Subsequently, Chapter 5 describes the first use of an independence scaled procedure-based assessment in video fragments of the LRYGB. A procedure-based assessment (PBA) can be used both as a formative feedback tool in the learning process, and as a summative assessment in credentialing residents and surgeons for specific procedures. PART 3 - Technical Training In the final part of this thesis, a specific technical step of the LRYGB is discussed: running of the small bowel and determining its length. Determining limb length is arguably an important component of the outcomes of gastric bypass surgery and thus should be performed within an acceptable range. To establish HOW we should train and assess trainees to perform this part of the procedure, this step was transferred to an ex vivo setting to allow repeated measurements. Chapter 6 describes a cross-sectional study of the performance of the bariatric surgical staff and surgical residents on their accuracy in this step. The goal of the study is to investigate whether residents and surgeons perform differently on this task. In Chapter 7 a laparoscopic training box exercise on a rope is used to train residents in this same step of determining small bowel limb length. This study aims to determine if ex vivo box training improves the accuracy of small bowel length determination before residents execute this step as part of a procedure in the operating theatre. Chapter 8 provides a general discussion and reflects on how the results of this research could improve bariatric surgical training and builds towards a bariatric surgical training curriculum. This thesis is summarized in Chapter 9. 1 17 General introduction and outline of this thesis
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