Brown Surgery Podcast

Today we are doing something different on this episode of our Chief Resident Podcast Project.  Dr Haley Leesley, MD is going to take us through two cases of esophageal perforations.  This should serve as a good overview and review of the surgical management of this disease process. Please let us know if you enjoy this format and would like to hear more cases presented like this on the podcast.  

The multimodal approach for patients with peritoneal carcinomatosis involves what is known as cytoreductive surgery, followed by hyperthermic intraperitoneal chemotherapy (HIPEC).  The specifics of this treatment regimen and how it is performed is not something we typically discuss outside of service specific surgical oncology conferences.  To better prepare our residents and medical learners out there, today we sit down with our Chief Surgical Resident, Constantinos Zambirinis, MD to discuss the evolution, patient management, and future applications of HIPEC therapy.

Follow Dr Zambirinis on Twitter at: @czambir

We are excited to kick off our first Chief Resident Podcast Episode.  Dr Zmijewski was our Chief of Wellness this past academic year at Brown.  In addition to doing an outstanding job in this role, she implemented a Narrative Surgery curriculum for both faculty and staff.  In this weeks episode, we explore the meaning, content and curriculum behind her Narrative Surgery efforts and gain insight into why this curriculum is meaningful for our surgical discipline as a whole.

Today we are going to continue with our career based podcast discussions and dive into the world of endocrine surgery. Our residents at Brown spend a lot of time rotating on this service during their PGY3 year and it is always a rotation they look forward to for many reasons.

Whether is the repetitive nature of the procedure, the ability to improve their dexterity working in in smaller spaces, or just getting more facile with neck anatomy and dissections, the overall experience of residents in this service is always very positive.

To help put this into better perspective for us, today I’d like to welcome Dr. Travis Cotton to the podcast. Dr Cotton is an assistant professor of surgery at Brown and one of our endocrine surgeons here at Brown Surgery. I thought he would be a great guest to have on today to explore some of the finer details about why he chose a career in endocrine surgery and what a day in his life looks like.

It is common practice to use mortality as a primary outcomes variable, particularly in critical care research. Today, we welcome Dr, Eric Benoit to the Podcast to discuss why this may not always be the best approach and the other ways we can examine outcomes in clinical-based research. We will touch on topics such as composite outcomes, quality adjusted life years, the treatment effect and the infrequently discussed fragility index.    

Selected references: 

Harhay, et al. “Outcomes & statistical power in adult critical care randomized trials.” Am J Respir Crit Care Med 2014. PMID 24786714  

Kent & Trikalinos. “Therapeutic innovations, diminishing returns, and control rate preservation.” JAMA 2009. PMID 19934428  

Sackett. “Why randomized controlled trials fail but needn’t: 2. Failure to employ physiologic statistics, or the only formula a clinician-trialist is ever likely to need (or understand!)” Can Med Assoc J 2001. PMID 11706914  

Tignanelli & Napolitano. “The Fragility Index in randomized controlled trials as a means of optimizing patient care.” JAMA Surgery 2019. PMID 30422256  

Ioannidis. “Why most published research findings are false.” PLoS Med 2005. PMID 16060772

Whether or not to enter the lab is a common career decision for surgical residents, either for fellowship or professional development opportunities. Unlike other medical disciplines, surgery is the only discipline where lab years are performed in between clinical years, typically after PGY 2 or 3. This episode continues our two-part look into the role of the surgical scientist to gain insight into the decision making process of entering the lab as a resident, the resources available to novice researchers, and how to ultimately balance a research career with clinical practice as well as family life. We continue part 2 with Dr Sean Monaghan, MD, one of our Trauma, Critical Care Surgeons here at Brown, who is also one of our former residents, and as a current NIH funded researcher, maintains a productive research lab focusing on RNA splicing in critical illness.

Whether or not to enter the lab is a common career decision for surgical residents, either for fellowship or professional development opportunities.  Unlike other medical disciplines, surgery is the only discipline where lab years are performed in between clinical years, typically after PGY 2 or 3.  We begin a two-part episode on the role of the surgical scientist to gain insight into the decision making process of entering the lab as a resident, the resources available to novice researchers, and how to ultimately balance a research career with clinical practice as well as family life.  We kick off part 1 with Dr Daithi Heffernan, MD, one of our Trauma, Critical Care Surgeons here at Brown who also maintains a productive research lab focusing on INKT cells in sepsis.   

It's definitely one thing to be in command of a case and tell your first assistant what you need from them.  It's an entirely different scenario when they have to get into the position of taking a junior resident through a case (the art of being a good first assistant and evaluating the decision making of the junior).  We further explore this concept in part 2 of our 3 part series exploring the transition from intra-operative learner to intra-operative teacher

It's definitely one thing to be in command of a case and tell your first assistant what you need from them.  It's an entirely different scenario when they have to get into the position of taking a junior resident through a case (the art of being a good first assistant and evaluating the decision making of the junior).  We explore this concept in what is going to be a 3 part series exploring the transition from intra-operative learner to intra-operative teacher