The utilization of podcasts and other free open access medical

education resources in vascular surgery

Adam P. Johnson, MD, MPH,a and Sharif Ellozy, MD,b Durham, NC; and New York, NY

ABSTRACT
Vascular surgery is a dynamic and complex specialty that requires many years of training and lifelong learning. Traditional
education methods may not be sufficient to meet the needs and preferences of learners in this field. Podcasting and
other free open-access medical education online materials may provide innovative tools to deliver up-to-date, evidence-
based information in an accessible and entertaining format. Many free resources have been developed in the past few
years and are now available to vascular surgery learners. The Audible Bleeding podcast is the first and largest podcast in
the United States dedicated solely to vascular surgery education. The Society for Vascular Surgery is the leading pro-
fessional organization for vascular surgeons, with a mission to advance excellence and innovation in vascular health. The
Society for Vascular Surgery and the Audible Bleeding podcast have established a successful collaboration that enhances
the podcast’s quality and promotes the society’s mission and vision. (JVS-Vascular Insights 2024;2:100091.)
Keywords: Education; Podcast; Video; Free open access medical education; Vascular surgery

The complexity and quantity of medical knowledge in
vascular surgery is rapidly expanding. In 2011, Peter Den-
son projected that, by 2020, medical knowledge more
broadly would double every 73 days, up from every 7
years in 1980.1 To add to this, burnout and stressors are
at an all-time high for health care workers in vascular sur-
gery, particularly those in training.2,3 Trainees need more
efficient and engaging educational resources to comple-
ment their clinical learning environment. Many institu-
tions that service the most complex patients often have
the fewest resources to purchase educational materials
for their faculty, staff, and learners. Therefore, medical
learners often turn to free educational sources through
social media, websites, videos, and podcasts.
Podcasts are streaming audio and digital media avail-
able for free across various devices. Podcasting and video
streaming have been increasingly used for medical edu-
cation, as they offer several advantages over traditional
methods, such as flexibility, accessibility, and enhanced
From the Division of Vascular Surgery and Endovascular Surgery, Department
of Surgery, Duke University School of Medicine, Durhama; and the Division
of Vascular Surgery, Department of Surgery, Weill Cornell School of Medicine,
New York.b
Correspondence: Adam P. Johnson, MD, MPH, Division of Vascular Surgery and
Endovascular Surgery, Department of Surgery, Duke University School of
Medicine, 2301 Erwin Rd, Durham, NC 27710 (e-mail: adam.johnson@duke.
edu).
The editors and reviewers of this article have no relevant financial relationships to
disclose per the Journal policy that requires reviewers to decline review of any
manuscript for which they may have a conflict of interest.
2949-9127
Copyright Ó 2024 Published by Elsevier Inc. on behalf of the Society for
Vascular Surgery. This is an open access article under the CC BY-NC-ND li-
cense (http://creativecommons.org/licenses/by-nc-nd/4.0/).
https://doi.org/10.1016/j.jvsvi.2024.100091
engagement. Vascular surgery is a specialty that requires
constant updating of knowledge and skills, as well as
effective communication and collaboration among prac-
titioners. A recent review found podcasts noninferior to
traditional educational resources when examining med-
ical knowledge retention across several studies.4 Pod-
casts provide an efficient and portable educational
resource allowing trainees to study during unproductive
periods, such as commuting. This may allow for
increased free time and decrease burnout among
trainees.5
Podcasts are being used as educational resources
across many medical specialties. Emergency medicine
and internal medicine residencies have described incor-
porating podcasts into their formal curricula.4 The adop-
tion of podcasts for education has increased over time
across many specialties. A survey in 2007 found that
60% of trainees thought that podcasts played no role
in professional development.6 In contrast, a more recent
study in 2015 of Canadian emergency medicine residents
found that 90% used podcasts, which were found to be
in the “top 3 resources most contributing to a resident’s
education.”7 Podcasts have been termed “edutainment,”
providing educational content in an engaging and
easy-to-listen format.8
Many podcasts and free online resources exist for
vascular surgery. Individual surgeons or trainees, training
programs, hospitals, or medical schools publish and main-
tain some of these resources. National organizations, pro-
fessional societies, or industry partners support others.
One of the most popular sources of video content is the
Houston Methodist DeBakey CV Education YouTube
channel, with >100,000 subscribers and 2,600 videos.9
They provide high-quality, free lectures, procedural videos,

1
2 Johnson and Ellozy
and expert interviews. Another repository of curated on-
line content can be found at vasculartraining.org.
Although this is a free resource, it requires a password.
Many other vascular surgery-related podcast episodes
are on Life of Flow, European Society for Vascular Surgery,
Behind the Knife, and BackTable Podcasts.10e13 Sutzko
et al14 describe developing and implementing a crowd-
sourced vascular surgery handbook using Microsoft One-
Note at two vascular surgery training programs.
However, this resource is not available outside of these
programs. This article aims to highlight the use of podcast-
ing for medical education, particularly in vascular surgery,
by presenting a case study of the Society for Vascular Sur-
gery (SVS) and the Audible Bleeding podcast.
METHODS
Podcast development. The SVS is a professional organi-
zation that promotes excellence and innovation in
vascular health through education, advocacy, research,
and public awareness. The Audible Bleeding podcast
was developed by an independent group of vascular fel-
lows and faculty at Columbia-Cornell New York-
Presbyterian Hospital Vascular Surgery Fellowship in
New York, New York, in 2018 to disseminate relevant and
timely information to vascular surgeons and trainees.15 In
2020, Audible Bleeding became a member of the SVS
family of publications. The Audible Bleeding podcast
features interviews with experts, reviews of articles, dis-
cussions of controversies, and updates on events and
opportunities in vascular surgery. The Audible Bleeding
podcast leverages a conversational tone featuring anec-
dotes from personal experience supported by scientific
evidence from credible sources. The podcast has adop-
ted a broad definition of peer review. Once in its final
edited form, each episode is shared with all podcast
contributors for a brief comment period and is reviewed
and approved formally by the episode guests, hosts, and
editors. This process aims to optimize format and accu-
racy, while also allowing for timely creation and publi-
cation of episodes.
In 2019, Audible Bleeding began releasing episodes
developed to prepare listeners for the Vascular Surgery
In Training Examination (VSITE). By 2022, they had devel-
oped a comprehensive set of 23 podcast episodes
covering the breadth of content knowledge required
for in-training examinations and they organized and
released them as a formal, comprehensive eBook and
study curriculum.18 The Audible Bleeding podcast dem-
onstrates the potential of podcasting for vascular surgery
medical education because it provides an accessible,
engaging, and interactive way of learning and sharing in-
formation. The podcast also showcases the role of the
SVS as a leader and innovator in vascular health, because
it supports the professional development and commu-
nity building of its members and stakeholders.
JVS-Vascular Insights
2024
Variable definitions. Metrics for podcast downloads
were aggregated by the online podcast publishing plat-
form, Libsyn (Pittsburgh, PA). This platform calculates
episode downloads, and the metrics reported here
follow the definitions outline by IAB Technology Labora-
tory.16 In brief, downloads are defined as the transfer of a
certain amount of the episode data from the distributer
to each user. A unique download is identified through IP
address and other user features. The research team does
not have access to unique IP addresses or specific user
information beyond what is provided in aggregate
through the podcast publishing platform. Download in-
formation does not provide any information in relation to
whether the content was consumed by the user after
being transferred to or streamed by the user’s personal
device.
Metrics for eBook use was derived from Google Ana-
lytics (Mountain View, CA). Google Analytics provides
aggregated reports related to user interaction with a
website and its embedded pages and links. Google Ana-
lytics defines active users as people who engage with the
website within a certain date range. Engagement in-
cludes visiting, viewing, and clicking on embedded links.
The unique nature of these views and visits are defined
by the IP address, date, and time of this access. Individual
user information is not available to the research team.
The users consent to capture of this data through the
websites embedded Cookie policy.
Statistical analysis. Data analysis and visualization was
performed using R (R Foundation for Statistical
Computing Platform, Vienna, Austria) and RStudio (Posit;
Boston, MA) using packages tidyverse, readr, qicharts2,
lubridate, rworldmap, and RColorBrewer. Download
data are presented as a run and control chart with down-
loads over time. Comparisons were performed by deter-
mining special cause variation if any values landed
outside 95% confidence interval with the run chart
mean.17
RESULTS
Since Audible Bleeding started in 2018, it has published
>250 episodes, featuring >100 contributors and 300
vascular surgeon guests from the United States and
internationally. Although most of the audience
resides in the United States, the podcast has been down-
loaded in >150 countries (Fig 1). There has been a steady
increase in downloads since the podcast first began, with
particularly notable increase in popularity following an
episode related to the Paclitaxel debate, the start of
the coronavirus disease 2019 pandemic, and with the
publication of the Exam Prep eBook. Joining the SVS
family of publications has helped to maintain the popu-
larity of the podcast (Fig 2).
When analyzing special cause variation related to Exam
Prep episodes. We found most Exam Prep episodes had
JVS-Vascular Insights Johnson and Ellozy 3
Volume 2, Number C

Fig 1. Map of countries with documented total downloads since the start of the podcast in 2018.

Fig 2. Run chart of monthly downloads from January 2019 to November 2023. The dashed horizontal line denotes
the mean number of monthly downloads over this time period. Vertical dashed lines denote times of notable
events. Paclitaxel: Date of Paclitaxel Debate, April 1, 2019. COVID-19: Date of first documented case of COVID-19 in
the USA, January 20, 2020. SVS: Date that Audible Bleeding officially joined the SVS family of publications,
November 18, 2020. Ebook: Date of Exam Prep eBook Publication, November 03, 2022.
4 Johnson and Ellozy
significantly higher rates of downloads in the first
30 days, when compared with other episodes released
in the same time frame. There were particularly high
rates of downloads with Exam Prep episodes in the
months immediately preceding a VSITE (Fig 3). This
finding was particularly prominent with the release of
the formal curriculum before the February 2023 VSITE
(Figs 2 and 3) In regard to the use of the eBook, the total
number of new users over the November 2022 to
February 2023 curriculum release was 2000, according
to Google Analytics (Fig 4). However, the average engage-
ment time was only 7 minutes and 16 seconds. This dura-
tion would be enough time to review a targeted portion
of the chapter, but not read the entire chapter, suggest-
ing this may be how trainees use this text.
DISCUSSION
The Audible Bleeding podcast is a case study for how
podcasting can be used within vascular surgery to
develop and disseminate free, accessible, and engaging
research materials for training examinations and
improving clinical care. From our anecdotal experience,
the growth of the podcast seems primarily via word of
mouth through peer and faculty recommendations,
which is similar across podcasts in other medical fields.19
The podcast can continue to grow and innovate by
exploring other podcast formats and lengths. A random-
ized trial involving emergency medicine trainees found
that podcasts with interpolated questions had
Fig 3. Control chart of downloads in the first 30 days for each episode by release date. Dashed line denotes mean
30-day downloads per episode. Grey box denotes 95% confidence interval. Exam Prep episodes are marked with
an asterisk. VSITE labels correspond with the dates of VSITE each year.
JVS-Vascular Insights
2024
significantly higher mean scores on testing performed 2
to 3 weeks after listening to the podcast and may have
increased knowledge retention.20 However, the podcast
also faces challenges, such as maintaining quality and
consistency, ensuring diversity and representation, and
evaluating impact and effectiveness. A few limitations
inherent to podcasts include that the learner often lis-
tens while engaging in other activities, so that retention
may be poor.19 The podcast seeks to explore these chal-
lenges to expand the audience and reach, incorporate
more evidence-based and patient-centered content,
and collaborate with other podcasters and educators.
The Exam Prep eBook provides an additional avenue
for innovation in vascular surgery education. In addition
to the audio content available related to the podcast,
the e-book features include a dynamic format optimized
for desktop or mobile reading, an interactive table of
contents for the book and each chapter, fully indexed
and searchable text, hyperlinks to referenced primary
literature, and social annotations powered by hypothe-
s.is. These are all features not available in traditional text-
books or paper review books. Social annotations relate to
the ability for a group to read and think together. Social
annotations in our e-book allow users to highlight and
take notes in-line with the book from any web browser.
Learners can either save the annotation privately for per-
sonal or small group use or publish it publicly so that
anyone reading the book can also read their annotation
in-line with the text. Social annotation has been found in
JVS-Vascular Insights
Volume 2, Number C
Fig 4. Daily users of the Audible Bleeding eBook over time from November 2022 through the VSITE in February
2023. Figure adapted from Google Analytics.
a recent review to help learners process domain-specific
knowledge; support argumentation, inquiry, and knowl-
edge construction; and connect learner spaces.21
Although we do not have any data on private use, several
public annotations have identified errata in the text that
have allowed for revision and updating in real time. The
e-book also references outside multimedia content,
such as other podcasts or videos that dive deeper into
the content beyond what is covered in the book.
CONCLUSIONS
Podcasting is a valuable tool for medical education,
especially in vascular surgery, because it can enhance
learners’ knowledge, skills, and attitudes. The Audible
Bleeding podcast, powered by the SVS, is a well-
accepted example of podcasting for medical education,
as it delivers relevant and timely content to vascular sur-
geons and trainees and promotes excellence and inno-
vation in vascular health. This collaboration between
the Audible Bleeding podcast and the SVS provides an
innovative platform for free to help trainees leverage
technology to improve and design their studying habits
to fit a busy lifestyle. In addition, these online platforms
provide unique insights into how learners are using these
resources so educators can iterate and meet the learners
where they are. Innovative features, such as searchable
text, interactive formats, and social annotations, can
further enhance the learner’s experience. We hope that
this article has inspired you to explore the potential of
podcasting for vascular surgery education and to join
Johnson and Ellozy 5
us in creating and sharing engaging and informative
content. We invite you to listen to the Audible Bleeding
podcast, access the e-book, and participate in the social
annotations to enrich your learning experience and
contribute to the vascular surgery community.
The authors acknowledge the support of the Society of
Vascular Surgery for the publication of the Audible
Bleeding podcast and the whole Audible Bleeding
team of editors, contributors, and guests, which can be
found at audiblebleeding.com/about-1/.
AUTHOR CONTRIBUTIONS
Conception and design: AJ, SE
Analysis and interpretation: AJ, SE
Data collection: AJ
Writing the article: AJ, SE
Critical revision of the article: AJ, SE
Final approval of the article: AJ, SE
Statistical analysis: Not applicable
Obtained funding: Not applicable
Overall responsibility: AJ
DECLARATION OF GENERATIVE AI AND
AI-ASSISTED TECHNOLOGIES IN THE WRITING
PROCESS
During the preparation of this work, the authors used
Microsoft Copilot (Redmond, WA) to improve manuscript
organization and readability. The authors used Zotero for
reference management and creation of the bibliography.
After using these tools, the authors reviewed and edited
6 Johnson and Ellozy
the content as needed and take full responsibility for the
content of the publication.
DISCLOSURES
The authors of this article are founding members of
Audible Bleeding: The Vascular Surgery Podcast. They
do not receive and have never received any financial
compensation for their work with the podcast. Any dona-
tions to the podcast were used entirely for the creation,
maintenance, and publication of podcast content. The
podcast is currently fully supported by the Society for
Vascular Surgery.
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Submitted Feb 3, 2024; accepted May 4, 2024.