ABSTRACT Purpose: Surgical procedures for severe obesity, including laparoscopic Roux-en-Y gastric bypass (LRYGB), are considered standardized laparoscopic procedures. Our goal was to determine how metabolic bariatric surgery is trained in the Netherlands. Materials and Methods: Questionnaires were sent to lead surgeons from all 19 bariatric centres in the Netherlands. At least two residents or fellows were surveyed for each centre. Dutch residents are required to collect at least twenty electronic Objective Standard Assessment of Technical Skill (OSATS) observations per year, which include the level of supervision needed for specific procedures. Centres without resident accreditation were excluded. Results: All 19 surgeons responded (100%). Answers from respondents who worked at teaching hospitals with residency accreditation (12/19, 63%) were analysed. The average number of trained residents or fellows was 14 (range 3-33). Preferred procedures were LRYGB (n=10), laparoscopic sleeve gastrectomy (LSG) resection (n=1), or no preference (n=1). Three groups could be discerned for the order in which procedural steps were trained: unstructured, in order of increasing difficulty or in order of chronology. Questionnaire response was 79% (19/24) for residents and 73% (8/11) for fellows. On average, residents started training in metabolic bariatric surgery in postgraduate year (PGY) 4 (range 0-5). The median number of bariatric procedures performed was 40 for residents (range 0-148) and 220 during fellowships (range 5-306). Conclusions: Training in metabolic bariatric surgery differs considerably among centres. A structured program incorporating background knowledge, stepwise technical skills training and life-long learning should enhance efficient training in bariatric teaching centres without affecting quality or patient safety. 44 3
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