Behind The Knife: The Surgery Podcast

Calcified peripheral artery disease (PAD) remains one of the most challenging problems in endovascular intervention. Calcium limits vessel expansion, increases the risk of dissection and procedural failure, and can ultimately lead to bailout stenting. The Disrupt PAD III program provided important evidence for a different approach: intravascular lithotripsy (IVL) as a vessel-preparation strategy. In this episode, we examine the randomized Disrupt PAD III trial published by Tepe and colleagues and the large, real-world observational analysis led by Armstrong and colleagues. Together, these studies explore whether IVL can make treatment of heavily calcified lesions more predictable, reduce the need for stenting, and support a “leave-nothing-behind” strategy.
Hosts:
Dr. Robert Beaulieu
Dr. Frank Davis
Dr. Luciano Delbono
Dr. Andrew Huang
Dr. Carolyn Judge
Learning Objectives
By the end of this episode, listeners should be able to:

Explain the challenges posed by moderate to severe vascular calcification during peripheral endovascular intervention and the rationale for dedicated vessel-preparation strategies.

Describe the design, patient population, endpoints, and primary findings of the randomized Disrupt PAD III trial comparing IVL with conventional PTA.

Interpret the procedural and longer-term outcomes associated with IVL, including residual stenosis, dissection rates, bailout stenting, and primary patency.

Evaluate how the Disrupt PAD III observational study complements the randomized trial by examining IVL in a larger, more complex, real-world population and across multiple vascular beds.

Identify the practical implications, limitations, and remaining unanswered questions surrounding IVL, including its role relative to other calcium-modification strategies such as atherectomy.

References

Tepe G, Brodmann M, Werner M, et al. Intravascular Lithotripsy for Peripheral Artery Calcification: 30-Day Outcomes From the Randomized Disrupt PAD III Trial. JACC Cardiovasc Interv. 2021;14(12):1352-1361. doi:10.1016/j.jcin.2021.04.010. https://pubmed.ncbi.nlm.nih.gov/34167675/

Tepe G, Brodmann M, Bachinsky W, et al. Intravascular Lithotripsy for Peripheral Artery Calcification: Mid-term Outcomes From the Randomized Disrupt PAD III Trial. J Soc Cardiovasc Angiogr Interv. 2022. https://pubmed.ncbi.nlm.nih.gov/39131928/

Armstrong EJ, Adams G, Soukas PA, et al. Intravascular Lithotripsy for Peripheral Artery Calcification: 30-Day Outcomes From the Disrupt PAD III Observational Study. J Endovasc Ther. 2026;33(2):853-862. doi:10.1177/15266028241283716. https://pubmed.ncbi.nlm.nih.gov/39422234/

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Breast cancer risk varies widely across patients, and surgeons play a central role in recognizing elevated risk and guiding appropriate management. In this episode, we review the spectrum of breast cancer risk and discuss practical strategies for risk assessment and risk reduction. We’ll cover surveillance, lifestyle interventions, risk-reducing medications, high-risk breast lesions, and prophylactic surgery—with an emphasis on translating the available evidence into individualized clinical care.
Hosts:
- Rashmi Kumar, MD, PhD
Resident, University of Michigan General Surgery Residency Program
Twitter/X: @RashmiJKumar
- Melissa Pilewskie, MD
Attending Breast Surgical Oncologist, Co-Director of the Weiser Family Center for Breast Cancer, Michigan Medicine
 Twitter/X: @MPilewskie
- Stephanie Downs-Canner, MD
Attending Breast Surgical Oncologist & Physician-Scientist, Memorial Sloan Kettering Cancer Center, Program Director of the Breast Surgical Oncology Fellowship Training Program
 Twitter/X: @SDownsCanner
Learning Objectives:

Identify major modifiable and nonmodifiable breast cancer risk factors, including genetic predisposition, family history, breast density, high-risk lesions, prior chest radiation, and lifestyle factors.

Select and interpret commonly used breast cancer risk-assessment tools—including the Gail, Tyrer-Cuzick, and BCSC models—while recognizing their important limitations.

Recommend appropriate risk-management strategies based on a patient’s risk level, including enhanced surveillance, lifestyle interventions, genetic evaluation, and endocrine risk-reducing therapy.

Explain the indications, benefits, limitations, and tradeoffs of managing high-risk breast lesions and pursuing risk-reducing surgery, including bilateral mastectomy and salpingo-oophorectomy.

References:
Risk-Assessment Tools

National Cancer Institute. Breast Cancer Risk Assessment Tool.https://bcrisktool.cancer.gov/

National Breast Cancer Foundation. What is the Tyrer-Cuzick model?https://www.nationalbreastcancer.org/blog/tyrer-cuzick-model/

Breast Cancer Surveillance Consortium. BCSC Breast Cancer Risk Calculator.https://tools.bcsc-scc.ucdavis.edu/BC5yearRisk/#/

Chemoprevention Guideline
Bevers TB, Ward JH, Arun BK, et al. Breast cancer risk reduction, version 2.2015. J Natl Compr Canc Netw. 2015;13(8):880-915. doi:10.6004/jnccn.2015.0105
CDC Overview of Risk Factors
Centers for Disease Control and Prevention. Breast cancer risk factors. https://www.cdc.gov/breast-cancer/risk-factors/index.html

Emerging Techniques in Risk Assessment

Breastcancer.org. Polygenic risk score may help predict invasive breast cancer risk. https://www.breastcancer.org/news/polygenic-risk-score-invasive-cancer-risk

Breast Cancer Research Foundation. Clairity Breast: The first FDA-authorized AI platform to predict breast cancer risk from a mammogram. https://www.bcrf.org/blog/clairity-breast-ai-artificial-intelligence-mammogram-approved/

Risk reduction

Pilewskie ML, Dimick JB. Bariatric Surgery for Breast Cancer Risk Reduction—Benefit May Not Be One Size Fits All. JAMA Surg. 2023;158(6):641–642. doi:10.1001/jamasurg.2023.0534 https://pubmed.ncbi.nlm.nih.gov/37043229/

Boraka Ö, Klintman M, Rosendahl AH. Physical Activity and Long-Term Risk of Breast Cancer, Associations with Time in Life and Body Composition in the Prospective Malmö Diet and Cancer Study. Cancers (Basel). 2022 Apr 13;14(8):1960. doi: 10.3390/cancers14081960. PMID: 35454864; PMCID: PMC9025884. https://pubmed.ncbi.nlm.nih.gov/35454864/

Tzenios N, Tazanios ME, Chahine M. The impact of BMI on breast cancer - an updated systematic review and meta-analysis. Medicine (Baltimore). 2024 Feb 2;103(5):e36831. doi: 10.1097/MD.0000000000036831. PMID: 38306546; PMCID: PMC10843423. https://pubmed.ncbi.nlm.nih.gov/38306546/

Hartmann LC, Schaid DJ, Woods JE, et al. Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. New England Journal of Medicine 1999; 340(2):77-84. https://pubmed.ncbi.nlm.nih.gov/9887158/

Domchek SM, Friebel TM, Singer CF, et al. Association of risk-reducing surgery in BRCA1 or BRCA2 mutation carriers with cancer risk and mortality. JAMA 2010; 304(9):967–975. https://pubmed.ncbi.nlm.nih.gov/20810374/

Rebbeck TR, Friebel T, Lynch HT, et al. Bilateral prophylactic mastectomy reduces breast cancer risk in BRCA1 and BRCA2 mutation carriers: The PROSE Study Group. Journal of Clinical Oncology 2004; 22(6):1055-1062. https://pubmed.ncbi.nlm.nih.gov/14981104/

Matteo Lazzeroni et al. Randomized Placebo Controlled Trial of Low-Dose Tamoxifen to Prevent Recurrence in Breast Noninvasive Neoplasia: A 10-Year Follow-Up of TAM-01 Study. J Clin Oncol 41, 3116-3121(2023).

Elizabeth S. McDonald et al. GLP-1 Agonists Are Associated With a Significant Reduction in Breast Cancer Incidence in Women. JCO Oncol Pract 22, 1341-1348(2026).

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Ever wonder how a mountain of clinical data transforms into a clinical practice guideline, or whether deviating from one puts you at legal risk? Join us as we pull back the curtain on guidelines methodology, decode the fine print, and put the evidence into practice. 

Hosts: 

Scott Steele, MD, MBA – Colon and Rectal Surgeon at Cleveland Clinic  

Nicole L. Petcka, MD, MHPE – General Surgery Resident at Emory University

Guests: 

Bethany Slater, MD – Pediatric Surgeon at Mount Siani, SAGES Guidelines Committee Chair 

Francesco Palazzo, MD – Minimally Invasive Surgeon at Jefferson Health, SAGES Guidelines Committee Co-chair 

Elisa Calabrese, MD – General Surgery Resident at UCSF-East Bay, SAGES/RACS Guidelines Fellow 

Resources: 
Kumar, S. S., Collings, A. T., Wunker, C., Athanasiadis, D. I., DeLong, C. G., Hong, J. S., Ansari, M. T., Abou-Setta, A., Oliver, E., Berghella, V., Alli, V., Hassan, I., Hollands, C., Sylla, P., Slater, B. J., & Palazzo, F. (2024). SAGES guidelines for the use of laparoscopy during pregnancy. Surgical endoscopy, 38(6), 2947–2963. https://doi.org/10.1007/s00464-024-10810-1

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You stayed late again, the service is still short-staffed, and when you finally say something, the answer is: you just need to be more efficient. More resilient. That's the go-to explanation for almost everything hard about residency — but what if the problem isn't your resilience at all? In the finale of Beyond the Match, Mckenzie Roebuck, Carl Engelke, Michael Brinton, and Omer Hassan of CoSEF look downstream at what happens after residents match: working conditions, culture and mental health, the practical barriers that make transferring so difficult, why residents may not trust existing reporting systems, and what real accountability and resident voice would require.
Hosts:

 Dr. Mckenzie Roebuck, CoSEF BTK Lead, Inova Fairfax Medical Campus, mckenzie.rowe@inova.org

Dr. Carl Engelke, The Ohio State University, Carl.Engelke@osumc.edu

 Dr. Michael Brinton, Medical College of Wisconsin, mbrinton@mcw.edu

  Dr. Omer Hassan, University of Calgary/Alberta Children's Hospital, omerh91@gmail.com

CoSEF: X @surgedfellows, cosef.org
 

Learning objectives:

Summarize the real problems the congressional report identifies in working conditions, mistreatment reporting, and resident mental health

Distinguish necessary difficulty in residency training from preventable system dysfunction, and describe its relationship to resident well-being and reporting

Explain the practical barriers to resident mobility, including position availability, training requirements, funding, visa status, professional risk, and stigma

Describe local and national accountability mechanisms — including program reporting, GMECs, ACGME pathways, and unions — and the limitations of each

Identify strategies to strengthen resident voice, psychological safety, anti-retaliation protections, and institutional accountability rather than relying on individual resilience alone. 

References:

House Committee on the Judiciary. Medical Mis-Match: How a Residency Hiring Monopoly Harms Patients, Doctors, and the American Public. Published online March 27, 2026.

Gianakos AL, Freischlag JA, Mercurio AM, et al. Bullying, Discrimination, Harassment, Sexual Harassment, and the Fear of Retaliation During Surgical Residency Training: A Systematic Review. World J Surg. 2022;46(7):1587-1599. doi:10.1007/s00268-021-06432-6PubMed Link: https://pubmed.ncbi.nlm.nih.gov/35006329/

Mata DA, Ramos MA, Bansal N, et al. Prevalence of Depression and Depressive Symptoms Among Resident Physicians: A Systematic Review and Meta-analysis. JAMA. 2015;314(22):2373-2383. doi:10.1001/jama.2015.15845PubMed Link: https://pubmed.ncbi.nlm.nih.gov/26647259/

Malone TL, Zhao Z, Liu TY, Song PXK, Sen S, Scott LJ. Prediction of Suicidal Ideation Risk in a Prospective Cohort Study of Medical Interns. PLoS One. 2021;16(12):e0260620. doi:10.1371/journal.pone.0260620PubMed Link: https://pubmed.ncbi.nlm.nih.gov/34855821/

Drolet BC, Schwede M, Bishop KD, Fischer SA. Compliance and Falsification of Duty Hours: Reports From Residents and Program Directors. J Grad Med Educ. 2013;5(3):368-373. doi:10.4300/JGME-D-12-00375.1PubMed Link: https://pubmed.ncbi.nlm.nih.gov/24404298/

National Resident Matching Program. The Match Agreement. Accessed August 2026. https://www.nrmp.org/intro-to-the-match/the-match-agreement/.

Intealth (ECFMG). J-1 Physicians Training in the US (infographic). Accessed August 2026. https://www.intealth.org/pdfs/J-1_US_Infographic.pdf. (Note: Institutional PDF; no PubMed entry available).

Foote DC, Rosenblatt AE, Amortegui D, et al. Experiences With Unionization Among General Surgery Resident Physicians, Faculty, and Staff. JAMA Netw Open. 2024;7(7):e2421676. doi:10.1001/jamanetworkopen.2024.21676PubMed Link: https://pubmed.ncbi.nlm.nih.gov/39018072/

Accreditation Council for Graduate Medical Education. Report an Issue. https://www.acgme.org/residents-and-fellows/report-an-issue/?utm_source.

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You matched into your dream program... but only after submitting 80 applications, spending thousands of dollars, and losing sleep wondering if anyone was even reading yours. Meanwhile, on the other side of the screen, a program director is staring down a thousand applications for six spots, trying to figure out who's actually serious about coming. Sound familiar? Join Mckenzie Roebuck, Milanie Milan, Sarah Lund, and Bryanna Stukes of CoSEF as they unpack the residency application arms race: why uncertainty drives overapplication, what preference signaling and application caps actually solve, the trade-offs of virtual versus in-person interviews, and how better transparency, advising, holistic review, and even AI might help applicants and programs find the right fit. 
Hosts:

Dr. Mckenzie Roebuck, CoSEF BTK Lead, Inova Fairfax Medical Campus, mckenzie.rowe@inova.org, insta @mrowemd, X @mrowemd1

 Dr. Milanie Milan, Cleveland Clinic, milanie.milan98@gmail.com, insta @m.mdgram

Dr. Sarah Lund, Mayo Clinic, slund@alum.mit.edu, X @DrSarahLund

Dr. Bryanna Stukes, UT Southwestern bryanna.stukes@UTSouthwestern.edu

CoSEF: X @surgedfellows, cosef.org

Learning objectives:

Explain how uncertainty across the residency selection process drives overapplication and distinguish the Match algorithm from the broader application ecosystem

Describe how preference signaling, application caps, and interview format affect applicant and program behavior, including equity trade-offs

Identify ways programs can improve both competitiveness and program-level transparency

Discuss how investment in holistic review and mission-specific selection criteria may improve application review while introducing new challenges. 

References:

House Committee on the Judiciary. Medical Mis-Match: How a Residency Hiring Monopoly Harms Patients, Doctors, and the American Public. Published online March 27, 2026.

National Resident Matching Program. Advance Data Tables: 2026 Main Residency Match. NRMP. Published March 20, 2026. Accessed August 2026. https://www.nrmp.org/match-data/2026/03/advance-data-tables-2026-main-residency-match/.

Ulin L, Bernstein SA, Nunes JC, et al. Improving Transparency in the Residency Application Process: Survey Study. JMIR Form Res. 2023;7:e45919. doi:10.2196/45919PubMed Link: https://pubmed.ncbi.nlm.nih.gov/38145482/

American Medical Association. Transparency in the Resident Physician Application Process (Issue Brief). Published online November 2023. Accessed August 2026.
https://www.ama-assn.org/system/files/cme-issue-brief-resident-application-process.pdf.

Nilsen K, Walling A, Callaway P, et al. "The End Game" — Students' Perspectives of the National Residency Matching Program: A Focus Group Study. Med Sci Educ. 2018;28(4):729-737. doi:10.1007/s40670-018-0627-1PubMed Link: https://pubmed.ncbi.nlm.nih.gov/34646549/

Weissbart SJ, Kim SJ, Feinn RS, Stock JA. Relationship Between the Number of Residency Applications and the Yearly Match Rate: Time to Start Thinking About an Application Limit? J Grad Med Educ. 2015;7(1):81-85. doi:10.4300/jgme-d-14-00270.1PubMed Link: https://pubmed.ncbi.nlm.nih.gov/26217439/

Angus SV, Williams CM, Kwan B, et al. Drivers of Application Inflation: A National Survey of Internal Medicine Residents. Am J Med. 2018. doi:10.1016/j.amjmed.2018.01.002PubMed Link: https://pubmed.ncbi.nlm.nih.gov/29355512/

Lund S, Santucci NM, Zarate Rodriguez J, et al. Message Received? Applicant Insights on Preference Signals in General Surgery Residency Recruitment. J Surg Educ. 2026;83(9):104096. doi:10.1016/j.jsurg.2026.104096PubMed Link: https://pubmed.ncbi.nlm.nih.gov/42418854/

Woodward JM, Gan CY, Foote DC, et al. Thanks for the Signal—Now What? Program Director Perspectives on How Preference Signals Are Shaping General Surgery Residency Recruitment. J Surg Educ. 2026;83(9):104061. doi:10.1016/j.jsurg.2026.104061PubMed Link: https://pubmed.ncbi.nlm.nih.gov/42418853/

Mullens CL, Picart JK, Dualeh SHA, et al. A Practical Approach for Implementing Holistic Review for General Surgery Resident Recruitment. J Surg Educ. 2026;83(9):104069. doi:10.1016/j.jsurg.2026.104069PubMed Link: https://pubmed.ncbi.nlm.nih.gov/42436210/

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