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

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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.

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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

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/.

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

Join Drs. Georgoff, Burke, and Premkumar in this episode of the EPA Playbook as they break down a practical, repeatable framework for managing patients in the trauma bay, one of the most high-pressure environments in surgical training. This episode focuses on the critical first minutes of evaluation, anchored in a structured primary survey. We emphasize how to recognize and immediately address life-threatening injuries, while maintaining situational awareness and clear communication with your team. From airway and hemorrhage control to adjuncts like FAST and early imaging, we highlight what matters most when time is critical.

***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/.

BTK Resources:

Trauma Video Playlist (FAST, How to Read a CT, and more!)
https://behindtheknife.org/video-playlists/trauma-videos

Big T Trauma Podcasts
https://behindtheknife.org/podcast-series/big-t-trauma

Trauma Surgery Video Atlas (Premium)
https://behindtheknife.org/premium/trauma-surgery-video-atlas

Join Drs. Georgoff, Burke, and Premkumar in this episode of EPA Playbook, where we tackle the evaluation and management of small bowel obstruction. Through a realistic series of scenarios, we walk step-by-step through how junior residents can approach this diagnosis using an evidence-based approach.

We break down the key components of the small bowel obstruction EPA, from rapid initial assessment and focused physical exam to early resuscitation, recognizing when to go straight to the OR, and post-operative care. Along the way, we highlight critical teaching points you’ll actually use on call. Whether you’re a new intern or an early resident looking to build confidence, this episode is designed to help you act decisively and move one step closer to entrustment.

***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/.

BTK Resources:

Nasogastric Tube (NGT) Management Video
https://behindtheknife.org/video/behind-the-knife-nasogastric-tube-ngt-management

Nasogastric Tube (NGT) Placement Video
https://behindtheknife.org/video/behind-the-knife-nasogastric-tube-ngt-placement

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

Cited Studies:

• National prospective cohort study of the burden of acute small bowel obstruction https://doi.org/10.1002/bjs5.50136
• Management and short-term outcomes of patients with small bowel obstruction in Denmark: a multicentre prospective cohort study https://doi.org/10.1007/s00068-022-02171-y
• Multi-institutional, prospective, observational study comparing the Gastrografin challenge versus standard treatment in adhesive small bowel obstruction https://doi.org/10.1097/ta.0000000000001499
• Evaluation and management of small-bowel obstruction: an Eastern Association for the Surgery of Trauma practice management guideline https://doi.org/10.1097/ta.0b013e31827019de

INTRODUCING Behind the Knife OBGYN Oral Board Review!
The oral boards aren't just about knowledge—they are about executing under pressure. This course is designed to give you the structure and confidence to command the room. We have curated 98 high-yield scenarios covering the "Big Three" of the exam: Obstetrics, Gynecology, and Office Practice. Whether it’s a surgical emergency or a complex clinic workup, we will walk you through exactly how to articulate your plan, defend your decisions, and pass this exam.
Each scenario includes 2 parts. The first part is a perfectly executed scenario. If you are able to achieve this level of performance in your preparation you are sure to pass the oral exam with flying colors. The second part introduces high-yield commentary to each scenario. This commentary includes tips and tricks to help you dominate the most challenging scenarios in addition to practical, easy-to-understand teaching that covers the most confusing topics. We are confident you will find this unique, dual format approach a highly effective way to prepare for the test.
Please check out the preview episodes below that include Parts A and B, with and without commentary.
This course includes access to our Oral Board Simulator. Step into the hot seat and experience the pressure of the real exam and receive detailed, actionable feedback with the most advanced oral board prep available.

• 3-Month Purchase - 10 exams
• 6-Month Purchase - 22 exams
• 12-Month Purchase - 46 exams