GENERAL AIM AND OUTLINE OF THIS THESIS This thesis aims to lay the fundament of a laparoscopic metabolic bariatric surgery training program, including assessment and credentialing tools. PART 1 - Current Training Practice The first part of this thesis focusses on the current national and international practice in teaching bariatric surgery. Chapter 2 provides an overview of the available international literature in this field. The review includes research on teaching, assessment and learning of the LRYGB and LSG. It entails the training of both residents and fellows. A systematic review of the available literature demonstrates a heterogeneous range of teaching techniques, and therefore gives a broad fundament of available tools including pre-theatre ex-vivo training - either virtual reality, box training or surgical models – and post theatre surgical coaching. Adopting a stepwise approach of teaching and learning MBS procedures, an overview of the current national practice is established in Chapter 3. Most teaching hospitals in the Netherlands that perform MBS have adopted some sort of stepwise education and instruct the procedural steps either in a chronological order or in the order of complexity of the steps.36,37 Residents in these MBS training programs are expected to have basic laparoscopic skills training, and some experience with less complex laparoscopic procedures. The main questions to be answered in this chapter is WHERE to start and WHEN to start training these procedures. PART 2 - Training and Assessment The second part of this thesis focusses on WHAT we are teaching. In the last decade, statements, and guidelines on the execution of metabolic bariatric procedures were published, supported by the national and international surgical associations such as the Dutch Society for Metabolic and Bariatric Surgery (DSMBS) and IFSO. Chapter 4 presents the results of a consensus amongst Dutch expert bariatric surgeons on which key steps of the LSG and LRYGB should be the focus of both training and assessment. In previous studies, including non-bariatric procedures, such a consensus, attained with the Delphi method, resulted in a framework of surgical key steps for training and assessment. 16 1
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