FNB Bariatric Surgery: Check out NBE released curriculum

The National Board of Examinations (NBE) has released the curriculum for FNB Bariatric Surgery.

I. INTRODUCTION

Morbid Obesity is a major health problem not only in developed nations but also developing nations like India. In India more than 135 million individuals are affected with obesity. Bariatric Surgery is the only effective means of significant and sustained weight loss. Besides weight surgery has a remarkable impact on co-morbidities including type 2 diabetes mellitus, obstructive sleep apnea, hypertension, non-alcoholic stereo-hepatitis.

There has been a steady rise in the number of bariatric surgical procedures in India and many surgeons desire to train properly in this field. However, the training opportunities are limited, and most current fellowship programs are non-accredited. There is only one fellowship program in the public sector (AIIMS, New Delhi). Most of the surgeons start performing bariatric surgery without any proper training. Morbidly obese patients are considered high risk sub-group and they tolerate any complication poorly. So proper training is essential for optimal outcomes.

However bariatric surgery encompasses not only surgical skills but also a whole lot of medical issues. There is a vast scope of research in this field. NBEMS has approved launch of fellowship programme in Bariatric Surgery which is a two-year programme.

The purpose of Fellowship education in bariatric surgery is to provide a structured educational and training experience necessary to achieve expertise in bariatric and metabolic surgery as well as further the cause of research in this field. Dedicated professionals are required to not only perform safe surgery but also do active research. Surgeons after completing their fellowship in this field will be fully equipped to start this sub-specialty in other institutions across India.

II. GOALS & OBJECTIVES

1. To develop a structured and accredited Training program to provide training opportunities in bariatric surgery

2. To prepare a fully trained Bariatric Surgeon capable of running a bariatric surgical program independently

3. To develop a pool of Trained Manpower in the field of Bariatric Surgery capable of taking care of the burden of patients with obesity

4. To Lay down the minimum criteria for Accreditation of Centers for the Fellowship

5. To increase Research output from India in this field

III. TEACHING AND TRAINING ACTIVITIES

1. Patient Care Activities acquired through Ward rounds, OPDs and clinics, perioperaive management, patient counselling

2. Surgical Skills Training through attending operation theatres and participating in operative procedures, attending skill courses; dry and wet lab courses

3. Bariatric support group meetings

4. Academic activities

a. Journal club Presentations

b. Seminars

c. Book Chapter Review

d. Video editing skills

e. Presentations at national & international conferences

f. Publications

5. Activity

a. Daily

• Participate in daily surgical rounds on all bariatric patients in the wards, write clinical progress notes in the chart; provide daily care to patients on the service.

• Participate in operating room (OR) patient preparation, positioning, Operative procedure and be readily available in OR when patient is going under anaesthesia and emerging from anaesthesia

• Provide postoperative patient care, write postoperative orders, and discharge patients

• Do On call duties

• Log operative cases in the online log bookSelf-education and research projects

b. Weekly

• Attend OPD and Clinics

• Morbidity & Mortality Conference

• Resident and student teaching rounds

• Seminar Presentation/Textbook Chapter Review

c. Monthly

• Data Audit

• Research project update/journal discussion

d. Semi-Annually

• Organize and Conduct Patient Support Group Meetings

e. Annually

• Participate in simulation lab and wet-lab teaching Courses

• Attend bariatric support meeting and information session.

• Submit at least one abstract and present it at regional or national meeting; complete at least one clinical and/or research manuscript and submit it for publication

• Evaluation of the fellow by the faculty at the end of first year

• Exit Examination at the End of 2-year Fellowship

6. Rotation:

First year should be at the center where the candidate is registered to learn basics and rotation should be initiated only in the first half of the second year, should not exceed 2 months in total (1 or 2 centers of candidate’s choice) and then the last 6 months should be spent in the primary centre

IV. SYLLABUS

1. Epidemiology of Obesity

2. History of Bariatric Surgery

3. Physio-pathogenesis of Obesity

4. Essentials of a Bariatric Program

5. Preoperative Evaluation of the Bariatric Patient: Medical, Dietary & Psychological.

6. Anesthesia Considerations in the Obese Patient for Bariatric Surgery

7. Preoperative Risk Scoring Systems, Patient and procedure Selection in Bariatric Surgery Patients

8. Peri-operative Management of the Bariatric Patient

9. Laparoscopic versus Open bariatric procedures

10. Sleeve Gastrectomy and Other Restrictive Operations: Techniques, Complications, Outcomes, and Controversies

11. One Anastomosis Gastric Bypass: Techniques, Complications, Outcomes, and Controversies

12. Roux-en-Y Gastric Bypass: Techniques, Complications, Outcomes, and Controversies

13. Other Restrictive & Malabsorptive Surgeries

14. Revisional Weight Loss Surgery

15. Managing Post-operative Complications

16. Metabolic Effects of Bariatric Surgery

17. Medical Management of Obesity & Weight Regain

18. Nutritional Considerations & Deficiencies

19. Psychological Issues Before and After Bariatric Surgery

20. Obesity in Childhood and Adolescence

21. Role of Endoscopy in Bariatric Surgery

22. Robotics & Newer Advancements in Bariatric Surgery

23. Radiological Imaging in Bariatric Surgery

24. Bariatric Surgery in Extreme of Ages.

25. Management of Extreme Obesity (BMI > 60 kg/m2)

26. Non-alcoholic Fatty Liver Disease (NAFLD) and Bariatric Surgery.

27. Gastro-esophageal Reflux Disease (GERD) and Bariatric Surgery.

28. Body Contouring Surgery after Bariatric Surgery

29. Training, Reporting, and Practice in Bariatric Surgery

30. Health-Related Quality of Life Before and After Bariatric Surgery.

V. COMPETENCIES

1. To safely perform all steps of Primary bariatric procedures including Sleeve gastrectomy and gastric bypass (OAGB/RYGB) independently

2. Perform revision procedures with supervision

3. Able to assess morbidly obese patients and optimize them for bariatric surgery

4. Recommend most suitable bariatric procedure for them based upon assessment

5. Detailed Counselling of patients and consenting

6. Assess motivation level, compliance for treatment and willingness of lifestyle modifications

7. Ability to recognize and manage intra and post-operative complications

8. Postoperative assessment and follow up

9. To understand the role of each member of MDT in Bariatric Surgery and learn to lead the team

10. Ability to conduct Bariatric Support Group Meetings

11. Presentation Skills for National and International Conferences

12. Video-Editing

13. Understanding of Basic Statistics

14. Audit of Data

VI. LOG BOOK

A candidate shall maintain a log book of operations (assisted / performed) during the training period, certified by the concerned post graduate teacher / Head of the department / senior consultant.

This log book shall be made available to the board of examiners for their perusal at the time of the final examination.

The log book should show evidence that the before mentioned subjects were covered (with dates and the name of teacher(s) The candidate will maintain the record of all academic activities undertaken by him/her in log book.

1. Personal profile of the candidate

2. Educational qualification/Professional data

3. Record of case histories

4. Procedures learnt

5. Record of case Demonstration/Presentations

6. Every candidate, at the time of practical examination, will be required to produce performance record (log book) containing details of the work done by him/her during the entire period of training as per requirements of the log book. It should be duly certified by the supervisor as work done by the candidate and countersigned by the administrative Head of the Institution.

7. In the absence of production of log book, the result will not be declared.

VII. RECOMMONDED TEXT BOOKS AND JOURNALS:

1. Suggested Textbooks

a. Obesity, Bariatric and Metabolic Surgery: A Practical Guide. Springer.

Editor: Sanjay Agrawal

b. ASMBS Textbook of Bariatric Surgery

c. Management of Nutritional and Metabolic Complications of Bariatric Surgery. Springer. Editors: Dr Aparna Govil Bhaskar, Dr Sarfaraz Baig

d. Clinics in Bariatric & Metabolic Surgery. Editor Pravin Raj

e. Bariatric Surgical Practical Guide: Recommendations. Editor Pravin Raj

2. Journals:

a. Surgery for Obesity & Related Diseases (SOARD)

b. Obesity Surgery

c. Journal of Bariatric Surgery

d. Clinical Obesity

e. Journal of Diabetes, Metabolic Syndrome and Obesity