training course (100%). Also, some surgeons actively reported that residents should show clear interest in the procedures and the background of metabolic surgery. One of the lead bariatric surgeons reported giving supervised laparoscopic box training before starting in vivo training. At the end of residency or fellowship training, 16% of residents and 66% of fellows were able to perform metabolic bariatric surgery independently and/or to supervise other fellows or residents (Table 3). Table 1: Baseline Characteristics of Surgeons and Hospitals Non-teaching hospital Teaching hospital Gender (male:female) 6:1 11:1 Age (years) 48 (38-62) 50 (38-62) Experience (years) 9 (5-12) 12 (4-25) No. of bariatric cases / year 273 (120-400) 235 (100-350) No. of trained residents - 10 (2-22) No. of trained fellows 0.4 (0-3) 6 (0-33) Total no. 0.4 (0-3) 15 (3-33) Data displayed as mean (range) Teaching Methods Three main groups could be discerned for the order in which procedural steps were taught: • unstructured (n=3) • increasing difficulty - jejunojejunostomy, pouch, gastrojejunostomy (n=6) • chronology - pouch, gastrojejunostomy, jejunojejunostomy (n=3) In the unstructured training group, residents started performing the procedure or parts of the procedure without a clear training plan or structure. In the second group, handling of the stapler and intracorporal suturing were practiced first, during creation of the jejunojejunostomy and later in creation of the pouch and gastrojejunostomy. Centres who had trained high numbers of residents/fellows were more likely to use this training order. In the third group, steps were taken in chronological order with creation of the pouch, gastrojejunostomy and finally, the jejunojejunostomy. One of the surveyed hospitals reported on their previously published training model in detail.6 Stringent pre-surgery conditions applied, including an advanced laparoscopic suturing course 3 47 Resident training in metabolic bariatric surgery in the Netherlands
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