Niethard M, Depeweg D
Zentrum für Orthopädie und Unfallchirurgie, HELIOS Klinikum Berlin-Buch.
Z Orthop Unfall. 2010 Aug;148(4):471-5. doi: 10.1055/s-0030-1250170. Epub 2010 Aug 16.
The specialty training reglementation in Germany is defined by a clear framework and aims regarding the obtainable specialty qualification. But its implementation is often difficult. The aim of the present study was to evaluate the demands of the new specialist qualification on the part of the trainers in Germany.
An e-mail questionnaire was distributed via the offices of DGU (German Society of Traumatology) and DGOOC (German Society of Orthopaedics and Orthopaedic Surgery) to 954 head physicians. Questions referred to abilities that are subject to concrete specialty training. Questions 1-3 referred to basic knowledge of the trained specialty. Questions 4 and 5 focused on self-reliant work, questions 6 and 7 touched aspects of conservative orthopaedics and multiple trauma management whereas questions 8-10 referred to the achieved surgical skills.
220 questionnaires were evaluated overall in a period of 6 weeks. 132 questionnaires were returned by the DGOOC and 88 by the DGU. Questions 1-3: basic knowledge regarding diagnostics and treatment of diseases and injuries of the musculoskeletal system as well as communication in adequate medical terminology were presumed by 97% and 85% respectively. 72% of the questioned trainers expected a brand new specialist to give a detailed and qualified description of an X-ray. Questions 4 and 5: 67% postulated that a brand new specialist should be capable of indicating a routine surgical intervention correctly. But only 30% expected a specialist to manage a consultation. Questions 6 and 7: the self-reliant conservative treatment of back pain patients was assumed by 60%, whereas the organisation of the medical care of multiple trauma patients is requested by 40%. Questions 8-10: referring to the surgical skills, 52% expected that one should handle the standard surgical approaches to the large extremity joints. Only 24% expected that after completing his training, a specialist can perform standard surgical procedures, which are required in the specialty training reglementation, without supervision. On the other hand they were expected to assist.
Expectations of the head physicians concerning the skills of a new specialist did not match the expected skills defined in the specialty training reglementation regarding basic knowledge, self-reliant work, surgical skills as well as conservative orthopaedics and multiple trauma management. A reasonable structuring is necessary in order to implement the requested contents of the specialty training reglementation. This can only be achieved if demands on aims are compliant.
德国的专科培训规定由关于可获得的专科资格的明确框架和目标所界定。但其实施往往困难重重。本研究的目的是评估德国培训人员对新专科资格的要求。
通过德国创伤外科学会（DGU）和德国骨科学与矫形外科学会（DGOOC）的办公室向954名主任医师发放了电子邮件调查问卷。问题涉及具体专科培训所需的能力。问题1 - 3涉及所培训专科的基础知识。问题4和5关注独立工作，问题6和7涉及保守骨科和多发伤处理的方面，而问题8 - 10涉及已掌握的手术技能。
在6周内共评估了220份问卷。DGOOC返回了132份问卷，DGU返回了88份问卷。问题1 - 3：分别有97%和85%的人认为新专科医生应具备肌肉骨骼系统疾病和损伤的诊断与治疗的基础知识以及用恰当医学术语进行交流的能力。72%的受访培训人员期望新专科医生能对X光片进行详细且专业的描述。问题4和5：67%的人假定新专科医生应能够正确指出常规手术干预。但只有30%的人期望专科医生能处理会诊。问题6和7：60%的人认为应能独立对背痛患者进行保守治疗，而40%的人要求具备组织多发伤患者医疗护理的能力。问题8 - 10：关于手术技能，52%的人期望能掌握大关节的标准手术入路。只有24%的人期望专科医生在完成培训后能在无监督的情况下进行专科培训规定中要求的标准手术操作。另一方面，期望他们能提供协助。
主任医师对新专科医生技能的期望与专科培训规定中关于基础知识、独立工作、手术技能以及保守骨科和多发伤处理所定义的期望技能不相符。为了实施专科培训规定所要求的内容，合理的架构是必要的。只有目标要求相符才能实现这一点。
