INTRODUCTION/PURPOSE Metabolic bariatric surgery (MBS) has become a substantial part of the workload of gastrointestinal surgeons.1 In the USA, residents who have completed surgical training can apply for fellowships accredited by the American Society for Metabolic and Bariatric Surgery (ASMBS).2,3 In Europe, resident programs and postgraduate training differ per country. In the Netherlands, MBS is performed in 19 high volume centres, most of which are non-academic teaching hospitals. In some of these centres unaccredited metabolic bariatric fellowships are offered, usually on an irregular basis. According to the Dutch guidelines for MBS, centres can only be certified if at least 200 metabolic bariatric procedures are performed by a minimum of two surgeons, with each surgeon performing at least 30 procedures.4 The general surgery residency is a six-year program, which included one to two years of training at academic teaching hospitals. Track specialization as proposed by Martin et al. has been incorporated in the Dutch curriculum.5 Residents are obliged to choose one subspecialty for the final two years of training; gastrointestinal surgery (including MBS as an option), oncological surgery, vascular surgery, traumatology (including orthopaedic trauma surgery), lung surgery, or paediatric surgery. Surgical procedures for severe obesity, including laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG), can be considered standardized laparoscopic procedures.4 Therefore, these procedures can be considered ideal for structured teaching of laparoscopic surgery skills to residents.1 However, large differences exist in the skill levels that residents reach in advanced laparoscopic and metabolic bariatric surgery, with a varying level of required supervision after completion of residency training.6 This study aims to determine how residents and fellows are trained in MBS in the Netherlands. MATERIALS AND METHODS Questionnaires were sent to lead surgeons from all 19 metabolic bariatric centres in the Netherlands by email and/or by regular mail in November 2014. Surgeon data included age; gender; number of years of experience with performing MBS; hospital setting (private practice, non-academic teaching hospital, non-academic non-teaching hospital or academic hospital); and yearly number of metabolic bariatric procedures. Also, surgeons were asked which was the preferred training procedure for residents (LRYGB/LSG), which pre-clinical 3 45 Resident training in metabolic bariatric surgery in the Netherlands
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