BackTable OBGYN

BackTable

The BackTable OBGYN Podcast is a resource for practicing OBGYN's to learn tips, techniques, and practical advice from their peers in the field. Listen here or on the streaming platform of your choice.

  1. 1 DAY AGO

    Ep. 115 Women’s Health Care Access, Childcare Challenges, & Advances in Adenomyosis with Dr. Kimberly Kho

    From surgery to systems to access, medicine is shaped as much by barriers to care as it is by innovation and the latest techniques. In this episode of BackTable OBGYN, Dr. Kimberly Kho, a complex benign gynecologic surgeon, joins host Dr. Amy Park to discuss her work expanding access to women’s healthcare, including building a surgical program in Hawaii, studying childcare as a barrier to care, and exploring the diagnosis and management of adenomyosis. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction08:35 - Faculty Development in Hawaii12:26 - Childcare as Access Barrier16:20 - Survey and Trial Findings18:10 - Annie's Place Childcare Center24:23 - Childcare Barrier Example25:43 - Applying Community Solutions 27:04 - What Is Adenomyosis30:22 - Diagnosis Strategies Beyond Hysterectomy34:07 - Risk Factors and Age Myths36:03 - Fertility and Pregnancy Risks38:02 - Medical and Surgical Treatments41:20 - Uterine Sparing Procedures45:59 - Closing Thoughts --- More about this episode Dr. Kho discusses her recent transition to the University of Hawaii, where she is building a complex benign gynecology program to serve patients across the state and broader Pacific region. Her work emphasizes faculty development through mentorship, strengthening research infrastructure for generalists, fostering inter-island collaboration, and implementing surgical coaching. She then reflects on her time at Parkland, where she expanded access to minimally invasive gynecologic surgery, demonstrated by a significant reduction in open hysterectomy rates. She also shares how her team identified unmet childcare needs as a major barrier to care, leading to multiple research initiatives, a clinical trial, and ultimately the creation of a five-year, no-cost, onsite childcare center (Annie’s Place) developed through hospital and community partnerships. The episode concludes with an in-depth discussion of adenomyosis, covering its pathophysiology, imaging-based diagnosis, common symptoms, and fertility implications. In the absence of formal guidelines or FDA-approved therapies, Dr. Kho reviews current management strategies, including medical therapy, uterine artery embolization (UAE), and endometrial ablation techniques. --- Resources Childcare needs as a barrier to healthcare among women in a safety-net health systemhttps://pubmed.ncbi.nlm.nih.gov/38886715/ Addressing childcare as a barrier to healthcare access through community partnerships in a large public health systemhttps://pubmed.ncbi.nlm.nih.gov/36261213/ Adenomyosis Pathophysiology, Diagnostic Advances, and Therapeutic Optionshttps://pubmed.ncbi.nlm.nih.gov/41926770/ --- BackTable OBGYN is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health.Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty.► https://www.backtable.com/app

    48 min
  2. 28 APR

    Ep. 114 Endometriosis Surgery Techniques & Challenges with Dr. Laura Ramirez

    Imaging, incisions, and Instagram: Dr. Ramirez on the cutting edge of endometriosis management. In this episode of BackTable OBGYN, host Dr. Mark Hoffman interviews Atlanta-based Complex Benign Gynecology (CBG/MIGS) surgeon Dr. Laura Ramirez about how her practice has shifted toward predominantly endometriosis care, driven in part by social media referrals bringing patients nationwide. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:57 - Introduction02:22 - Mentorship Mission and Career Focus06:13 - Social Media Referrals08:10 - What Is Endo Surgery and Targeted Excision13:27 - Multidisciplinary Care16:53 - Lesions and Adhesions Approach 22:20 - Imaging and Case Triage24:07 - Hysterectomy Expectations27:28 - Going Solo on Bowel Endo31:25 - Team Support and Mentors34:27- Residency Training Gaps40:39 - Call for Help Culture43:07 - Challenging Surgeries 48:10 - Noninvasive Tests and Therapy Limits51:26 - Conclusion --- More about this episode Dr. Ramirez discusses why endometriosis surgery varies by patient, pathology, and surgeon experience. She emphasizes careful symptom-based assessment, recognizing atypical lesions, and setting realistic expectations. The conversation contrasts radical peritoneal stripping with her preference for targeted excision to reduce complications, highlights multidisciplinary management for central sensitization and overlapping bowel/bladder symptoms, and covers imaging triage, robotic vs. laparoscopic approaches, collaborating with colorectal specialists, and diaphragmatic endometriosis as an ongoing surgical challenge. --- BackTable OBGYN is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health.Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

    54 min
  3. 21 APR

    Ep. 113 Managing Surgical Complications with Surgical Coaching & Emotional Resilience with Dr. Joseph Chen

    What if we trained surgeons to recover from complications, not just avoid them? In this BackTable OBGYN episode, Dr. Joseph Chen, a complex benign gynecologic surgeon at Kaiser Permanente and certified surgical coach, joins host Dr. Nicole Faulkner to explore how surgeons process and recover from complications. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction01:15 - Dr. Chen’s Origin Story06:34 - Coaching Framework08:08 - Second Victim Phenomenon10:10 - Four Phases Of Stress15:07 - Managing OR Chaos19:22 - Delegation as Surgeons22:11 - Peer Review Programs25:09 - How Coaching Programs Work30:52 - Timeline After Complications33:16 - Avoiding The Advice Trap35:37 - Debriefing With Residents40:51 - Future of Coaching and AI47:13 - Resolution of Complic --- More about this episode Dr. Chen reflects on a serious complication during his fellowship that exposed an “emotional gap” in surgical training beyond technical solutions. This experience shaped his focus on psychological safety, crisis-management frameworks, and supportive coaching. He outlines the phases following an adverse event, from the initial chaos and cognitive overload to reflection, identity challenges, and resolution. Do these factors influence whether one experiences burnout, survival or growth. This episode also recommends practical strategies such as focused breathing, effective delegation, and simulation training to improve performance under pressure. Dr. Chen discusses the “second victim” phenomenon, reviews data on surgeons’ emotional responses after complications, and emphasizes the importance of allowing time before debriefing. They advocate for peer support, non-punitive systems, and coaching programs to improve surgeon well-being, patient safety, and operating room efficiency. Finally, they explore future roles for AI and video review in surgical learning. --- Resources Medical error: the second victim. The doctor who makes the mistake needs help toohttps://pubmed.ncbi.nlm.nih.gov/10720336/ Dare to Lead by Brené Brownhttps://brenebrown.com/book/dare-to-lead/ Atlas of the Heart by Brené Brownhttps://brenebrown.com/book/atlas-of-the-heart/ The Advice Trap by Michael Bungay Stanierhttps://www.mbs.works/advice-trap-book/#purchase-options --- BackTable OBGYN is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health.Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

    51 min
  4. 14 APR

    Ep. 112 Overactive Bladder Management: Updates and Guidelines with Dr. Jason Kim

    What if we’re waiting too long to offer our OAB patients the treatments that actually work? In this episode of BackTable Urology, Dr. Jason Kim joins host Dr. Anjali Kapur to discuss updates in overactive bladder management and evolving guidelines, including a shift away from rigid stepwise care toward shared decision-making. --- Get the BackTable apphttps://www.backtable.com/app --- Timestamps 00:00 - Introduction03:06 - 2024 AUA/SUFU Idiopathic OAB Guideline07:32 - Patient Experience with OAB11:59 - Beta-3 Agonists vs Anticholinergics15:15 - Botox Counseling and Dosing18:11 - Tibial Nerve Stimulation25:47 - Sacral Neuromodulation32:09 - Cost Burden of OAB39:38 - Evolution of OAB Care41:39 - Future Research Directions --- More about this episode The conversation positions OAB as a clinical diagnosis, supported by focused initial evaluation and selective use of advanced testing, with attention to the emerging role of ambulatory urodynamics. Dr. Kim and Dr. Kapur review management across the care continuum, including behavioral strategies, pelvic floor physical therapy, and pharmacologic options, with consideration of beta-3 agonists in older patients. The discussion also focuses on earlier use of minimally invasive therapies such as intradetrusor Botox and neuromodulation, and how introducing these options sooner may improve follow-up, reduce delays, and help patients achieve symptom control more efficiently. --- Resources The AUA/SUFU Guideline on the Diagnosis and Treatment of Idiopathic Overactive Bladder (2024)https://www.auanet.org/guidelines-and-quality/guidelines/idiopathic-overactive-bladder Anticholinergic Drug Exposure and the Risk of Dementiahttps://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2736353 Randomized trial of percutaneous tibial nerve stimulation versus Sham efficacy in the treatment of overactive bladder syndrome: results from the SUmiT trial https://pubmed.ncbi.nlm.nih.gov/20171677/ Trends in Utilization of Sacral Neuromodulation for Overactive Bladder: Insight From the AUA AQUA Registryhttps://www.auajournals.org/doi/10.1097/UPJ.0000000000000916 A retrospective longitudinal evaluation of new overactive bladder patients in an FPMRS urologist practice: Are patients following up and utilizing third-line therapies?https://pubmed.ncbi.nlm.nih.gov/33197059/ --- BackTable OBGYN is the go-to podcast for gynecologists, gynecologic surgeons, and other healthcare professionals focused on women’s health.Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

    45 min
  5. 31 MAR

    Ep. 110 Integrated Healthcare & Minimally Invasive Hysterectomies with Dr. Eve Zaritsky

    What happens when a fully integrated healthcare system aligns training, data, and access to improve surgical outcomes? In this BackTable OBGYN episode, Dr. Eve Zaritsky joins hosts Dr. Mark Hoffman and Dr. Amy Park to discuss how Kaiser’s integrated health system enables rapid care coordination, large-scale quality improvement, and population-level research using one of the largest US datasets. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 01:17 - Introduction 03:35 - How Kaiser Works07:24 - Research Using Big Data09:19 - Changing Hysterectomy Culture13:36 - Ending Racial Disparities15:22 - Handling Large Uteri17:52 - Vaginal Hysterectomy Trends20:38 - Myomectomy Reintervention Rates24:23 - Shared Decision Making26:30 - Mini Lap Versus Robotic27:41 - Hybrid Extraction Strategy29:08 - Credentialing Robotic Myomectomy30:19 - MIG Referral Pathways32:03 - Fibroids Across Asian Subgroups34:55 - Mentoring Research Pipeline36:44 - Funding Analysts Through GME40:49 - Endometriosis Disparities Findings43:59 - Mentorship Mindset --- More about this episode Dr. Zaritsky describes how a coordinated, system-wide effort transformed hysterectomy care, shifting from 80% open procedures to nearly 90% minimally invasive within five to eight years through focused training, reducing low-volume practice, and tracking system metrics, ultimately decreasing racial disparities once minimally invasive rates exceeded 90%. She also highlights Kaiser-based research on variation in vaginal hysterectomy by service area and surgeon volume, long-term reintervention rates for fibroids across procedures, increasing use of minimally invasive myomectomy, and a JAMA analysis showing differences in fibroid diagnosis among Asian subgroups with the highest rates in South Asians. The episode concludes with Dr. Zaritsky calling attention to how Kaiser’s research infrastructure creates robust opportunities for meaningful mentorship across all levels of training, supporting the development of physicians, residents, and medical students. --- Resources Minimally Invasive Hysterectomy and Power Morcellation Trends in a West Coast Integrated Health System https://pubmed.ncbi.nlm.nih.gov/28486359/ Racial Disparities in Endometriosis and Pelvic Pain Treatment Within an Integrated Health Care Delivery System https://pubmed.ncbi.nlm.nih.gov/40839882/ Uterine Fibroid Diagnosis by Race and Ethnicity in an Integrated Health Care Systemhttps://pubmed.ncbi.nlm.nih.gov/40172885/

    49 min
  6. 24 MAR

    Ep. 109 Hereditary GYN Cancer Syndromes: Practical Screening & Risk-Reduction Guide with Dr. Marcia Ciccone

    When to test, how to prevent, and what you need to know about hereditary gynecologic cancer syndromes. Two USC gynecologic oncologists, Dr. Mona Guo and Dr. Marcia Ciccone, go in-depth in this BackTable OBGYN x Tumor Board crossover episode. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction01:37 - Why Hereditary Cancer Matters04:51 - Family History Red Flags09:01 - Who Should Order Genetic Testing11:32 - Variants and Counseling Pitfalls13:30 - Access and Remote Testing Options19:27 - BRCA1 Positive Patient Walkthrough24:52 - Risk-Reducing Surgeries29:11 - Prevention and Screening Limits32:38 - Why Ovarian Cancer Is Hard34:04 - Combining Breast and Gyn Surgery35:41 - Preop Ultrasound and CA-12536:27 - BRCA Timing and HRT Nuance42:32 - Nonhormonal Menopause Options47:14 - Lynch Syndrome Screening Basics54:22 - Endometrial Biopsy Debate56:43 - Insurance and Coverage Pitfalls59:00 - Fertility Preservation and REI01:01:41 - Cascade Testing01:02:45 - Conclusion --- More about this episode Dr. Guo and Dr. Ciccone discuss how careful family history can identify patients who may benefit from genetic evaluation and highlight key red flags, including a family history of ovarian cancer, breast cancer at age 50 or younger, and metastatic prostate cancer. They explain the role of genetic counseling, including pre- and post-test discussions and how to approach variants of uncertain significance. They then cover BRCA counseling and risk-reduction strategies, including the timing of risk-reducing bilateral salpingo-oophorectomy, ongoing salpingectomy trials, and considerations for hysterectomy. Additionally, they touch on pathology protocols, breast cancer screening, and the potential protective effect of hormonal contraception. The doctors address the limitations of ovarian cancer screening and outline patterns suggestive of Lynch syndrome, such as endometrial cancer occurring alongside gastrointestinal or urinary tract cancers. They review the Lynch workup, including tumor mismatch repair immunohistochemistry and MLH1 hypermethylation testing. Finally, they discuss practical considerations like barriers to access, Medicare coverage challenges, fertility preservation referrals, menopause management, and cascade testing in families, including the timing of testing in children. --- Resources NCCN Guidelines: Detection, Prevention, and Risk Reductionhttps://www.nccn.org/guidelines/category_2

    1hr 6min
  7. 10 MAR

    Ep. 108 Treating Urogynecologic Frailty: Perioperative Strategies for Surgeons with Dr. Mary Ackenbom

    As our patients' age progresses, so should our definition of 'recovery'. In this episode of BackTable OBGYN, Dr. Mary Ackenbom, associate professor of urogynecology and reconstructive pelvic surgery at the University of Michigan, is welcomed by host Dr. Amy Park to discuss improving outcomes for older surgical patients. --- SYNPOSIS Dr. Ackenbom shares her journey from studying finance at Ohio State to ultimately specializing in urogynecology. The conversation mainly focuses on perioperative cognitive health, particularly in aging populations, and how conditions like frailty and comorbidities impact surgical risk and recovery. Dr. Ackenbom highlights the importance of individualized patient care, early mobility, enhanced recovery protocols, and prehabilitation in improving postoperative outcomes. The episode also explores the prevalence of postoperative cognitive decline and offers practical insights on counseling and managing older patients undergoing urogynecologic surgery. --- TIMESTAMPS 00:00 - Introduction02:18 - Dr. Ackenbom’s Journey to Urogynecology04:47 - Research on Brain Fog06:18 - Personal Support and Hobbies09:54 - Age vs Frailty in Surgery13:05 - Procedures with Perioperative Complexity16:11 - Counseling on Operative Risk20:10 - ERAS and Earlier Discharge23:35 - Patient Goals and Tradeoffs27:53 - Surgical Clearance and Preop Consults33:30 - Prehabilitation Basics36:24 - Minimally Invasive Surgery Benefits37:15 - Surgical Cognitive Complications with Age41:42 - Finding the Surgery Window46:05 - Cognitive and Frailty Screening50:01 - Guidelines for Perioperative Care52:52 - Future Research 54:07 - Conclusion --- RESOURCES Incidence of postoperative cognitive dysfunction in older women undergoing pelvic organ prolapse surgeryhttps://pubmed.ncbi.nlm.nih.gov/32827107/ ACS NSQIP/AGS Optimal Perioperative Care of the Geriatric Patienthttps://www.facs.org/media/y5efmgox/acs-nsqip-geriatric-2016-guidelines.pdf

    56 min

About

The BackTable OBGYN Podcast is a resource for practicing OBGYN's to learn tips, techniques, and practical advice from their peers in the field. Listen here or on the streaming platform of your choice.

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