General recommendations for professional and personal growth such as team training, selfassessment and peer assessment were not included in this proposal, as these should preferably be integrated in a personal professional development plan. Limitations of our study include the low number of fellows who participated in our survey, which is reflective of the lack of accreditation for bariatric fellowships in the Netherlands. Also, based on the overall low number of LSG procedures nation-wide, no data on learning steps of this procedure were available. Our study showed that bariatric procedures can be trained during residency in our country and supports the statement of Eltorai et al. that metabolic bariatric surgery could be incorporated in the resident training curriculum.22 It may, however, be difficult to extrapolate our study results and recommendations to other countries where different training models are used. European working hour regulations have become strict, with 48-hour working weeks probably resulting in higher absence of residents in operating theatres and in outpatient clinics. Moreover, shortening of medical doctor specialist training has been advocated, as for example in the United Kingdom.23 Restriction of resident working hours in the USA to 80 hours per week has impacted resident exposure to complex cases and overall presence, as summarized by Varas et al..24 Therefore, it is essential that residents are trained efficiently, whilst ensuring patient safety. We believe that our recommendations may help to use the period of structured training in patients more effectively. CONCLUSION Training of residents and fellows in metabolic bariatric surgery differs considerably among centres. A structured program incorporating background knowledge, stepwise supervised technical skill training, and life-long learning should enhance efficient training in bariatric teaching centres without affecting quality or safety. Note This chapter was updated to adhere to the 2024 IFSO Accepted Definitions for Publication and to enhance uniformity throughout this thesis. This research was originally published as: van Ramshorst GH, Kaijser MA, Pierie JEN, van Wagensveld BA. Resident Training in Bariatric SurgeryA National Survey in the Netherlands. Obes Surg. 2017;27(11):2974-2980. 54 3
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