OBJECTIVE This study examined reasons for specialty choice among Swiss residents (post graduate doctors training in specialties). METHODS In 2006, a questionnaire was sent to 8626 Swiss residents registered in postgraduate medical training programmes to obtain specialist qualifications. The response rate was 65% (n = 5631). As residents are allowed to decide on the specialty they want to acquire later in the training process, only residents who had already chosen a specific specialty were included (n = 5038). In responding, residents rated the importance of 19 factors in making their choice of specialty. Categorical principal component analysis was conducted to obtain underlying dimensions within the reasons for choice. A two-way analysis of variance was performed for each dimension to compare the mean object scores for the 10 specialties chosen by the most residents and to examine possible interactions by gender and year of graduation. Contrasts between the specialties were analysed with Scheffe post hoc tests. RESULTS Categorical principal component analyses yielded three factors underlying residents' choice of specialty, which explained 40.8% of the variance in responses: work and time-related aspects; career-related aspects, and patient orientation. Women considered work and time-related aspects and patient orientation to be more important factors in their choice, and career-related aspects to be less important, than did men. Career-related aspects became less important with advancing training status. CONCLUSIONS This study showed that reasons for specialty choice differ according to gender, year of graduation and specialty. With progressing training status, gender differences in reasons for choice and specialty choice may become more pronounced, especially regarding career aspects, which may lead to a change in preferred specialty. Therefore, a modular constructed postgraduate training programme might give residents the flexibility to change from one specialty to another.

The Paling Perspective Scale resulted in a higher level of perceived risk compared with the other formats. This effect must be taken into account when choosing a graphical or numerical format for risk communication.

BackgroundIntegrative medicine (IM) integrates evidence-based Complementary and Alternative Medicine (CAM) with conventional medicine (CON). Medical schools offer basic CAM electives but in postgraduate medical training (PGMT) little has been done for the integration of CAM. An exception to this is anthroposophic medicine (AM), a western form of CAM based on CON, offering an individualized holistic IM approach. AM hospitals are part of the public healthcare systems in Germany and Switzerland and train AM in PGMT. We performed the first quality evaluation of the subjectively perceived quality of this PGMT.MethodsAn anonymous full survey of all 214 trainers (TR) and 240 trainees (TE) in all 15 AM hospitals in Germany and Switzerland, using the ETHZ questionnaire for annual national PGMT assessments in Switzerland (CH) and Germany (D), complemented by a module for AM. Data analysis included Cronbach’s alpha to assess internal consistency questionnaire scales, 2-tailed Pearson correlation of specific quality dimensions of PGMT and department size, 2-tailed Wilcoxon Matched-Pair test for dependent variables and 2-tailed Mann–Whitney U-test for independent variables to calculate group differences. The level of significance was set at p < 0.05.ResultsReturn rates were: D: TE 89/215 (41.39%), TR 78/184 (42.39%); CH: TE 19/25 (76%), TR 22/30 (73.33%). Cronbach’s alpha values for TE scales were >0.8 or >0.9, and >0.7 to >0.5 for TR scales. Swiss hospitals surpassed German ones significantly in Global Satisfaction with AM (TR and TE); Clinical Competency training in CON (TE) and AM (TE, TR), Error Management, Culture of Decision Making, Evidence-based Medicine, and Clinical Competency in internal medicine CON and AM (TE). When the comparison was restricted to departments of comparable size, differences remained significant for Clinical Competencies in AM (TE, TR), and Culture of Decision Making (TE). CON received better grades than AM in Global Satisfaction and Clinical Competency. Quality of PGMT depended on department size, working conditions and structural training features.ConclusionThe lower quality of PGMT in German hospitals can be attributed to larger departments, more difficult working conditions, and less favorable structural features for PGMT in AM, possibly also in relation to increased financial pressure.

Hintergrund: Die anthroposophischen Kliniken arbeiten integrativmedizinisch, indem sie konventionelle Medizin (KON) anthroposophischmedizinisch (AM) ergänzen. Die Integrativmedizin wird dabei in der ärztlichen Weiterbildung vermittelt. Im Rahmen einer erstmaligen Untersuchung der Weiterbildungsqualität an anthroposophischen Kliniken analysierten wir die Probleme dieser Weiterbildung aus Sicht der Assistenzärzte und Weiterbilder. Methodik: Im Rahmen der Erhebung führten wir eine anonymisierte Querschnittsbefragung aller Assistenzärzte und aus- und weiterbildenden Ärzte (Weiterbilder) der 15 AM-Kliniken in Deutschland (DE) und der Schweiz (CH) mit Fragebögen der Eidgenössischen Technischen Hochschule (ETH) Zürich durch. Der Fragebogen war durch ein anthroposophisches Modul ergänzt. Zudem führten wir deskriptive Statistiken zu den skalierten Fragen, einen statistischen Gruppenvergleich mittels zweiseitigem Mann-Whitney-U-Test und eine qualitative Inhaltsanalyse (Mayring) der Freitextantworten sowie eine Problemanalyse durch. Ergebnisse: Die Rücklaufquote in DE umfasste 89 von insgesamt 215 (41.39%) befragten Assistenzärzten und 78 von 184 (42.39%) Weiterbildern. In CH füllten 19 von 25 (76%) Assistenz-ärzten und 22 von 30 (73.33%) Weiterbildern die Fragebögen aus. Die Freitextoption zur Problemanalyse in DE und CH wurde von insgesamt 16 (14,8%) Assistenzärzten und 20 (20%) Weiterbildern genutzt. Zu den Hauptproblemen zählen ein Übermaß an Arbeitsbelastung, Mängel bei der Arbeitsorganisation, Kompetenzabgrenzung, interprofessionelle Zusammenarbeit, personelle und finanzielle Ressourcen (Weiterbilder), Bezahlung (Assistenzärzte DE), Praxisbezogenheit der AM (Assistenzärzte und Weiterbilder DE), Fach- oder didaktische Kompetenz der Weiterbilder, fehlendes Interesse der Assistenzärzte an AM, Aneignungs- und Umsetzungsprobleme in AM, fehlendes Weiterbildungscurriculum in AM sowie Spannungen zwischen AM und KON. Als Gründe für die Unterschiede zwischen DE und CH werden die Existenz größerer Abteilungen und das DRG-System in DE sowie bessere strukturelle Bedingungen für die AM-Weiterbildung in CH diskutiert. Schlussfolgerung: Hauptprobleme der Weiterbildung in AM betreffen zum Teil unspezifische und systemische Aspekte, aber auch spezifische Probleme der AM selbst. Um konkrete Ansatzpunkte für Problemlösungsoptionen zu schaffen, soll diese Untersuchung ergänzt werden durch eine Analyse von Problemlösungsvorschlägen aus Sicht der betroffenen Assistenzärzte und Weiterbilder.