Behind The Knife: The Surgery Podcast

In this episode of EPA Playbook, Drs. Jason Bingham, Emma Burke, and Agnes Premkumar discuss the evaluation and management of inguinal hernias through a case-based approach that reinforces key EPA concepts for surgical trainees. We specifically highlight the importance of a thorough history and physical exam, emphasize risk stratification, and indications for surgery versus watchful waiting. We briefly review a few postoperative considerations as well.
***FREE EPA COURSE: https://behindtheknife.org/premium/epa-playbook
Simply create an account on behindtheknife.org or our app and you the course will automatically show up in your Library.
For additional information on EPAs, visit the American Board of Surgery EPA webpage: https://www.absurgery.org/get-certified/epas/. 
Cited studies:

Miserez M, et al. "Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients." Hernia. 2014;18(2):151-163. PubMed ID: 24504225

Carrick MA, et al. "Smoking and anaesthesia." BJA Educ. 2019;19(1):1-6. PubMed ID: 33456860

Amid PK, et al. "Local anesthesia for inguinal hernia repair step-by-step procedure." Ann Surg. 1994;220(6):735-737. PubMed ID: 7979603

Huy TC, et al. "Reoperation for chronic postoperative inguinal pain." JAMA Surg. 2025;160(9):984-991. PubMed ID: 39855588

In this episode of EPA Playbook, Drs. Kevin Kniery, Emma Burke, and Agnes Premkumar discuss management of critically ill surgical patients, using case-based discussions to reinforce core principles of shock, resuscitation, and ICU care. We first review the four major types of shock. We then discuss two cases centered around managing a patient in septic shock and cardiogenic shock, delving into the nuances on how management differs between the two. Additionally, we underscore a physiology-driven approach to critical care, the importance of multidisciplinary collaboration, and the need to align treatment decisions with patient goals and values.
***FREE EPA COURSE: https://behindtheknife.org/premium/epa-playbook
Simply create an account on behindtheknife.org or our app and you the course will automatically show up in your Library.
For additional information on EPAs, visit the American Board of Surgery EPA webpage: https://www.absurgery.org/get-certified/epas/.

Join Drs. Steele, Burke, & Premkumar in this episode of EPA Playbook, where we tackle a core general surgery EPA: the evaluation and management of benign and malignant colon disease. From common presentations like diverticulitis and lower GI bleeding to the diagnosis and workup of colon cancer, this episode provides a structured framework you can use on the wards, in clinic, and on call. Using case-based discussions, we walk through how to distinguishing benign from malignant processes, selecting appropriate imaging and endoscopy, and recognizing when a patient needs urgent intervention versus outpatient workup. We also cover key principles of colon cancer management, including staging, surgical planning, and multidisciplinary care, alongside high-yield management of benign conditions.
***FREE EPA COURSE: https://behindtheknife.org/premium/epa-playbook
Simply create an account on behindtheknife.org or our app and you the course will automatically show up in your Library.
For additional information on EPAs, visit the American Board of Surgery EPA webpage: https://www.absurgery.org/get-certified/epas/. 
Cited Studies:
Gustafsson, U.O., Scott, M.J., Hubner, M. et al. Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations: 2018. World J Surg 43, 659–695 (2019). https://doi.org/10.1007/s00268-018-4844-y

BTK Resources:
Ostomy Marking Video
https://behindtheknife.org/video/behind-the-knife-ostomy-marking

How to Change an Ostomy Appliance Video
https://behindtheknife.org/video/behind-the-knife-how-to-change-an-ostomy-appliance

How to Manage a Challenging Ostomy Video
https://behindtheknife.org/video/behind-the-knife-how-to-manage-a-challenging-ostomy

Two years into the EPA era — are we actually training surgeons differently, or just checking new boxes? In this episode, Behind the Knife co-director and Duke Trauma Surgeon Dr. Patrick Georgoff and Behind the Knife surgical education fellows Dr. Agnes Premkumar and Dr. Emma Burke sit down with Dr. Ruchi Thanawala, thoracic surgeon at OHSU, informatician, and founder of Firefly Labs, to get an honest look at the state of competency-based surgical education. We dig into why surgery is uniquely hard to assess, what the data are actually showing (spoiler: significant skewing, and we're not ready to make promotion decisions off it yet), and why collecting assessments is only 25% of the work. If you've ever wondered whether EPAs are moving the needle or just adding noise, this one's for you
***FREE EPA COURSE: https://behindtheknife.org/premium/epa-playbook
Simply create an account on behindtheknife.org or our app and you the course will automatically show up in your Library.
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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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-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review
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In this episode, we use the recent SAGES guidelines to tackle one of the most common and controversial questions in general surgery. Through a case-based discussion, our experts review the evidence for intraoperative biliary imaging, discuss strategies for difficult anatomy, and compare IOC with other imaging modalities. Join us as we translate the latest recommendations into practical lessons that can be applied in the operating room.
Take Home Points: 

Routine IOC is supported; however, this remains a conditional recommendation that should be individualized based on anatomy, surgeon experience, and available resources.

Use a selective approach to IOC in special populations, including pediatric and pregnant patients, where risks and benefits may differ.

Alternative imaging modalities including ICG fluorescence and laparoscopic ultrasound have complementary roles. 

Routine IOC may help maintain surgeon and team proficiency, and trainees should learn both IOC performance and interpretation 

Hosts: 

Jason Bingham, MD – General and Bariatric Surgeon 

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

Guests: 

Emily Miraflor, MD – General and Colorectal Surgeon at UCSF East Bay, Senior Author on the SAGES Guidelines 

Kevin El-Hayek, MD - HPB and Foregut Surgeon at MetroHealth and Professor of Surgery at Case Western Reserve School of Medicine, Chair of the SAGES HPB/Solid Organ Committee 

Dena Shehata, MD - SAGES Guideline Fellow, Co-first author on the SAGES Guidelines 

Resources: 
Kumar, S. K., Shehata, D. G., Cetrulo, L. N., Ignacio, R., Chiu, J., Davis, B. R., McDonald, M., Bloom, M. B., Ayloo, S., Kchaou, A., Orthopoulos, G., Pucher, P. H., Oliphant, U., Hallowell, P. T., Serrot, F., Overby, D., Moreno-Paquentin, E., Slater, B. J., & Miraflor, E. (2025). SAGES guidelines for the use of intraoperative imaging of the common bile duct. Surgical endoscopy, 39(11), 7091–7102. https://doi.org/10.1007/s00464-025-12142-0 
SAGES Safe Cholecystectomy Program - 
https://www.sages.org/safe-cholecystectomy-program/
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: https://behindtheknife.org/premium
Oral Board Review: https://behindtheknife.org/oral-board
Oral Board Simulator: https://behindtheknife.org/oral-board/simulator
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-review
Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-review
Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-review
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-review
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