FUTURE PERSPECTIVES: A METABOLIC BARIATRIC SURGERY CURRICULUM After discussing why an MBS curriculum is a valid addition to general surgical training, three questions remain: • Which are the surgical competencies to be trained? • Which training or rotations lead to these competencies? • Which assessments are used to evaluate this? These questions can be answered by proposing an MBS training curriculum. In Chapter 3 three key components of an MBS curriculum are described: • Background of metabolic bariatric surgery (knowledge). • Technical skill training, including: o Ex vivo laparoscopic dexterity training. o Cadaver training for specific procedures. o Stepwise supervised in vivo training in selected patients. o Surgical coaching and regular feedback using different assessments. • Life-long learning through participation in for example teaching rounds. These three components resemble the results of a Delphi expert consensus on an international curriculum for LSG proposed by Blackham et al..25 The following proposal combines the work of Zevin (Figure 1) and Blackham et al. and adds to this a proposal for an MBS rotation to facilitate basic and advanced laparoscopic skills acquisition. With the increasing numbers of MBS, every general and gastrointestinal surgeon should have knowledge about the pathophysiology of obesity, the main effects of MBS, the altered anatomy, and the most common surgical complications. These ‘metabolic bariatric fundamentals’ should be incorporated in general surgical training and could probably be covered with an MBS oriented course. General surgical residents that specialize in gastrointestinal surgery require advanced laparoscopic skills training. A ‘metabolic bariatric rotation’ can be a platform to obtain these skills. Moreover, it would extend the knowledge and skills in the surgical management of complications in MBS. The goal of this rotation is to master skills, not procedures. Finally, for those who pursue a career in MBS, a final rotation leads to the MBS ‘EPA’, including procedural certification for the LRYGB and LSG. The prerequisites for the MBS EPA in the Dutch curriculum are shown in Appendix B. The technical parts of the LRYGB and LSG are instructed 8 163 General discussion and future perspectives
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