symposia. Seven respondents had not participated in any scientific meeting dedicated to metabolic bariatric surgery (26%). Outpatient Clinic and National Training A majority of residents and fellows (78%, 21/27) reported regular involvement with bariatric patients in the outpatient clinic, with six respondents actively reported seeing new patients (22%), and five respondents had performed follow-up of operated patients (19%). Half of respondents (13/27) believed that metabolic bariatric surgery should be a voluntary topic in the national resident training program’s lectures, twelve trainees believed that this should be a mandatory subject, and the remaining two respondents had no opinion. DISCUSSION Our survey is the first national survey on resident training in bariatric surgery. Teaching experience varied highly between centres. In centres with more teaching experience, training programs were developed and were more likely to teach residents/fellows procedural steps in order of increasing difficulty. All residents who started performing bariatric procedures were experienced with basic laparoscopic procedures. The number of assisted procedures showed high variability among residents. The use of more than three trocars could be beneficial for residents/fellows, as this allows for giving and receiving of assistance in laparoscopy (‘a helping hand’) as part of the learning experience. One resident had assisted in 1100 laparoscopic bariatric procedures (mainly gastric band placement) as part of preparation for his PhD thesis on bariatric surgery. The fellows had performed more procedures during their residency than the current residents, which may be reflective of selection bias. One resident and three fellows reported a case load of more than 100 procedures during residency, and four residents more than 50 procedures. This suggests that it is possible to overcome the supposed learning curve of the LRYGB during residency. For those with less experience, either a fellowship or supervised proctoring will still be needed to pursue a career in bariatric surgery. In our survey amongst (former) fellows, five out of eight fellows had performed over 200 procedures, with a significant number of these procedures performed without a supervising attendant. The presence of a supervising attendant was not recorded for residents, which hindered the exact interpretation of training level D “without supervision”. 3 51 Resident training in metabolic bariatric surgery in the Netherlands
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