Ibrahim Mohammed, Axt Steffen, Dechantsreiter Judith, Marty Adrian P, Milazzo Alfio, Mihaljevic André L, Kron Philipp
Klinik für Allgemeine, Viszeral- und Transplantationschirurgie, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland.
Abteilung für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinik Balgrist, Zürich, Schweiz.
Chirurgie (Heidelb). 2025 Sep 4. doi: 10.1007/s00104-025-02370-4.
Since the 2020 revision of the medical training regulations surgical training in Germany has been based on the acquisition of knowledge (cognitive and methodological competence) as well as experience and skills (practical competence). As in previous training catalogues, minimum numbers are defined for essential operations; however, these operation catalogues do not reflect the actual surgical competence of residents.
This paper highlights the current challenges faced by prospective surgeons. It presents a perspective on a core competency-oriented surgical training model using entrustable professional activities (EPAs) and provides suggestions for the implementation and digitalization of surgical education based on EPAs.
Overview in the sense of a narrative review.
The EPAs are clearly defined clinical tasks in the medical practice that can be entrusted to residents, observed and evaluated. The purpose of EPAs is the structured and continuous assessment of individual competencies in medical training. They are specific, embedded in the surgical routine and can support supervisors in implementing competency-based training. The EPAs serve to assess and promote surgical skills. Through digitalization tools such as smartphone applications, these evaluations can be integrated into daily clinical practice.
In the future, surgical education should evolve towards competency-based learning. The use of EPAs enables a more practice-oriented training approach: moving away from the quantitative focus of procedure catalogues toward a qualitative improvement of surgical training.
自2020年德国医学培训条例修订以来，德国的外科培训基于知识的获取（认知和方法能力）以及经验和技能（实践能力）。与之前的培训目录一样，为基本手术定义了最低数量；然而，这些手术目录并未反映住院医师的实际手术能力。
本文强调了未来外科医生面临的当前挑战。它提出了一种基于可托付专业活动（EPA）的以核心能力为导向的外科培训模式的观点，并为基于EPA的外科教育的实施和数字化提供了建议。
进行叙述性综述意义上的概述。
EPA是医疗实践中明确界定的临床任务，可以托付给住院医师、进行观察和评估。EPA的目的是在医学培训中对个人能力进行结构化和持续评估。它们具体、融入外科常规，并且可以支持监督者实施基于能力的培训。EPA有助于评估和提升手术技能。通过智能手机应用程序等数字化工具，这些评估可以融入日常临床实践。
未来，外科教育应朝着基于能力的学习方向发展。使用EPA能够实现一种更注重实践的培训方法：从手术目录的数量关注转向外科培训的质量提升。
