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Background: Since its academic inception in the 1960s, Germany's general practice has seen numerous dissertations, many of which are housed in the 'Archive of German language General Practice' (ADAM)., Aim: This study aims to provide the first comprehensive overview of dissertation topics from the discipline of general- and family medicine in Germany, establishing a foundation for advancing research., Method: We employed a systematic review approach, examining 801 dissertations from both ADAM and online sources. Each topic was identified, categorized, and finalized through consensus by two independent reviewers., Results: Our analysis encompassed 486 dissertations from ADAM, 176 from the German national library, and 139 from university libraries. A total of 167 unique research topics were identified. The predominant themes included medical education ( n  = 49), medication orders ( n  = 39), frequent consultation issues ( n  = 33), complementary medicine ( n  = 32), and screening measures ( n  = 29). The use of qualitative methods was constantly rising, from no qualitative methods used from 1965-1974, up to 22% of dissertations in recent years., Conclusion: The diversity of 167 research topics underscores the vastness and complexity of general practice in Germany. This structured overview is pivotal for facilitating focused and interconnected research endeavors in the field.

Background: There is a discussion among general practitioners and psychiatrists regarding over-diagnosing versus under-reporting of psychiatric diagnoses. A deeper understanding of this topic is relevant for providing reasonable health care and for planning future studies. A crucial factor to understanding this discussion is the difference in the prevalence of a disease in each sector. One way to attain knowledge about such prevalences is the analysis of routine care data of the sector in question. However, diagnosis-related data might be modified by several additional influencing factors., Aims: This study aims to explore what kind of motives and modifying factors play a role for or against giving psychiatric diagnoses in psychiatric and general medical settings., Methods: Twenty-six semi-structured interviews were conducted with German physicians in the fields of general medicine and psychiatry. Interviews were analysed using content analysis., Results: The analysis revealed three major motivational categories for finding a diagnosis: (1) "objective matters" such as "categorisation for research"; (2) "functional and performance-related factors" such as "requirement for medication", "billing aspects" that go with certain diagnoses or "access to adequate care" and (3) "Individual factors" such as the "personality of a physician". Similarly, factors emerged that lead to not making psychiatric diagnoses like "fear of stigmatization among patients" or "detrimental insurance status with psychiatric diagnosis". Additionally participants mentioned other reasons for "not diagnosing a psychiatric diagnosis", such as "coding of other clinical pictures"., Conclusion: The diagnostic process is a complex phenomenon that goes far beyond the identification of medical findings. This insight should be considered when processing and interpreting secondary data for designing health care systems or designing a study., (© 2024. The Author(s).)

In the wake of the COVID-19 pandemic, video consultation was introduced in general practice in many countries around the world as a solution to provide remote health care to patients. It was assumed that video consultation would find widespread adoption in post-COVID-19 general practice. However, adoption rates remain low across countries in Northern Europe, suggesting that barriers to its use exist among general practitioners and other practice staff. In this viewpoint, we take a comparative approach, reflecting on similarities and differences in implementation conditions of video consultations in 5 Northern European countries' general practice settings that might have created barriers to its use within general practice. We convened at a cross-disciplinary seminar in May 2022 with researchers and clinicians from 5 Northern European countries with expertise in digital care in general practice, and this viewpoint emerged out of dialogues from that seminar. We have reflected on barriers across general practice settings in our countries, such as lacking technological and financial support for general practitioners, that we feel are critical for adoption of video consultation in the coming years. Furthermore, there is a need to further investigate the contribution of cultural elements, such as professional norms and values, to adoption. This viewpoint may inform policy work to ensure that a sustainable level of video consultation use can be reached in the future, one that reflects the reality of general practice settings rather than policy optimism., (©Elisabeth Assing Hvidt, Helen Atherton, Jelle Keuper, Eli Kristiansen, Elle Christine Lüchau, Børge Lønnebakke Norberg, Jost Steinhäuser, Johannes van den Heuvel, Lilian van Tuyl. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 22.05.2023.)

Background: Germany is facing a shortage of primary care physicians (general practitioners, GPs). To improve post-graduate training in general practice, competency centres were established across Germany. The core of their work is a seminar programme. It was observed that some GP trainees constantly participate, while others are seldomly seen. The aim of this study was to explore what helps and what hinders constant participation., Methods: GP trainees of the Verbundweiterbildung plus Baden-Württemberg (2008 - 2017), predecessor of the KWBW Verbundweiterbildung plus© program (2017 - present), were included in the study. First, participation in the years 2014 and 2015 was analysed. We recruited the very active as well as the no-show participants for semi-structured telephone interviews. Content analysis was performed by three independent scientists., Results: Participation of n=353 trainees was analysed. N=30 trainees participated in the study (including n=13 no show). The average interview length was 25minutes (13-36minutes). Trainees felt motivated by practice-oriented, varying and learner-oriented subjects. They highlighted the professional and personal interaction and its networking effects. Participants favoured lecturing during working days, topics structuring daily training and supporting every day practice. The seminar moderators' treasure trove of experience and their teaching competencies were regarded as essential. The fact that employers do not regularly grant time away from work to attend the training programme was cited as a major inhibiting factor. Other reasons given for non-attendance included long travel distances, repeat topics or an imbalance between gain of knowledge and social interactions, and finally, a high individual level of work strain, given the dual burden on those trying to combine work and family life and taking on the main responsibility for children., Conclusions: The main enablers (motivators) of participation were practice- and learner-oriented topics and beneficial social interactions. During the seminars, participants experience group membership and the enthusiastic (learning) atmosphere boosts trainees to proceed with their training and follow their career paths in general practice. Continuous participation requires protected time. Competence centres for postgraduate medical education should take these findings into consideration for quality management and programme planning, and, if possible, should initiate and evaluate appropriate countermeasures., (Copyright © 2021. Published by Elsevier GmbH.)

Background: In recent years, the motivation of the new generation of general practitioners to set up their own practice is decreasing. Knowledge of factors that promote and inhibit the process of setting up a practice can enable developing strategies to support this process. The aim of this study was to explore these determinants., Methods: Between April and October 2016, self-employed general practitioners from Baden-Württemberg were invited to participate in a qualitative interview study. Stratification of 553 physicians, who participated in a general practice support program between 2008 and 2011 and set up a practice in 2008 to 2014, was based on the agglomeration in rural areas, the peripheral zones around the agglomeration and the urban agglomerations themselves. The transcripts of the interviews were analyzed by two authors with the content analysis according to Mayring and summarized. In a second step, a consensus version was elaborated., Results: A total of 23 general practitioners were recruited, 57% female and 42 years on average, and mostly working in group practices. The main motivation to set up a practice was the desire to improve the situation in relation to the daily clinical routine. These included a lower duty load and more family-friendly working hours. Relevant supportive factors during setting up a practice were family support, participation in a postgraduate training rotation network program and professional counseling. Inhibiting factors were fears of recourse and indebtedness, a complicated accounting system and a bureaucratic process of admission., Conclusions: On the one hand, the study shows that the many advantages of working as a general practitioner, such as its being family friendly, need to be better communicated to the doctors and their financial concerns alleviated. On the other hand, the need for courses on management of one's practice has also become clear. A standardized and optimized process of setting up a practice with an improved overview and a collegial contact person can facilitate the decision for and implementing the setting up a medical practice as a general practitioner., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Objective: In many places in Germany, the need for primary care physicians has been steadily increasing for several years, especially in rural areas. It is hypothesized that physicians are more likely to practice in rural areas if they have received a broad education and vocational training. Differences between general practitioners (GPs) and physicians in general internal medicine (GIM) in the breadth of their vocational training are created by the underlying distinct training schemes. The aim of the analysis was to test whether GPs and GIM physicians differ in their distribution between urban and rural regions of Schleswig-Holstein and whether there are differences in the rate and frequency of performing home visits., Methods: Based on invoicing data of the Association of Statutory Health Insurance Physicians in the federal state of Schleswig-Holstein (Northern Germany) covering the years 2015 up to the third quarter (Q3) of 2018, we analysed differences between GPs and GIM physicians in their regional distribution. Furthermore, we looked at differences between both specialties regarding the application rate and the number of home visits performed and unforeseen physician visits. In addition to bivariate approaches, we also used multivariate regression analysis., Results: Between 2017 (Q4) and 2018 (Q3), 1,378 GPs and 585 GIM physicians provided medical services in Schleswig-Holstein. While 27.5 % of the GPs had practices in rural areas, the share of GIM physicians was 14.5 % (p < 0.001). Home visits were performed by 97.8 % of the GPs and 93.2 % of the GIM physicians (p < 0.001). This difference was even more pronounced in rural areas (99.5 % vs. 94.1 % (p = 0.002)). Significant differences have also been found in the number of billed home visits. GPs made 36 % more home visits than GIM physicians. In rural areas, the difference was 60 %., Conclusion: The analysis revealed significant differences between GPs and GIM physicians regarding the type of region where they work, the application rate and the number of performed home visits. The findings could foster a discussion about how GIM physicians can be better prepared to provide primary care, especially in rural areas., (Copyright © 2020. Published by Elsevier GmbH.)

Objective: The aims of the study were the translation and a first reflection of the psychometric properties of the Aeronautics and Space Administration-Task Load Index (NASA-TLX), a multidimensional instrument to measure workload in general practice., Methods: During April and September 2015, the NASA-TLX was translated and evaluated. For this purpose, a questionnaire composed of the NASA-TLX items and others items related to demographic data, was developed. Postgraduate family medicine trainees and family physicians were then asked to assess patient consultations by applying the questionnaire. The psychometric properties of the NASA-TLX were identified using explorative and confirmatory factor analysis. Reliability was assessed using Cronbach's α., Results: Overall, 16 participants completed 769 surveys after a single patient consultation. The highest average was observed for the item 'mental demand' (mean 6.9 ± 5.4), followed by the item 'effort' (mean 6.6 ± 5.5). Factor analysis revealed a one-factor solution with an explained variance of 56.9 %. The German version of NASA-TLX demonstrated a high internal consistency (Cronbach's α = 0.84). Confirmatory factor analysis showed that there was an acceptable consistency between the expected unidimensional structure and the data., Conclusions: The German version of NASA-TLX provides preliminary indications of psychometric properties and presents an important tool to evaluate family physicians' workload in direct patient contact., (Copyright © 2019. Published by Elsevier GmbH.)

Background: In most western countries a shortage of general practitioners (GP) exists. Newly qualified GPs often prefer to work in teams rather than in single-handed practices. Therefore, new practices offering these kinds of working conditions will be attractive in the future. From a health care point of view, the location planning of new practices will be a crucial aspect. In this work we studied solutions for locating GP practices in a defined administrative district under different objectives., Methods: Using operations research (OR), a research discipline that originated from logistics, different possible locations of GP practices were identified for the considered district. Models were developed under two main basic requirements: that one practice can be reached by as many inhabitants as possible and to cut down the driving time for every district's inhabitant to the next practice location to less than 15 minutes. Input data included the demand (population), driving times and the current GP locations., Results: Three different models were analysed ranging from one single practice solution to five different practices. The whole administrative district can reach the central community "A" in at most 23 minutes by car. Considering a maximum driving time of 15 minutes, locations in four different cities in the district would be sufficient., Conclusion: Operations research methods can be used to determine locations for (new) GP practices. Depending on the concrete problem different models and approaches lead to varying solutions. These results must be discussed with GPs, mayors and patients to find robust locations regarding future developments., Competing Interests: The authors have declared that no competing interests exist.

Background: Key recommendations for the management of patients with polypharmacy are structured medication counselling (SMC), medication lists and systematic medication reviews., Objective: The aim of this study was to identify determinants (hindering and facilitating factors) for the implementation of the recommendations in general practice., Methods: This study was linked to a tailored intervention aimed at improving the implementation of the recommendations in German general practice. Interviews and focus groups with different healthcare professionals were carried out in the design phase and after delivery of the intervention. The material from both data collections was analysed separately in a content analytical approach resulting in two sets of categories. For this study, the subcategories of both sets were assigned to the Tailoring Interventions for Chronic Diseases (TICD) checklist, a comprehensive framework of determinants of practice., Results: Interviews with 24 general practitioners (GPs), 4 other medical specialists, 1 pharmacist, 3 nurses and 6 medical assistants as well as 2 mixed focus groups with 17 professionals were conducted. We identified 93 determinants: 29 referred to medication counselling, 21 to the use of medication lists, 20 to medications reviews and 23 to all recommendations. The determinants were related to all 7 main domains and to 25 of the 57 subdomains on the TICD checklist including guideline factors, patient factors, individual healthcare professional factors, social, political and legal factors, incentives and resources, and capacity for organizational change., Conclusion: While many interventions to improve polypharmacy focus on the provision of pharmacological knowledge, a much wider range of domains need to be addressed, such as communication skills, patient involvement and practice organization.

Background: In the future, 'delegation' as task shifting from general practitioners (GPs) to non-physicians will be important in primary care. Therefore, the aim of this study was to evaluate the attitudes towards the concept of task shifting and to identify predictors of a positive attitude towards task shifting from the perspective of GPs., Methods: This cross-sectional questionnaire study analysed attitudes towards the concept of task shifting and delegated tasks from the perspective of GPs who were recruited in the German federal state of Schleswig-Holstein. Descriptive statistics and binary regression analyses were computed to identify potential predictors of a positive attitude towards task shifting., Results: Out of 1538 questionnaires distributed, 577 GP questionnaires were returned (response rate: 37.5%). A total of 53.2% of the respondents were male, and 37.3% were female. A positive attitude regarding task shifting was shown by 49% of the participating GPs. The highest level of agreement (95.2%) was found for time savings with task shifting, and a lower agreement (39%) was found regarding the lack of clarity concerning the responsibilities and legal aspects with regards to task shifting. The most frequently delegated tasks were recording electrocardiograms and measuring blood glucose levels. A positive attitude towards task shifting was positively associated with higher job satisfaction and a need for qualified staff., Conclusion: Our sample of GPs for this study was very open-minded towards the concept of task shifting. Germany is just beginning this delegation, but the implementation of task shifting depends on different aspects, such as legal requirements, adequate payment and qualified staff. Finally, there is a need for continuing professional development in primary care teams, especially for non-clinical practice staff.

Introduction : In different German regions, seminar programs have been conducted for General practice residents. In each region, selection and teaching of learning content is conducted in a different manner. So far, no structured, standardized curriculum has been implemented nationwide. We have investigated, if the development of a common 5-year program of learning topics is conceivable between the different university departments of General practice in Germany. Method: The seminar program working group of the DEGAM (German College of General Practitioners and Family Physicians) has conducted an online survey based on information gathered via preliminary telephone conference (n=7; physicians with postgraduate teaching experience) among all German university departments of General Practice and two non-university teaching institutions, identified via the internet. 884 topics were extracted from 14 Seminar programs. The topics were entered in a database, discussed and categorized: Practice management/practice work flow/standardized documentation forms/quality management (n=33 topics), common acute and chronic diseases, including disease management programs (n=29 topics), communication, neurological, psychological and psychiatric consultations (n=24 topics), common medical problems, including eye, ear, nose, throat, skin and pediatric problems (n=99 Topics) family physicians general approach, including epidemiology, shared decision making, test of time (n=42 Topics). These topics have been rated for priority and desirable number of teaching-units. Results: A catalogue of 111 topics was designed, encompassing 160 teaching units. There is a suggestion of wide topics collections plus an add-on catalogue. Conclusion : A proposal for a 5-year-thematic catalogue for postgraduate training of general practice residents in Germany has been developed. This newly developed curriculum has the potential to improve knowledge and skills that have not been covered during in-house and ambulatory general practice residencies.

Background: In face of the looming shortage of general practitioners, primary healthcare providers and post-graduate training in general practice are increasingly becoming part of the political agenda in Germany. In 2009 the program "Verbundweiterbildung plus Baden-Württemberg" (VWB plus BW) was developed by the Competence Center for General Practice in Baden-Wuerttemberg to ensure primary healthcare in the future by enhancing the attractiveness of general medicine. This paper describes the experiences that have been gathered in developing a post-graduate training-program for physicians undergoing specialist training in general practice. Project description: The Competence Center for General Practice in Baden-Wuerttemberg supports the organization of regional networks dedicated to post-graduate medical education. First core element of the VWB plus BW program is a special seminar series for physicians pursuing post-graduate training. This seminar program is aligned with the German competency-based curriculum in general medicine and is meant to promote medical expertise and other related competencies, such as business and medical practice management and communication skills. Mentoring and advising the physicians regarding professional and personal planning form the second core element. The third core element is seen in the train-the-trainer seminars that address the competencies of the trainers. In order to focus the program's content closely on the needs of the target groups, scientifically based evaluations and research are carried out. Results: Since starting in 2009, 685 physicians have entered the program and 141 have passed the examination to become medical specialists (as of December 2016). In total, 31 networks, 60 hospitals and 211 general practices have participated. The seminar sessions have been rated on average with 1.43 on a six-point Likert scale by the physician trainees (1=extremely satisfied, 6=extremely dissatisfied). Alongside the medical training, these physicians viewed the exchange of information and experiences with other physicians as very positive and important. In 185 seminars lasting 90 minutes each, the seminar program has presently covered 250 out of 320 units in the competency-based curriculum for general medicine. A total of 281 trainers have been trained in 13 train-the-trainer courses and have rated this course on average with 1.36 on a six-point Likert scale. Above all, the trainers emphasized the exchange of information and experiences with other trainers as very positive. In 2013 the DEGAM concept for its Verbundweiterbildung plus program was developed based on that of the VWB plus BW. Since 2008 over 40 articles on the topic of post-graduate medical education have been published. Conclusion: The steadily increasing number of participants over the years demonstrates that the VWB plus BW is relevant for recent medical graduates and contributes to the attractiveness of general practice. The consistently excellent evaluations of the training program and the train-the-trainer course affirm the focus on the needs of the target groups. The post-graduate VWB plus BW program advances structured, competency-based and quality-oriented specialist training and fosters professional sharing between physicians - something that could also be relevant for other fields. The increasing numbers of participating physicians and specialists in general practice in Baden-Württemberg lead to the conclusion that the VWB plus BW program positively influences the number of general practitioners.

Background: General practitioners (GPs) are among the specialists who prescribe the highest number of medication. Therefore the improvement of pharmacological competencies is an important part of the GP specialist training. The self-concept of general practice stating that GPs are the first contact persons for all health problems makes it challenging to define and acquire competencies for specialist training. While the "Competence-based Curriculum" developed by the German College of General Practitioners and Family Physicians defines diagnoses, reasons for counselling and competencies which are essential for general practice, a similar orientation guide is lacking for the pharmacological field. The aim of this study is to define and characterize pharmacological substances which every GP should know so well that he or she is able to conduct counselling and monitoring., Methods: We analysed private and public health insurance prescriptions of all general practices participating in the CONTENT project in the period from 2009 to 2014. The analysis was limited to substances with oral application which were prescribed at least once by at least 25 % (n = 11) of the practices. While the 100 most frequent prescriptions were included due to their frequency, less frequently prescribed substances were assessed concerning their relevance for general practice in a rating procedure. The substances included were classified by diagnoses and reasons for counselling., Results: We analysed 1,912,896 prescriptions from 44 practices and 112,535 patients on the basis of the Anatomical Therapeutic Chemical (ATC) classification system. After applying the inclusion criteria, 453 substances were left, 302 of which were considered relevant for general practice and could be assigned to 45 diagnoses / reasons for counselling., Conclusions: The result of this study could be considered a working draft for a pharmacological curriculum for general practice, which may complement the "Competence-based Curriculum" in the medium term., (Copyright © 2017. Published by Elsevier GmbH.)

Background: A Train-The-Trainer course (TTT course) for general practice trainers was developed as part of the program Verbundweiterbildung plus Baden-Württemberg. The course included aspects of training such as organizational and legal knowledge as well as didactic skills for trainers in 9.5 teaching units (45minutes each). The present article analyzes the evaluation of the course and considers possible future developments for TTT courses in Germany., Methods: An evaluation tool was used covering aspects such as information, relevance for daily work, opportunities for participant engagement in the seminars and working environment as well as didactic competencies among teachers. Within five years, 256 trainers participated in a TTT course and received an evaluation sheet. Data were analyzed descriptively., Results: 249 evaluation sheets were included (response rate 97 %). Overall, the participants were (very) satisfied with the course in general, its organization, the exchange with colleagues and the teaching units. The participants used the free text mode to give positive feedback; in particular, teaching units in organizational and legal regulations as well as practical feedback training to strengthen professionalism were evaluated positively. Suggestions for improvements included follow-up courses or a deepening of understanding of course contents., Conclusion: The participants gave a very positive overall rating and claimed to have benefited from the course contents. Future projects should address further qualifications of general practice trainers and facilitate the exchange with colleagues on an ongoing basis., (Copyright © 2016. Published by Elsevier GmbH.)

Background: Medical education is intended to enable students to become a physician who can practise the profession of medicine on his own authority, responsibility and accountability. In 2015, the competencies required to accomplish this have been described in the National Competency-based Catalogue of Learning Objectives Medicine. The aim of this study was to survey the extent to which the respective medical procedures were learned during medical school. Postgraduate trainees were asked to self-assess their level of proficiency in carrying out procedures commonly performed in family medicine., Methods: A questionnaire involving 17 procedures was distributed among 328 postgraduate trainees in family medicine attending training sessions in Baden-Wuerttemberg. Participants could assess the extent to which they were able to independently perform each procedure (ranging from "not able to do it", "able to do it under direct supervision", "able to do it if supervision is provided upon request" to "able to do it on my own", and "able to provide supervision to others" respectively). Respondents that were able to perform procedures without the need for supervision were asked to indicate when they acquired the competency. Data were analysed descriptively., Results: A total of 196 postgraduate trainees (59.8%) completed the questionnaire. The average age was 35 years, 71 % of the participants were female. For five out of 17 procedures at least half of the participants regarded themselves as being "able to do it on my own" or "able to provide supervision to others". The procedure that was most often (52.5 %) named as having been learned in medical school was "otoscopy", followed by "wound suturing" and "mask ventilation" (42%)., Conclusions: Following graduation, GP trainees are unable to independently perform the majority of common procedures in family medicine. This indicates that insufficient proficiency in procedural skills is provided in undergraduate medical education, revealing the need for structured, supervised specialty training following graduation., (Copyright © 2016. Published by Elsevier GmbH.)

Background: Statistical projections suggest that by 2020 the number of general practitioners (GPs) in Germany will have decreased by about 13 %, which will lead to a risk of medical undersupply, especially in rural areas. This study was conducted on behalf of the Bavarian Ministry of Environment and Health in order to answer the following questions: How satisfied are young Bavarian physicians in GP specialty training with their training situation? To what extent are they willing to start a private practice, in general and, in particular, in rural areas?, Method: The study's online questionnaire contained items concerning the context of GP specialty training and the willingness to set up a private practice. In addition, the "Heidelberger Niederlassungsbarometer", a structured questionnaire illustrating self-assessment of competencies of GPs in training, was included in the survey. We asked GP specialty trainees to participate by e-maiI, directly or via their GP trainers., Results: In total, 99 questionnaires were returned, whereof 95 fulfilled the criteria for analysis. In 76 % of the cases participants were female, 63 % working in practice and 37 % in a structured training programme. The majority of participants (58 %) preferred to work in a practice with more than one GP, followed by those preferring to work as a salaried GP (26 %). Their disposition to work in rural areas after having passed their specialty certificate examination was high or very high (59 %). Feedback on a regular basis was given to 29 % of the study participants. Almost every second participant received a structured initial training programme. Most of the participating GP trainees (59%) were satisfied or very satisfied with their training., Conclusion: In general, there is a high level of motivation among study participants to become an independent and self-employed GP, also in rural areas. Despite the fact that not even every second received central training elements like individual feedback and structured initial training, the participants were mostly satisfied with their GP specialty training., (Copyright © 2016. Published by Elsevier GmbH.)

Background: The German Society of General Practice and Family Medicine (DEGAM) has defined educational seminars during post-graduate training as a core element to improve trainees' specific knowledge and competencies. Furthermore, these seminars facilitate networking among trainees and support the process of identity formation in family medicine. Since its implementation in 2009, the Verbundweiterbildung(plus) Baden-Württemberg (VWB(plus) Ba-Wü) has offered educational seminars. Aim of this article is to analyse the content of these educational seminars and to derive implications for other family medicine training programmes in Germany., Methods: From 2009 to 2015, the data from all educational seminars was descriptively analysed. Furthermore, two researchers categorised the seminar contents independently of each other and assigned them to the competence-based curriculum for family medicine training (Kompetenzbasiertes Curriculum Allgemeinmedizin, KCA)., Results: Until 2015, 600 trainees participated in a starter seminar of the VWB(plus) Ba-Wü. In total, 1,116 teaching units and 160 different seminars covered all relevant topics of the KCA. A restructuring of organisational processes and seminars was necessary to handle the increase in the number of participants, including the development of specific software for electronic support. Of all these seminars, 56% were held by specialists or trainees in family medicine. The participating trainees rated the educational seminars in general and the possibility for networking as (very) good., Conclusions: The contents of the educational seminars included in family medicine training programs will have to be specifically based on family medicine and cover all relevant aspects of the KCA - medical expertise, competencies and procedures. In order to ensure a common standard concerning didactic methods and qualifications of teachers, a didactic guideline is to be developed. The increasing demand of family medicine training programmes requires (further) development of the software eSchoolab, including integration of the KCA., (Copyright © 2016. Published by Elsevier GmbH.)

Background: Since 2008 the Verbundweiterbildung(plus) programme of the Competence Centre General Practice Baden-Wuerttemberg offers continual improvement with regards to content and structure of general practice training. The programme uses the didactical concept of the CanMEDs competencies, which were developed in Canada, as a postgraduate medical training framework. Train the trainer (TTT)-programmes are an additional important element of these contentual optimisations of postgraduate training. Within this article we describe the conception and evaluation of the first TTT-workshop within the programme Verbundweiterbildung(plus)., Methods: The conception of the first TTT-workshop was influenced by results of a survey of general practitioner (GP) trainers and by experiences with teaching GP trainers involved in medical undergraduate teaching. A questionnaire was designed to get a self-assessment about organisational and didactic aspects oriented on the CanMEDs competencies of postgraduate medical training. In addition, the workshop was evaluated by the participants., Results: The workshop lasted 12 teaching units and included the following elements: introduction into the CanMEDs competencies, feedback training, fault management, legal and organisational aspects of post graduate training. From the 29 participating trainers 76% were male and on average 57 years old. The evaluation showed a good to very good acceptance of the workshop. Initial self-rating showed the need of improving in the fields of determining learning objectives, providing formative feedback and incorporation of a trainee. Most trainers rated themselves as very good in procure CanMEDs competencies with the exclusion of the competencies "Manager" and "Scholar"., Conclusion: A TTT-programme is an important method to improve GP training which has not been used in Germany so far. Such a GP TTT-programme should highlight especially training in providing feedback and teaching in management aspects. Results of this article add information that can be used for developing TTT-programmes also in other specialties.

Background and Purpose: Due to the increasing lack of physicians, an ageing and thus multi-morbid society and a misdistribution of physicians in Germany primary care provided by general practitioners is at risk. Therefore, approaches to recruit more physicians for general practice are being sought. The aim of the present study was to explore individual motivations for choosing a career in general practice, vocational trainees' perspectives on the current situation of vocational training and to identify possible approaches to improve the situation with suggestions from vocational trainees in Germany., Methods: A qualitative study was conducted by interviewing 13 trainees. The interviews that were based on a predefined interview guideline were recorded and transcribed. The analysis was performed according to Mayring supported by the software Atlas.ti., Results: In general, the reasons given for choosing general practice include the holistic view towards patients, the opportunity to see the direct impact of therapies and self-employment. Furthermore, general practice was perceived as a job with a positive work-life balance. Barriers to vocational training are the lack of structure of individual rotations and the low salaries during the rotation in practice. Furthermore, the basic conditions for working as a self-employed general practitioner in Germany were described as being a disincentive. A general suggestion for improvement was to promote professional recognition of general practice at universities. A qualification of vocational trainers was requested. Specific suggestions were: better payment, better-structured rotations and a specific preparation for the self-employed general practitioner., Conclusion: The results of this study reveal that a single measure is insufficient for recruiting more young doctors for general practice. In fact, a package of measures is necessary to improve aspects of the vocational training but also general conditions for the profession., (Copyright © 2010. Published by Elsevier GmbH.)

Background: In order to ensure the delivery of primary care part of the vocational medical training must take place in the general practice setting. In Germany, this requires the authorization to provide general practitioner (GP) training. While in many countries specific qualification programmes for GP trainers are obligatory, this does not yet apply in Germany. The aim of this survey was to explore perspectives and experiences of GP trainers focusing on their needs in view of a possible qualification course., Methods: A three-page questionnaire was developed and sent to all 1,780 GP trainers in the federal state of Baden-Wuerttemberg, Germany., Results: Of the 1,780 GP trainers 656 responded (response rate: 37%), 18% of them being female trainers. About a quarter of the respondents had a vocational trainee, while 36% were looking for one at the time of the survey. The reason most frequently given for not having a vocational trainee was "no applicants" (n=323). Motivational reasons for involvement as a GP trainer were most commonly "interpersonal co-operation" (83%) and "enthusiasm for education" (69%). Only 2% of the respondents reported a bad experience with vocational trainees. Special needs were expressed regarding both legal and fiscal issues with vocational trainees in general practice and the development of a curriculum., Conclusions: For the first time the perspectives and experiences of GP trainers have been explored in the present study. The results may provide a basis for the development of a qualification programme for GP trainers in Germany., (Copyright © 2010. Published by Elsevier GmbH.)

Background: In Germany content-related vocational training mostly is the responsibility of the trainees themselves. The aim of this needs assessment is to explore the requirements of a longitudinal training course in vocational training., Methods: A combined quantitative-qualitative needs assessment was chosen. We used data of a continuous record keeping system in primary care to assess the occupational field, and the needs of vocational trainees were explored in a qualitative survey., Results: Data of more than 120,000 consulting problems in primary care were attributed to different medical expertises by frequency (orthopaedics 22.1%; internal medicine 17.2%; dermatology 12.2%; ear, nose, and throat medicine 11.9%). They revealed a high concordance between the needs derived from the consulting problems and the vocational trainees' needs identified in the qualitative survey (421 text units in the categories: medical expertise, competencies and skills and reflection on one's own performance)., Conclusion: The results of this needs assessment demonstrate the importance of vocational trainees' needs and the findings of health services research for improvement of content-related vocational training. Furthermore, the results form the basis for longitudinal training courses in vocational training, as shown in the approach of the training course within the training programme Verbundweiterbildung(plus)., (Copyright © 2010. Published by Elsevier GmbH.)

Background: The increasing shortage of (primary care) physicians in Germany is currently being discussed within and outside the profession. A national survey among general practice trainees aimed to explore their perspectives of vocational training (VT)., Methods: After translation, cultural adaptation and web implementation of the questionnaire of the "Vasco da Gama Movement," the survey was conducted during 2009. Descriptive analyses were performed., Results: Among 436 participants (mean age 36 years, 64% female, 49 months of VT) discipline-specific ("medically diverse discipline", "one-to-one care", and "holistic approach"), but also gender-related (females: "compatibility with family life", males: "autonomy and independence", and "opportunities to start their own practice") aspects were important to their choice of career. Despite the heavy workload job satisfaction, but not salary satisfaction, was generally high. Participants rated the following general conditions and content of VT as important: "structured rotations", "rotations in hospitals", "management skills", "working in a local care setting and in a multidisciplinary team" (all>88%)., Conclusions: These results provide clues to improving VT in General Practice with respect to organisation and content including the consideration of gender-related living conditions. Furthermore, improvement and further development of VT programmes should ideally be part of an area-wide, interdisciplinary and intersectoral approach., (Copyright © 2010. Published by Elsevier GmbH.)