The Intentional Surgeon with Sharon L. Stein, MD

In this episode of The Intentional Surgeon, Dr. Sharon Stein speaks with Gil Spitz—former classical musician, athletic training specialist, and founder of Surgical Strong. They reframe surgical practice as high-performance endurance athletics, explore modality-specific physical strains (open, laparoscopic, and robotic), and break down actionable strategies to prevent chronic pain and extend surgical career longevity.Key TakeawaysSurgeons as Precision Athletes: Operating requires holding asymmetric, isometric postures for hours. Maintaining fine motor control under this physical strain demands task-specific strength training rather than generic fitness.Modality-Specific Strains & SolutionsOpen Surgery: Demands strong posterior spinal muscles and unilateral hip stability to offset weight-shifting onto the non-dominant leg.Laparoscopic Surgery: Drives severe shoulder, trapezius, and elbow strain when working away from the midline.Robotic Surgery: Seated positioning removes gluteal/core engagement, creating spinal compression and pelvic twisting from asymmetrical pedal use.Intraoperative Micro-Breaks: Taking a 90-second micro-break every 60–90 minutes flushes metabolic waste, restores muscle perfusion, and preserves fine motor precision during long procedures.Active Recovery & Down-Regulation: True physical recovery requires actively shifting out of sympathetic "fight-or-flight" mode post-op to allow muscles and connective tissue to heal.Featured Quotes"Surgeons are precision athletes. There's nothing more athletic than using deep kinesthetic knowledge to recreate specific, precise physical outcomes inside another human being." — Gil SpitzLearn more at www.surgicalstrong.com

Surgery is a team sport, yet many departments operate as isolated individuals sharing a call schedule. In this episode of The Intentional Surgeon, Dr. Sharon Stein welcomes Dr. Faisal Aziz (Chief of Vascular Surgery at Penn State Health) to discuss how his division built a true "one team" culture where surgeons stay long-term and support each other at 2 AM.Key Discussion Points:The Recruitment Post That Sparked the Call: Why Penn State’s group stands out as a unified team rather than a collection of independent contractors.Culture Eats Strategy: Applying Peter Drucker's rule and Jim Collins’ Good to Great framework to surgical leadership.Hiring for Character First: Why technical skills can be taught, but integrity and humility cannot.Uncovering True Culture: Practical strategies for applicants to assess a department's real culture—from observing how staff are treated to Dr. Julie Freischlag’s "3-second pause" technique.Vulnerability in the OR: How senior leaders asking for help builds psychological safety, breaks down ego, and improves patient care.Cross-Generational Skill Exchange: Bridging the gap between open-operative mastery and modern endovascular/robotic techniques through mutual mentorship.Featured Quote:"I can teach surgeons how to do complicated operations. What I cannot teach is how to be kind, or how to have character and integrity. It is much easier to hire for character and invest in technical growth than to hire competence without integrity." — Dr. Faisal Aziz

Technical prowess and clinical knowledge are the bedrock of any surgical career, but they are only two pieces of the puzzle. The third—and arguably most impactful—element is communication. Despite its outsized influence on resident evaluations, operating room efficiency, and patient outcomes, intentional communication is rarely explicitly taught in medical school or residency programs.In this episode of The Intentional Surgeon, Dr. Sharon Stein breaks down why communication isn't just a "soft skill," but a critical clinical tool. Dr. Stein also introduces The Launchpad, a new program designed to empower graduating residents with the communication, prioritization, and negotiation skills needed to navigate high-stakes career decisions.In This Episode:The Communication Gap: Why attendings often complain about consults or presentations due to formatting and communication disconnects rather than a lack of clinical knowledge.Decoding Communication Styles:The Punchline First: High-yield communicators who need the core verdict up front (e.g., Do I need to check a box, get out of bed to operate, or listen closely to offer expertise?).The Logical Processors: Thinkers who require a structured, step-by-step chronology.The Relational Communicators: Team members who build rapport through personal connection before diving into clinical details.The Power of the Open-Ended Intake: Why asking new patients "In your own words, what is going on with you?" unlocks crucial insights into both their communication style and their baseline understanding of their diagnosis.Building Trust Through Airtime: How allowing patients and colleagues to speak uninterrupted for the first minute fosters psychological safety and accelerates clinical trust.Mirroring to Meet Needs: How recognizing a patient’s need to process information slowly allows you to adapt your delivery style, reducing anxiety around difficult diagnoses.Continuous Skill Acquisition: Why seasoned surgeons can and should learn new communication models just as they learned laparoscopic or robotic techniques mid-career.The Launchpad: A dedicated 6-month program equipping graduating residents and fellows with essential tools in communication, prioritization, and negotiation as they navigate their first job search and career launch.Key Takeaway:"We spend years perfecting our technical craft, yet so much of our daily success hinges on how effectively we communicate. When you learn to deliver information in a way that aligns with how the other person’s brain processes it, you transform your relationships with your residents, your OR teams, and your patients. Communication isn't a fixed personality trait—it's a learnable surgical skill." — Dr. Sharon SteinResources:The Launchpad Program: A 6-month, interactive coaching initiative starting this September for graduating residents and fellows looking for their first surgical position. Learn how to identify your priorities, master negotiation, and communicate effectively to land in a practice environment where you will thrive. Register here.

Surgeons operate in a high-stakes, highly penalized environment where mistakes carry immediate, human consequences. As a result, surgical culture has traditionally been deeply risk-averse, favoring short-term event tracking over long-term process evolution. But in an era driven by generative AI, non-linear thinking, and shifting generational values, how do we advance the craft without compromising safety?In this episode, Dr. Sharon Stein sits down with Dr. Julio Mayol, Professor of Surgery at the University of Madrid, Chief of General Surgery at Hospital Clínico San Carlos, and Scientific Director of the San Carlos Health Research Institute. Dr. Mayol pulls back the curtain on his "crazy ideas" for surgery, explaining why the future of the field relies not on doing more volume, but on mastering the hard skill of communication, fostering organizational trust, and embracing simulation over fear.In This Episode:The Fear of Innovation: Why surgeons are trained to reduce variance and noise, making the profession hesitant to re-evaluate established practices even when long-term outcomes remain unknown.Overcoming Inertia with Generative AI: How advanced simulation tools allow surgeons to test complex, non-linear realities before stepping into the operating room—drawing parallels to how aerospace engineers test aircrafts.Cognitive Biases and M&M Culture: Moving away from punitive "find the guilty party" morbidity and mortality conferences to evaluating near-misses, structural complexity, and systemic learning opportunities.The Myth of the "Soft Skill": Why communication is actually the single hardest clinical skill in surgery, acting as a crucial filter against cognitive overload and a prerequisite for medical trust.Redefining Professional Incentives: Challenging the "industrial revolution" mindset where volume, RVUs, and paper counts define success, and shifting toward metrics based on patient-reported outcomes, social capital, and collaborative networks.The "If It's Difficult, You're Doing It Wrong" Philosophy: Examining how alignment, clarity, and deep, deliberate thinking eliminate unnecessary friction in surgical education and clinical practice.Humanities as Table Stakes: Why treating surgery merely as a technical, reproducible task leaves clinicians vulnerable to automation, whereas embracing the deeply human aspects of medicine protects both patient and surgeon well-being.Key Takeaways:"Healing starts with communication. Communication is not a soft skill—it is the hardest skill for surgeons. When we operate solely as technical machines doing reproducible tasks, we miss the entire point of our craft. If we act like machines, we should be replaced by machines. Medicine is deeply human, and we must measure our value by how we transform practice and improve lives, not just by how much volume we accumulate." — Dr. Julio MayolKey Concepts:Trust isn't created by saying "yes" to everything; it's built on coherence—doing what you say, saying what you do, and clearly explaining the "why" when you must say "no."Healthy clinical and research teams actively include voices that challenge authority and question established norms to prevent groupthink.Recognizing when an administrative or clinical role no longer provides growth (often around the 6–8 year mark) and stepping aside to foster new talent and build collaborative networks.

What does it take to train a modern surgeon? For decades, residency has relied on the "see one, do one, teach one" model. But according to one of the field's leading innovators, technical skill is only a tiny fraction of the job.In this episode, Dr. Sharon Stein sits down with Dr. Patrick Jackson, Chief of General Surgery and the Robert A. Altman Endowed Chair of Surgical Education at MedStar Georgetown University Hospital. Backed by a historic $10 million grant funded by Lynda Carter and the Robert Altman Foundation, Dr. Jackson outlines his vision to dismantle and rebuild surgical training around four core pillars.In This Episode:Residency as a Leadership Track: Why the operating room requires training clinicians to execute irreversible decisions using incomplete data under extreme uncertainty.Recruiting for Character over Research: The five core attributes Dr. Jackson filters for: integrity, compassion, communication skills, work ethic, and team adaptability.The Four Pillars of the Institute:Technical Training: Blending traditional craftsmanship with simulators, Virtual Reality (VR), and AI.Humanistic Leadership: Shifting medicine away from commoditization and "RVU generators" back to human-to-human care.Educational Research: Eliminating fear as a motivator and studying systemic training inefficiencies.Community & Global Engagement: Democratizing surgical access globally while investing directly in local community outcomes.The "Lane Assist" Future of Robotics: How upcoming AI software will mimic vehicle lane assistance—providing real-time haptic and visual feedback to prevent structural errors during complex dissections.Tailored, Flexible Residencies: Proposing a hybrid model where senior residents can customize their rotations—such as deep pelvic work with gynecologists or specialized rural training.NASCAR and Bartenders: Why surgical culture should look outside the medical bubble to learn team efficiency from elite pit crews and human connection from bartenders.Key Takeaway:"The operating room is a place where we're making irreversible decisions based on incomplete data... As medicine has become commoditized, we have started to lose the aspect that you are taking care of another human being. We have to reinvest in human-to-human contact. The only fear a surgical trainee should have is that they aren't going to do their patient well." — Dr. Patrick Jackson