skill reduced the error margin. In the baseline assessment of skills, residents estimated with a 21% deviation of the predefined goal length. After training, this was reduced to 8%. Residents who trained sufficiently scored better, and 70% of residents felt their skills had improved. With these studies taken together, Chapter 8 proposes an MBS training curriculum. The role of MBS in the surgical curriculum is threefold: ● Basic training in MBS for all surgical residents includes knowledge about obesity, anatomical knowledge and awareness of the stigma and attitudes related to obesity. ● An MBS rotation for those residents who pursue a career in gastrointestinal surgery focuses on skills acquisition through participating in MBS. Residents get accustomed with the indications, consequences, and complications of MBS. By participating in MBS procedures, they practise suturing, stapling, omental dissection, and small bowel handling, and can also master closure of mesenteric defects. ● Residents and fellows who aspire to become MBS surgeons and aim to obtain the entrustable professional activity (EPA) of MBS, follow an MBS learning plan. In this they master the LRYGB and LSG stepwise in three phases: obtaining procedural knowledge, stepwise training, and procedural certification. Valid assessments will be necessary to support the suggested MBS training curriculum. The most frequently used assessment method of most surgical skills in the Netherlands is the OSATS. Unfortunately, the OSATS lacks validity for summative assessments and for assessing advanced surgical training. Research on didactic assessments suggests that the combination of the OSATS and a PSAT are likely superior for summative assessment and credentialing of EPAs. This thesis has provided an overview of current training practice in MBS and has investigated specific tools for training with a focus on technical skills. It has provided the framework for independence-scale procedure-based assessments of the LRYGB and LSG. With a three-part curriculum, future surgeons will be knowledgeable and skilled in metabolic bariatric surgery. 9 177 Summary
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