Table 1: GRADE Assessment of Included Studies Study Year of publica2on Type of trial Region N. of par2cipants N. of procedures GRADE Up- or down grading Reason for adjustment Azer et al.18 2013 Cohort USA 12 - Very low Downgrade High risk of biasa Bonrath et al.26 2015 RCT Canada 18 - High Upgrade Large effects Buchwald et al.2 2006 Survey USA 251 - Low No downgrade 100% response Davis et al.5 2013 RetrospecOve USA N/A 6133 Low No upgrade Extent of resident involvement not reported Fanous et al.6 2012 Cohort USA 18 711 Very low Downgrade SelecOon biasa Extent of role of senior residents unclear. Harrington et al.25 2007 Cohort USA 12 23 Low No upgrade Small sample size, short observaOon period, no long term follow-up, yet prospecOve work Iordens et al.23 2012 RetrospecOve Europe 5 83 Low No upgrade RetrospecOve study, small sample size Leandros et al.19 2009 Survey Europe 73 - Low No upgrade Effects not that large MarOn et al.28 2010 Cohort USA Unclear 140 Very low No upgrade Small sample size, prospecOve database Moran-Atkin et al.27 2014 RCT USA 20 40 High No upgrade Risk of a[riOon bias Rovito et al.24 2005 RetrospecOve USA 5 200 Very low Downgrade Unclear resident learning curve, small sample size Varas et al.20 2012 Cohort Chili 25 - Moderate Upgrade Large effect Zevin et al.21 2012 Syst. Review Global N/A - Moderate No upgrade Good review, but no grading of mostly retrospecOve arOcles Zimmerman et al.22 2010 Cohort USA 36 - Low No upgrade Effects not that large RCT = randomized controlled trial, RYGB = Roux-en-Y gastric bypass. N/A = not applicable a Risk of bias assessed (Appendix I) 2 29 Current techniques of teaching and learning in bariatric surgical procedures
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