CORR® Curriculum--Orthopaedic Education: The Evolution of Orthopaedic Surgery Education in Germany.

Abstract

Prior to World War I, German medical education strongly influenced training in the United States. One example of this influence is William Steward Halsted MD, a young surgeon from New York who observed postgraduate education while traveling to Germany and Austria in the late 19th century. When Halsted returned to New York, he created the Halsted residency, which set itself apart from less-formal training programs by educating surgeons for a set period of time with a slow, but progressive increase in responsibility and operating time, culminating with independent practice [10, 14]. Surgical education in Germany has a long tradition of excellence [2, 3, 5, 6, 10, 11, 13, 14], producing giants in the field like Billroth [1], Volkmann [18], and Kirschner [9]. In the past, the United States and Europe took their cues from German postgraduate surgical training, which relied heavily on mentorship. But the traditional postgraduate surgical training model in Germany has recently been challenged on several fronts. First, by the ever-increasing specialization of medicine, which required more sophisticated, innovative, and dynamic training programs. Second, by the formation of the European Union and the reunification of Germany, which underscored the need to have a similar, streamlined educational experience throughout the European Union. Because of these pressures, German postgraduate education became more aligned with other European Union educational standards. In this column, we will examine the educational structure of German postgraduate training, review the recent changes to residency programs in Germany, and determine how those changes have influenced the quality of German medical education.