In addition to specific procedural steps, training of specific skills can be transferred from the OR to ex vivo training exercises. Training of laparoscopic suturing skills ex vivo may improve these skills in novice as well as trained laparoscopic surgeons.33 This type of training can be added to the MBS curriculum. After ex vivo training a trainee can use the obtained skills to perform a specific sub step of the LRYGB, in this case suturing the remaining defects of the GJ and JJ after linear stapling or a handsewn anastomosis. Xia et al. have worked on an extensive 3D printed model to provide a cost-effective training model for the LRYGB.34 A combination of these different models could enhance the first phase of MBS training. Assessment In surgical training, assessment of operative skills is important. In this paragraph the assessments relevant to the training of LRYGB and LSG will be presented. First, the different aspects of validation of assessments will be discussed, as well as the use of different rating scales. Validity The reliability of an assessment is crucial in its use. Does the assessment support feedback and training? Does the assessment score what it is meant to score? In surgical training an assessment may eventually be part of credentialing the procedure to surgeons or residents. Therefore, the test should be a valid assessment of skills, and everyone who passes the test should have mastered the skill. Gallagher et al. describe five types of validity in an assessment.35 • Face validity - early evaluation: does the test measure what is meant to measure. • Content validity - detailed evaluation of the role and use of different items in the test. • Concurrent validity – evaluation of the test scores in relation to the gold standard. • Discriminate validity – do the test scores relate to the factors they should relate to. • Predictive validity – does the test (scores) predict the performance of the actual task. Predictive validity is key to take a new assessment to the resident curriculum. In multiple studies, including research on BOSATS and SOSATS, assessments are validated on two expertise levels, mostly novice and expert.19,24 Although the definition of these levels differs between studies, often based on previous surgical case load or years of experience, it seems 8 155 General discussion and future perspectives
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