stepwise and assessed with both OSATS for formative feedback and PSAT / PBA for feedback and assessment. This EPA rotation could also be applied for MBS fellows. An overview of this three-part curriculum is shown in Table 5. Several aspects discussed above could be summarized to create a learning plan for the LRYGB within the Dutch curriculum. This plan aims to train residents to meet the criterium ‘Can perform a primary gastric bypass independently (level D)’. This LRYGB learning plan is summarized in Figure 4. Basic laparoscopic skills should be obtained through experience in other laparoscopic procedures. In phase 1 advanced laparoscopic skills could be trained with an SMBE program or hands-on course.68 Procedural knowledge is instilled by assisting on 20 LRYGB procedures. In phase 2 the key steps of the LRYGB are trained with a stepwise program. Each session starts with a briefing and warm-up and finalizes with an assessment (either PBA or OSATS). After training the GJ 10 to 20 times, and if the trainee scores a high level of independence on the IS-PBA (score 3-5) the trainee will proceed to practice creation of the pouch, and so on. If available, including a short video of the crucial parts of the step with the INVEST method could enhance training even further. Starting procedural training of the LRYGB with teaching the gastrojejunostomy is supported by the possibility of a blue dye test for additional safety and the evidence of Bonrath et al. in which the error frequency of low performers matches the performance of the high performance most, followed by pouch formation.21,43 Depending on the situation, other sequences are possible, for example starting with the jejunojejunostomy as suggested in Chapter 3. After completion of training of all steps separately, these steps could be integrated with the resident performing more steps or the entire procedure. This third phase ensures completing the learning curve for LRYGB and could be supported by video-based coaching and finalized with a PBA. The second and third phase of this MBS curriculum could induce prolonged operative times which may impact negatively on patient outcomes. Discussing a fixed time slot of, for example, 10-20 minutes training time for the trainee per procedure, could prevent prolonged duration. 164 8
RkJQdWJsaXNoZXIy MTk4NDMw