Problems in Integrative Postgraduate Medical Training of Physicians at Anthroposophic Hospitals in Germany and Switzerland

Background: Anthroposophic hospital provide integrative medical care by complementing conventional (CON) with anthroposophic medicine (AM). They teach integrative medicine in postgraduate medical training (PGMT). In a first evaluation of PGMT quality in AM, we analyzed the problems of this training from the perspectives of trainers and trainees. Method: We conducted an anonymous cross-sectional full survey of all trainee and trainer physicians at the 15 AM hospitals in Germany (DE) and Switzerland (CH) with questionnaires of the Swiss Institute of Technology (ETH) Zurich, complemented by a module for AM. We also conducted descriptive statistics for questions with answering scales as well as calculations of group differences (two-tailed Mann-Whitney U test) and a qualitative content analysis (Mayring) of free text answers related to the problem analysis. Results: The response rate in DE embraced 89 out of 215 (41.39%) surveyed trainees and 78 out of 184 (42.39%) trainers; in CH, the response rate comprised 19 out of 25 (76%) trainees and 22 out of 30 (73.33%) trainers. Free text answers related to problem analysis in DE and CH were given by 16 out of 108 (14.8%) trainees and by 20 out of 100 (20%) trainers, overall. Perceived main problems include work overload; shortcomings in work organization; delimitation of competences; interprofessional cooperation; financial resources (trainers); wages (trainees DE); practical relevance of AM (trainees and trainers in DE); professional or didactic competence of trainers; lack of interest in AM (trainees); problems with learning and practicing AM; no curriculum for postgraduate medical training in AM; tensions between AM and CON. Explanations for the differences between DE and CH include larger departments and the DRG system in DE, but also better structural conditions for AM PGMT in CH. Conclusion: Main problems of PGMT in AM include not only non-specific and systemic aspects, but also AM-specific issues. In order to develop a basis for concrete problem solving options, this study will be complemented by an analysis of solution ideas from the perspective of the involved trainers and trainees.