STORIES (Structured apprOach to the Reporting In health care education of Evidence Synthesis) is available, but this system is less suitable when reporting on patient outcome data.29 The results of this review should however be interpreted with care as only 2 studies provided a high level of evidence. Bonrath et al. studied the effect of surgical coaching on the performance of residents.26 This well designed but small RCT showed that additional extra-operative coaching based on video fragments significantly improved BOSATS scores and reduced technical errors. Their intervention added structured and guided self-assessments. The positive effects of this selfassessment technique continued to show after 2-month follow-up. Although the coaching was a time investment for both coach and residents, all participants concluded that coaching should be a part of resident training. Whether a surgeon or educationalist should do the coaching remains unclear. Moran-Atkin et al. studied the effect of a preoperative ex vivo warm-up by residents before entering the operating theatre to perform laparoscopic surgery.27 Significant improvements in depth perception and dexterity were found in residents who performed laparoscopic cases, including laparoscopic sleeve resection and LRYGB. Owing to the small RCT, the results cannot be specified for the bariatric procedures, but the overall effect is noted. These 2 high-quality studies showed that training programs should focus not only on the operating room but also on what happens before and after surgery. Warming up could be a way to make training more efficient. Adequate debriefing and the specification of goals before training could shorten the learning curve. Several attempts have been described to ease the mastering of metabolic bariatric surgery and reduce the learning curve. Two retrospective series of Iordens et al. and Rovito et al. studied the concept of dividing the procedure up into different steps.23,24 The residents performed the first of 3 fundamental steps of the procedure (jejunojejunostomy, pouch creation, and gastrojejunostomy). After mastery of the first step, the next step was trained. Both groups did not report effects of their methods on test scores or other performance indicators. The relatively short operation times in the group of Iordens et al. may be influenced by the different 6-year Dutch surgical curriculum. The Dutch residents all had over 100 cases of minimal invasive surgery experience as primary surgeon and had attended basic laparoscopic and suturing courses. The generalizability of this single-centre study is hampered by its 2 35 Current techniques of teaching and learning in bariatric surgical procedures
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