Change in postgraduate medical education - how much didactic shaping is possible at all? A document analysis of the guideline regulations on specialty training 1992-2018 with a focus on surgery

Background: The structures of postgraduate medical education are regulated by the (guideline) regulations on specialty training ((M-)WBO). This formal structure is the result of medical discourse between medical associations, specialist societies and other associations. Various developments can be seen in the WBO. This study examines whether changes at the level of the WBO can contribute to changing and didactically optimizing postgraduate education in hospitals. Methods: Based on Mayring's theory a document analysis of the MWBO 1992, 2003 and 2018 was carried out with an additional focus on aspects of surgery. For this purpose, texts and contents of the MWBOs were compared and word frequencies were analyzed. In addition, three guided interviews with experts were conducted and analyzed according to Kuckartz using MAXQDA. The experts were selected based on their position and their involvement in the MWBO adaptation process. Results: The analysis of the WBO shows that efforts are being made to adapt specialty training in hospitals in order to make it more structured and didactically optimized. Concepts are being introduced and, in some cases abolished (e.g. specialist knowledge "Fachkunden") or further developed (e.g. competencies). The word frequency analysis shows the use of the same eight most frequent terms, which seem to define the basic character of postgraduate education. There are also obstacles to communication between the medical self-administration and the clinical stakeholders, which limit the possibilities for change. Conclusion: For implementation of the WBO in hospitals, clinicians need to be included even more intensively. This should not only take place during the development of the WBO, but especially during its implementation in the hospitals themselves to enable better integration of the new structures and didactic concepts of the WBO.