and performance of one hundred basic laparoscopic procedures such as cholecystectomy and appendectomy. Residents commenced with assisting 10 LRYGB procedures. Next, the residents performed the first teaching step of the procedure, the distal anastomosis, in subsequent operations until this step was mastered, meeting the standards of both bariatric surgeons in this metabolic bariatric centre. Next the second teaching step, creating the pouch, was practiced to complete. The third and final teaching step was creation of the gastrojejunostomy. Supervised laparoscopic box training was offered on regular basis. To avoid prolongation of operating times only after sufficient skills on all three steps, residents were allowed to integrate the steps into the full procedure. Surgeons reported that the results of this training technique results showed that residents could be taught the full procedure without significant increase in duration of surgery or complications of the LRYGB.6 Resident and Fellow Responses Overall questionnaire response was 79% (19/24) for residents, with a mean age of 34 years (range 30-39 years) and 73% (8/11) fellows, with a mean age of 36 years (range 34-39 years). Most residents started metabolic bariatric surgery in PGY 4 (range 0-6 years) and were female (11/19). One resident had started assisting and performing laparoscopic metabolic bariatric surgery during his internship (defined as PGY 0). Fellows had completed general surgical training 14 months before the survey (range 3-28 months) and were predominantly male (7/8). Fellows had started performing metabolic bariatric surgery in PGY 5 (range 2-6). The median number of bariatric procedures performed was 40 for residents (range 0-148) and 220 during fellowships (range 5-306) (Table 3). The median number of assisted procedures was 52 (range 8-1100). Residents performed a median of 20 LRYGB procedures during their residency. Fellows had performed a median of 38 LRYGB during their residency and 150 LRYGB during their fellowships. The one anastomosis gastric bypass (OAGB) was only performed by a small minority of residents and fellows. LSG was performed 8 times during residency, and 14 times during the residencies of those working as fellows (median). During fellowships, a median number of 14 (range 5–51) LSG procedures were performed. Open procedures of gastric bypass and duodenal switch were rare (n = 5 and n = 1, respectively). 48 3
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