Keywords Training - Board Certification Gastroenterology - Survey - Training Satisfaction -
Generational Differences
Schlüsselwörter Weiterbildung - Facharzt Gastroenterologie - Umfrage - Zufriedenheit - Generationenkonflikt
Introduction
High-quality training of future gastroenterologists is important for improving patient
care and reducing physician turnover [1 ]. The contents and regulations of further training in gastroenterology are laid down
in Germany in both state and federal law. To achieve uniform training legislation
in the medical associations of the federal states, the German Medical Congress adopts
a training regulation, which is recommended to the federal state medical associations
for adoption. Nevertheless, there is considerable variability in implementation. In
Germany, satisfaction with conditions in residency training remains low, with up to
60% of trainees not being satisfied with their training conditions [2 ]
[3 ]
[4 ]. Around one-third of residents in Germany are considering changing their field of
work, and more than half want to reduce working hours to part-time [5 ]. Specific data on physician training satisfaction in gastroenterology in Germany
are lacking.
Conversely, around 80% of gastroenterology residents in Canada report being satisfied
with their training programs [6 ]. Furthermore, training conditions are an important reason for physician emigration,
in addition to increased salary and improved work–life balance [7 ]. These data underline the importance of training conditions for physician retention,
which is essential regarding the projected lack of physicians in Germany [8 ].
Staff shortage, high workload, and suboptimal work-life balance are commonly cited
reasons for low trainee satisfaction [3 ]
[4 ]
[9 ]. Although these issues are being increasingly addressed, solutions, such as increased
training of physicians or shifting the workload from physicians to other healthcare
workers (e.g., administrative staff, nurse practitioners, or physician assistants),
remain a policy challenge. Nevertheless, single institutions still have at least some
degree of freedom regarding the organization of their physician training program.
Unfortunately, data on expectations and wishes regarding training for gastroenterology
board certification in Germany are lacking. In the US, training conditions are seen
more favorably by program directors compared to trainees in gastroenterology programs,
pointing toward a disconnect in perception and expectations between trainers and trainees
[10 ].
This study assesses the views of trainers and trainees in gastroenterology and medical
students. We surveyed members of the biggest German Gastroenterology Society, the
German Society for Gastroenterology, Digestive, and Metabolic Disorders (Deutsche
Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselerkrankungen, DGVS)
and German medical students. The survey aims to identify possibilities to improve
training conditions. Training is not formally organized in programs in Germany. Still,
physicians in training rotate through different wards and specialties. One of this
survey’s focuses is determining the best way to organize these rotations. We also
hypothesize that there would be significant differences concerning the position in
a medical hierarchy structure, age, parental status, gender, and place of work.
Methods
An anonymous questionnaire (original survey supplemental 1 , English translation of questions supplemental 2 ) using SoSci Survey software (Version 3.1.06) was circulated among trainers and trainees
in gastroenterology and medical students in Germany; 6396 members of the DGVS were
asked to participate via email. Invitations were additionally circulated through the
student council mailing lists of all German medical schools. The survey was accessible
from April 6th through May 7th, 2022, in the German language. The survey consisted
of both single- and multiple-choice questions, and Likert-scale and fill-in responses
were utilized [11 ]. Response to all questions was voluntary, and every question was skippable. Query
logic branched depending on the response to the current position and part-time status
and included 21 to 25 items. The spatial alignment of Likert scales was randomly alternated
to exclude the possibility of left bias [12 ]. The authors of this paper jointly created the survey, which was subsequently pretested
in March 2022 among members of the Young Gastroenterology Task Force (Arbeitsgruppe
Junge Gastroenterologie) of the DGVS.
Responses and data censoring
There were 1136 participants, 139 of whom did not answer all questions. Incomplete
surveys were excluded from further analysis. Additionally, we excluded the responses
from physicians currently looking for jobs (n = 3) because of small case numbers and
respondents who decided not to disclose their training status. Another 18 responses
without answers to single questions were censored. Ultimately, 958 responses were
used for the final analysis. Given that 158 students answered our survey, the response
rate for the DGVS was approximately 8%. The response rate for students was not calculable
but most probably was considerably lower.
Ethics approval
Ethics approval was sought and granted before the circulation of the survey at the
ethics committee of the Martin-Luther-Universität Halle-Wittenberg (2022-051). The
study protocol adhered to all relevant data security and ethics guidelines.
Statistical analysis and representative study sample size calculation
Data cleaning, aggregation, descriptive analysis, and visualizations were realized
in Python (version 3.7). The full raw data and annotated code are available for reproduction
in a Google Colab document, which can be accessed via a GitHub repository: https://github.com/GeneralGrube/JUGA_survey . A graphical overview over the responses to all questions can be found in supplemental 3 . The sample size needed for a representative sample was calculated following Kotrlik
et al. [13 ]. Given the 6396 members of the DGVS with active email addresses, a margin of error
= 0.05, and a confidence interval of 95%, a sample of n = 364 was calculated. The
sample size is therefore sufficient for DGVS members. Students currently enrolled
at a German medical school were also included in this survey, but the sample size
in this group is insufficient. Before analysis, the following subgroups were defined:
workplace (university hospital, maximum provider, primary provider, and outpatient
centers), age (≥ 42 years, <42 years), sex, professional position (physician in an
outpatient center, department head, senior physician, board-certified physician, resident
physician, or student), employment status (full-time or part-time), and parental status.
Board-certified physicians (German: Facharzt) are physicians who passed the board
exam. Generally, physicians in Germany are able to take the exam after a minimum of
5–6 years of training, depending on the field of board certification and additional
prerequisites, which are different between federal states in Germany. ‘Senior physicians’
(German: Oberarzt) are physicians in an inpatient setting with a leadership role,
promoted to senior physician, with being board-certified being a criteria that must
be fulfilled in most cases, along with heterogeneous informal criteria depending on
settings Department heads, senior physicians, board-certified physicians, and outpatient-care
physicians were defined as trainers and residents and students as trainees.
Results
Study cohort
Of the 958 respondents included in the final analysis, 465 (49%) were older than 42.
The age structure in subgroups defined by position is shown in [Fig. 1 ]. Among physicians in the hospital, the median age of heads of departments was 54.0
+/– 15.91 years; of senior physicians 43.0 +/– 13.43 years; of board-certified physicians
37.0 +/– 14.34 years; of resident physicians 30.0 +/– 4.35 years. Among physicians
working in outpatient centers, the median age was 54.0 +/– 12.5 years, and among students,
24.0 +/– 5.54 years. Of note, resident physician respondents were equally distributed
among years of training ([Table 1 ]), while medical student respondents were in the later parts of their studies. There
was a dominance of male respondents (n = 579; 60%) correlating with the predominance
of male members of the DGVS. Less than half of the respondents (42.6%) care for children.
Further characteristics, including place of work and position of respondents, are
presented in [Table 1 ].
Fig. 1 Age of respondents stratified by professional position and sex.
Table 1 Baseline Characteristics.
Characteristic*
Survey (958)
DGVS (6736)
* Respondents were given the option to not disclose personal information. Therefore,
characteristics of sex, age, and parental status contain a small fraction of missing
information, and percentages do not add up to 100%.
Sex
Female
36 (38%)
1771 (26%)
Male
579 (60%)
4963 (74%)
Diverse
3 (0%)
–
Age
Median (years)
42.0
50.8
< 42 years
465 (49%)
1755 (26%)
≥ 42 years
453 (47%)
4637 (69%)
Parental status
Children
408 (43%)
N/A
No children
540 (56%)
N/A
Professional position
Department head
158 (16%)
721 (11%)
Senior physician
291 (30%)
1771 (26%)
Board-certified physician
100 (10%)
562 (1%)
Resident physician
123 (13%)
1193 (18%)
1st year
17
N/A
2nd year
26
N/A
3rd year
16
N/A
4th year
20
N/A
5th year
21
N/A
≥ 6th year
23
N/A
Student
158 (16%)
73 (0%)
Outpatient Care Physician
128 (13%)
1222 (18%)
Place of work
University Hospital
195 (24%)
688 (10%)
Maximum provider
154 (19%)
N/A
Basic provider
274 (34%)
N/A
Outpatient center
166 (21%)
1222 (18%)
Employment status
Full-time
672 (70%)
N/A
Part-time
117 (12%)
N/A
Most respondents favor fixed rotation schedules based on the length of training
Approximately two-thirds responded that rotations to other specialties, emergency
departments, intensive-care units, outpatient departments, and functional diagnostics
should follow a fixed curriculum. Both trainers and trainees agreed to a similar degree.
There was a shift in the response by seniority. Students and resident physicians preferred
a fixed curriculum to a lesser extent than the board-certified physicians. Similarly,
51% of students preferred concurrent continuous sonographic or endoscopic training
at the start of work, whereas 86% of residents preferred a fixed rotation in sonography
and endoscopy ([Fig. 2 ]). Physicians working at primary-care hospitals preferred fixed rotations to a lesser
extent (64%) than university hospitals (88%), as well as full-time workers (68%) to
a lesser extent than part-time workers (79%).
Fig. 2 Organization of Training for Endoscopy and Sonography.
In addition, 63% of respondents felt that the rotation order should be based on the
length of training time rather than on performance and commitment. Overall, trainees
agreed to a higher degree (68%) than trainers (61%), but surprisingly, there was considerable
heterogeneity in this group with 42% of students having the opinion that performance
and commitment should decide rotation order. This was more than double the share compared
to resident physicians (20%). Also, a gradual shift from department heads to resident
physicians was seen here, with department heads valuing performance and commitment.
A large majority (80%) of respondents value education at several institutions higher
than at a single institution. Again, we observed strong concordance among trainers
(78%) and trainees (83%). Solely, department heads share this view less (67%) ([Fig. 3 ]).
Fig. 3 Opinions upon training in multiple institutions.
Interestingly, about two-thirds of the respondents believe that overtime is necessary
for good clinical training ([Fig. 4 ]). Nevertheless, a majority of trainees (58%) disagree with this opinion. Of note,
there was considerable dissent between students (67%) and resident physicians (42%)
in the response to this question. Most trainers (76%), on the other hand, hold the
opinion that good clinical education is impossible without overtime. Women (60%) overall
agree less with the sentiment that overtime is essential for good clinical training
than men (70%).
Fig. 4 Overtime and Quality of Training.
Most respondents prefer in-house training during work hours
Most respondents (87%) reported that in-house training opportunities should occur
during working hours instead of after work, with trainees (92%) agreeing slightly
more than trainers (85%). In particular, respondents < 42 years (92%) and resident
physicians (93%) agreed with this view more than average. The lowest level of agreement
was found in respondents performing outpatient care (75%).
Interestingly, most respondents, especially trainees (76%) and respondents < 42 years
(74%), preferred internal versus external training (71%) before taking their first
steps in sonography or endoscopy. Physicians working in primary-care hospitals (64%)
agreed to a lesser degree with this statement compared to those working at university
hospitals (75%). The same was true for part-time workers (63%) compared to full-time
workers (70%).
In addition, 91% of respondents believe that external training should be paid for
through a training budget from their institution. Almost every responder younger than
42 (96%) and resident physician (97%) supported this idea. Although physicians in
outpatient care shared this view somewhat less, the acceptance remained high (84%).
There is an excellent agreement (89%) that at an early stage of the training in endoscopy
or ultrasound, the trainee/resident should be under direct supervision (in the same
room) during examinations and not work independently with on-call supervision. There
was a strong consensus about this statement in all subgroups investigated.
There is substantial disagreement about whether advanced endoscopy techniques such
as endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic
biliary drainage (PTBD), and endoscopic ultrasound should remain integral parts of
board-certified training for gastroenterology ([Fig. 5 ]). Trainees (69%) and especially students (72%) would prefer advanced endoscopy techniques
to be included as part of the regular training to become gastroenterologist specialists.
Trainers (51%) marginally agreed, but board-certified physicians without a management
position (45%), physicians in outpatient care (44%), and part-time employees (43%)
favored the introduction of a new additional sub-specialty for “interventional endoscopy”.
Fig. 5 Views on advanced techniques in endoscopy.
Broad consensus on responsibility for patient care and preferred structuring of working
days
The majority of respondents (71%) believe that the responsibility for patient care
lies with the senior physician, an opinion shared by trainers (70%) and trainees (74%)
to a similar degree. Resident doctors (76%) and those employed at university hospitals
(74%) share this opinion, in particular.
Two-thirds of the respondents would like the workday of the training assistant to
be structured by the training assistants themselves. Trainees (72%) and part-time
employees (75%) prefer a self-structured workday even more. In contrast, self-structuring
of the working day is less favored in outpatient clinics (60%).
Yearly training evaluation as a place for feedback on performance and training opportunities,
less for discussing additional commitment
There was a consensus that in the yearly training evaluation, the trainer should give
feedback on performance (94%), discuss rotations (91%), inform about further training
opportunities (86%), and show prospects at the training place (83%) during yearly
training evaluations. Consensus about the first two points was most striking among
physician residents (feedback on performance: 98%, rotations: 97%). Research opportunities
were only an exciting topic for university employees (73%). Interestingly, 63% of
all residents were interested in bringing up research in the yearly training evaluation,
with residents in university hospitals wishing to discuss research to an even greater
extent (72%). Besides regular patient care, discussing additional commitment in the
clinic was most likely desired at university hospitals (61%). Of note, most respondents
(66%) did not see the training interview as an opportunity to discuss development
opportunities for soft skills.
Reduced work hours should not lead to disadvantages in physician training in the view
of most respondents
Around three-fourths of the respondents believe that part-time work must not lead
to disadvantages in continuing education ([Fig. 6 ]). There is substantially stronger agreement among trainees (88%) than trainers (69%),
with especially strong agreement among women (87%), respondents < 42 years (85%),
students (92%), and part-time employees (87%). Physicians in outpatient care (60%)
and full-time employees (68%) showed lower agreement rates.
Fig. 6 Part-time work and its effect on training.
A substantial proportion (59%) of respondents believe that part-time work in continuing
education should be made possible in all areas of activity and supported by colleagues.
Rates of agreement are similar between trainers (58%) and trainees (61%). Substantial
differences are particularly evident between full-time and part-time employees (54%
versus 75%).
Significant disagreement about whether own research should be considered on the roster
There is substantial disagreement on whether research should be fully reflected in
the roster. While 87% of trainees agree, only a minority of 47% of trainers do. University
staff especially (77%) would like to see research included in the roster ([Fig. 7 ]). A slight majority of men (49%) and even more colleagues in the outpatient clinics
(37%) think that research should not be considered in the roster.
Fig. 7 Representation of research in the duty roster.
Discussion
This study is the first survey of trainers and trainees for gastroenterology in Germany
concerning the desired training conditions.
Overall, we found a strong concordance in most responses between trainers and trainees
and in the pre-defined subgroups: medical hierarchy level, place of work, gender,
age, full-time/part-time work, and parental status [14 ]. Consistently, earlier quantitative research showed no generational differences
regarding self-reported work–life balance, work hours, and attitudes toward patient
care among internal medicine physicians of different generations, besides significant
perceived differences [15 ].
Above all, trainers and trainees agree that internal training should take place during
working hours and that external training should be supported through a training budget.
There is substantial agreement that a supervisor’s presence should initially support
resident physicians’ training in a new technique, such as endoscopy or sonography.
Although these points seem not surprising initially, they might act as a foundation
to jointly improve training conditions.
Remarkably, most respondents believe that training for board certification in gastroenterology
is better if performed at multiple institutions ([Fig. 3 ]). Department heads share this view less, perhaps because they have high confidence
in the training provided at the institutions they lead. An impressive 86% of respondents
in private practice see training at multiple institutions as superior. Exclusively
training in the outpatient setting is not possible in Germany. Therefore, respondents
in private practice did change their employment at least once and, hence, are the
group with the most direct experience. To our knowledge, no reliable data on resident
mobility between institutions in Germany are available. However, the possibility of
changing institutions while in training seems relatively underutilized. Perhaps increasing
mobility in training is a way to improve training quality in the future. At the same
time, the acceptance of mobility for career purposes is decreasing in different disciplines,
a trend that might also hold true for health care.
Considerable differences in responses to the questions of whether good clinical training
is possible without overtime were documented in our survey ([Fig. 4 ]). Trainers considered overtime essential for good continuing education, a view that
trainees did not share. It is unclear whether the difference here stems from a generational
difference as respondents under the age of 42 agreed strongly. Alternatively, it might
be carried by the opinion firmly held by students that clinical training is hindered
and not supported by working overtime. This view might be due to a lack of understanding
of clinical training realities and might change when current students enter residency.
However, whether a change to this belief will occur is unclear. Additionally, how
this perspective would affect day-to-day work on the wards is even less clear. Of
note, an older evaluation from 2009 revealed that physicians in Germany work roughly
4 million hours of overtime per year, with around 25% of overtime uncompensated [9 ]. One can infer that senior physicians who believe that overtime is essential for
good clinical education presumably misinterpret a lack of willingness to work overtime
as a lack of enthusiasm toward high-quality training. This misunderstanding can further
fuel a potential conflict. Maybe a wish for higher compatibility of private life and
work is reflected in the responses of the next generation, as seen in a Swiss study
of generation Z in 2022 [16 ]. Joint efforts by trainees and trainers have to be made to find a consensus on how
clinical training can be structured to ensure high-quality training with a limited
number of extra work hours.
The most striking heterogeneity in responses we observed was whether research time
should be fully considered work time ([Fig. 7 ]). Respondents under 42 years, trainees, and especially resident physicians want
research to be reflected in the duty roster, while this idea does not find a majority
among doctors older than 42 years or trainers. From our point of view, the response
from trainees speaks against a lack of enthusiasm for research. Research time increases
stress and strain in the clinical setting and, therefore, should be considered work
time in their understanding. The reality of research on weekends and after the end
of a shift is probably one of the main reasons for the lamentable lack of young researchers
[17 ]
[18 ]. There was also a considerable difference between female and male respondents. While
71% of women stated that research should be reflected in the roster, only 49% of men
did. Of note, this effect might be bolstered by women in our survey being younger
than men, but as it holds true among all age groups, a different gender-specific preference
is to be assumed. Clinician-scientists believe that sacrifices must be made regarding
family to be successful in their research career [17 ]
[19 ]. In dual-physician couples, it was shown that mothers, unlike fathers, reduce work
hours [20 ]
[21 ]
[22 ]. Consistently, female clinician-scientists reduce their clinical work hours more
often than their male counterparts [17 ]
[19 ]. Reasons for this gender difference are numerous: health issues during pregnancy
and after delivery, maternity protection, breastfeeding, socialization, lack of support
from partner and social network, nearly no daycare places for children below 6 months,
limited opening hours in daycare places and schools, lack of kindergarten teachers,
lack of support and mentoring at the workplace, and many more. These facts might explain
why women are more dependent than men on research being mapped in service time and
not being a private matter.
As the economic pressure on departments remains high, we think there is a strong need
for a joint effort by doctors, professional organizations, hospitals, and political
actors to guarantee that research is adequately reflected in the duty roster. Expanding
clinician-scientist programs could be one of several solutions [23 ]. However, as yet, implementing research time as part of the board certification
is either not allowed at all or only partially accepted by regulatory authorities
in Germany. If supporting clinician scientists’ career paths is a societal priority,
joint forces on the trainer’s and the authority’s side are needed to remove obstacles
on this path.
Regarding integrating part-time work in clinical practice, our survey showed an ongoing
conflict ([Fig. 6 ]). Most respondents stated that part-time work must not lead to disadvantages in
training, with trainees agreeing significantly more often than trainers do. Only a
slim majority of overall respondents say that part-time work should be made possible
even if it burdens co-workers. Strikingly, the dissent among trainers and trainees
nearly completely vanishes here. As colleagues working part-time probably burden trainees
in the day-to-day more often, this response is understandable but bears some structural
inconsistency. Naturally, more respondents working part-time stated that it should
be possible to work part-time even if it puts a strain on the working conditions of
full-time colleagues. Notably, more women than men in our survey were working part-time,
and significantly more women than men think that part-time employment must not lead
to training disadvantages. Instead of framing this finding as a conflict between full-
and part-time working physicians, we interpret it as a call to reimagine and reinvent
our organizational structures to minimize or even diminish the negative impact of
integrating part-time work into everyday work.
Interestingly, there is considerable heterogeneity in the trainee group in our survey,
as the responses to some questions strongly differ between resident physicians and
students. For example, regarding ultrasound and endoscopy, most residents prefer rotations,
while most students prefer continuous parallel training on their patients ([Fig. 2 ]). During their studies, students strongly demand the teaching of hands-on skills
and might hope to learn sonography and endoscopy as early as possible through parallel
training. Residents may have experienced that the parallel learning of sonography
and endoscopy, in addition to shifts on the ward, only succeeds to a limited extent.
Accordingly, the discussion about rotations and future training perspectives during
the yearly evaluation should be integral.
The most remarkable differences in workplace expectations were found between university
hospitals and outpatient clinics or primary providers. As expected, research has a
much higher priority in university clinics. Physicians at university hospitals desire
more than physicians in outpatient clinics features of a reasonable work–life balance,
such as educational training courses or part-time work. It is unclear whether outpatient
clinics provide these desired features more than university hospitals. Possibly, physicians
in outpatient clinics just do not favor training courses during work time as much
as physicians at university hospitals because their salaries depend much more on the
number of patients they treat. However, the fact is that many physicians are switching
from university hospitals to outpatient clinics to work part-time after becoming parents.
It could be a chance for university hospitals to consider ongoing medical education
during work hours to respond to the loss of physicians and to support a better work–life
balance in the inpatient setting.
While many items received high levels of consensus across subgroups, we observed issues
on which gastroenterologists, regardless of subgroup affiliation, are highly divided:
for example, whether advanced endoscopy techniques such as ERCP and PTBD should remain
a part of training for board certification in Germany ([Fig. 5 ]). Strikingly, in all predefined subgroups, we equally observed respondents intensely
in favor or strongly opposed to the idea of creating a new additional designation,
“interventional endoscopy”. As medicine and scientific progress lead to more and
more subspecialization, answering this question is closely linked to how endoscopy
and gastroenterology patient care should be organized in the future [24 ]. Our survey reveals that a consensus is still missing and that the divide runs through
all ages and medical hierarchy levels.
Several limitations should be considered when interpreting the findings of our survey.
As we approached current and future German gastroenterologists through the DGVS, our
study only represents members of the largest German professional society for gastroenterology.
As resident physicians are less represented in the DGVS, this might result in a selection
bias, especially regarding this subgroup of physicians. Also, our cohort of medical
students is not representative of medical students in Germany, as there was no other
measure of approaching the whole medical student body in Germany other than emailing
all student councils. Hence, all results in this group should be interpreted cautiously
and seen as exploratory.
The response rate to our survey was relatively low, albeit still in the expected range
for an email survey in a large cohort [25 ]. Respondents are likely more interested in training conditions than nonrespondents.
In our survey, we classified department heads, senior physicians, board-certified
physicians, and outpatient care physicians as trainers and residents and students
as trainees. This does not fully grasp the fluidity of the trainer and trainee roles
in the German medical system. For example, residents provide training to students,
and board-certified physicians are sometimes in training for additional (sub)specializations.
The distinction by seniority is a pragmatic solution, but the considerable heterogeneity,
especially between resident physician and student responses, underscores the need
to understand neither trainees nor trainers as monolithic blocs.
The censoring of data points always holds the risk of bias. As 39 responses were censored
in our study, other biases through our approach cannot be ruled out but seem unlikely,
as less than 4% of all completed responses were excluded.
Due to privacy concerns, we did not collect any data enabling the correlation of trainees
and trainers at the same institution. We can, therefore, not conclude if consensus
on training conditions is weaker or stronger at single institutions compared to the
national picture. We believe that interinstitutional heterogeneity exists and that
a one-size-fits-all approach is not the answer to improving the quality of medical
training. Solutions should always be found through direct communication and assessment
of specific situations.
In conclusion, there is considerable consensus about many aspects of training implementation
for board certification in Germany. The authors strongly advise implementing changes
to physician training, reflecting the preferences held by the clear majority (as defined
as approval by more than 75% of respondents, [Table 2 ], in bold) of both trainers and trainees. Additionally, there are aspects with strong
preferences by trainees not shared by trainers. From an employer’s perspective, these
implementations might decrease employee turnover through increased training satisfaction
and should be thoroughly considered.
Table 2 Opinions with broad consensus in trainers and trainees (1–6) and strong support by
trainees not shared by trainers (7–10).
1. Educational training courses should take time during working hours.
2. External training should be paid for through the department’s training budget.
3. When learning new techniques, resident physicians should be initially closely supervised
by a board-certified physician, who is always present in the examination room.
4. As training at multiple institutions is seen as superior to a single institution,
mobility between institutions should be supported.
5. Reducing working hours must not lead to disadvantages in training.
6. Trainers should give feedback on performance, discuss rotations, inform about further
training opportunities, and deliberate potential prospects at the training place in
the training evaluations.
7. Training in endoscopy and ultrasound should be performed in fixed rotations.
8. The length of training should define rotation orders instead of performance and commitment.
9. Trainees should structure their workday on their own.
10. Research should be reflected entirely on the duty roster.
Besides its limitations, our survey gives the first glimpse into the expectations
and beliefs of trainers and trainees for board certification in gastroenterology in
Germany. We hope that these data will create a basis on which training conditions
can be discussed and improved with the help of all stakeholders.
