The current state of bariatric surgery training: management of complications in the era of bariatric tourism

INTRODUCTION The UK Intercollegiate Surgical Curriculum Programme outlines national standards and competences for surgical training but there has been limited guidance on bariatric surgery, with only 9 of 73 upper gastrointestinal surgery modules in the general surgery curriculum addressing it. The rise of bariatric tourism has led to an increase in bariatric emergencies in the UK, demanding wider surgical competence to provide optimum care for patients. Our survey evaluates the current state of bariatric training among UK surgical trainees. METHODS A national online survey was conducted, which was live from July to August 2024. The survey included 26 questions on exposure to bariatric procedures, confidence in managing bariatric emergencies and perceptions of training emphasis, using a 6-point Likert scale. Participation was anonymous and voluntary. Descriptive statistics were used for analysis. RESULTS A total of 103 general surgical trainees participated in the survey. Only 21% expressed an interest in bariatric surgery, with 73% having no operative exposure in bariatric cases and 27% having performed bariatric procedures as the primary surgeon. There was variation in trainee confidence in managing different emergency scenarios. Endoscopic bariatric procedures were rarely available, with over two-thirds reporting no access to gastric balloon or sleeve gastroplasty cases. Over half reported no formal bariatric teaching, and most advocated for earlier and greater emphasis on bariatric training in the curriculum. CONCLUSIONS There is an inevitable, recognised training gap in bariatric surgery training for UK general surgical trainees. Implementing a structured curriculum with more emphasis and supervised hands-on experience in bariatric surgery is recommended.