INTRODUCTION Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most effective treatments in the pandemic of obesity, resulting in sustainable weight loss, remission of comorbidities and improved quality of life.1–4 With the number of procedures still increasing worldwide, training of surgeons who can perform these procedures is essential. LRYGB has a learning curve of around 50-200 procedures, but numbers as high as 500 procedures for complete mastery have been described in literature.5–8 Several studies have shown that training of residents and fellows during LRYGB procedures may affect outcomes in terms of complications and costs.9,10 In any training situation, assessment is necessary to support feedback in the learning process and, eventually, to prove adequate skill.11,12 Residents and other trainees can be given feedback and undergo formal assessments with for example the Global Rating Scale (GRS), the Objective Structured Assessment of Technical Skill (OSATS) and Global Operative Assessment of Laparoscopic Skills (GOALS). 13–17 OSATS seems to be the standard assessment in surgical training.14–16 These assessments focus on generic surgical skills, but not on a specific procedure or its crucial steps. Moreover, feedback and assessment by certified surgeons to those who are learning new procedures may be less formal, and the aforementioned assessments may not be validated for these groups.13 The role of GRS in summative assessments or grading is unsure.16 When training complex (laparoscopic) procedures such as the LRYGB many surgical resident programs have adopted some sort of stepwise training, in which the different procedural steps are instructed consecutively.18 Additional operative times, and risks, are kept to a minimum by transferring it to the trainee in only small parts. Likewise, medical training programs are progressing from master-apprentice training to competency-based medical education (CBME). Some training programs, including the Dutch Surgical training program, are now based on entrustable professional activities (EPAs). In this transition the need for summative feedback next to formative feedback increases.19 A procedure-based assessment (PBA) focuses on the execution of a specific procedure or operation as well as its substeps.20 PBAs have been created for different surgical procedures, including laparoscopic cholecystectomy, colectomy, fundoplication and bariatric procedures.21–23 Several of these are graded in a specific ‘technical performance’ scale specified for each observed item. 5 83 A new procedure-based assessment in gastric bypass surgery
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