box training can accommodate skills acquisition and reduce the mental workload of performing surgical procedures. These are forms of simulation-based medical education, an important tool in surgical training. However, most surgical training is still situated in the OR. To maximise the effect of participating in, and training of the actual procedures, a preoperative warming-up can be useful. For example, a trainee could warm up with endoscopic suturing in a box- trainer before entering the OR, which improves laparoscopic skills such as depth perception and bimanual dexterity. Post-operative surgical (video-based) feedback may steepen the learning curve of MBS procedures. A stepwise approach, thus breaking the operation into procedural (key) steps, may empower the residents in a structured learning program. Some studies have focused on knowledge acquisition about the pathophysiology of obesity and metabolic complications, and future research could focus on incorporating this important part of surgical training in a structural fashion. Non-technical skills, including teamwork and decision making, were not part of this systematic review. However, these important skills cannot be overlooked in the training of future surgeons. Chapter 3 describes the current national practice of MBS training in the Netherlands. Twelve out of the 19 metabolic bariatric centres in the Netherlands were accredited to general surgical residency training. A structured stepwise approach in training the LRYGB was used in 9 centres, either chronologically or in ascending order of difficulty. In these MBS centres a median of 40 MBS procedures were performed by residents with interest in MBS, although these numbers differ significantly between trainees and centres. Generally, the number of MBS procedures during residency are considered insufficient to complete the learning curve of these procedures, supporting development of a goal-directed MBS curriculum. PART 2 – Training and Assessment Stepwise training is the groundwork for goal-directed procedural training and the development of an MBS curriculum. Standardisation of procedures clarifies what we are teaching to residents. Multiple attempts have been made, both on national and international levels, for standardisation of the LRYGB and LSG techniques. Chapter 4 presents a Delphi consensus in which the key steps of these procedures were defined by expert Dutch metabolic bariatric surgeons. After a task analysis of the procedures, 73 substeps of the LRYGB and 51 substeps of the LSG were identified. After two consensus rounds in which 38 surgeons out of 9 175 Summary
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