surgery, Eastern Virginia Medical School. They discuss their study, in which a Delphi panel identified 125 potential disparity-sensitive measures which could be used to track health disparity, evaluate the impact of focused interventions, and reduce healthcare inequity.

Episode 6: Permanent vs Absorbable Mesh for Ventral Hernia Repair in Contaminated Fields

In this episode, Dr. Dante Yeh is joined by Flavio Malcher, MD, MSc, from the Department of Surgery at New York University. They discuss his study, which validates the findings of recent randomized controlled trials in a larger multicenter cohort, suggesting that permanent mesh is the ideal prosthetic to enhance ventral hernia repair even in contaminated fields, which challenges a longstanding surgical dogma.

Episode 5: Core Entrustable Professional Activities for Entering Residency: A National Survey of Graduating Medical Student Self-Assessed Skills by Specialty

In this episode, Dr. Coleman is joined by Dorothy Andriole, MD, FACS, who is a surgeon and the Senior Director of Medical Education Research at the Association of American Medical Colleges, and Jonathan Amiel, MD, who is a professor of psychiatry and Senior Associate Dean for Innovation in Health Professions Education at Columbia University. They discuss their recent study, which found that many graduating students intending to enter surgery agreed they had skills to perform some, although not all, Core Entrustable Professional Activities for Entering Residency. Continued efforts to prepare graduates more optimally for the start of residency training are warranted.

Episode 4: Analyzing Impact of Multimorbidity on Long-Term Outcomes after Emergency General Surgery: A Retrospective Observational Cohort Study

In this episode, Dr. Yeh is joined by Claire Rosen, MD, from the Hospital of the University of Pennsylvania. They discuss her recent paper, which demonstrates that past medical history, specifically multimorbidity, influences the risk of adverse outcomes after emergency general surgery, from increased mortality to limited independence and function. When surgeons understand and communicate these risks, shared decision-making is improved.

Episode 3: Long-Term Outcomes after Adolescent Bariatric Surgery

In this episode, Dr. Coleman is joined by Nestor F. De la Cruz-Muñoz Jr, MD, Professor of Surgery and Section Chief of Bariatric Surgery at the University of Miami. They discuss his , which demonstrates the lasting, positive impact of bariatric surgery even decades later, and confirms that bariatric surgery should not be denied to adolescents struggling with morbid obesity.

Episode 2: Use of Direct Oral Anticoagulant and Associated Bleeding and Thrombotic Complication after Lower Extremity Bypass

In this episode, Dr. Yeh is joined by lead author Danielle C. Sutzko, MD, MS, from the University of Alabama at Birmingham, and senior author Andrea T. Obi, MD, FACS, from the University of Michigan, both vascular surgeons. They discuss their on outcomes associated with direct oral anticoagulant and vitamin K antagonist use after lower extremity bypass.

Episode 1: Mass Shootings in America: Consensus Recommendations for Healthcare Response

In the inaugural episode, Jamie Coleman, MD, FACS, and Dante Yeh, MD, FACS, speak with Craig Goolsby, MD, MEd, FACEP, Professor and Vice Chair of Emergency Medicine at the Uniformed Services University of the Health Sciences and Science Director at the National Center for Disaster Medicine and Public Health in Bethesda, MD about his group’s , which was conducted using a Delphi process and resulted in 19 recommendations for training, public education, triage, communication, patient tracking, medical records, family reunification, and mental health. These consensus recommendations from the surgeons, physicians, and medics who cared for recent mass shooting patients will help everyone prepare for future incidents.

About the Hosts

Dante Yeh, MD, FACS, is a professor of surgery and chief of emergency general surgery at Denver Health. He is an acute care surgeon specializing in trauma, emergency general surgery, and surgical critical care, with additional expertise in advanced nutrition support and short bowel syndrome. He completed his general surgery residency in Miami at Jackson Memorial Hospital and his trauma and surgical critical care fellowship in San Francisco at San Francisco General Hospital.

Disclosure Information: Dr Yeh receives author royalties from UpToDate, advisory panel/training honoraria from Takeda Pharmaceuticals, and advisory panel honoraria from Baxter, Eli Lilly, and Fresenius Kabi.

Jamie Coleman, MD, FACS, is an associate professor of surgery and the vice-chair of wellness in the department of surgery at the University of Louisville. She is an acute care surgeon specializing in trauma, emergency general surgery, and surgical critical care. She completed her general surgery residency in Chicago at Cook County Hospital and Rush University and her trauma and surgical critical care fellowship in Atlanta at Grady Memorial Hospital with Emory University.

Her research focus is on the physiologic impact of sleep deprivation, stress, and burnout amongst physicians and surgeons. She is the PI for the SuPer Trial (Surgeon Performance Trial), the largest study of continuous physiologic monitoring of acute care surgeons. In addition to her scientific publications, her focus on the intersection of physician wellness and work-life integration has been featured in Forbes, Huffington Post, and US News and World Report.

Disclosure Information: Dr Coleman has nothing to disclose.

The opinions expressed in this podcast are those of the participants and not necessarily that of the ACS.

About JACS

The Journal of the 鶹ý is a monthly peer-reviewed journal publishing original contributions on all aspects of surgery. These contributions include original scientific articles, collective reviews, experimental investigations with clear clinical relevance, and a surgeon-at-work section.