hours dedicated to educational purposes.23 This urges a time-balanced and goal-directed resident training curriculum. Technical Training Technical training – mastering surgical procedures - has different aspects: the trainee must learn WHY they must perform an operative step; WHAT steps are needed to accomplish this and HOW these steps are executed technically. The technical training includes procedural knowledge, i.e. the knowledge of the techniques available, psychomotor, or manual skills, and the ability to handle unexpected situations. These skills are obtained by observational learning, technical discussions, simulation training and obtaining hands-on experience.24 A major part of surgical training takes place in the operating theatre. Participation of general surgical residents or fellows may lead to a higher complication rate, mainly due to prolonged operation times.25 The effect of training in the operating theatre on patient safety should therefore be monitored. Patient safety is not an issue in surgical simulation, which is used throughout training of residents, fellows, and surgeons. Simulation training includes the use of animal and synthetic models, augmented- and virtual reality, box-training and human cadavers. This type of training can be both used to obtain specific procedural skills and to prevent decay of skills in time.26,27 Assessment A crucial point in learning is guided training, feedback, and assessment. Although in Dutch history the Amsterdam Surgeons’ Guild (1461-1736) finalized surgical training with a master’s exam, in current practice surgical training is completed after a set time, provided the learning goals are met and the EPAs are entrusted.28 During progression to an EPA, formative, not summative, assessments are used to support feedback as well as prove of skill. Formative assessments are usually designed for low-stake assessments, to support the training process, and feedback. Summative assessments, like exams, are usually used in high-stakes situations, for example credentialing of specific privileges. Entrustment of professional activities, including a check of all necessary formative assessments, can therefore be seen as summative assessments. For technical training the standard assessment in the Dutch curriculum is the Objective Structured Assessment of Technical Skill (OSATS) introduced by Martin et al..29 The standard OSATS uses a Global Rating Scale (GRS). A modified version was introduced in the Netherlands 1 13 General introduction and outline of this thesis
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