Wellness in Residency: A Paradigm Shift

There has been a cultural shift in the state of residency training over the past two decades. While the traditional view of trainees heavily emphasized the service component of residency, training programs are gaining an increasing awareness of the trainees’ well-being as crucial to their functioning, the success of the training program, and ultimately, to the care of patients. To this end, work-hour limitations have been imposed universally. Additionally, some programs have established interventions that allow residents to lead balanced lives with emphasis on time away from work, sleep, and outside activities. A paradigm shift recognizing the importance of wellness in residency may reduce the risk of physician burnout in the long term

Esophageal Stenting in the Setting of Malignancy

Esophageal cancer is often diagnosed at an advanced stage, with many patients found to have locoregional or metastatic disease at time of diagnosis. Because of this, cure may be unlikely, leading treatment efforts to focus more on symptom palliation and improving patient quality of life. The majority of patients with advanced disease suffer from some degree of dysphagia. Palliative efforts are therefore directed at relieving dysphagia, allowing patients to manage their oropharyngeal secretions, reduce aspiration risk, and maintain caloric intake orally. A variety of endoscopic treatment modalities have been utilized with these objectives in mind, with options determined by the location and size of the tumor, as well as the patient's expected prognosis. In this article, we review the use of endoscopically-placed stents for palliation in patients with advanced esophageal cancer. We discuss the history of stent use in such cases, as well as more recent developments in stent technology. We give an overview of some of the more commonly used stents in practice, discuss the technique of insertion, and survey the short- and long-term outcomes of stent placement

Surgical Education in the 21st Century

Surgical education has evolved drastically since the 19th century. Previously education of surgical residents was limited to on job clinical training following the “see one, do one, teach one” model with knowledge gleaned from textbooks and journals. Presently a growing emphasis has been placed on both patient safety and resident well-being leading to a development of novel training paradigms. The textbook, while remaining a core source of knowledge, is now only one of many resources available to residents. Many residencies have their libraries online, making learning possible almost anywhere, even without physical books in hand. Most programs now incorporate education days where a structured curriculum allows for standardized education; this makes it less likely that residents miss out on mandatory concepts. The 2020 Covid-19 pandemic has led to further evolution of this model, making the classroom virtual yet interactive. Technology has allowed for residents to train on surgical simulators, so that laparoscopic and robotic skills may be practiced before application on a live patient. Altogether residents are afforded multiple ways to learn due to greater availability of time, structured educational modules, and technology

To Treat or Not to Treat: The Role of Adjuvant Radioiodine Therapy in Thyroid Cancer Patients

Radioactive iodine (RAI) is used in treatment of patients with differentiated papillary and follicular thyroid cancer. It is typically used after thyroidectomy, both as a means of imaging to detect residual thyroid tissue or metastatic disease, as well as a means of treatment by ablation if such tissue is found. In this paper, we discuss the indications for and the mechanisms of RAI in the treatment of patients with thyroid cancer. We discuss the attendant risks and benefits that come with its use, as well as techniques used to optimize its effectiveness as an imaging tool and a therapeutic modality