Significant disparities in the availability of MBS services and the level of resident training and exposure

A global survey on general surgery resident involvement in metabolic and bariatric surgery (MBS) has reported that significant disparities currently exist across different geographic areas, regarding the availability of MBS services and the resulting level of resident training and exposure.

Researchers from Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, sought to evaluate global patterns of general surgery residents’ exposure to MBS, including operative experience, outpatient clinic participation, and academic or research involvement. They conducted an online survey to compare training experiences across global regions to identify differences in exposure to key aspects of MBS care.

In total, 198 general surgery residents from 35 countries (Figure 1) completed the survey. Most commonly, residents were from the following regions: Europe (51%), Asia and the Pacific (22%), Latin America (13%), the Middle East and North Africa (10%), North America (2%), sub-Saharan Africa (1%), and other regions (1%). The mean age of respondents was 34.0 ± 6.71 years, and 31% were women. The mean duration of general surgery residency was 5.11 ± 1.53 years, and the mean postgraduate year of responding residents was 4.11 ± 3.22 years.

Figure 1: Distribution of resident survey respondents

Among the study cohort, residents were most interested in the following subspecialties: MBS (52%), upper gastrointestinal (GI) tract surgery (40%), surgical oncology (33%), colorectal surgery (31%), abdominal wall and hernia surgery (30%), hepatic-pancreatic-biliary surgery (25%), breast surgery (13%), endocrine surgery (10%), and other subspecialties (11%). More than two-thirds of the study cohort (68%) considered completing an MBS fellowship.

The researchers found that more than a quarter of residents (28%) had no MBS service at their hospital. More than half of the respondents (59%) were trained in low-volume centres performing 100 or fewer MBS procedures a year. However, over three-quarters (77%) of residents had participated in MBS procedures at their workplace. The vast majority of respondents (83%) had participated as primary surgeons in MBS procedures (either leading the surgery or performing the majority of the case), most commonly: sleeve gastrectomy (SG): 47%, Roux-en-Y gastric bypass (RYGB): 25%, one anastomosis gastric bypass (OAGB): 22%, single anastomosis duodeno-ileal bypass (6%), biliopancreatic diversion (3%), gastric banding (3%), and duodenal switch (1%).

Around one-fifth of respondents (21%) had participated in more than 100 MBS procedures. Most respondents had participated in MBS outpatient care (71% preoperative, 71% postoperative), and almost all (92%) believed that participation in MBS should be mandatory during surgical residency. Most residents had a surgical mentor (81%), and the mentor was an MBS surgeon for nearly half (49%).

Nearly two-thirds of responding residents (65%) had a scientific mentor, and for nearly one-third (32%), the mentor was an MBS surgeon. The vast majority of respondents had published at least one publication (86%), almost one-half (45%) had published MBS-related research, and one-quarter (25%) of respondents had published at least 20 publications. Many respondents had previously presented at national (70%) and international (56%) scientific conferences, and a significant minority of respondents had previously presented MBS-related research at national (38%) and international (30%) conferences.

The percentage of high-volume centres (high-volume centres were considered as centers performing 100 or more MBS procedures yearly) and centres with an MBS service in each region, according to residents' responses, can be seen in Figure 2.

Figure 2: Percentage of high-volume centres and centres with a metabolic and bariatric surgery service (MBS) according to respondents from each region

 Meaningful differences were found in the length of general surgery residency between regions, which was shortest in Latin America (3.88±0.61 years) and longest in Europe (5.78±1.03 years). Meaningful differences were also found in the frequency of high-volume centers and MBS services between regions. Both were most frequent in North America (66.7%, 100%) and Latin America (68.0%, 96.0%), followed by (in decreasing order) the Middle East and North Africa (50%, 77.8%), Europe (38.5%, 73.1%), Asia and the Pacific (31.1%, 55.6%), and sub-Saharan Africa (0%, 33.3%, p=0.023 and 0.004, respectively).

“To address these gaps and foster greater uniformity in MBS education, a more formalised, multi-pronged approach is necessary. We propose that the global surgical community pursue collaborative strategies that include the formal integration of MBS-specific modules into general surgery curricula,” the researchers concluded. “Furthermore, the development of structured global exchange programs would provide residents with invaluable clinical training in diverse geographic settings, exposing them to varying MBS practices and volumes. By implementing such targeted and collaborative initiatives, we can ensure that all general surgery residents receive comprehensive and high-quality MBS training, which is essential for improving patient care and long-term outcomes worldwide.”

The findings were reported in the paper, ‘A Global Survey on General Surgery Resident Involvement in Metabolic and Bariatric Surgery’, published in Cureus. To access this paper, please click here