instructed to perform adequate follow-up, detect, and treat complications of bariatric surgery. As proposed by Schirmer et al., dedicated fellowship programs should include journal clubs and teaching rounds and provide the opportunity to contribute to research.18 Currently, the effectiveness of most different training methods for metabolic bariatric surgery has remained unclear. Based on the outcomes of our survey and the available data in literature we recommend the following components for a training program in bariatric surgery:12,19,20 1. Background of bariatric and metabolic surgery A variety of methods (e-learning, courses, video instructions) can be used to instruct residents on patient selection, pathophysiology, operative procedures, and complication management. Multidisciplinary conferences and morbidity and mortality conferences should be considered part of the training. 2. Technical skill training a. Ex vivo laparoscopic dexterity training (unsupervised box training and supervised box training with formative feedback) b. Cadaver training for specific procedures c. Stepwise supervised in vivo training in selected patients Surgical coaching and regular feedback using bariatric OSATS, Global Operative Assessment of Laparoscopic Skills (GOALS) and an independence-scaled procedural assessment should be provided.21 Key steps should preferably be determined using Delphi consensus and mastered in level of increasing difficulty before continuation to the next step. Individual steps should be combined to result into performance of full procedures, and further development of skills according to the Dreyfus and Dreyfus.19 3. Life-long learning Continuous medical learning can be achieved through participation in journal clubs, teaching rounds, clinical research and (inter-)national scientific meetings. Also, reporting surgical outcome data in national databases is important for establishing benchmarks and quality improvement. 3 53 Resident training in metabolic bariatric surgery in the Netherlands
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