Hospital.Help

Mainz The topic of further training is almost always a source of controversy at doctors’ conferences, as was the case before the 128th German Doctors’ Day in Mainz at the dialogue forum organized by the Federal Medical Association with young doctors on the topic of further medical training – desire and reality. Today’s discussion showed that although improvements for doctors in further training have been sought for years, many do not feel that they are receiving optimal training.

There is often no designated space for further training at the clinics, complained Sarah Woldu, who is in her first year of training in gynecology at the University Hospital of Cologne. There is a particular lack of structure, she explained.

We young people want to become very good specialists, so we need structured further training, good training officers and appropriate feedback, said Constanze Weber, a doctor in training in the neurology clinic and polyclinic at the University Hospital Dresden.

Further training is an ongoing topic, confirmed Ellen Lundershausen, Vice President of the Federal Medical Association (BK) and patron of the annual dialogue forum. In order to be able to specifically address problems in the medical associations, they rely on the help of doctors. Give us some information about what concerns you, she asked the participants.

This was also emphasized by Pedram Emami, President of the Hamburg Medical Association and moderator of the forum. He particularly referred to the evaluation of further training, in which there were still too few further trainees taking part. All efforts will be of no use if you at the grassroots level do not tell us your opinion, he emphasized.

In a welcoming speech, the President of the World Medical Association (WMA), Lujain Alqodmani, called on young doctors to get involved in medical associations and to actively shape their future.

The young doctors are a relevant part of patient care. Without doctors in further training, care in Germany would not be possible, said Hans-Albert Gehle, President of the Westphalia-Lippe Medical Association and Co-Chairman of the BK’s Standing Conference on Continuing Medical Education.

Use good training as a competitive advantage

We have to design further training in such a way that it is attractive, said Alexander Radbruch, director of the Neuroradiology Clinic at the University Hospital of Bonn and person authorized to provide further training. This is an advantage for clinics in the competition for scarce young talent. Word gets around about good further training. Radbruch pointed out that the structures in further training need to be designed differently and that flexible access for individuals needs to be made possible.

Weber added that a safe and structured environment must be created for the trainees. Hierarchies are still widespread in the medical field. Many young doctors did not dare to express problems or request support.

The group agreed that women need to be given more flexible opportunities in further training in order to be able to better combine family and career. Flexible working hours, part-time models and better care options for young people should become the rule, said several young doctors in further training.

It should be made easier for mothers to return to work and further training with a family should be made more possible. Women also often experienced discrimination. Women have to do a lot more to get the same position as men, said Weber. Woldu also complained that the decisive factor is often the sympathies of those authorized to provide further training, and that further trainees are particularly encouraged and supported.

A good fifth works part-time

The trend towards part-time employment was confirmed by the President of the Medical Association, Gehle. Approved part-time further training, especially for women, has increased significantly in Hamburg and Westphalia-Lippe in recent years. However, young fathers have recently also been working part-time more frequently. According to Gehle, 22 percent of further trainees were working part-time in 2023.

Uwe Khler, specialist in gynecology at the St. Georg Hospital in Leipzig and vice president of the Saxon State Medical Association, explained that there are 14 female doctors in further training in his department. All but one of them work part-time. This presents us with special challenges, said Khler. Part-time work has an impact on systematized further training and the transfer of skills.

It is important to build a partnership between those responsible for further training and those undergoing further training, says Khler. Further training only works with appropriate coordination and involvement. But you also have to demand personal responsibility from your young colleagues.

This was confirmed by a young doctor in the discussion group. But medicine has become more complex. The challenges that young doctors face are often not visible. At the same time, trainees would then have the feeling that they were not living up to expectations, the doctor complained. Here the framework conditions would have to be adjusted accordingly and solutions found.

For Kühler, the further training regulations would also have to be slimmed down. It is also important to shift further training more to the outpatient area.

There is already progress there. Many of the demands have already been implemented in the outpatient area, said Bernhard Lenhard, general practitioner and vice president of the Rhineland-Palatinate State Medical Association. For example, there is one-to-one support from the person responsible for further training and relatively short training times.

Take better training into your own hands

The medical profession can do a lot to improve further training, said Henrik Herrmann, President of the Schleswig-Holstein Medical Association and co-chairman of the Federal Medical Association’s Standing Conference on Continuing Medical Education.

However, changes under European law must also be taken into account, added his colleague Gehle. The reason for this is that further training to become a specialist is also internationally recognized and with this qualification you can also work abroad.

Herrmann outlined the ideal for further training in three years, i.e. in 2027: A young doctor will then be accompanied during her further training by someone authorized to provide further training who has already completed a train-the-trainer seminar and a didactics seminar. At the beginning of her further training, she would receive an individual rotation plan, which also included outpatient work for six months. In addition, there will initially be a four-week onboarding period in which the clinic’s IT and other basics will be explained to you.

In general, their further training would only contain 24 instead of 48 skills, which would be described as Entrustable Professional Activities (EPAs). Every week there are feedback discussions lasting at least one hour with the person responsible for further training, continued Herrmann. These discussions would also be financed, as would the further training components in the outpatient area. And at the end of the further training, the young doctor’s competence to act would be directly checked by the chamber, he concluded.

In order for this dream to become reality, four points must be overcome, said Herrmann. Most of these can be handled by the medical profession themselves. Firstly, there needs to be a real, partnership-based relationship between those undergoing further training and those authorized to provide further training. We need a real culture of further training, said the chamber president.

Secondly, the medical profession must sharpen, purify and reduce the training regulations to the essentials, with the help of young doctors. Get involved, appealed to the participants in the dialogue forum.

Thirdly, Herrmann suggested a uniform training regulation. In the future, there could no longer be 17 further training regulations, but rather a one-to-one implementation of the model further training regulations, he outlined.

Only the fourth point is not in the power of the medical profession, said Herrmann. This is a task for politics. More resources should be made available for further training, for example through a further training fund.

“But three out of four points are in our hands,” said the co-chairman of the Federal Medical Association’s Standing Conference on Continuing Medical Education. It is in our hands to create this reality in the next three years. © ER/nfs/cmk/aerzteblatt.de