[Focus on Hand Surgery Training: Challenges, Perceptions, and Solutions from the Perspective of Trainee Surgeons].

Abstract

Training in hand surgery presents a central challenge due to the field's broad requirements, ongoing healthcare reforms, and outpatient care structures. Training is pursued through specialist qualifications such as orthopaedics and trauma surgery, or plastic and aesthetic surgery, and it is supplemented by a two-year additional qualification (Zusatzbezeichnung, ZB) in hand surgery. Despite the significance of hand surgery, comprehensive studies on the subjective perception of training and potential areas for improvement in the German-speaking region are lacking. Given the increasing shift towards outpatient care, which relocates training procedures to the outpatient setting, this study aimed to assess the current training situation and to develop solutions for a more structured surgical education.This study sought to evaluate the quality of practical and theoretical training from the perspective of surgical trainees (Weiterbildungsassistenten, WBA), to identify weaknesses, and to develop targeted measures for optimization. A particular focus was placed on examining these factors with respect to the stage of training, both during specialist training and in the ZB hand surgery program.Between April and June 2024, an online survey was conducted among 117 WBAs in Germany. The survey included questions on demographics, training status, satisfaction, continuing education opportunities, surgical exposure, and subjective perceptions of training. Additionally, data were collected on trainees' wishes, challenges, and issues related to their education.Most participants (63% women, 42% aged 30-34) were enrolled in specialist training (58%) or the additional qualification (ZB) hand surgery program (42%). While satisfaction increased with each year of training, 51% rated their surgical exposure as insufficient. A total of 56% desired more surgical exposure, while 18% sought better individualized mentorship. Frequently reported challenges included staff shortages and inadequate support for continuing education.The findings suggest that targeted measures - such as increased surgical exposure, structured mentoring programs, and better financial support for continuing education - could significantly improve the perceived quality of training. A continuous dialogue between WBAs and trainers is essential to establish practical and motivating trainin.