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Challenges and Deficiencies in Orthopaedic Surgical Training in Germany - A Qualitative Study

Author(s): Johanna Ludwig, Julia Seifert, Julia Schorlemmer

Objective

Surgical training is an essential factor for patient safety and care. Germany is in the process of implementing competency-based training. Before changes are made, it is recommended to analyze the current process and its deficiencies to improve a process accordingly. Without analyzing current deficiency, risks for ineffective changes are high. This research aims to reveal the deficiencies in surgical training perceived by stakeholders and the factors leading to insufficient training in Germany to undertake changes of the system accordingly.

Methods

Semi-structured interviews and process mapping was chosen to enable an in-depth exploration and allow unexpected areas to emerge. Trainees, trainers, members of the Federal States - and German Medical Council were identified as key stakeholders. 20 interviews were conducted and analyzed using qualitative content analysis method as well as a PESTEL-Analysis for categorization.

Setting

One-on-one interviews with stakeholders of surgical training in Germany.

Results

Factors leading to deficiency in training were identified, as a lack of compliance with standards, false logbook entries, insufficient educational resources and unsatisfactory trainer-trainee-relationship. Factors leading to deficiency in training are critical economic and structural issues. Furthermore, political and social factors and a lack of consistent oversights between agencies responsible for curriculum quality were described to affect surgical training persistently.

Conclusion

Orthopaedic surgical training in Germany is facing multiple challenges. Apart from a change of curriculums and logbook, economic, political and structural factors need to be considered and improved to enhance training in Germany.

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