SUMMARY Whether it is riding a bicycle, preparing a meal, flying a plane, or performing an operation: one must practice it before one can do it. In the first two examples, learning by trial-and-error may be a relatively harmless strategy. In the latter, it is not. More complex skills are adopted by training, instruction, and deliberate practice. Surgical training historically uses a teacher-apprentice training model, ironically summarized with the bold adagio ‘see one, do one, teach one’. Currently, influenced by restricted working hours of residents and ever-increasing standards in surgical outcomes, medical and surgical education is shifted to competency-based curricula and is guided by assessments and portfolio. The Dutch surgical curriculum SCHERP is based on entrustable professional activities (EPAs). One of these EPAs is metabolic bariatric surgery (MBS). This type of surgery is used in the treatment of severe obesity, one of the main health care challenges of this time. The EPA defines the end-goals that residents must meet to certify for this part of the general- and gastrointestinal surgical practice. This includes performing the two most common MBS procedures, the laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG), at an independent level. However, the surgical curriculum does not specify how these end-goals can or should be reached by residents. This thesis lays a fundament for a specific MBS curriculum, including procedure-based assessments (PBAs) for the LSG and LRYGB. This curriculum will support summative assessment and procedural certification, as an addition to the currently used assessment the Objective Structured Assessment of Technical Skill (OSATS). Teaching MBS to surgical residents is important, as the number of patients with obesity and therefore the number of MBS procedures is still rising. New MBS surgeons need to master these procedures and obtain significant knowledge to treat MBS related complications. PART 1 – Current Training Practice To create an evidence-based MBS training curriculum, the first part of this thesis presents a systematic review on the currently available teaching techniques in MBS internationally, and a survey of the current clinical practice in the Netherlands. In Chapter 2 an extensive literature search reveals fourteen relevant studies. Simulation training serves as the foundation for acquiring laparoscopic skills needed in the operating room. Virtual reality, surgical models and 174 9
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