Behind The Knife: The Surgery Podcast

In response to increasing surgeon burnout, unsustainable clinical demands, and ongoing loss of surgeon autonomy in the setting of employee-based models, the American College of Surgeons is speaking out. In this episode, hosts Dr. Steven Thornton and Dr. Emma Burke sit down with Dr. Douglas Wood, Chair of Surgery at the University of Washington and Dr. Thomas Varghese, Editor-in-Chief of the Journal of the American College of Surgeons, to discuss the new ACS Workplace Standards Framework. The conversation covers how this initiative grew out of discussions around unionization, what domains the framework addresses — from call intensity and OR block access to administrative burden and inpatient census limits — and how specialty-specific guidelines can be developed and implemented at the local level. Dr. Wood and Dr. Varghese also reflect on the culture of "unlimited endurance" that has long defined surgery, why meaningful systems-level change is both necessary and achievable, and how improving workplace sustainability could transform the pipeline of future surgeons for generations to come.
Hosts: Emma Burke and Steven Thornton
Guests: Dr. Douglas Wood & Dr. Thomas Varghese Jr.
Papers Discussed:
1. Wood DE, Wolinsky PR, Dodgion CM, et al. Developing Specialty-Specific Workplace Standards for Surgeons: A Framework to Support Sustainable Surgical Careers. Journal of the American College of Surgeons, 2026. DOI: 10.1097/XCS.0000000000001880 https://pubmed.ncbi.nlm.nih.gov/41773743/
2. Varghese TK Jr. Toward Sustainable Surgical Practice: Defining Workplace Standards for the Modern Era. J Am Coll Surg. 2026 Mar 3. doi: 10.1097/XCS.0000000000001888. Epub ahead of print. PMID: 41773737. https://pubmed.ncbi.nlm.nih.gov/41773737/
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General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review
Oral Board Simulator: https://app.behindtheknife.org/oral-board-simulator
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
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
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The House Judiciary Committee just dropped a 47-page report calling the National Residency Match Program a hiring monopoly that harms patients, doctors, and the public — and the surgical community is talking. In this episode, Dr. Patrick Georgoff is joined by BTK surgical education fellows Dr. Emma Burke and Dr. Agnes Prem Kumar, along with special guest Dr. Brian Carmody (aka the Sheriff of Sodium), a pediatric nephrologist and one of the sharpest analysts of medical education policy working today. Together, they break down the report's central claims: that the NRMP exercises monopolistic control over residency hiring, suppresses resident wages, and strips trainees of bargaining power — and they separate what the report gets right from where its rhetoric badly outruns its evidence. From the history of Section 207 and the antitrust lawsuit that nearly brought down academic medicine, to the real economics of GME funding, resident unionization, and what a match-free world would actually look like — this is the context you need to understand one of the most consequential debates in graduate medical education in years. Don't miss Dr. Carmody's six-part YouTube series on the match, linked in the show notes.
Congressional Report: https://judiciary.house.gov/media/press-releases/new-report-exposes-how-medical-residency-hiring-monopoly-harms-patients-and
The Match 6-Part Video Series: https://www.youtube.com/playlist?list=PLc36yFQWkuG1sXk62A3zeRWB8aoK5SISP
The Sodium Sheriff Blog:  https://thesheriffofsodium.com/
***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6
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
Oral Board Simulator: https://app.behindtheknife.org/oral-board-simulator
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
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
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A career in surgery has a profound impact on those who practice the craft. High rates of poor mental health are well described but incompletely understood. One potential mechanism for advancing our understanding of surgeon well-being is studying surgeons' emotional experiences. Shame, a self-conscious emotion reflecting how an individual feels about themselves, could be a particularly powerful lens. In this series on shame in surgery, we explore what we know about shame in surgery and what shame can tell us about learning and working as surgeons.
In this third episode, we talk with Drs. Sheina Theodore and Tejal Brahmbhatt about their study examining the relationship between internalized shame states and burnout among surgery residents. They make a compelling case that addressing the well-being crisis in surgery requires looking beyond external stressors to the internal experience of shame: the quiet, invisible voice that tells residents they aren't good enough, and ask what role the culture of surgery plays in that internal monologue. 
Host: Steven Thornton
Guests:
1.    Sheina Theodore (Assistant Professor of Surgery, Boston University)
2.    Tejal Brahmbhatt (Associate Professor of Surgery, Cedars Sinai Medical Center)

Publications Discussed:
1.    Smith SM, Kobzeva-Herzog A, McGillen P, Castagne-Charlotin M, Davies J, Sanchez SE, Dechert T, Brahmbhatt TS, Theodore S. Internalized Shame Experiences and Burnout in General Surgery Residents. J Surg Educ. 2025 Apr;82(4):103447. doi: 10.1016/j.jsurg.2025.103447. Epub 2025 Feb 6. PMID: 39919584. https://pubmed.ncbi.nlm.nih.gov/39919584/
***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6
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
Oral Board Simulator: https://app.behindtheknife.org/oral-board-simulator
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
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
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A career in surgery has a profound impact on those who practice the craft. High rates of poor mental health are well described but incompletely understood. One potential mechanism for advancing our understanding of surgeon well-being is studying surgeons' emotional experiences. Shame, a self-conscious emotion reflecting how an individual feels about themselves, could be a particularly powerful lens. In this series on shame in surgery, we explore what we know about shame in surgery and what shame can tell us about learning and working as surgeons.

In this second episode, we talk with Dr. ElAbd and Dr. Zammit about their study examining the relationship between shame-based learning, grit, and burnout across surgical specialties. Their findings highlight how grit may both protect against burnout and mediate whether residents go on to shame others. 
Host: Steven Thornton
Guests:
1.    Rawan ElAbd (Plastic Surgery Resident, McGill University)
2.    Dino Zammit (Assistant Professor of Plastic Surgery, McGill University)
Publications Discussed:
1.    ElAbd R, Pu L, Esmonde-White C, ElHawary H, Vorstenbosch J, Zammit D. Association of Grit and Shame Based Learning on Burnout in Surgical Training: A Single Institution Analysis. J Surg Educ. 2025 Sep;82(9):103583. doi: 10.1016/j.jsurg.2025.103583. Epub 2025 Jun 27. PMID: 40580606.
https://pubmed.ncbi.nlm.nih.gov/40580606/
***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6
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
Oral Board Simulator: https://app.behindtheknife.org/oral-board-simulator
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
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
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A career in surgery has a profound impact on those who practice the craft. High rates of poor mental health are well described but incompletely understood. One potential mechanism for advancing our understanding of surgeon well-being is studying surgeons’ emotional experiences. Shame, a self-conscious emotion reflecting how an individual feels about themselves, could be a particularly powerful lens. In this series on shame in surgery, we explore what we know about shame in surgery and what shame can tell us about learning and working as surgeons.
In this first episode, we talk with Dr. Will Bynum and Professor Luna Dolezal about how they understand shame in medicine, why it's so hard to see even when it's everywhere, and how developing what they call "shame competence" might be one of the most important steps we can take toward humanizing surgical training.
Host: Steven Thornton
Guests:

Will Bynum (Associate Professor of Family Medicine, Duke University)

Luna Dolezal (Professor of Philosphy and Medical Humanities, Exeter University)

Publications Discussed:

Dolezal L, Bynum W. Shame competence: addressing the effects of shame in health care. Lancet. 2024 Oct 19;404(10462):1514-1515. doi: 10.1016/S0140-6736(24)02269-4. PMID: 39426826. https://pubmed.ncbi.nlm.nih.gov/39426826/

The Nocturnists. Shame in Medicine: The Lost Forest [podcast series]. The Nocturnists; 2022. https://thenocturnists.org/shameinmedicine

Nguyen LN, Bynum WE 4th. When I Say…self-conscious emotions. Med Educ. 2021 Mar;55(3):291-292. doi: 10.1111/medu.14425. Epub 2020 Dec 23. PMID: 33289140. https://pubmed.ncbi.nlm.nih.gov/33289140/

Tracy, J. L., Robins, R. W., & Tangney, J. P. (Eds.). (2007). The self-conscious emotions: Theory and research. The Guilford Press.

***Fellowship Application Link: https://forms.gle/QSUrR2GWHDZ1MmWC6
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
Oral Board Simulator: https://app.behindtheknife.org/oral-board-simulator
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
Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review
Download our App:
Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049
Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US