[The suffering surgeon-How do German surgeons protect themselves? : Survey of the German Society of General and Visceral Surgery on the extent of occupational safety measures and health burden among German surgeons]. / Der leidende Chirurg ­ Wie schützen Chirurgen sich selbst? : DGAV-Umfrage zur Verbreitung von Arbeitssicherheitsmaßnahmen und Gesundheitsbelastung bei deutschen Chirurgen.

BACKGROUND: There are few data on how surgeons implement occupational safety measures to protect their own health and how they assess their subjective health burden. OBJECTIVE: In times of a shortage of surgeons it makes sense to examine these relationships in order to evaluate future-oriented adjustments to increase the attractiveness of the profession of "surgeon". MATERIAL AND METHODS: An online questionnaire was sent to the registered members of the German Society for General and Visceral Surgery (DGAV) in October 2016. The members were asked about the application of occupational safety measures, individual living conditions, working conditions and the subjective health burden depending on the level of training and type of hospital (basic, standard, maximum care). RESULTS: The response rate was 21% (1065/5011). Occupational safety measures were not strictly implemented: routine use of dosimeters, thyroid radiation protection, smoke extraction and protective goggles only took place in 40% (427/1065), 39% (411/1065), 10% (104/1065) and 5% (55/1065), respectively. The majority of surgeons (51%, 548/1065) rated their lifestyle as unhealthy. The majority of them are senior physicians, 46% (250/548) consider their job to be a health hazard. The proportion of chief physicians and assistant physicians is only 21% (115/548) and 18% (98/548). CONCLUSION: Guidelines for standardizing the perioperative protection of German surgeons are desirable. Health-promoting behavior could have a positive effect on the occupational safety of surgeons and ultimately also on patient safety. This can contribute to increasing the attractiveness of the profession "surgeon" in the long term.

[Survey of Training in Laparoscopic Skills in Germany]. / Umfrage zum Training laparoskopischer Fertigkeiten in Deutschland.

Background: Training in laparoscopic skills on simulators such as box-, POP- or VR-trainers improves intraoperative performance. Although this training is not mandatory in Germany at the moment, certified centres for minimally invasive surgery need to account for training opportunities. According to previous surveys, laparoscopic simulators are desired, yet not sufficiently available. The aim of the current project was a structured analysis of laparoscopic simulation sites in Germany. Materials and Methods: An online survey was performed among members of the "Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie". This consisted of 16 questions on the availability, type, use and financing of a laparoscopic simulator. If more than one person in an institution completed the questionnaire, answers were pooled and an analysis of clinics as well as single persons was performed. Results: Of 4605 persons, 422 participants (9.2 %) from 265 different departments completed the survey. In 140 Institutions (52.8 %) a simulator for laparoscopic training was present. No training possibility was available in 37.8 % (n = 99) of the hospitals. A curriculum for laparoscopic training was obtained in 43.3 % (n = 103) of the participants with laparoscopic training facilities. The use of available simulators by surgical residents increased when they were embedded in a mandatory training curriculum (at least monthly use: 33.3 vs. 57.1 %). Conclusion: Compared to previous surveys, the proportion of hospitals with simulators is increasing. Their use is currently very heterogenous. A mandatory basic curriculum may encourage acquisition of more simulators. A DGAV database is supposed to encourage cooperation between training centres and clinics without simulators.

[Surgical Training in Germany: Desire and Reality]. / Chirurgische Weiterbildung an deutschen Kliniken - Wunsch und Realität.

BACKGROUND: In-house surgical education and practical training of surgical skills are inhomogeneous in German hospitals and vary greatly in terms of teaching content and forms. The present survey provides an overview of the currently practiced surgical education and practical training of surgical skills in German hospitals. MATERIAL AND METHODS: An online survey was performed among members of the "Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie" (DGAV). It was a prospective data collection, divided into the following two groups: "junior physicians/consultants/senior physicians" and "chief physicians". The questionnaire consisted of 30 questions concerning the frequency, type and quality of in-house surgical education and practical training of surgical skills in German hospitals. RESULTS: A total of 325 physicians participated in the survey, including 61 chief physicians and 264 junior physicians/consultants/senior physicians. Amongst the participants, 107 (33 %) worked in university hospitals, 57 (18 %) in maximum care clinics, 73 (22 %) in major regional hospitals with specialised medical services and 88 (27 %) in basic care facilities. 199 (75.4 %) of the junior physicians/consultants/senior physicians reported a regular, 57 (21.6 %) an irregular and 8 (3.0 %) no formal surgical education or practical training of surgical skills in their hospitals. Assistance in substeps of an operation was considered to be very important by 72 % of the survey participants. Similarly, 71 % rated the practical teaching of basic surgical skills as very important. Furthermore, we investigated the availability of theoretical and practical training offerings as well as satisfaction with educational measures and their importance as assessed by the respondents. SUMMARY: The present survey illustrates the current state of surgical education and training in German hospitals. An implementation of pragmatic approaches such as the assistance in substeps of an operation and guided practical training of surgical skills might help to improve the satisfaction of physicians undergoing surgical training.

[The competent surgeon. Bridging the gap between undergraduate final year and postgraduate surgery training]. / Der kompetente Chirurg. Brückenschlag zwischen der Ausbildung im Praktischen Jahr und der chirurgischen Weiterbildung.

Competency-based frameworks rely on relevant professional competency rather than formal regulations. The transitional phase between final year undergraduate and common trunk postgraduate medical training is characterized by an increase of professional responsibility whereby previously acquired knowledge, skills and abilities have to be merged and applied to patients. Undergraduate and postgraduate training programs should ensure a successive transfer of responsibility for medical practice to final year students and young residents depending on individual competence. The concept of entrustable professional activities (EPA) represents a curricular concept based on concrete medical tasks which may be assigned to the responsibility of the trainee.