Abstract
Introduction
Skill in bariatric surgery has been associated with postoperative outcome. Appropriate surgical training is of paramount importance. In order to continuously improve training strategies, it is necessary to assess current practices.
Aim
To determine how German bariatric surgeons have been trained and to assess current training strategies.
Methods
Between February 2017 and March 2017, an online census of surgeons registered as members of the German Society for Bariatric and Metabolic Surgery was conducted. A total of three reminders were sent out. Data were analyzed using descriptive statistics. Data was reported as median (interquartile range); percentages were adjusted for completed answers only.
Results
A response rate of 51% (n = 214) was achieved. Surgeons reported a median of 14.5 (8–20) years of surgical experience after initial training, with a specific bariatric experience of 7 (4–13) years. The total cumulative bariatric case volume was 240 (80–500) cases, with an annual case volume of 50 (25–80). The most commonly applied approaches to bariatric skills acquisition were “learning by doing” (71%), “course participation” (70%) and “observerships” (70%). Fellowships and the use of operating videos were less frequently applied strategies (19%/ 47%). Interestingly, observerships (94%) and course participation (89%) were rated as very important/important, whereas “learning by doing” (62%), watching operation videos (59%), and fellowships (48%) were less frequently perceived as important/very important training strategies.
Conclusions
The majority of surgeons performing bariatric cases were senior surgeons with more than 10 years of post-training experience; nevertheless, the survey revealed a lack of structured approaches to bariatric specialization training.
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References
Hales C, Carroll M, Fryar C, Ogden C. Prevalence of obesity among adults and youth: United States, 2015–2016. NCHS Data Brief 2017;288.
World Health Organization. Obesity and overweight. 2017 [cited 2018 21.06.2018]; Available from: http://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight.
Borisenko O, Colpan Z, Dillemans B, et al. Clinical indications, utilization, and funding of bariatric surgery in Europe. Obes Surg. 2015;25:1408–16.
ASMBS. Estimates of bariatric surgery numbers, 2011–2016. [21.06.2018]; Available from: https://asmbs.org/resources/estimate-of-bariatric-surgery-numbers.
Birkmeyer JD, Finks JF, O'Reilly A, et al. Surgical skill and complication rates after bariatric surgery. N Engl J Med. 2013;369(15):1434–42.
Schauer P, Ikramuddin S, Hamad G, et al. The learning curve for laparoscopic Roux-en-Y gastric bypass is 100 cases. Surg Endosc. 2003;17(2):212–5.
Major P, Wysocki M, Dworak J, et al. Analysis of laparoscopic sleeve gastrectomy learning curve and its influence on procedure safety and perioperative complications. Obes Surg. 2018;28(6):1672–80.
Zevin B, Aggarwal R, Grantcharov T. Volume-outcome association in bariatric surgery: a systematic review. Ann Surg. 2012;256(1):60–71.
Kohn GP, Galanko JA, Overby DW, et al. High case volumes and surgical fellowships are associated with improved outcomes for bariatric surgery patients: a justification of current credentialing initiatives for practice and training. J Am Coll Surg. 2010;210(6):909–18.
Andalib A, Bouchard P, Bougie A, et al. Variability in bariatric surgical care among various centers: a survey of all bariatric surgeons in the province of Quebec, Canada. Obes Surg. 2018;28(8):2327–32.
Hasenberg T, Weiner S, Birk D, et al. Barriers to the German Society for General and Visceral Surgery (DGAV) accreditation “Center for bariatric and metabolic surgery”. Chirurg. 2018;89(9):710–6. Barrieren auf dem Weg zur DGAV-Zertifizierung “Zentrum fur Adipositas- und metabolische Chirurgie”. ger
Ericsson KA. Deliberate practice and acquisition of expert performance: a general overview. Acad Emerg Med. 2008 Nov;15(11):988-94. doi: 10.1111/j.1553-2712.2008.00227 .x. Epub 2008 Sep 5.
Grantcharov TP, Kristiansen VB, Bendix J, et al. Randomized clinical trial of virtual reality simulation for laparoscopic skills training. Br J Surg. 2004;91(2):146–50.
Kundhal PS, Grantcharov TP. Psychomotor performance measured in a virtual environment correlates with technical skills in the operating room. Surg Endosc. 2009;23(3):645–9.
Bonrath EM, Dedy NJ, Gordon LE, et al. Comprehensive surgical coaching enhances surgical skill in the operating room: a randomized controlled trial. Ann Surg. 2015;262(2):205–12.
Singh P, Aggarwal R, Tahir M, et al. A randomized controlled study to evaluate the role of video-based coaching in training laparoscopic skills. Ann Surg. 2015;261(5):862–9.
Hu YY, Mazer LM, Yule SJ, et al. Complementing operating room teaching with video-based coaching. JAMA Surg. 2017;152(4):318–25.
Zevin B, Dedy NJ, Bonrath EM, et al. Comprehensive simulation-enhanced training curriculum for an advanced minimally invasive procedure: a randomized controlled trial. Surg Obes Relat Dis. 2017;13(5):815–24.
International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). [cited 2018 19.06.2018]; Available from: https://www.eac-bs.com/site/index.php/ifso-endorsed-coe-programs/surgeon-of-excellence-soe-program.
International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). [20.09.2018]; Available from: https://www.eac-bs.com/site/index.php/ifso-endorsed-coe-programs/centre-of-excellence-coe-program.
AWMF, S3- Leitlinien: Chirurgie der Adipositas und metabolischer Erkrankungen. 2018 [11.07.2019]; Version 2.3: Available from: https://www.awmf.org/uploads/tx_szleitlinien/088-001l_S3_Chirurgie-Adipositas-metabolische-Erkrankugen_2018-02.pdf.
Hutter MM, Behrns KE, Soper NJ, et al. Advanced GI surgery training-a roadmap for the future: the white paper from the SSAT task force on advanced GI surgery training. J Gastrointest Surg. 2017;21(4):755–60.
Kolb DA. Experiential learning : experience as the source of learning and development. Englewood Cliffs: Prentice-Hall; 1984. xiii, 256 p. p
Tuovinen JE, Sweller J. A comparison of cognitive load associated with discovery learning and worked examples. J Educ Psychol. 1999;91(2):334–41.
Hamad GG, Brown MT, Clavijo-Alvarez JA. Postoperative video debriefing reduces technical errors in laparoscopic surgery. Am J Surg. 2007;194(1):110–4.
Mendez A, Seikaly H, Ansari K, et al. High definition video teaching module for learning neck dissection. J Otolaryngol Head Neck Surg. 2014;43:7.
Hamour AF, Mendez AI, Harris JR, et al. A High-definition video teaching module for thyroidectomy surgery. J Surg Educ. 2018;75(2):481–8.
Altieri MS, Yang J, Yin D, et al. Presence of a fellowship improves perioperative outcomes following hepatopancreatobiliary procedures. Surg Endosc. 2017;31(7):2918–24.
Kim PS, Telem DA, Altieri MS, et al. Bariatric outcomes are significantly improved in hospitals with fellowship council-accredited bariatric fellowships. J Gastrointest Surg. 2015;19(4):594–7.
Johnston MJ, Singh P, Pucher PH, et al. Systematic review with meta-analysis of the impact of surgical fellowship training on patient outcomes. Br J Surg. 2015;102(10):1156–66.
Cottam D, Holover S, Mattar SG, et al. The mini-fellowship concept: a six-week focused training program for minimally invasive bariatric surgery. Surg Endosc. 2007;21(12):2237–9.
Briet JM, Mourits MJ, Kenkhuis MJ, et al. Implementing an advanced laparoscopic procedure by monitoring with a visiting surgeon. J Minim Invasive Gynecol. 2010;17(6):771–8.
Gagliardi AR, Wright FC. Exploratory evaluation of surgical skills mentorship program design and outcomes. J Contin Educ Heal Prof. 2010;30(1):51–6.
Lewis T, Aggarwal R, Sugden C, et al. The adoption of advanced surgical techniques: are surgical masterclasses enough? Am J Surg. 2012;204(1):110–4.
McBride CL, Rosenthal RJ, Brethauer S, et al. Constructing a competency-based bariatric surgery fellowship training curriculum. Surg Obes Relat Dis. 2017;13(3):437–41.
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Bonrath, E.M., Weiner, S., Birk, D. et al. Training in Bariatric Surgery: a National Survey of German Bariatric Surgeons. OBES SURG 30, 56–62 (2020). https://doi.org/10.1007/s11695-019-04137-3
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DOI: https://doi.org/10.1007/s11695-019-04137-3