Postgraduate medical education in obstetrics & gynecology in Switzerland in comparison to Germany and Austria, results of an international survey

Postgraduate medical education in obstetrics & gynecology in Switzerland in comparison to Germany and Austria, results of an international survey | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Postgraduate medical education in obstetrics & gynecology in Switzerland in comparison to Germany and Austria, results of an international survey Benedict Krischer, Ruth Brechbühl-Litzel, Georg-Daniel Breuer, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4298688/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background There is frequent academic exchange between Switzerland, Germany and Austria, facilitated by the common language. Also the postgraduate training curricula in obstetrics & gynecology show some similarities. We aimed to compare self-perceived level of ability, availability of simulation training and teaching and feedback culture among residents in obstetrics & gynecology in Switzerland, Germany, and Austria. The focus was on Switzerland, to gain better understanding of strengths and room for improvement. Methods In a cross sectional design, a web-based survey with 30 questions was distributed under obstetrics & gynecology residents in the three countries in August and September 2020. Primary outcome was the self-perception of skills in between-countries-comparison in mid-training trainees, i.e. omitting trainees in their first year as well as very advanced trainees and specialists. Secondary outcome was reported teaching, simulation training and feedback culture. German and Austrian responses were calculated together and compared with the Swiss replies. Results 422 participants took part in the survey, with 27.5% (n=116) from Switzerland, corresponding to a questionnaire response rate of around 19%. 48% of Swiss trainees were in training years 2-5. 57% of Swiss participants felt confident in obstetric procedures and 69% in gynecological procedures - compared to 52% and 68% in non-Swiss (p=0.005 and p=0.176). Swiss participants felt significantly more confident in performing gynecological than obstetric procedures (p=0.015). 63 % of Swiss participants had obstetric and 28% had gynecological simulation training compared to 37% and 17% in Germany and Austria, respectively (p<0.001 and p=0.007). 56% of Swiss participants reported “enough structured teaching”, 43% reported a “good teaching culture”, 47% of Swiss participants stated to receive regular feedback. Conclusions The majority of trainees in Switzerland feel confident in a range of procedures and interventions. Simulation training is relatively widespread, although especially surgical simulation training should be expanded. Clinical teaching and feedback culture should be strengthened. “Teach the teacher” courses should be encouraged to promote a sustainable feedback culture. Gynecology Obstetrics Postgraduate Medical Education Switzerland Background Obstetrics and gynecology (O&G) represents the fourth largest medical specialty in Switzerland with 1917 specialists and 5% of medical specialist workforce 1 . Specialists in O&G comprise specialists in surgery as well as endocrinology, reproductive medicine, gynecologic oncology, obstetrics, ultrasound, and urogynecology but they also bridge the gap and act as primary care physicians, responsible for preventive medicine and general women’s health 2,3 . This professional width requires a comprehensive training. O&G training in Switzerland is a postgraduate curriculum of at least five years of specialty training 3 . At least one year has to be spent in a smaller “level B” hospital and one year in a larger “level A” hospital. This enables different perspectives and access to different population structures. Different courses, including an obligatory ultrasound course and an obligatory psychosomatic curriculum are prerequisites. Finally, a catalogue of certain interventions and procedures is compulsory. These, as well as training periods, courses and exams must be documented in an electronic logbook which is provided by the Swiss Institute for Medical Continuing Education (SIWF). All proceedings are being discussed with the supervisor or program director in a yearly evaluation interview, which is being documented. During the course of the specialty training, three exams have to be passed: two written exams and one oral exam 3 . There is frequent academic exchange between Switzerland, Germany and Austria, facilitated by the common language. There is also frequent exchange of workforce. Although the training curricula in the three countries are similar, there are several differences between the requirements. A comparison can be seen in Table 1 : Table 1 Comparison of Austrian, German and Swiss O&G training curricula; MC: Multiple choice Austria 4 Germany 5 Switzerland 3 Duration and structure 6 years, of which: 9 months basic training, 36 months specialty training, 3x9 months rotation in sub-specialties. Rotation in a second hospital of 6–9 months is recommended 5 years, of which 12 months in a different specialty are being recognized 5 years, of which 1 year A-level hospital (> 2000 hospitalizations/y) 1 year B-level hospital (> 600 hospitalizations/y) Courses None obligatory 80h psychosomatic course 11 certified courses, of which: 2 psychosomatic 1 ultrasound course (5 days) Working in private practice Up to 1 year training in practice is being recognized No time limit 12 months max Catalogues 180 deliveries 40 caesareans 45 obstetric interventions/Procedures 250 gynecological procedures (20% as 1st assistant are being recognized) 200 deliveries 20 caesareans 200 gynecological procedures (100 as responsible surgeon, 100 as “participant”) 300 deliveries 40 caesareans 40 obstetric procedures 305 gynecological procedures (215 as responsible surgeon, every type of operation defined) Ultrasound 500 ultrasonographies 1000 ultrasonographies 800 ultrasonographies Documentation Paper logbook Paper logbook e-logbook Exams 1 MC-exam 1 oral exam 2 MC-exams of 120 questions 1 oral exam of 60-75mins The boards of the junior professional organizations of O&G in Germany, Austria, and Switzerland together aim to support training and professional development in O&G in their respective countries. In a joint collaboration, research questions were formulated: How do trainees perceive their level of skills and ability? How do they compare internationally? How supportive are the respective training curricula? Where and how do the curricula need to improve to meet future challenges? Methods A panel of curriculum experts compiled a survey with a total of 30 questions. Eligible for participation were O&G trainees and doctors briefly after specialization in the three countries. The questions encompassed trainees’ working situation, training content, curriculum and formally organized simulation training. To ask for fitness in practical skills, the following common standard procedures in obstetrics were chosen: caesarean section, vacuum extraction, management of postpartum hemorrhage and shoulder dystocia. Within gynecology, the following procedures were chosen: dilation and curettage (D&C), hysteroscopy and laparoscopy. The questions were single-choice questions asking for the participants’ agreement or disagreement on a 7-value Likert scale with “1” corresponding to “little agreement” and “7” to “strong agreement”. Some questions were also simple yes/no questions. The questionnaire was formatted as an online survey by ETH Zurich, Department of Health Science and Technology, Consumer Behavior group. The survey was written in German. [See supplementary materials for the original questionnaire]. The questions were presented sequentially, requiring that each question had to be answered in order to complete the survey. An initial screen presented circumstances and background of the survey and asked for consent before starting the survey. Responses were collected anonymously. In accordance with local ethics regulations, no ethics committee votum was required for collection of non-health-related anonymized data and no respective study protocol was issued beforehand. Multiple participation by the same person was excluded with an anonymized IP address monitoring. None of the three countries has a central training registry of all trainees; the best option to reach a maximum of O&G trainees, therefore, was through the membership of the junior organizations of which a large number of trainees are members. The survey link was therefore distributed via the respective e-mail newsletters, their respective homepages and through their social media channels. Several reminders were distributed. The survey was open for participation in August and September 2020. The data collection, compilation and statistical analysis was undertaken by ETH Zurich using SPSS Version 26 (IBM Corp., 2020) and GraphPad® Software. Primary outcome was the self-perception of skills in between-countries-comparison, secondary outcome was reported teaching, simulation training and feedback culture. We focused on trainees in training years 2–5, omitting first-year trainees as well as very experienced trainees (> training year 5) and specialists. Descriptive statistics and chi square test were used to calculate two-sided p-values, a significance level of 0.05 was regarded as significant. The null hypothesis in each case was “no difference between the countries”. For the Likert scale questions the values 5, 6 and 7 were ranked as “agreement” while 1, 2 and 3 were interpreted as “disagreement”. The values of agreement or disagreement for German and Austrian participants were calculated together, unless stated explicitly. Results A total of 422 participants from all three countries took part in the survey. 209 (49.5%) came from Germany, 116 (27.5%) from Switzerland and 97 (23%) from Austria. According to the registry of the SIWF there were 623 training posts for O&G in Switzerland in 2019 6 , therefore 116 replies correspond to a questionnaire response rate of 19% for Switzerland. 89% were female, the average age was 32 years. 48% of Swiss trainees were in training years 2–5. For further demographics, see Table 2 : Table 2 Demographics by training year per country Training year 1 2.-5. > 5 specialist total Switzerland n= 1 56 22 37 116 % 1% 48% 19% 32% Germany n= 30 146 13 20 209 % 14% 70% 6% 10% Austria n= 12 60 16 9 97 % 12% 62% 16% 9% Total n= 43 262 51 66 422 Regarding the self-perceived confidence in performing interventions and procedures, an overview can be obtained from Table 3 and Table 4 below. Table 3 – Confidence in performing obstetric interventions/ operations Confidence in obstetric interventions/operations How confident do you feel in …. … vacuum extraction Training year 2–5 not at all confident - rather not confident indifferent rather confident - very confident total Swiss n= 20 15 21 56 % 36% 27% 38% Germany/ Austria n= 118 31 57 206 % 57% 15% 28% p= 0.025 … management of postpartum hemorrhage Training year 2–5 not at all confident - rather not confident indifferent rather confident - very confident total Swiss n= 6 11 39 56 % 11% 20% 70% Germany/ Austria n= 35 38 133 206 % 17% 18% 65% p= 0.257 … management of shoulder dystocia Training year 2–5 not at all confident - rather not confident indifferent rather confident - very confident total Swiss n= 18 18 29 65 % 28% 28% 45% Germany/ Austria n= 82 58 66 206 % 40% 28% 32% p= 0.375 … primary caesarean section Training year 2–5 not at all confident - rather not confident indifferent rather confident - very confident total Swiss n= 3 9 44 56 % 5% 16% 79% Germany/ Austria n= 18 19 169 206 % 9% 9% 82% p= 0.487 Obstetric interventions, total : Training year 2–5 not at all confident - rather not confident rather confident - very confident total Swiss n= 47 133 180 % 26% 74% Germany/ Austria n= 253 425 678 % 37% 63% p= 0.005 Table 4 – Confidence in performing gynecological interventions/ operations Confidence in gynecological interventions/operations How confident do you feel in …. … dilation & curettage Training year 2–5 not at all confident - rather not confident indifferent rather confident - very confident total Swiss n= 2 3 51 56 % 4% 5% 91% Germany/ Austria n= 13 13 180 206 % 6% 6% 87% p= 0.425 … hysteroscopy Training year 2–5 not at all confident - rather not confident indifferent rather confident - very confident total Swiss n= 5 9 42 56 % 9% 16% 75% Germany/ Austria n= 29 23 154 206 % 14% 11% 75% p= 0.369 … laparoscopy Training year 2–5 not at all confident - rather not confident indifferent rather confident - very confident total Swiss n= 18 15 23 56 % 32% 27% 41% Germany/ Austria n= 83 39 84 206 % 40% 19% 41% p= 0.506 Gynecological interventions, total : Training year 2–5 not at all confident - rather not confident rather confident - very confident total Swiss n= 25 116 141 % 18% 82% Germany/ Austria n= 125 418 543 % 23% 77% p= 0.176 For the obstetric procedures, Swiss participants in training years 2 through 5 reported to feel confident in 57% of the cases in the obstetric procedures compared to 52% in non-Swiss participants (p = 0.005). For the gynecological procedures, Swiss participants in training years 2 through 5 reported to feel confident in 69% of the cases in the gynecological procedures compared to 68% in non-Swiss participants (p = 0.176). Swiss participants felt significantly more confident in gynecological than in obstetric procedures (p = 0.015). The majority of Swiss participants reported to have a structured obstetric simulation training available in their hospital (63% vs. 37% from Germany and Austria, p < 0.001) and also for gynecological surgical training (28% vs. 17%, p = 0.007). Swiss participants reported “enough structured teaching” in 56% of answers compared to 29% of German and Austrian participants (p < 0.001). While 43% of Swiss participants reported a “good teaching culture”, 16% were indecisive and 41% disagreed; yet, for German and Austrian participants, the responses were 25%, 16% and 59%, respectively (p < 0.001). Of Swiss residents, 50% reported a “structured teaching rotation” opposed to only 31% of non-Swiss residents (p < 0.001). For details, see Table 5 . Table 5 Availability of teaching In my hospital there is…. … enough structured teaching … a good teaching culture .. Enough case load for teaching … arbitrary decisionmaking by superiors … a structured teaching rotation Switzerland Agree (n=) 65 50 68 57 58 % 56% 43% 59% 49% 50% Indifferent (n=) 25 18 23 16 19 % 22% 16% 20% 14% 16% Disagree (n=) 26 48 25 43 39 % 22% 41% 22% 37% 34% Germany/ Austria Agree (n=) 90 76 234 164 94 % 29% 25% 76% 54% 31% Indifferent (n=) 43 48 36 36 55 % 14% 16% 12% 12% 18% Disagree (n=) 173 182 36 106 157 % 57% 59% 12% 35% 51% 47% of Swiss participants stated to receive regular feedback regarding their work, opposed to 33% German and Austrian participants (p = 0.005). 48% of Swiss stated that their clinical teachers would take “sufficient time to answer questions” compared to 39% of German and Austrian participants (p = 0.081). 79% of Swiss participants agreed that they received an annual evaluation opposed to 46% of German and Austrian participants (p < 0.001). 84% of Swiss residents reported that they had someone in their department with whom they could consult regarding questions concerning their training (69% in Germany and Austria, p = 0.002) and 72% that they could address a dedicated person with regard to career planning (48% in Germany and Austria, p < 0.001). Discussion The O&G training curricula in all three countries share similarities, with differences in courses, required obligatory numbers of self-performed interventions and mode of exams. The comparison of the confidence levels in obstetric and gynecological procedures between Swiss, German and Austrian trainees in their second through fifth year of training showed similar levels. Independent from their level of training, Swiss participants quoted more structured teaching, more structured teaching rotations and a better teaching culture than their Austrian and German colleagues. This teaching culture also translates into a feedback culture: Swiss participants answered to have more regular and structured feedback and that their superiors took time to explain things or answered questions. With 63% of responses, obstetric simulation training seems to be by far more established in Switzerland than gynecological simulation training with 28%. Already 20 years ago leading opinion makers in Switzerland, Germany and Austria voiced concerns about a deterioration of surgical training in gynecology due to the limitation of working hours 7,8 . While it is beyond the scope of this paper to discuss working hour restrictions and their impact, it is surprising that since then, so few countermeasures have been taken to tackle this issue. The advantages and success of simulation training especially regarding laparoscopic skills is without doubt 9–11 and yet it seems hardly established. This finding uncovers a huge potential for improvement within surgical training in gynecology. While simulation is common in obstetrics in most hospitals, it seems reasonable and easily implementable to provide a comparable option for surgical training as well. The European Board and College of Obstetrics and Gynaecology (EBCOG) has issued a model curriculum and recommendations for teaching and simulation training 12 . While the aim of the model curriculum is to harmonize training contents on a national level, the teaching and simulation recommendations can be adopted on single institution level, to improve structured teaching. The responses regarding teaching culture must be seen in the light of a high proportion of Generation Y under the participants. The special considerations of teaching Generation Y are being discussed e.g. by Schmidt 13 or Eckleberry-Hunt 14 : this generation rejects steep hierarchies and authorities and demand open communication and direct feedback. While most responses regarding teaching prove good results for Switzerland, the “teaching culture” leaves room for improvement. Most participants are discontent with the teaching culture in their departments, even more so in Germany and Austria. “Institutional teaching culture” has been described as “[a culture that] recognizes the importance of teaching, constructively assesses teaching […] and supports teacher development.” 15 . This implies that teaching in a clinical setting is being recognized as such and institutionally supported. It also implies that teaching is regarded as a part of daily clinical work. Just under half of Swiss participants agreed that their superiors would take sufficient time to explain things and give feedback, even less so for German and Austrian participants. Swiss participants did, however, significantly more often state that they had regular feedback on their work as compared to non-Swiss participants, and this is because it is a compulsory prerequisite in the Swiss curriculum. The responses imply that less than every second Swiss and only around every third German or Austrian trainee receives regular feedback or explanations when required. This is alarming when considering the needs of the workforce of Generation Y for regular and direct feedback and support. The institutional teaching culture can therefore have direct impact on workplace satisfaction and staff retention. There are inherent limitations to an online survey. Although it is plausible that all participants were in O&G, this cannot be guaranteed. Although an IP-address tracking was implemented to exclude double participation, this can technically be bypassed by a virtual private network (VPN) – although this effort seems rather improbable. The language chosen represents a limitation, as Switzerland has four national languages and not everyone speaks German; by default, a part of residents is thereby excluded. This was, however, decided upon on purpose as the number of (only) Italian speaking trainees is rather small; the collaboration between the countries is strongly facilitated by the common language and the French-speaking part of Switzerland is usually more oriented towards France. In the German group, the response rate seems relatively small compared to the other countries; this limits the generalizability. A final important limitation is the character of the answers being a self-perception, not an objective evaluation. An obvious strength of this study is the international comparison. Conclusion Overall, the majority of trainees in Switzerland feel confident in a range of procedures and interventions. There is, however, room for improvement: especially surgical simulation training is not broadly established. Furthermore, feedback and teaching culture need to be improved to make training sustainable and fit for the future. “Teach the teacher” courses should be encouraged to promote a sustainable feedback culture. Ideally, teaching should be recognized as part of daily clinical work. To our best of knowledge, this is the first study examining the differences in training in O&G between different countries. Abbreviations O&G Obstetrics & Gynecology EBCOG European Board and College of Obstetrics and Gynaecology SIWF Swiss Institute for Medical Continuing Education VPN Virtual Private Network Declarations Ethics approval and consent to participate Not applicable – ethics approval is not necessary as per national regulations (Swiss human research ordenance, Art. 2), as no health related data were processed and the information are fully anonymized. Therefore ethics approval was not sought. Informed consent to participate was obtained from all participants prior to participation. Consent for publication Not applicable - no such images or identifiable information in this manuscript Availability of data and materials Data is provided within the supplementary information files Competing interests No competing interests declared. Funding The professional organizations of O&G in Germany, Austria, and Switzerland (DGGG, ÖGGG, SGGG) funded the expenses by ETH Zurich for data compilation and processing, contributing in equal parts each. They did not have influence or insights into the research or writing of the publication. Authors' contributions All authors composed the questionnaire and contributed to the data collection. BK performed the statistical analysis, drafted, and wrote the paper. RB, MFr and KW contributed to the final version. GB, MF, PF, MFr, MW and FW gave input to the final version. Acknowledgements We thank Mrs. Larissa Luchsinger for support in drafting the questionnaire and compiling the data. We also acknowledge the financial support of our respective professional societies and thank their presidents and boards for their trust and support. References Hostettler S, Kraft E. FMH Ärztestatistik 2019. Schweizerische Ärztezeitung. 2020;101(13):450–5. Hurd WW, Barhan SM, Rogers RE. Obstetrician-gynecologist as primary care provider. Am J Manag Care. 2001 Sep 25;7 Spec No:SP19-24. FMH. Weiterbildungsprogramm Facharzt für Gynäkologie und Geburtshilfe [Training Program Outlines for OBGYN] [Internet]. FMH Facharzttitel. 2014 [cited 2016 Oct 24]. Available from: http://www.fmh.ch/files/pdf17/gynaekologie_version_internet_d1.pdf Bundesministerium für Gesundheit. Ärztinnen-/Ärzte- Ausbildungsordnung 2015. Wien; 2015 p. 1–34. Bundesärztekammer. Weiterbildungsordnung 2018. Berlin; 2018. SIWF. SIWF Register der zertifizierten Weiterbildungsstellen [Internet]. 2020 [cited 2021 Feb 5]. Available from: https://www.siwf-register.ch/ Haller U, Hepp H, Winter R. Muss die weiterbildung zum facharzt gynäkologie und geburtshilfe in der schweiz überdacht werden? Gynakol Geburtshilfliche Rundsch. 2004;44(3):127–8. Kaderli R, Businger A, Oesch A, Stefenelli U, Laffer U. Morbidity in surgery: Impact of the 50-hour workweek limitation in Switzerland. Swiss Med Wkly. 2012;142(1):1–8. Mannella P, Malacarne E, Giannini A, Russo E, Caretto M, Papini F, et al. Simulation as tool for evaluating and improving technical skills in laparoscopic gynecological surgery. BMC Surg. 2019;19(1):1–9. Nagendran M, Toon CD, Davidson BR, Gurusamy KS. Laparoscopic surgical box model training for surgical trainees with no prior laparoscopic experience. Vol. 2014, Cochrane Database of Systematic Reviews. John Wiley and Sons Ltd; 2014. Seymour NE, Gallagher AG, Roman SA, O’Brien MK, Bansal VK, Andersen DK, et al. Virtual reality training improves operating room performance results of a randomized, double-blinded study. Ann Surg. 2002;236(4):458–64. UEMS Standing Committee on Training and Assessment. European Training Requirements in Obstetrics and Gynaecology [Internet]. 2018. Available from: https://www.uems.eu/__data/assets/pdf_file/0004/64399/UEMS-2018.18-European-Training-Requirements-OBGYN.pdf Schmidt C. Generation Y - Eine neue Generation von Mitarbeitern verändert die Arbeitswelt. Aktuelle Urol. 2013 Sep 16;44(05):352–6. Eckleberry-Hunt J, Tucciarone J. The challenges and opportunities of teaching “generation y”. J Grad Med Educ. 2011;3(4):458–61. Kustra E, Meadows KN, Dawson D, Hondzel CD, Goff L, Wolf P, et al. Teaching culture indicators: Enhancing quality teaching. 1st ed. Ministry of Training, Colleges and Universities; 2014. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4298688","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":298533523,"identity":"4d105779-f643-4812-b776-b550447306d5","order_by":0,"name":"Benedict 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medical education in obstetrics \u0026 gynecology in Switzerland in comparison to Germany and Austria, results of an international survey","fulltext":[{"header":"Background","content":"\u003cp\u003eObstetrics and gynecology (O\u0026amp;G) represents the fourth largest medical specialty in Switzerland with 1917 specialists and 5% of medical specialist workforce\u003csup\u003e1\u003c/sup\u003e. Specialists in O\u0026amp;G comprise specialists in surgery as well as endocrinology, reproductive medicine, gynecologic oncology, obstetrics, ultrasound, and urogynecology but they also bridge the gap and act as primary care physicians, responsible for preventive medicine and general women\u0026rsquo;s health \u003csup\u003e2,3\u003c/sup\u003e. This professional width requires a comprehensive training. O\u0026amp;G training in Switzerland is a postgraduate curriculum of at least five years of specialty training \u003csup\u003e3\u003c/sup\u003e. At least one year has to be spent in a smaller \u0026ldquo;level B\u0026rdquo; hospital and one year in a larger \u0026ldquo;level A\u0026rdquo; hospital. This enables different perspectives and access to different population structures. Different courses, including an obligatory ultrasound course and an obligatory psychosomatic curriculum are prerequisites. Finally, a catalogue of certain interventions and procedures is compulsory. These, as well as training periods, courses and exams must be documented in an electronic logbook which is provided by the Swiss Institute for Medical Continuing Education (SIWF). All proceedings are being discussed with the supervisor or program director in a yearly evaluation interview, which is being documented. During the course of the specialty training, three exams have to be passed: two written exams and one oral exam \u003csup\u003e3\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThere is frequent academic exchange between Switzerland, Germany and Austria, facilitated by the common language. There is also frequent exchange of workforce. Although the training curricula in the three countries are similar, there are several differences between the requirements. A comparison can be seen in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e:\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Austrian, German and Swiss O\u0026amp;G training curricula; MC: Multiple choice\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAustria\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGermany\u003csup\u003e5\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eSwitzerland\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration and structure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 years, of which:\u003c/p\u003e \u003cp\u003e9 months basic training, 36 months specialty training, 3x9 months rotation in sub-specialties. Rotation in a second hospital of 6\u0026ndash;9 months is recommended\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 years, of which 12 months in a different specialty are being recognized\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 years, of which\u003c/p\u003e \u003cp\u003e1 year A-level hospital (\u0026gt;\u0026thinsp;2000 hospitalizations/y)\u003c/p\u003e \u003cp\u003e1 year B-level hospital (\u0026gt;\u0026thinsp;600 hospitalizations/y)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCourses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone obligatory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80h psychosomatic course\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 certified courses, of which: 2 psychosomatic\u003c/p\u003e \u003cp\u003e1 ultrasound course (5 days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorking in private practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUp to 1 year training in practice is being recognized\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo time limit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 months max\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCatalogues\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e180 deliveries\u003c/p\u003e \u003cp\u003e40 caesareans\u003c/p\u003e \u003cp\u003e45 obstetric interventions/Procedures\u003c/p\u003e \u003cp\u003e250 gynecological procedures (20% as 1st assistant are being recognized)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e200 deliveries\u003c/p\u003e \u003cp\u003e20 caesareans\u003c/p\u003e \u003cp\u003e200 gynecological procedures (100 as responsible surgeon, 100 as \u0026ldquo;participant\u0026rdquo;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e300 deliveries\u003c/p\u003e \u003cp\u003e40 caesareans\u003c/p\u003e \u003cp\u003e40 obstetric procedures\u003c/p\u003e \u003cp\u003e305 gynecological procedures (215 as responsible surgeon, every type of operation defined)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUltrasound\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e500 ultrasonographies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1000 ultrasonographies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e800 ultrasonographies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDocumentation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePaper logbook\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePaper logbook\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ee-logbook\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExams\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 MC-exam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 oral exam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 MC-exams of 120 questions\u003c/p\u003e \u003cp\u003e1 oral exam of 60-75mins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe boards of the junior professional organizations of O\u0026amp;G in Germany, Austria, and Switzerland together aim to support training and professional development in O\u0026amp;G in their respective countries. In a joint collaboration, research questions were formulated:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eHow do trainees perceive their level of skills and ability? How do they compare internationally?\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eHow supportive are the respective training curricula?\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eWhere and how do the curricula need to improve to meet future challenges?\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eA panel of curriculum experts compiled a survey with a total of 30 questions. Eligible for participation were O\u0026amp;G trainees and doctors briefly after specialization in the three countries. The questions encompassed trainees\u0026rsquo; working situation, training content, curriculum and formally organized simulation training. To ask for fitness in practical skills, the following common standard procedures in obstetrics were chosen: caesarean section, vacuum extraction, management of postpartum hemorrhage and shoulder dystocia. Within gynecology, the following procedures were chosen: dilation and curettage (D\u0026amp;C), hysteroscopy and laparoscopy. The questions were single-choice questions asking for the participants\u0026rsquo; agreement or disagreement on a 7-value Likert scale with \u0026ldquo;1\u0026rdquo; corresponding to \u0026ldquo;little agreement\u0026rdquo; and \u0026ldquo;7\u0026rdquo; to \u0026ldquo;strong agreement\u0026rdquo;. Some questions were also simple yes/no questions.\u003c/p\u003e \u003cp\u003eThe questionnaire was formatted as an online survey by ETH Zurich, Department of Health Science and Technology, Consumer Behavior group. The survey was written in German. [See supplementary materials for the original questionnaire]. The questions were presented sequentially, requiring that each question had to be answered in order to complete the survey. An initial screen presented circumstances and background of the survey and asked for consent before starting the survey. Responses were collected anonymously. In accordance with local ethics regulations, no ethics committee votum was required for collection of non-health-related anonymized data and no respective study protocol was issued beforehand. Multiple participation by the same person was excluded with an anonymized IP address monitoring. None of the three countries has a central training registry of all trainees; the best option to reach a maximum of O\u0026amp;G trainees, therefore, was through the membership of the junior organizations of which a large number of trainees are members. The survey link was therefore distributed via the respective e-mail newsletters, their respective homepages and through their social media channels. Several reminders were distributed. The survey was open for participation in August and September 2020. The data collection, compilation and statistical analysis was undertaken by ETH Zurich using SPSS Version 26 (IBM Corp., 2020) and GraphPad\u0026reg; Software. Primary outcome was the self-perception of skills in between-countries-comparison, secondary outcome was reported teaching, simulation training and feedback culture. We focused on trainees in training years 2\u0026ndash;5, omitting first-year trainees as well as very experienced trainees (\u0026gt;\u0026thinsp;training year 5) and specialists.\u003c/p\u003e \u003cp\u003eDescriptive statistics and chi square test were used to calculate two-sided p-values, a significance level of 0.05 was regarded as significant. The null hypothesis in each case was \u0026ldquo;no difference between the countries\u0026rdquo;.\u003c/p\u003e \u003cp\u003eFor the Likert scale questions the values 5, 6 and 7 were ranked as \u0026ldquo;agreement\u0026rdquo; while 1, 2 and 3 were interpreted as \u0026ldquo;disagreement\u0026rdquo;. The values of agreement or disagreement for German and Austrian participants were calculated together, unless stated explicitly.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 422 participants from all three countries took part in the survey. 209 (49.5%) came from Germany, 116 (27.5%) from Switzerland and 97 (23%) from Austria.\u003c/p\u003e \u003cp\u003eAccording to the registry of the SIWF there were 623 training posts for O\u0026amp;G in Switzerland in 2019 \u003csup\u003e6\u003c/sup\u003e, therefore 116 replies correspond to a questionnaire response rate of 19% for Switzerland. 89% were female, the average age was 32 years. 48% of Swiss trainees were in training years 2\u0026ndash;5. For further demographics, see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e:\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographics by training year per country\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTraining year\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.-5.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003especialist\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003etotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSwitzerland\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGermany\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e209\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e70%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAustria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e262\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e422\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eRegarding the self-perceived confidence in performing interventions and procedures, an overview can be obtained from Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e below.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u0026ndash; Confidence in performing obstetric interventions/ operations\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eConfidence in obstetric interventions/operations\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eHow confident do you feel in \u0026hellip;.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u0026hellip; vacuum extraction\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraining year 2\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003enot at all confident - rather not confident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eindifferent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003erather confident - very confident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003etotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSwiss\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e38%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGermany/ Austria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e206\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.025\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u0026hellip; management of postpartum hemorrhage\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraining year 2\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003enot at all confident - rather not confident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eindifferent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003erather confident - very confident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003etotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSwiss\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e70%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGermany/ Austria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e206\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e65%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.257\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u0026hellip; management of shoulder dystocia\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraining year 2\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003enot at all confident - rather not confident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eindifferent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003erather confident - very confident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003etotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSwiss\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e45%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGermany/ Austria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e206\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.375\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u0026hellip; primary caesarean section\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraining year 2\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003enot at all confident - rather not confident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eindifferent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003erather confident - very confident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003etotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSwiss\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e79%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGermany/ Austria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e206\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e82%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.487\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eObstetric interventions, total\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraining year 2\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003enot at all confident - rather not confident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"4\" rowspan=\"5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003erather confident - very confident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003etotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSwiss\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e74%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGermany/ Austria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e253\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e425\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e678\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e63%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003ep=\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u0026ndash; Confidence in performing gynecological interventions/ operations\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eConfidence in gynecological interventions/operations\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eHow confident do you feel in \u0026hellip;.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u0026hellip; dilation \u0026amp; curettage\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraining year 2\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003enot at all confident - rather not confident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eindifferent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003erather confident - very confident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003etotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSwiss\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e91%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGermany/ Austria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e206\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e87%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.425\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u0026hellip; hysteroscopy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraining year 2\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003enot at all confident - rather not confident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eindifferent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003erather confident - very confident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003etotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSwiss\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e75%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGermany/ Austria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e206\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e75%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.369\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u0026hellip; laparoscopy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraining year 2\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003enot at all confident - rather not confident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eindifferent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003erather confident - very confident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003etotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSwiss\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e41%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGermany/ Austria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e206\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e41%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.506\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGynecological interventions, total\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraining year 2\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003enot at all confident - rather not confident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"4\" rowspan=\"5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003erather confident - very confident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003etotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSwiss\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e141\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e82%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGermany/ Austria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e418\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e543\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e77%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.176\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFor the \u003cem\u003eobstetric\u003c/em\u003e procedures, Swiss participants in training years 2 through 5 reported to feel confident in 57% of the cases in the obstetric procedures compared to 52% in non-Swiss participants (p\u0026thinsp;=\u0026thinsp;0.005). For the \u003cem\u003egynecological\u003c/em\u003e procedures, Swiss participants in training years 2 through 5 reported to feel confident in 69% of the cases in the gynecological procedures compared to 68% in non-Swiss participants (p\u0026thinsp;=\u0026thinsp;0.176). Swiss participants felt significantly more confident in gynecological than in obstetric procedures (p\u0026thinsp;=\u0026thinsp;0.015).\u003c/p\u003e \u003cp\u003eThe majority of Swiss participants reported to have a structured obstetric simulation training available in their hospital (63% vs. 37% from Germany and Austria, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and also for gynecological surgical training (28% vs. 17%, p\u0026thinsp;=\u0026thinsp;0.007).\u003c/p\u003e \u003cp\u003eSwiss participants reported \u0026ldquo;enough structured teaching\u0026rdquo; in 56% of answers compared to 29% of German and Austrian participants (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). While 43% of Swiss participants reported a \u0026ldquo;good teaching culture\u0026rdquo;, 16% were indecisive and 41% disagreed; yet, for German and Austrian participants, the responses were 25%, 16% and 59%, respectively (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eOf Swiss residents, 50% reported a \u0026ldquo;structured teaching rotation\u0026rdquo; opposed to only 31% of non-Swiss residents (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). For details, see Table \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAvailability of teaching\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c7\" namest=\"c3\"\u003e \u003cp\u003eIn my hospital there is\u0026hellip;.\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026hellip; enough structured teaching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026hellip; a good teaching culture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.. Enough case load for teaching\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026hellip; arbitrary decisionmaking by superiors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026hellip; a structured teaching rotation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eSwitzerland\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAgree (n=)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e59%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e49%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e50%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIndifferent (n=)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e16%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisagree (n=)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e37%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e34%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eGermany/ Austria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAgree (n=)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e234\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e164\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e76%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e54%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e31%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIndifferent (n=)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e18%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisagree (n=)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e157\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e35%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e51%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e47% of Swiss participants stated to receive regular feedback regarding their work, opposed to 33% German and Austrian participants (p\u0026thinsp;=\u0026thinsp;0.005). 48% of Swiss stated that their clinical teachers would take \u0026ldquo;sufficient time to answer questions\u0026rdquo; compared to 39% of German and Austrian participants (p\u0026thinsp;=\u0026thinsp;0.081). 79% of Swiss participants agreed that they received an annual evaluation opposed to 46% of German and Austrian participants (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). 84% of Swiss residents reported that they had someone in their department with whom they could consult regarding questions concerning their training (69% in Germany and Austria, p\u0026thinsp;=\u0026thinsp;0.002) and 72% that they could address a dedicated person with regard to career planning (48% in Germany and Austria, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe O\u0026amp;G training curricula in all three countries share similarities, with differences in courses, required obligatory numbers of self-performed interventions and mode of exams. The comparison of the confidence levels in obstetric and gynecological procedures between Swiss, German and Austrian trainees in their second through fifth year of training showed similar levels.\u003c/p\u003e \u003cp\u003eIndependent from their level of training, Swiss participants quoted more structured teaching, more structured teaching rotations and a better teaching culture than their Austrian and German colleagues. This teaching culture also translates into a feedback culture: Swiss participants answered to have more regular and structured feedback and that their superiors took time to explain things or answered questions.\u003c/p\u003e \u003cp\u003eWith 63% of responses, obstetric simulation training seems to be by far more established in Switzerland than gynecological simulation training with 28%. Already 20 years ago leading opinion makers in Switzerland, Germany and Austria voiced concerns about a deterioration of surgical training in gynecology due to the limitation of working hours \u003csup\u003e7,8\u003c/sup\u003e. While it is beyond the scope of this paper to discuss working hour restrictions and their impact, it is surprising that since then, so few countermeasures have been taken to tackle this issue. The advantages and success of simulation training especially regarding laparoscopic skills is without doubt \u003csup\u003e9\u0026ndash;11\u003c/sup\u003e and yet it seems hardly established. This finding uncovers a huge potential for improvement within surgical training in gynecology. While simulation is common in obstetrics in most hospitals, it seems reasonable and easily implementable to provide a comparable option for surgical training as well.\u003c/p\u003e \u003cp\u003eThe European Board and College of Obstetrics and Gynaecology (EBCOG) has issued a model curriculum and recommendations for teaching and simulation training\u003csup\u003e12\u003c/sup\u003e. While the aim of the model curriculum is to harmonize training contents on a national level, the teaching and simulation recommendations can be adopted on single institution level, to improve structured teaching.\u003c/p\u003e \u003cp\u003eThe responses regarding teaching culture must be seen in the light of a high proportion of Generation Y under the participants. The special considerations of teaching Generation Y are being discussed e.g. by Schmidt \u003csup\u003e13\u003c/sup\u003e or Eckleberry-Hunt \u003csup\u003e14\u003c/sup\u003e: this generation rejects steep hierarchies and authorities and demand open communication and direct feedback. While most responses regarding teaching prove good results for Switzerland, the \u0026ldquo;teaching culture\u0026rdquo; leaves room for improvement. Most participants are discontent with the teaching culture in their departments, even more so in Germany and Austria. \u0026ldquo;Institutional teaching culture\u0026rdquo; has been described as \u0026ldquo;[a culture that] recognizes the importance of teaching, constructively assesses teaching [\u0026hellip;] and supports teacher development.\u0026rdquo; \u003csup\u003e15\u003c/sup\u003e. This implies that teaching in a clinical setting is being recognized as such and institutionally supported. It also implies that teaching is regarded as a part of daily clinical work. Just under half of Swiss participants agreed that their superiors would take sufficient time to explain things and give feedback, even less so for German and Austrian participants. Swiss participants did, however, significantly more often state that they had regular feedback on their work as compared to non-Swiss participants, and this is because it is a compulsory prerequisite in the Swiss curriculum. The responses imply that less than every second Swiss and only around every third German or Austrian trainee receives regular feedback or explanations when required. This is alarming when considering the needs of the workforce of Generation Y for regular and direct feedback and support. The institutional teaching culture can therefore have direct impact on workplace satisfaction and staff retention.\u003c/p\u003e \u003cp\u003eThere are inherent limitations to an online survey. Although it is plausible that all participants were in O\u0026amp;G, this cannot be guaranteed. Although an IP-address tracking was implemented to exclude double participation, this can technically be bypassed by a virtual private network (VPN) \u0026ndash; although this effort seems rather improbable. The language chosen represents a limitation, as Switzerland has four national languages and not everyone speaks German; by default, a part of residents is thereby excluded. This was, however, decided upon on purpose as the number of (only) Italian speaking trainees is rather small; the collaboration between the countries is strongly facilitated by the common language and the French-speaking part of Switzerland is usually more oriented towards France. In the German group, the response rate seems relatively small compared to the other countries; this limits the generalizability. A final important limitation is the character of the answers being a self-perception, not an objective evaluation. An obvious strength of this study is the international comparison.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOverall, the majority of trainees in Switzerland feel confident in a range of procedures and interventions. There is, however, room for improvement: especially surgical simulation training is not broadly established. Furthermore, feedback and teaching culture need to be improved to make training sustainable and fit for the future. \u0026ldquo;Teach the teacher\u0026rdquo; courses should be encouraged to promote a sustainable feedback culture. Ideally, teaching should be recognized as part of daily clinical work.\u003c/p\u003e \u003cp\u003eTo our best of knowledge, this is the first study examining the differences in training in O\u0026amp;G between different countries.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eO\u0026amp;G\u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Obstetrics \u0026amp; Gynecology\u003c/p\u003e\n\u003cp\u003eEBCOG\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;European Board and College of Obstetrics and Gynaecology\u003c/p\u003e\n\u003cp\u003eSIWF \u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Swiss Institute for Medical Continuing Education\u003c/p\u003e\n\u003cp\u003eVPN \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Virtual Private Network\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch3\u003eEthics approval and consent to participate\u003c/h3\u003e\n\u003cp\u003eNot applicable \u0026ndash; ethics approval is not necessary as per national regulations (Swiss human research ordenance, Art. 2), as no health related data were processed and the information are fully anonymized. Therefore ethics approval was not sought. Informed consent to participate was obtained from all participants prior to participation.\u003c/p\u003e\n\u003ch3\u003eConsent for publication\u003c/h3\u003e\n\u003cp\u003eNot applicable -\u0026nbsp;no such images or identifiable information in this manuscript\u003c/p\u003e\n\u003ch3\u003eAvailability of data and materials\u003c/h3\u003e\n\u003cp\u003eData is provided within the supplementary information files\u003c/p\u003e\n\u003ch3\u003eCompeting interests\u003c/h3\u003e\n\u003ch3\u003eNo competing interests declared.\u003c/h3\u003e\n\u003ch3\u003eFunding\u003c/h3\u003e\n\u003cp\u003eThe professional organizations of O\u0026amp;G in Germany, Austria, and Switzerland (DGGG, \u0026Ouml;GGG, SGGG) funded the expenses by ETH Zurich for data compilation and processing, contributing in equal parts each. They did not have influence or insights into the research or writing of the publication.\u003c/p\u003e\n\u003ch3\u003eAuthors\u0026apos; contributions\u003c/h3\u003e\n\u003cp\u003eAll authors composed the questionnaire and contributed to the data collection. BK performed the statistical analysis, drafted, and wrote the paper. RB, MFr and KW contributed to the final version. GB, MF, PF, MFr, MW and FW gave input to the final version.\u003c/p\u003e\n\u003ch3\u003eAcknowledgements\u003c/h3\u003e\n\u003cp\u003eWe thank Mrs. Larissa Luchsinger for support in drafting the questionnaire and compiling the data. We also acknowledge the financial support of our respective professional societies and thank their presidents and boards for their trust and support.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHostettler S, Kraft E. FMH \u0026Auml;rztestatistik 2019. Schweizerische \u0026Auml;rztezeitung. 2020;101(13):450\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eHurd WW, Barhan SM, Rogers RE. Obstetrician-gynecologist as primary care provider. Am J Manag Care. 2001 Sep 25;7 Spec No:SP19-24. \u003c/li\u003e\n\u003cli\u003eFMH. Weiterbildungsprogramm Facharzt f\u0026uuml;r Gyn\u0026auml;kologie und Geburtshilfe [Training Program Outlines for OBGYN] [Internet]. FMH Facharzttitel. 2014 [cited 2016 Oct 24]. Available from: http://www.fmh.ch/files/pdf17/gynaekologie_version_internet_d1.pdf\u003c/li\u003e\n\u003cli\u003eBundesministerium f\u0026uuml;r Gesundheit. \u0026Auml;rztinnen-/\u0026Auml;rzte- Ausbildungsordnung 2015. Wien; 2015 p. 1\u0026ndash;34. \u003c/li\u003e\n\u003cli\u003eBundes\u0026auml;rztekammer. Weiterbildungsordnung 2018. Berlin; 2018. \u003c/li\u003e\n\u003cli\u003eSIWF. SIWF Register der zertifizierten Weiterbildungsstellen [Internet]. 2020 [cited 2021 Feb 5]. Available from: https://www.siwf-register.ch/\u003c/li\u003e\n\u003cli\u003eHaller U, Hepp H, Winter R. Muss die weiterbildung zum facharzt gyn\u0026auml;kologie und geburtshilfe in der schweiz \u0026uuml;berdacht werden? Gynakol Geburtshilfliche Rundsch. 2004;44(3):127\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eKaderli R, Businger A, Oesch A, Stefenelli U, Laffer U. Morbidity in surgery: Impact of the 50-hour workweek limitation in Switzerland. Swiss Med Wkly. 2012;142(1):1\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eMannella P, Malacarne E, Giannini A, Russo E, Caretto M, Papini F, et al. Simulation as tool for evaluating and improving technical skills in laparoscopic gynecological surgery. BMC Surg. 2019;19(1):1\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eNagendran M, Toon CD, Davidson BR, Gurusamy KS. Laparoscopic surgical box model training for surgical trainees with no prior laparoscopic experience. Vol. 2014, Cochrane Database of Systematic Reviews. John Wiley and Sons Ltd; 2014. \u003c/li\u003e\n\u003cli\u003eSeymour NE, Gallagher AG, Roman SA, O\u0026rsquo;Brien MK, Bansal VK, Andersen DK, et al. Virtual reality training improves operating room performance results of a randomized, double-blinded study. Ann Surg. 2002;236(4):458\u0026ndash;64. \u003c/li\u003e\n\u003cli\u003eUEMS Standing Committee on Training and Assessment. European Training Requirements in Obstetrics and Gynaecology [Internet]. 2018. Available from: https://www.uems.eu/__data/assets/pdf_file/0004/64399/UEMS-2018.18-European-Training-Requirements-OBGYN.pdf\u003c/li\u003e\n\u003cli\u003eSchmidt C. Generation Y - Eine neue Generation von Mitarbeitern ver\u0026auml;ndert die Arbeitswelt. Aktuelle Urol. 2013 Sep 16;44(05):352\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eEckleberry-Hunt J, Tucciarone J. The challenges and opportunities of teaching \u0026ldquo;generation y\u0026rdquo;. J Grad Med Educ. 2011;3(4):458\u0026ndash;61. \u003c/li\u003e\n\u003cli\u003eKustra E, Meadows KN, Dawson D, Hondzel CD, Goff L, Wolf P, et al. Teaching culture indicators: Enhancing quality teaching. 1st ed. Ministry of Training, Colleges and Universities; 2014. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Gynecology, Obstetrics, Postgraduate, Medical Education, Switzerland","lastPublishedDoi":"10.21203/rs.3.rs-4298688/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4298688/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground\u003c/p\u003e\n\u003cp\u003eThere is frequent academic exchange between Switzerland, Germany and Austria, facilitated by the common language. Also the postgraduate training curricula in obstetrics \u0026amp; gynecology show some similarities. We aimed to compare self-perceived level of ability, availability of simulation training and teaching and feedback culture among residents in obstetrics \u0026amp; gynecology in Switzerland, Germany, and Austria. The focus was on Switzerland, to gain better understanding of strengths and room for improvement.\u003c/p\u003e\n\u003cp\u003eMethods\u003c/p\u003e\n\u003cp\u003eIn a cross sectional design, a web-based survey with 30 questions was distributed under obstetrics \u0026amp; gynecology residents in the three countries in August and September 2020. Primary outcome was the self-perception of skills in between-countries-comparison in mid-training trainees, i.e. omitting trainees in their first year as well as very advanced trainees and specialists. Secondary outcome was reported teaching, simulation training and feedback culture. German and Austrian responses were calculated together and compared with the Swiss replies.\u003c/p\u003e\n\u003cp\u003eResults\u003c/p\u003e\n\u003cp\u003e422 participants took part in the survey, with 27.5% (n=116) from Switzerland, corresponding to a questionnaire response rate of around 19%. 48% of Swiss trainees were in training years 2-5. 57% of Swiss participants felt confident in obstetric procedures and 69% in gynecological procedures - compared to 52% and 68% in non-Swiss (p=0.005 and p=0.176). Swiss participants felt significantly more confident in performing gynecological than obstetric procedures (p=0.015). 63 % of Swiss participants had obstetric and 28% had gynecological simulation training compared to 37% and 17% in Germany and Austria, respectively (p\u0026lt;0.001 and p=0.007). \u003cbr\u003e\n56% of Swiss participants reported “enough structured teaching”, 43% reported a “good teaching culture”, 47% of Swiss participants stated to receive regular feedback.\u003c/p\u003e\n\u003cp\u003eConclusions\u003c/p\u003e\n\u003cp\u003eThe majority of trainees in Switzerland feel confident in a range of procedures and interventions. Simulation training is relatively widespread, although\u003c/p\u003e\n\u003cp\u003eespecially surgical simulation training should be expanded. Clinical teaching and feedback culture should be strengthened. “Teach the teacher” courses should be encouraged to promote a sustainable feedback culture.\u003c/p\u003e","manuscriptTitle":"Postgraduate medical education in obstetrics \u0026amp; gynecology in Switzerland in comparison to Germany and Austria, results of an international survey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-06 05:43:00","doi":"10.21203/rs.3.rs-4298688/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c79c8100-0568-4e26-9dbb-6d6d2660b5c3","owner":[],"postedDate":"May 6th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-05-27T10:03:47+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-06 05:43:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4298688","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4298688","identity":"rs-4298688","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}