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Evolution of the Surgical Residency System in Switzerland: An In-Depth Analysis Over 15 Years

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Abstract

Background

The landscape of surgical training has been subject to many changes over the past 15 years. This study examines resident satisfaction, determinants of satisfaction, demographics, working hours and the teaching rate of common operations in a longitudinal fashion with the aim to identify trends, shortcomings and possible ways to improve the current training system.

Methods

The Swiss Medical Association administers an annual survey to all Swiss residents to evaluate the quality of postgraduate medical training (yearly respondents: 687–825, response rate: 68–72%). Teaching rates for general surgical procedures were obtained from the Swiss association for quality management in surgery.

Results

During the study period (2003–2018), the number of surgical residents (408–655 (+61%)) and graduates in general surgery per year (42–63 (+50%)) increased disproportionately to the Swiss population. While the 52 working hour restriction was introduced in 2005 reported average weekly working hours did not decline (59.9–58.4 h (−3%)). Workplace satisfaction (6 being highest) rose from 4.3 to 4.6 (+7%). Working climate and leadership culture were the main determinants for resident satisfaction. The proportion of taught basic surgical procedures fell from 24.6 to 18.9% (−23%).

Conclusions

The number of residents and graduates in general surgery has risen markedly. At the same time, the proportion of taught operations is diminishing. Despite the introduction of working hour restrictions, the self-reported hours never reached the limit. The low teaching rate combined with the increasing resident number represents a major challenge to the maintenance of the current training quality.

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Acknowledgements

We thank the ACQ (Swiss association for quality management in surgery; Arbeitsgemeinschaft für Qualitätssicherung in der Chirurgie) for providing the data on teaching rates for different surgical procedures.

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Authors and Affiliations

  1. Department of Visceral- and Transplantation Surgery, Zurich University Hospital, Universitätsspital Zürich, Rämistrasse 100, 8091, Zürich, Switzerland

    Beat Moeckli, Pierre A. Clavien & Samuel A. Käser

  2. Department of Health Sciences and Technology (HEST), ETH Zurich, Zürich, Switzerland

    Lea C. Burgermeister & Michael Siegrist

Authors
  1. Beat Moeckli
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  2. Lea C. Burgermeister
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  3. Michael Siegrist
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  4. Pierre A. Clavien
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  5. Samuel A. Käser
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Correspondence to Samuel A. Käser.

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Moeckli, B., Burgermeister, L.C., Siegrist, M. et al. Evolution of the Surgical Residency System in Switzerland: An In-Depth Analysis Over 15 Years. World J Surg 44, 2850–2856 (2020). https://doi.org/10.1007/s00268-020-05552-9

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