The Challenges of Being A Female (Acute Care) Surgeon Are you sure? < Back The Challenges of Being A Female (Acute Care) Surgeon My 17-year journey to become an Acute Care Surgeon started when I applied for medical school in my senior year of high school. I went to a 6-year combined-degree medical school and then completed a 6-year surgical residency. At age 29, I began my practice as a General Surgeon. After 3 years as a Staff Surgeon, during which I had one combat deployment and one medical readiness exercise in Africa, I then chose to complete an acute care surgery fellowship. Our acute care surgery department was comprised of 14 surgeons, only 3 of whom were female. Surgery has historically been a male-dominated specialty, and female surgeons continue to face significant obstacles.(1) There has been a noticeable shift with more females choosing surgical specialties, although they continue to be under-represented in trauma. This can create a sense of rivalry or competition, the need to be seen as equally competent as our male colleagues. On top of the difficulties inherent to surgical training and practice, the constant pressure to live up to expectations can foster stress and doubt. Imposter syndrome, which is "a psychological pattern in which people doubt their accomplishments and have a persistent, often internalized fear of being exposed as a ‘fraud’," can result.(2) Are You Sure This is What you Want to Do? Twelve years ago, during my internship, I was in the process of reapplying for the remaining 5 years of my surgical residency (a phenomenon that was subsequently eliminated from military surgery residencies). As I asked one of the senior (male) surgeons for a letter of recommendation, he discussed the issue with me in the middle of a busy clinic, with other residents and staff present. He asked if I was sure I wanted to do a surgery residency, and he encouraged me to consider other career paths. Thankfully, I did not experience this discrimination from any of my other staff. But I do wonder if there was discrimination of omission...were my male co-residents provided encouragement or advantages that I was not afforded? In my small residency, with a total of 18 residents, we had a total of 5 females during my first year, including another female intern. I felt encouraged that 2/3 of my class was female, but this was the exception and not the rule. Eight years ago, during my surgical residency, I was at a very busy Level 1 trauma center. I can't recall the exact ratio of male to female surgeons, but I know women were in the minority. During a non-emergent trauma case, there was a product representative in the room. During a casual conversation, he was clarifying who was the surgeon. When the senior surgeon in the room (a female), introduced herself, he actually stated "Oh I didn't know women could be trauma surgeons." In an article published in the American Journal of Surgery in 2019, half of all hospitals with emergency general surgery services reported no female surgeons. For the subset of hospitals with EGS services who have an ACS Model, they reported a higher median proportion of women surgeons (17%).(3) Specifically in trauma surgery, women are still under-represented. 28% of surgeons who are board-certified in critical care are female. Thankfully, our voice is gaining strength. More women are going into surgical disciplines, and there are more woman in leadership positions in surgical organizations.(4) 29% of EAST members and 13% of AAST members are female, although there has been an increase in female executive leaders in AAST.(5) "Why should women have to sound like men to get people to listen to them? Why isn't it that everyone in the room should be quiet when she asks for quiet because she is a doctor asking for quiet?" "The theme was clear. Women physicians do not get the same respect men get when dealing with emergencies."(6) Women bring unique strengths to this discipline. It's not a matter of competing to prove that we are superior, but women are inherently different from men and this should be nurtured, not belittled, or ridiculed. Improved communication and patient engagement are just a few of the benefits we can bring to the team. Researchers Find Women Make Better Surgeons Than Men . "The authors attribute the favorable patient outcomes to the female doctors’ ability to communicate and engage with their patients to ensure compliance with medications and therapy, their adeptness at collaborating with colleagues and their tendency to adhere to guidelines when treating patients." This is not a simple problem, and it won't have a simple solution. So what can you do to combat the stereotypes and respectfully establish and maintain your position comparable to your male surgical colleagues? I've learned a few things over the years, with a handful of specific things over the years of my fellowship. Introduce yourself with your Title and name. Previously, I introduced myself as "Christina, part of the surgical team". I regarded my introduction as a display of humility. But I was actually unintentionally undermining my role in the team. I now introduce myself as "Dr ----, one of the trauma surgeons/ acute care surgeons" or "Dr ----, the trauma surgeon/ acute care surgeon who will be taking care of you." Find your team. Seek out mentors, or be a mentor for a younger trainee. Seek support from those who have led the way in this specialty. Get involved. This can be done at all levels, from hospital-level leadership and committee membership, city/ state/ national trauma organizations/ associations Counteract the negative thoughts that can accompany Imposter Syndrome. Keep a list of your strengths and the reason why you chose this specialty. 1. Stamp N. I'm a female surgeon. I feel uncomfortable telling girls they can be one, too. Washington Post. 29 July 2019. 2. McGuire K. Imposter Syndrome: The Dirty Little Secret of Successful Women (And Men Too). Association of Women Surgeons. 3 April 2019. 3. Oslock WM, Paredes AZ, Baselice HE, et al. Women surgeons and the emergence of acute care surgery programs. Am J Surg. 2019;218(4):803-808. 4. Haskins J. Where are all the women in surgery? Association of American Medical Colleges. 15 July 2019. 5. Foster SM, Knight J, Velopulos CG, et al. Gender distribution and leadership trends in trauma surgery societies. Trauma Surg Acute Care Open. 2020;5(1):1-5. 6. Riley, Edward. Voices in the OR: A Self-Reflection and Examination of Unconscious Bias. Doximity. 28 Oct 2020. Previous Next

< Back Unusual Case of Peritonitis A 23-year-old male presents to the ED with several days of abdominal pain. He is otherwise healthy and denies any other symptoms. On exam, he has diffuse peritonitis, but no other obvious findings. He is tachycardic with a heart rate in the 110s-120s. His blood pressure is 100s/60s. No significant medical or surgical history. No remarkable events recently. He had plain films of his chest and abdomen. Plain film of the chest and upper abdomen What's going on? Differential diagnosis? Perforated hollow viscus- gastric or duodenal ulcer, bowel obstruction leading to perforation, procedural complication (EGD, ERCP). On further questioning, the patient endorses a recent soccer game during which he blocked a goal and was hit in the stomach. Unsure if it was the soccer ball or a kick to the stomach. He then had a CT of his abdomen and pelvis. CT of the abdomen and pelvis, representative slices What's going on? Diagnosis? Intervention? Free air (pneumoperitoneum) and free fluid are consistent with a perforated hollow viscus. No clear source on the CT. This requires abdominal exploration. We proceeded with exploratory laparotomy. Found liters of succus. There was a single perforation of the small bowel that was resected and anastomosis was performed. The abdomen was closed and a drain was placed. Intraoperative Findings Management of Peritonitis from Perforated Hollow Viscus The hollow viscus refers to the gastrointestinal tract from the esophagus to the rectum. Pain associated with hollow viscus perforation is classically acute onset, constant, severe, and worse with movement. The peritoneal lining of the abdomen becomes inflamed in reaction to the leaking enteric contents. This is a surgical emergency. The diagnosis can be made with the visualization of pneumoperitoneum on an upright chest x-ray (lucency under the diaphragm). A patient with peritonitis and free air requires surgical exploration. A CT scan can help identify the underlying pathology, but is not mandatory and should not delay operative intervention. Non-operative management is reserved for the patient with a sealed perforation (example- retroperitoneal duodenum) or a patient who is a prohibitively high-risk operative candidate (example- patient on palliative or hospice care). Cultural differences Not all cultures have adopted the practice of Western medicine. In some cultures, people still seek advice and medical care from traditional healers. Unfortunately, this can delay treatment if a patient requires operative intervention. Some of the treatments provided by traditional healers can also lead to further injury. This patient with a small bowel injury was seen by a traditional healer several times before he was finally brought to the hospital. The marks on his skin are the result of a practice of cutting the skin to heal the cause of his abdominal pain. Another patient was brought to the hospital for a severe infection of his genitalia. By the time he came to the hospital, his infection was so extensive that he required a debridement of a large portion of the skin in his perineum. He had been seeing a healer who was treating him with a topical solution that had essentially burned his skin, so in addition to the underlying infection, he had severe tissue damage. Previous Next

< Back The Trauma Bag Why was there a need for a trauma bag in the hospital? As an acute care surgeon responding to trauma activations, airway emergencies, and a variety of other hospital surgical emergencies, there are a handful of supplies that I always have with me. The two basics are a scalpel for surgical airways and trauma shears (classically used to remove clothes in the trauma bay, but I seem to find more uses all the time). Eventually, I added a Kelly clamp to my armamentarium- handy for disconnecting or unscrewing a wide variety of impossibly tight connections or securing something in place. During the COVID Pandemic, numerous changes were made in our hospital to minimize infection transmission. Unfortunately, several of the modifications had unintended negative consequences. When we stopped wearing white coats, we lost our pocket space for stashing scalpels and shears. We also carried more gear, including eye protection and N-95 masks (carried in a brown bag when not worn). Many surgeons adapted by using an assortment of bags, such as sling backpacks or CamelBak cases. My own choice is this fanny pack , which draws many compliments! The next challenge was the relocation of supplies from the wall of our trauma bay onto shelves in the hallway. Team members had to leave the trauma bay, locate which cart the item was on, and then scan for the item, which created delays. This disrupted communication as well because team members missed changes when they were outside the room. Another hurdle that existed even before the pandemic was the array of different names for the same item. Most people who place cotton-tipped applicators in their ears after their shower call them by the brand name “Q-tip”…they are actually called “cotton tip applicators” or “CTA”. **Note- don’t use Q-tips in your ears!** Drop the Q-tip! Why ENTs are begging you to leave your ears alone. The surgeon might ask for 4x4s, which is what we call gauze in the operating room. Some say "Quik-Clot” while others know the product by the name “Combat Gauze”. Sutures are a whole other bag of worms…do you use silk or Ethibond to secure your chest tube? Curved or straight needle? Countless times, the trauma chief is managing the trauma and when someone calls for a suture, their attention is often diverted to advising the person reaching into the suture box on the wall.…"no, the one to the left, top row." It’s not always easy to tell from the box what the suture and needle look like. In addition to the elimination of white coats, relocation of commonly used supplies outside the trauma bay, and different names for supplies, I noticed that several key items were frequently used and they seemed to be unreasonably challenging to locate in a timely fashion. Combat Gauze, Coban, specific suture on a specific needle, etc. Therefore, I created a backpack of supplies that I carry when on call. What does this bag do? This bag was created from my perception of a necessity to ensure specific supplies are readily available when responding to surgical emergencies. A Level 1 trauma center is equipped with the highest level of resources and personnel to manage the most complex patients, and our resources and patient population dictate what supplies are needed on a routine basis. My focus was on supplies that are (1) frequently used, (2) unique and not readily available in all locations where they are used, and when they are required, (3) delays in employment are remarkably morbid, and (4) portable. Why didn’t I include tourniquets? They’re frequently used and delays in employment are morbid, but patients typically have them in place on arrival and if not, they are readily available in the trauma bay. Why didn’t I include chest tubes? They are frequently used and delays in employment are morbid, but they are relatively widely available. In addition, the life-threatening physiology of hemothorax or pneumothorax can be resolved with a finger thoracostomy using a scalpel and Kelly (essentially the same process as placing a chest tube, but stopping at the step of a finger sweep in the thoracic cavity, releasing massive hemothorax or tension pneumothorax). Why didn’t I include a REBOA kit? This is a controversial topic. However, in the situation where resuscitative thoracotomy is deferred in favor of REBOA, rapid employment is ideal. However, this device is not frequently used at our facility. Paper clips? In a trauma bag? Yes, paper clips. They are used to mark wounds for creating a road map of the trajectory. What DOESN’T this bag do? This is NOT an all-inclusive bag for responding to all emergencies. It should not be considered a guide for pre-hospital emergency response, non-surgical emergencies, or any situations outside of the specifications reviewed above. There are other response teams in the hospital that have different supplies. For example, we have ICU nurses that respond to rapid response or code blue situations, and they carry critical care transfer bags. I don’t know the list of supplies that they carry, but here is a sample of potential contents of a “transfer bag”. In summary, my trauma bag is focused on specific needs that I perceived based on my daily work at my facility. If you perceive a need for a similar tool at your facility, I would encourage you to develop a supply list tailored to your needs. Trauma Bag- Supply List Personal Protective Equipment Blue gown, non-sterile (2) Medium gloves Mask with eye shield (1) Sterile Supplies for Procedures Pack of blue towels (1) Stapler (1) Sterile gown (1) Small Chloraprep (2) Laceration tray (1) Dressings and Hemostatic Agents Gauze, 4x4 (2) Surgicel, 2 in x 3 in (4) Quik-Clot, 3 in x 4 yds (3) Kerlix, 3.4 in x 3.6 yds (3) Kerlix, 4.5 in x 4.1 yds (1) Coban, 4 in x 5 yds (1) Large Tegaderm (4) Sutures and Instruments #1 Ethibond, curved needle (8) #0 Silk, straight needle (4) #0 Silk, curved needle (1) #2-0 Silk, curved needle (2) #2-0 Vicryl, curved needle (5) Skin stapler (1) Adsons (1) Kelly clamp (2) Needle driver (1) Laceration tray (1) Scalpel #10 (1) Scalpel #11 (1) Miscellaneous Cotton tip applicators (3) Tongue Depressors (2) Paper clips Disclaimer: This was created early in the pandemic, while I was a fellow at a different institution. Previous Next

< Back Who is on the Trauma Team? This can vary by institution and by the severity of the anticipated trauma (Code 1 or 2, etc), but I have an tried to include all the potential participants. Please note, all members of the team are crucial to an effective and timely resuscitation. Roles and Responsibilities - Team leader- directs/ coordinate the trauma resuscitation. Typically stands at the foot of the bed so they can see the whole picture. Assist when advanced procedures are indicated, such as resuscitative thoracotomy. This role can be filled by a member of the surgery or emergency medicine team (chief resident). - Primary examining provider- performs primary/ secondary survey. Perform interventions including chest tubes, central lines. This role can be filled by a member of the surgery team or emergency medicine team (intern, resident, APP). - Airway- this role can be filled by a member of the emergency medicine team (senior resident) or anesthesia (CRNA, anesthesiologist). - Nursing- establish intravenous access, draw blood for labs, place monitors, administer medication, place foley catheter. - Writer/ scribe- creates chronological record of interventions (medication, procedures), exam findings announced by the examining physician. - Respiratory therapist- assist with establishing mechanical ventilation if needed. - Radiology technician- assists with obtaining rapid portable images. Other team members - Trauma attending- support the trauma chief, ultimately in charge of critical decisions such as proceeding to the operating room. - Trauma/ ACS fellow- functions as junior faculty, training to fill the role of trauma attending. - Emergency Medicine attending- support the emergency medicine residents, whichever role they are filling (airway, team leader, procedures, FAST). Previous Next

< Back Abdominal Pain- Renal Disease A 72-year-old male with multiple medical co-morbidities presents with several weeks of right-sided abdominal pain. His family reports he hasn't been eating or drinking much. He has a slightly altered mental status and was unable to provide any more detailed history of his symptoms, such as aggravating/ alleviating factors or the relationship of his pain to meals. His medical history is significant for poorly controlled diabetes with neuropathy and renal insufficiency. He has not seen a primary care provider in over 6 months. On exam, he is uncomfortable but not in acute distress. His heart rate is in the 100s, and his blood pressure is normal. He is febrile to 101. He has dry mucous membranes. He has tenderness in the right upper quadrant with a positive Murphys sign. His exam was otherwise unremarkable. Workup? Imaging- right upper quadrant ultrasound Laboratory evaluation- CBC, basic metabolic panel, AST/ALT, bilirubin His labs are remarkable for mild leukocytosis and an elevated Cr (baseline 1.2, currently 2). Imaging was remarkable for cholelithiasis and gallbladder thickening. The EGS team is consulted and the patient is admitted to the surgical ICU given his acute on chronic renal insufficiency. What are the possible etiologies of his renal insufficiency and the initial treatment strategies based on the underlying cause? Pre-renal causes, such as hypovolemia, lead to decreased renal perfusion. Treatment involves volume repletion. Intra-renal causes, such as medication and acute tubular necrosis from sepsis, requires treatment of the underlying cause concurrent with volume repletion, treatment of electrolyte derangements and avoiding further nephrotoxin exposure. Post-renal causes, such as kidney stones or foley catheter malfunction, require relief of the obstruction. Based on the patient's history of decreased oral intake, he is at risk for acute hypovolemia, which can worsen his baseline chronic renal insufficiency. He was treated with volume resuscitation and close monitoring of his urine output. When should he undergo cholecystectomy? If cholecystitis was the precipitating cause, he would likely continue to worsen if his surgery was postponed. If hypovolemia was the precipitating cause, it would benefit from volume resuscitation, which can be administered throughout the operative course. If his renal insufficiency was not an acute change, and it was a slow decline since his last clinic visit, it was unlikely to significantly improve in a short time. The ICU team, EGS team and anesthesiology discussed the risks versus benefits of proceeding with surgery. Regardless of the etiology, postponing his surgery would be unlikely to improve his operative risk profile. We proceeded with laparoscopic cholecystectomy, and he returned to the ICU postoperatively for ongoing resuscitation and monitoring. Management of Renal Failure The causes of renal failure can be categorized into pre-renal, intra-renal, or post-renal. Acute infection can precipitate renal insufficiency, which is associated with poorer outcomes. Pre-Renal Caused by hypovolemia (dehydration) from decreased intake, nausea/ vomiting, excessive diuresis, third-spacing from acute inflammatory processes (pancreatitis), blood loss, inadequate replacement of insensible losses. The common final etiology in pre-renal causes is decreased renal perfusion. Treatment- volume replacement. Intra-Renal Multiple different intra-renal causes, including vascular or micro-vascular etiologies, glomerular disease, and interstitial disease (acute tubular necrosis, medications, and various precipitates such as myoglobin and crystals). The most common acute causes are medication and ATN from ischemic/ sepsis. Treatment involves management of the underlying etiology and supportive care. Post-Renal Caused by any obstruction from the renal pelvis to the urethra, including kidney stones, malignancy (can obstruct anywhere from the ureter to the bladder), retroperitoneal fibrosis, prostate enlargement, blood clots in the bladder or foley catheter malfunction. Treatment involves relief of the obstruction. Acute Cholecystitis with Renal Dysfunction Diabetes and severe cholecystitis (Grade III- organ dysfunction) are risk factors for increased mortality in patients with acute cholecystitis.[1] As noted in the discussion above, it is crucial to weigh the risks and benefits of operative intervention. If there is a modifiable risk factor, such as an acute cardiac event that is amenable to intervention. Escartin A et al. Acute Cholecystitis in Very Elderly Patients: Disease Management, Outcomes, and Risk Factors for Complications. Surgery Research and Practice. 2019;2019:9709242. Previous Next

6 < Back EGS Resources Society Guidelines EAST Practice Management Guidelines. Evidence-based guidelines developed and published by EAST. Covers EGS, ICU, trauma, and injury prevention. World Society of Emergency Surgery (WSES). Guidelines and reviews covering topics including trauma, pancreatitis, colitis, cholecystitis, and large bowel malignancy, and many others. American Society of Colon and Rectal Surgeons (ASCRS) Clinical Practice Guidelines. Guidelines on common colo-rectal diseases such as diverticulitis, preoperative bowel preparation, hemorrhoids, and colorectal cancer. Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Guidelines and Clinical Reviews. Guidelines include cholecystitis, ERAS protocol, choledocholithiasis, laparoscopy, to name a few. American Society for Gastrointestinal Endoscopy (ASGE). Evaluation, diagnosis and management of patients undergoing GI endoscopy. Previous Next

< Back Common Conditions Trauma and ICU Patient education: Preventing infection in people with impaired spleen function (Beyond the Basics) For patients who have had their spleen removed (typically related to trauma) Patient education: Pulmonary embolism (Beyond the Basics) Also known as a blood clot in the lung or PE. Disclaimer from UpToDate (included at the end of every patient handout) [This generalized information is a limited summary of diagnosis, treatment, and/or medication information. It is not meant to be comprehensive and should be used as a tool to help the user understand and/or assess potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider's examination and assessment of a patient's specific and unique circumstances. Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. UpToDate, Inc. and its affiliates disclaim any warranty or liability relating to this information or the use thereof. The use of this information is governed by the Terms of Use, available at https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms ©2022 UpToDate, Inc. and its affiliates and/or licensors. All rights reserved.] Previous Next

How to be a Terrible First Date Dating, Pt 1 How to be a Terrible First Date I've been dabbling in the world of online dating for years. Some dates have been more successful than others. But until this point, I've always had pleasant encounters. That all changed with my last couple of dates. I've been shocked to discover how different people can behave in public compared to the persona they project via text. I always imagined people would be more reckless in their text and more personable in real life. Oh, how wrong I was… My first date was a few months after I moved to town. We video chatted a handful of times before we met, and he seemed like a nice normal guy. The first clue should have been when he told me he had a lawsuit against him related to a business deal. I'm too trusting and gave him the benefit of the doubt. So…what went wrong? First, he spent the beginning of the date asking me leading judgmental questions. How many guys have I dated/ slept with, etc, etc. He proceeded to tell me I was promiscuous (really? I've dated like 7 people and I'm 35 years old). Next, he proceeded to discuss pornography and sexual preferences. Then he asked whether I thought people could know each other if they don't live together before getting married, and he told me I was wrong when I said yes. Next, he insinuated that he didn't believe that I'm a surgeon. Weird, but whatever. He went on to Google me in front of me. Like, legit. Probably spent about 10 minutes staring at his phone while I ate my dinner. A couple times I told him he should probably pay attention to the person who took time out of their day to come to meet him… Then he decided to tell me he didn't believe I was Hispanic because Hispanic women wear a lot of makeup. He found a picture from a few years ago when I was applying for a job and told me if I put in some effort, I could look better. I told him I'm so much more than my appearance, and I don't value myself based on looks. After a complete shitshow for the first half, I told him I'd give him a chance to start over and consider a different approach. I gave him the benefit of the doubt that he was just nervous. Unfortunately, he didn't adjust his approach in the second half. He then told me more details about his legal issues. Seriously, he spent a year in a work camp for white-collar criminals. He reminisced about the friends he made and the work he did. I had a hard time keeping a straight face. And the cherry on top of the terrible date? He lied about his height. He wasn't 5'6. I'm 5'3 and he didn't have an inch on me. Note- I'm not against short guys. I AM against guys who lie about their height. Don't be that guy. *Note- Grammarly assessed the tone of this post as "sad" and "disapproving". I'm impressed. Previous Next

10 < Back Research Resources Literature Search PubMed . National Library of Medicine, database to search for biomedical and life sciences literature. Cochrane Library . Leading journal and database for systematic reviews in health care. For a more extensive list of surgical and critical care references, please see Medical Literature . References Zotero . Free computer program that organizes all your medical literature. Highly recommend. You can create folders and add tags to help index your documents. If you want to sync your documents across devices (phone, tablet, etc), you can purchase a storage subscription. 2 GB costs $20/ year, 6 GB costs $60/ year and $120/ year gives you unlimited data storage. Tools and shortcuts in Zotero: Automatically add articles from any electronic resource (PubMed, journal website, etc). Easily tag and sort documents into categories to help easily locate articles on a particular topic. Search your entire database of documents for any author, title, year of publication, and journal source, and perhaps most usefully- search for any individual words to find a comprehensive list of documents that address a particular topic. There is a note panel on the right side of the document that allows you to type a note while reading the article. Automatically create a note from the text you highlight while reading an article. Alternatively, if you choose to type your own notes, you can also highlight text and add a single highlighted section to the note. EndNote . Free application that simplifies citation management. Use Cite While You Write to embed references while writing manuscripts. Data Analysis Covidence . Systematic review management program. It requires a subscription. GraphPad QuickCalcs . I do NOT endorse this as the most reliable/ valid/ precise options for doing statistics. HOWEVER, I have used it for simple calculations and it always matches or is incredibly close to what my formally trained statistician reported. PubMed . National Library of Medicine, database to search for biomedical and life sciences literature. Cochrane Library . Leading journal and database for systematic reviews in health care. Research Manuscript Submission Manuscript Title Page Template .docx Download DOCX • 49KB Manuscript Cover Letter Template .docx Download DOCX • 49KB Previous Next

< Back C dificle Colitis...pending Management of Clostridium Difficle Colitis Previous Next

2 < Back Operating General Surgery Texts Chassin's Operative Strategy in General Surgery: An Expositive Atlas. 5th Edition, 2022. Zollinger's Atlas of Surgical Operations. 11th Edition, 2021. Operative Dictations in General and Vascular Surgery. 2012. Acute Care Surgery Texts Operative Techniques and Recent Advances in Acute Care and Emergency Surgery (Aseni). 1st edition, 2019. Surgical Decision Making in Acute Care Surgery. Atlas of Trauma/Emergency Surgical Techniques. Top Knife (Mattox). 1st edition, 2004. High yield of trauma operative management. Back to the basics. Atlas of Surgical Techniques in Trauma (Demetriades). 2nd edition, 2020. Anatomic Exposures in Vascular Surgery (Wind). 3rd edition, 2013. Key anatomic exposures for less commonly encountered injury patterns. Recommended by Dr. Feliciano at AAST 2020 Conference. Videos Surgical Stabilization of Rib Fractures and Cryoablation. Collection of videos of different surgical approaches. WebSurg. Free access to expert videos of minimally invasive surgery. Highly recommend. The Toronto Video Atlas of Surgery. Free access to expert videos of GI operative procedures. [Reference courtesy of EJS @ElliotJScottMD] Difficult Cholecystectomy: A learning module for laparoscopic cholecystectomy How to Tie Knots Like a Heart Surgeon How to Secure Chest Tubes (Soweto Tie) Previous Next

8 < Back Continuing Med Ed (CME) National Organizations American Association for the Surgery of Trauma [Must log-in to access] Journal of Trauma and Acute Care Surgery articles Archived AAST Virtual Grand Rounds Certain Annual Meeting Master Surgeon Lectures and topic-specific presentations Region VII Sessions Critical Care Committee Journal Reviews American College of Surgeons Journal of the American College of Surgeons [Must log-in to access] Surgical Education and Self-Assessment Program (SESAP®) [$685 for 168 CME credits] Training Courses ATLS Traditional Student Course - 16 AMA PRA credits BEST, ATOM, ASSET ACLS, PALS Annual Medical Conferences Other Sources UpToDate Local conferences at your facility (Morbidity and Mortality, Grand Rounds, etc) Military training courses Previous Next