a mean number of 52.6 LRYGB and 60.7 laparoscopic SG (LSG) cases in 2018-2019, which are low numbers compared to the learning curve of these procedures.35 This calls for further integration of MBS the general surgery curriculum to ensure adequate skill acquisition to perform advanced laparoscopic surgery and deal with complications of these procedures. With a yearly total of 10,000 - 12,000 procedures in the Netherlands, MBS is a rapidly evolving part of gastrointestinal surgery and therefore claiming its place in the surgical training programs (Figure 5). In the Netherlands, MBS is an optional module in the gastrointestinal differentiation program. The goal of this module is to obtain knowledge about the screening, pre- and postoperative care and follow up of the metabolic bariatric patient and to master the LSG and LRYGB at a completely independent level.20 If these goals are not obtained during the residency, metabolic bariatric fellowship programs are available to obtain these skills. This MBS training module in the SCHERP curriculum results in the EPA MBS, presented in Appendix B of this thesis. Figure 5: Role of MBS in the Extended Surgical Curriculum EPA = entrustable professional activity, MBS = metabolic bariatric surgery, PGY = postgraduate year As MBS is incorporated in the fellow- and resident training programs a more specified curriculum may target the learning curve of both general technical skills and specific procedures. This curriculum should be supported by assessment that are both summative and formative, to provide feedback during training and formalize the EPA in MBS. 1 15 General introduction and outline of this thesis
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