ESC Congress August to 1 September 2010

Transcription

1 ESC Congress August to 1 September 2010 Future of Training and CME in Europe Specialist Training in Germany Facts and Fiction Dr. med. Frank Ulrich Montgomery Vice President, Vice President, CPME

2 Physician s Self-Government in Germany 17 State Chambers of Physicians 2

3 Structure and organization of specialist training in Germany STATE CHAMBERS OF PHYSICIANS 17 State Chambers of Physicians are legally responsible for postgraduate training according to the Heilberufe-Kammergesetze of the German States is the umbrella organisation of 17 State Chambers of Physicians 3

4 Physicians' Self-Government - Chamber of Physicians Tasks: Professional Representation: Professional code and supervision of the profession Postgraduate specialist training Certification of particular training Continuing medical education Quality assurance Registration Pension Scheme Representation in politics & media Expert's reports Support of public health service Publication of a press organ 4

5 Physicians' Self-Government - Chamber of Physicians Tasks: Professional Representation: Professional code and supervision of the profession Postgraduate specialist training Certification of particular training Continuing medical education Quality assurance Registration Pension Scheme Representation in politics & media Expert's reports Support of public health service Publication of a press organ 5

6 Structure and organization of specialist training in Germany STATE CHAMBERS OF PHYSICIANS...are responsible for......and organise......residency......without a programme......entirely through framework-setting 6

7 Structure and organization of specialist training in Germany STATE CHAMBERS OF PHYSICIANS Set the legal framework......under the assumption that training is a personal obligation of the specialist towards the resident working under his responsibility... 7

8 Structure and organization of specialist training in Germany Specialist training is not a matter of a work contract between a hospital and a young physician 8

9 Structure and organization of specialist training in Germany STATE CHAMBERS OF PHYSICIANS Set the legal framework Observe state, federal and European regulations Discuss contents with the specialties Aspire national and international compatibility 9

10 Abundant criticism, mainly from residents...unstructured...insufficient...ineffective...hierarchical 10

11 Structure and organization of specialist training in Germany However: Germany complies with all EU directives German specialists are accepted with compliments in all other countries of Europe 11

12 Survey Background We wanted to know......is the organisation of training as insufficient as some residents say?...what are the consequences of theses assumed insufficiencies for the organisation of training? 12

13 Evaluation of specialist training in Germany Online Survey 2009 A Project of the and the State Chambers of Physicians 13

14 Survey Background Assessing the quality of the process of specialist training Identification of positive and negative influences on specialist training Comparison of specialist training at state and federal level Development of potentials for improvement and structural concepts for specialist training 14

15 Survey Background Assessing the quality of the process of specialist training by asking the physicians undergoing specialist training = Residents by asking the specialist physicians in charge of the training = Specialists 15

16 Methods Online survey 59 specialties 2 Questionnaires: 100 questions for specialist training residents (residents) 39 questions for specialists responsible for training (specialists) Response scales: German school grade system 1.0 (highest) to 6.0 (lowest) Survey period: June September 2009 Scientific supervision and data analysis by the Swiss Federal Institute of Technology Zurich (ETHZ) 16

17 Eight Sets of Questions in the Survey 1. Overall rating 2. Effectiveness in mediating professional competence 3. Learning culture 4. Management culture 5. Error avoidance culture 6. Decision-making culture 7. Working conditions 8. Use of evidence-based medicine 17

18 Selected Questions and/or Responses from the Eight Sets of Questions in the Survey Overall rating I would recommend this specialist training centre to others. Effectiveness in mediating professional competence How much did the specialist training centre (that you currently attend) contribute to the development of your knowledge, experience and skills in the following areas? A) Differential diagnostic thinking 18

19 Selected Questions and/or Responses from the Eight Sets of Questions in the Survey Learning culture The person responsible for my specialist training takes ample time to answer questions and explain situations that I did not understand. Management culture My specialist(s) provide a good teamwork atmosphere Error avoidance culture Our specialist training centre has a system for reporting critical incidents (CIRS - Critical Incident Reporting System). 19

20 Selected Questions and/or Responses from the Eight Sets of Questions in the Survey Decision-making culture The specialist responsible for my training sets the example that all aspects (social, psychological and medical) must be considered in decision-making. Working conditions There is a good working climate at our postgraduate training centre. Use of evidence-based medicine I learn to concretely apply the results of scientific studies to the treatment of patients. 20

21 Presentation of Results Individual specialist training report Report for the specialist Dynamic spider web chart Interactive graph for medical specialties comparison at state and federal level State and federal report Specialty group-specific reports at the state and federal level 21

22 Some Statistics... All specialties Internal Medicine Cardiology Return rate specialists % % % Return rate residents % % % 22

23 National Averages for the Eight Sets of Questions (Mean 2.6) 23

24 Does this reflect the complaints? 24 24

25 National Averages for the Eight Sets of Questions National Spider Web Chart Overall rating Evidence based medicine Mediating professional competence Working conditions Learning culture Decision-making culture Management culture Error avoidance culture Generated according to the methods described in Evaluation der Weiterbildungssituation (2003) by M. Siegrist, P. Orlow (Consumer Behavior, ETH Zurich) and M. Giger (FMH Swiss Medical Association) 25

26 Dynamic Spider Web Chart Interactive graph for medical specialty comparisons at state and federal level Public access via the following link: 26

27 Results for other Questions Specialty Training DE Cardiology % % Which person primarily supervises your practical specialty training (clinical examinations and surgery)? Senior Resident / postgraduate Registrar Senior Consultant / Department Head Other Did you receive a structured specialist training plan? Are concrete specialist training goals and/or learning objectives being agreed upon in writing and/or verbally? Written and verbal Written or verbal None Written and verbal Written or verbal None

28 Results for other Questions Self-initiative DE % Do you contribute to specialist training at your training centre (by organizing a course for other residents/staff physicians, etc.)? Do you regularly attend external training and specialist training courses? Yes 62.6 No 37.4 Yes 83.4 No 16.6 Working conditions Grade Point Average 1.0 (highest) to 6.0 (lowest) Cardiology DE I can complete my specialist training to my fullest satisfaction during my contractually-agreed working time. Administrative constraints impede the completion of my specialist training

29 Results for other Questions Work time DE % Cardiology % Do you do on-call work? Yes How often can you take the resting times prescribed in the statutory working time regulations (when on call)? When you continue to work after finishing on-call duty, what type of activities do you do? Never / very seldom Occasionally Frequently / always Regular job activities postgraduate training related activities Research Do you have to work overtime? Yes If so, are all of the overtime hours recorded? Completely Partially Not at all How are you compensated for overtime? Free time Additional pay Free time and pay Not at all

30 fehlende Werte Survey results for specialists National averages for the eight sets of questions (mean 2.1) R = 2,6 R = 2,46 R = 2,21 30

31 Individual Specialists Report Prototype 31

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34 Positive findings of the survey There was a high rate of participation by specialists Basic satisfaction of residents was observed (mean score of 2.6). The majority of physicians regularly participate in specialist training and continuing medical education courses. There were no significant differences between conservative medicine and surgical specialties. General medicine received the best marks. The results were homogeneous for all State Chambers of Physicians 34

35 Critical findings of the survey Poor participation of residents Poor average scores for culture of error avoidance and use of evidencebased medicine Dissatisfaction of residents with working conditions high workload time pressure bureaucracy overtime Nearly half of all residents do not receive a structured specialist training plan or concrete postgraduate training goals and/or learning objectives that had been agreed upon in writing and/or verbally 35

36 Recommendations The individual report for a given specialist training centre should be discussed with residents and specialists. The individual results should be published if necessary. The individual scores should be compared with the state and federal averages. Positive and negative influences on specialist training should be clearly outlined Feedback culture should be developed. Residents should be motivated to participate in the next survey in

37 Further project schedule Spring 2011 Second survey Starting in 2011 Planned publication of spider web chart results for all postgraduate training centres Starting in 2012 Survey to be routinely repeated every two years 37

38 Consequences We can find the bad apples and have to discuss improvements with them We can find best practice models and show them to others We consider all this as work in progress the method has to be developed We have to improve participation by asking why physicians haven t participated 38

39 Thank you for your attention Dr. Frank Ulrich Montgomery 39 39