reasonable to validate assessments on at least three levels of competence, especially when an assessment is used in summative feedback and certification. Assessments in Laparoscopic Metabolic Bariatric Surgery Many surgical curricula, including the Dutch, United Kingdom, and United States, shift to competency-based medical education (CBME). The core components of CBME are entrustable professional activities (EPAs). As Nau et al. observed in their research on reliable assessments, critical for EPA entrustment are assessments that entail the following characteristics: • Easy to use in daily surgical practice. • Reliable / valid in assessing surgical skill. • Promote safe, competent surgeons.36 Table 2 provides an overview of available assessments in laparoscopic metabolic bariatric surgical training, adapted from the work of Vaidya and Gruter.37,38 The Objective Structured Assessment of Technical Skill (OSATS) is the most used assessment, its main use is formative assessment. However, the role of the OSATS in summative, high stakes assessments is debatable, as well as its validity in advanced surgical training such as fellowships. Therefore, it is eminent to discuss the use of other assessments in metabolic bariatric surgery. 156 8
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