Cold Steel: Canadian Journal of Surgery Podcast

Why is a surgical podcast talking about tax credits????

We strongly believe that in order to be a more effective surgeon, we have to address all aspects of our lives. Unfortunately or fortunately, a big part of that is making sure our finances are well taken care of.

Nikhil Patil is the CEO of Innovotis Consulting. He joined us on this episode to talk about Scientific, Research & Experimental Development (SR & ED) Credits. We talk about what SR&ED is, how physicians can make use of it, and more broadly, how physicians can support innovation in their practice.

Links:

Dr. Nikhil Patil:
nikhil@innovotis.com
https://www.innovotis.com/
https://www.linkedin.com/in/nikhilpatilmd/
Check out our previous episode with Mark Soth on "Designing a Good Life": https://open.spotify.com/episode/13sCyzbP7wAR3R4wwPrYIW?si=kjMveLBaSg-NmkqnNa8p6Q

AI is likely to change the way that medical and surgical education happens over the next decade. We needed to find out how, and Dr. Samir Grover joined us on this episode to talk about it. 

Dr. Samir Grover is a gastroenterologist, clinician-educator, and education researcher whose career has been defined by building the simulation and technology-enhanced learning infrastructure that trains the next generation of physicians, and by translating that work into national and international practice. He serves as Executive Vice-President, Academics at Scarborough Health Network (SHN), where he holds the hospital's inaugural Pialis Family Chair in Education.

Samir and the Grover lab have really pivoted to study the impact of AI on medical education. In this episode, we take a deep dive into the implications of AI on medicine. Samir also talks to us about his current AI stack and how we might immediately start to use AI in our own practice.
Links:
Samir C. Grover | About | University of Toronto
Samir Grover Substack:  Samir C. Grover, MD | Substack
AI empathy:  AI empathy is artificial. But could that possibly be better.
AI stack for med students or residents:  The AI stack for the medical student or resident
Neverskilling:  Neverskilling - Samir C. Grover, MD
Grover Lab:  Grover Lab | Dr. Samir C. Grover | AI in Medical Education

Jeremy Heffner is a trauma and acute care surgeon at Lima Memorial Health System in Ohio. He is also the Chief Operating Officer of SurgeON, a social media company dedicated to surgeons. Heffner was also previously a bioengineer who worked at NIH. He has been incredibly open about his journey and struggles with PTSD as a surgeon, and how those struggles ultimately caused his breakdown. Sadly, Dr. Heffner's story is not unique, and we brought him on the podcast to hear his insights about how many surgeons struggle with PTSD. 

What is unique is Dr. Heffner's approach to dealing with his PTSD. His approach is outlined in his recently released book, Proof of the Impossible. Dr. Heffner used AI to try to find answers to many of the questions he had while struggling with burnout and PTSD. He had some very strange and unusual conversations with AI, including a moment where he felt the AI was having a "misalignment event", defined as when "AI acts in ways that go against human intent, safety, or core instructions". 

Our discussion spanned the gamut of PTSD in surgery, and how AI may or may not be a tool that can help with mental health and burnout. For me, the most powerful message Jeremy had for us was the power of human connection and also that the only way to deal with the hard things is to face them.

We would just like to warn listeners that we do discuss some pretty traumatic things that Dr. Heffner experienced, and some of the description is pretty graphic. Also, we would always recommend professional help if you are dealing with mental illness, burnout, or suicidal ideation. 

We would love to hear your thoughts - do you think there is a role for AI in providing empathy to humans? Send us your feedback at podcast.cjs@gmail.com. 
 Links:
Source: LinkedIn https://share.google/yBOCofBF9BhotNeWh
Pre-Order "Proof of the Impossible"  https://share.google/w0jGPSiz9WLBstaqU
SurgeON with Mark Soliman interview:  https://open.spotify.com/episode/3znH6DkcDDcg7Zqyca2YSb?si=p3zoYYb_RCiNvL5hkX4l9g&utm_source=copy-link&sci=spotify%3Acard-config%3A0qjrdqA8ITGkKr0375x09R

This week's guest is Dr. Bishal Gyawali. Bishal is an oncologist at Queen's University and a policy researcher. His focus as a researcher has been both sensational and at the same time extremely fundamental. Bishal has been asking questions around how we decide which drugs are approved for funding by the government, as well as how we might best allocate resources to help cancer patients around the world. Bishal has been an integral part of the "Common Sense Oncology" movement, which will promote interventions that measurably improve the lives of patients, promoting effective treatments but  also challenging interventions that might cause more harm than good.
Our conversation focused around Bishal's training, how he became interested in cancer health policy and his thoughts around the idea of value in cancer care. We also discussed Bishal's thoughtful use of technology, blogs, and social media.

Links:
Grounded in Groundshot Podcast – Dr. Bishal Gyawali

BG lab: Dr. Bishal Gyawali

Common Sense Oncology: Home - Common Sense Oncology

Mittal A, Kim MS, Dunn S, Wright K, Gyawali B. Frequently asked questions on surrogate endpoints in oncology-opportunities, pitfalls, and the way forward. EClinicalMedicine. 2024 Sep 13;76:102824. doi: 10.1016/j.eclinm.2024.102824. PMID: 39764569; PMCID: PMC11701476.

Surrogate Endpoints: The 15 Most Common Misunderstandings in Oncology

Cancer groundshot: Access to proven treatments must parallel development of new therapies

Do Oncology Board Exams Make Us Better Doctors?

Ending Medical Reversal: Ending Medical Reversal | Hopkins Press

In 2013, when I was a medical student, I wrote an essay entitled, #nomoretextbooks? for the Canadian Undergraduate Surgical Education Committee essay competition. In the essay I wrote, “Tomorrow, I start my vascular surgery rotation. Before bed tonight, I will watch a YouTube video of a femoral-popliteal bypass surgery, review the surgical anatomy from Zollinger’s Atlas of Surgical Operations on my iPad while waiting for my car tires to be changed, listen to a podcast on peripheral vascular disease while riding my exercise bike, and perhaps tweet about my new rotation.” At the time, I really felt strongly that the future of surgical textbooks would be virtual. 
To explore that future, I spoke with Tanner Schrank, the head of impact for the Journal of Medical Insight (also called JOMI). JOMI is a website that showcases a wide range of operations across multiple disciplines. What I really like about JOMI is the in-depth interviews that are done with surgeons before the operation, where the surgeon will describe their thought process and indications for the operation. The videos are also extraordinarily well filmed, often from multiple camera angles and with great detail. JOMI clearly offers a fantastic resource for residents and attendings to learn new surgical techniques.
Tanner and I discuss the implications for a transition to a “virtual” textbook that is more reliant on video than an actual written textbook. I must caveat this episode by saying that I think there is pretty good evidence that reading something and actively trying to absorb information is more effective than passively viewing it. In other words, I am not totally convinced that you can effectively learn something by passively watching video. I think it’s important, especially for trainees, to learn actively.  As the great expert on performance, Anders Ericsson said, deliberate practice, not just practice, is required to really acquire mastery. However, there is no question in my mind that video needs to augment the learning that we do as surgeons. At Queen’s, we use video review on a weekly basis to give residents and fellows feedback on how they can improve their technique. 
We would love to hear your thoughts. Do you think videos are the way of the future for surgical textbooks? Shoot us an email at podcast.cjs@gmail.com. 

Links:
AMBOSS: Beyond the Textbook: amboss.com/int/internationalpodcast
JOMI: https://jomi.com/
#nomoretextbooks: https://www.canjsurg.ca/content/57/4/E119