takes 150-500 procedures to master the LRYGB. These skill phases and their learning curve in LRYGB and LSG are shown in Table 4 in relation to other expertise levels used in this thesis. Table 4: Expertise Levels by Different Authors and Learning Curve Author Defini2on Learning Curve Levels and Learning Curve Dreyfus et al.7 Level Novice Competent Proficient Expert Master Kaijser et al.13 Experqse Novice Intermediate Expert Wehrtmann et al.56 Skill phases Competency Proficiency Mastery Wehrtmann et al.56 LRYGB No. procedures 30-70 70-150 150-500 Wehrtmann et al.56 LSG No. procedures 30-50 60-100 100-200 LRYGB = laparoscopic Roux-en-Y gastric bypass, LSG = laparoscopic sleeve gastrectomy Learning curve = number of procedures needed to reach this skill level. The Assessor or Mentor Most assessments, either formative or summative are done by supervisors, i.e. surgical experts. However, being a surgical expert does not necessarily qualify one as a teaching expert, a great assessor or mentor. In work of Graziano et al. they demonstrated that supervision of medical students by other students, 1 year above, results in fewer errors compared to supervision by residents.57 The concept of training by peers, i.e. residents supervising other residents, is common practice in surgical training in the Netherlands. Arguably, the ideal mentor or supervisor is motivated, has empathy, the ability to teach and to motivate the trainee, communicates well and creates the right circumstances for training. Moreover, the supervisor has adequate knowledge about the curriculum, goals, and assessments. Being a surgical expert can only add to this profile. Non-Technical Skills and Knowledge Acquisition In the demanding work environment of the operating theatre, behavioural aspects of the surgeon and staff are crucial to surgical outcomes. Training and assessments of these nontechnical skills, including teamwork and decision making, are important. Research from the imperial college in London has created the NOTECHS assessment, with the non-technical skills of surgeons (NOTSS) as its Scottish counterpart.3 The Dutch surgical curriculum uses 360160 8
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