studies have shown an effect of surgical skill on the outcomes of LRYGB, but this was not reproduced for LSG.49,50 Neither of the assessments mentioned in Table 2 has been shown to be valid in high stakes assessment, such as credentialing procedural privileges and EPAs. As laparoscopic procedures can easily be videotaped, assessments and even certification on video recordings can be considered. Vassiliou et al. have demonstrated this for the GOALS.51 The use of the IS-PBA for LRYGB based on key steps in video-recordings is shown in Chapter 5.13 Reviewing all available video-based tools for assessments in laparoscopic training Gruter et al. concluded that high stakes evaluation probably is best executed with the combination of a global assessment scale (GAS) like the OSATS, and a procedure-specific assessment tool (PSAT).38 In considering a metabolic bariatric surgical curriculum a PSAT as the IS-PBA could allow summative assessments of specific end-goals. Development and validation of these is therefore a crucial step to an MBS curriculum. The complete IS-PBA described in Chapter 5 can be found in Appendix E. Based on the Delphi consensus in Chapter 4 an IS-PBA for laparoscopic sleeve gastrectomy can be constructed as well. This new created assessment for LSG is shown in Appendix F. Coaching and Feedback Formative assessments are used to provide feedback on (directly) observed skills. However, this still entails numerous procedures performed by the trainee. With reduced operative exposure it is important to optimize the number of teachable interactions. After Bonrath et al. introduced the concept of surgical coaching, as reviewed in Chapter 2, Augestad et al. demonstrated the positive effect of video-based coaching on the performance of residents.52– 54 A laparoscopic or MBS curriculum could include this form of feedback to shorten the learning curve for trainees. Lack of resources, specifically time and coaches, are possibly hindering implementation of video-based coaching in curricula. Simple preoperative briefing and postoperative debriefing between trainee and supervisor could be less-time consuming alternatives.55 The learning curve of the LRYGB and LSG has been studied extensively and definitions of a learning curve are multiple. In a review of Wehrtmann et al. three skill phases in this learning curve were introduced to provide a better comparison.56 The competency level in the LRYGB for example, is reached after 30-70 procedures, proficiency after 70-150 procedures, while it 8 159 General discussion and future perspectives
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