{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T10:01:17Z","timestamp":1776333677629,"version":"3.51.2"},"reference-count":65,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Interdisciplinary Center for Clinical Research (Interdisziplin\u00e4res Zentrum f\u00fcr Klinische Forschung, IZKF) W\u00fcrzburg","award":["ZZ.38"],"award-info":[{"award-number":["ZZ.38"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Pediatric surgical care in Germany is delivered within a highly decentralized system, and training structures vary considerably between institutions. Adequate operative exposure is essential for competency-based training. The specialty requires a high number of operative procedures during training, yet concerns have been raised that residents may not achieve the required case numbers within the standard training period. The German Model Training Regulations (Musterweiterbildungsordnung, MWBO) define 22 procedural categories with specific case number targets for pediatric surgery. However, the extent to which current training structures allow for the fulfillment of these requirements remains unclear. This study examines the distribution of procedures and residents across different hospital types and estimates whether the available procedural volume may be sufficient under simplified allocation assumptions. Methods: We conducted a nationwide analysis of pediatric surgical training capacity in Germany using procedural data from hospital quality reports published by the Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA) between 2012 and 2023. A total of 3440 OPS codes were assigned to 22 training categories, and case volumes were analyzed across different hospital types. The estimated training capacity was calculated assuming even distribution of cases among residents, and that all eligible procedures are performed with full resident access. Results: Data from an average of 82.3 pediatric surgical departments per year were analyzed, including 29.7% university hospitals, 58.7% non-university departments, and 11.7% other institutions. Most departments reported fewer than five residents. Between 2012 and 2023, the mean number of residents increased slightly across all hospital types, while inpatient numbers declined. Consequently, inpatient exposure decreased from 469.8 to 354.0 cases per resident per year. Patient exposure differed significantly by institutional category (p &lt; 0.001), with higher exposure in non-university departments compared with university hospitals. Across all hospital types, the mean number of fulfilled procedural training categories declined over time. No institution met the target numbers for all categories without cooperation with other units. Thoracic surgery procedures were least frequently covered, whereas appendectomies and inguinal hernia repairs were most consistently fulfilled. Distinct patterns of subspecialization emerged, with trauma procedures less frequently reported at university hospitals and thoracic procedures less frequently reported at non-university departments. Although the overall national procedural volume appears sufficient for most training requirements, low-volume and highly specialized procedures were concentrated at selected centers, limiting their accessibility for trainees. Conclusions: Even though there are sufficient pediatric surgical procedures in Germany, they are unevenly distributed between hospitals. Under a simplified allocation model, many pediatric surgical departments in Germany currently lack sufficient procedural volume to meet training requirements in the defined training timeframe for all trainees. Structural reforms\u2014including mandatory national documentation, minor MWBO adjustments and the creation of training networks\u2014are necessary to ensure comprehensive and equitable pediatric surgical education. Without these changes, extended training durations and reduced trainee satisfaction may contribute to workforce shortages and limit the future quality of pediatric surgical care in Germany.<\/jats:p>","DOI":"10.3390\/children13040554","type":"journal-article","created":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T09:04:42Z","timestamp":1776330282000},"page":"554","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Mind the Gap: A Nationwide Analysis of Case Distribution, Resident Exposure and Institutional Variation in German Pediatric Surgery Training"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3442-4851","authenticated-orcid":false,"given":"Sabine","family":"Drossard","sequence":"first","affiliation":[{"name":"Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital W\u00fcrzburg, 97080 W\u00fcrzburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6820-522X","authenticated-orcid":false,"given":"Maria Christina","family":"Stefanescu","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7796-3329","authenticated-orcid":false,"given":"Andrea","family":"Schmedding","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery and Pediatric Urology, City Hospital Braunschweig, 38124 Braunschweig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,16]]},"reference":[{"key":"ref_1","unstructured":"German Society of Pediatric Surgery (2026, February 13). The Spectrum of Pediatric Surgery. Available online: https:\/\/www.dgkjch.de\/kinder-jugendchirurgie\/spektrum-der-kinder-und-jugendchirurgie."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1080\/0142159X.2018.1536260","article-title":"Supporting the Development of a Professional Identity: General Principles","volume":"41","author":"Cruess","year":"2019","journal-title":"Med. Teach."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Rickham, P.P. (1986). Historical Aspects of Pediatric Surgery, Springer. Progress in Pediatric Surgery.","DOI":"10.1007\/978-3-642-70825-1"},{"key":"ref_4","unstructured":"German Society of Pediatric Surgery (2026, April 01). Timeline of Pediatric Surgery in Germany. Available online: https:\/\/www.dgkjch.de\/?view=article&id=56:zeitleiste&catid=56."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/978-3-642-70825-1_1","article-title":"The History of Pediatric Surgery in Germany","volume":"Volume 20","author":"Hecker","year":"1986","journal-title":"Historical Aspects of Pediatric Surgery. Progress in Pediatric Surgery"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1055\/s-2001-13796","article-title":"Paediatric Surgical Reality in Germany and Visions for the Future","volume":"11","author":"Holschneider","year":"2001","journal-title":"Eur. J. Pediatr. Surg."},{"key":"ref_7","first-page":"98","article-title":"Pediatric surgery in the Federal Republic of Germany after 1945","volume":"164","year":"2016","journal-title":"Monatsschrift Kinderheilkd."},{"key":"ref_8","first-page":"92","article-title":"Pediatric surgery in the German Democratic Republic (GDR)","volume":"164","author":"Gdaniez","year":"2016","journal-title":"Monatsschrift Kinderheilkd."},{"key":"ref_9","unstructured":"Schmedding, A. (2023). Healthcare Provision in German Pediatric Surgery with Special Focus on the Management of Congenital Malformations. [Habilitation Thesis, Johann Wolfgang Goethe-Universit\u00e4t]."},{"key":"ref_10","unstructured":"Federal Joint Committee (G-BA) (2026, April 03). Qualit\u00e4tssicherungs-Richtlinie Fr\u00fch-Und Reifgeborene. Available online: https:\/\/www.g-ba.de\/downloads\/62-492-4030\/QFR-RL_2025-10-16_iK-2026-01-17.pdf."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1055\/s-0037-1607026","article-title":"Decentralized Rather than Centralized Pediatric Surgery Care in Germany","volume":"27","author":"Schmedding","year":"2017","journal-title":"Eur. J. Pediatr. Surg."},{"key":"ref_12","unstructured":"German Society of Pediatric Surgery (2025, January 31). Departments and Private Practice of Pediatric Surgery. Available online: https:\/\/www.dgkjch.de\/kinder-jugendchirurgie\/kinder-und-jugendchirurgische-kliniken-und-praxen."},{"key":"ref_13","unstructured":"Federal Statistical Office of Germany (2026, April 06). Number of Hospitals, Hospitals Beds and Patients. Available online: https:\/\/www.destatis.de\/DE\/Themen\/Gesellschaft-Umwelt\/Gesundheit\/Krankenhauser\/Tabellen\/gd-krankenhaeuser-jahre.html."},{"key":"ref_14","unstructured":"(2026, February 18). Bundes\u00e4rztekammer. \u00c4rztestatistik zum 31.12.2023. Available online: https:\/\/www.bundesaerztekammer.de\/fileadmin\/user_upload\/BAEK\/Ueber_uns\/Statistik\/AErztestatistik_2023_Update_Juni_2024.pdf."},{"key":"ref_15","unstructured":"Federal Ministry of Health (2026, March 09). Bundes-Klinikatlas. Available online: https:\/\/bundes-klinik-atlas.de."},{"key":"ref_16","unstructured":"Bundes\u00e4rztekammer (2025, January 11). (Muster-)Weiterbildungsordnung 2018 in der Fassung vom 29.06.2023. Available online: https:\/\/www.bundesaerztekammer.de\/fileadmin\/user_upload\/BAEK\/Themen\/Aus-Fort-Weiterbildung\/Weiterbildung\/20250703_Muster-Weiterbildungsordnung-2018.pdf."},{"key":"ref_17","first-page":"15","article-title":"Structured Surgical Residency Training in Germany: An Overview of Existing Training Programs in 10 Surgical Subspecialties","volume":"4","author":"Drossard","year":"2019","journal-title":"Innov. Surg. Sci."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Drossard, S., and Schuffert, L. (2025). Challenges and Opportunities in Pediatric Surgery Training in Germany: A View from the Trenches. BMC Med. Educ., 25.","DOI":"10.1186\/s12909-025-06727-5"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1055\/s-0030-1253402","article-title":"Working and Training Conditions of Residents in Pediatric Surgery: A Nationwide Survey in Germany","volume":"20","author":"Reismann","year":"2010","journal-title":"Eur. J. Pediatr. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"108477","DOI":"10.1016\/j.clineuro.2024.108477","article-title":"Challenges and Aspirations of Neurosurgery Residents in Germany: Insights from a Questionnaire-Based Survey","volume":"245","author":"Omer","year":"2024","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1007\/s00398-018-0278-y","article-title":"Karriere Und Perspektiven Assistentenbefragung 2016 Des Jungen Forums Der DGTHG Alles Beim Alten Oder Neue Erkenntnisse?","volume":"32","author":"Helms","year":"2018","journal-title":"Z. Herz Thorax Gef\u00e4\u00dfchirurgie"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1093\/icvts\/ivaa248","article-title":"Challenges and Satisfaction in Cardiothoracic Surgery Residency Programmes: Insights from a Europe-Wide Survey","volume":"32","author":"Cerqueira","year":"2021","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1097\/SAP.0000000000002413","article-title":"Satisfaction from Plastic Surgery Residency: A National Survey","volume":"85","author":"Kaufman","year":"2020","journal-title":"Ann. Plast. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e46","DOI":"10.2106\/JBJS.17.00928","article-title":"Factors Influencing Resident Satisfaction and Fellowship Selection in Orthopaedic Training Programs: An American Orthopaedic Association North American Traveling Fellowship Project","volume":"101","author":"Li","year":"2019","journal-title":"J. Bone Jt. Surg."},{"key":"ref_25","unstructured":"Federal Statistical Office of Germany (2026, April 07). Hospital Patients: Germany, Years, Gender, Age-Groups, Diagnoses (ICD). Available online: https:\/\/www-genesis.destatis.de\/datenbank\/online\/statistic\/23131\/table\/23131-0002."},{"key":"ref_26","unstructured":"(2003). Directive 2003\/88\/EC of the European Parliament and of the Council of 4 November 2003 Concerning Certain Aspects of the Organisation of Working Time."},{"key":"ref_27","unstructured":"Marburger Bund (2026, January 21). Agreement in the Collective Bargaining for Physicians (TV-\u00c4rzte): New Regulations on Working Hours, Additional Leave, and Salary Increases. (In Germany)."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2501","DOI":"10.1007\/s00268-020-05539-6","article-title":"See (n)One, Do (n)One, Teach (n)One: Reality of Surgical Resident Training in Germany","volume":"44","author":"Huber","year":"2020","journal-title":"World J. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1016\/j.euf.2016.12.001","article-title":"Training, Research, and Working Conditions for Urology Residents in Germany: A Contemporary Survey","volume":"4","author":"Borgmann","year":"2018","journal-title":"Eur. Urol. Focus"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1016\/j.surg.2021.03.062","article-title":"A 20-Year Review of Surgical Training Case Logs: Is General Surgery Still General?","volume":"170","author":"Kearse","year":"2021","journal-title":"Surgery"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1016\/j.jsurg.2013.09.015","article-title":"Operative Experience of Surgery Residents: Trends and Challenges","volume":"70","author":"Malangoni","year":"2013","journal-title":"J. Surg. Educ."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1001\/jamasurg.2016.0261","article-title":"Understanding the Operative Experience of the Practicing Pediatric Surgeon: Implications for Training and Maintaining Competency","volume":"151","author":"Abdullah","year":"2016","journal-title":"JAMA Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"161642","DOI":"10.1016\/j.jpedsurg.2024.07.027","article-title":"Finnish Pediatric Surgery Hub\u2014From Centralization to Collective Learning and Sharing of Expertise","volume":"59","author":"Pakarinen","year":"2024","journal-title":"J. Pediatr. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2333794X241263169","DOI":"10.1177\/2333794X241263169","article-title":"Pediatric Surgery Workforce Around the World: A Need to Revise Residency Programs?","volume":"11","author":"Mohajerzadeh","year":"2024","journal-title":"Glob. Pediatr. Health"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.1016\/j.jpedsurg.2004.04.002","article-title":"Pediatric Surgical Training: An Historic Perspective, a Formula for Change","volume":"39","author":"Ziegler","year":"2004","journal-title":"J. Pediatr. Surg."},{"key":"ref_36","unstructured":"Joint Committee on Surgical Training (JCST) (2026, April 07). Paediatric Surgery Curriculum. Available online: https:\/\/www.iscp.ac.uk\/iscp\/curriculum\/paediatric-surgery-curriculum\/2-purpose\/."},{"key":"ref_37","unstructured":"(2026, April 07). UEMS Education & Training. Available online: https:\/\/www.uemspaedsurg.org\/education-training\/european-registry\/10-education-training."},{"key":"ref_38","first-page":"2","article-title":"Training in Pediatric Surgery in Europe","volume":"9","author":"Holschneider","year":"1999","journal-title":"Eur. J. Pediatr. Surg."},{"key":"ref_39","unstructured":"UEMS (2022, October 30). European Syllabus in Paediatric Surgery. Available online: http:\/\/www.uemspaedsurg.org\/downloads\/European%20Syllabus-1-2.pdf."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1055\/s-0037-1603102","article-title":"European Pediatric Surgical Training","volume":"27","author":"Schmedding","year":"2017","journal-title":"Eur. J. Pediatr. Surg."},{"key":"ref_41","unstructured":"UEMS (2022, October 30). European Training Requirements for Pediatric Surgery. Available online: https:\/\/www.uemspaedsurg.org\/images\/Announcements\/ETR_Paediatric_Surgery_102020.pdf."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"162993","DOI":"10.1016\/j.jpedsurg.2026.162993","article-title":"Who\u2019s Training Tomorrow\u2019s Pediatric Surgeons? A Global Review of Pediatric Surgery Postgraduate Training Programs in Low- and Middle-Income Countries","volume":"61","author":"Livergant","year":"2026","journal-title":"J. Pediatr. Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1097\/SLA.0000000000000852","article-title":"The Influence of Volume and Experience on Individual Surgical Performance: A Systematic Review","volume":"261","author":"Maruthappu","year":"2015","journal-title":"Ann. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e006679","DOI":"10.1136\/bmjopen-2014-006679","article-title":"Surgical Learning Curves and Operative Efficiency: A Cross-Specialty Observational Study","volume":"5","author":"Maruthappu","year":"2015","journal-title":"BMJ Open"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"4500","DOI":"10.21037\/jtd-21-578","article-title":"Association between Individual Surgeon Volume and Outcome in Mitral Valve Surgery: A Systematic Review","volume":"13","author":"Akmaz","year":"2021","journal-title":"J. Thorac. Dis."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"280","DOI":"10.4300\/JGME-D-23-00461.1","article-title":"Looking Beyond the Numbers: A Comparison of Operative Self-Efficacy, Supervision, and Case Volume in General Surgery Residency","volume":"16","author":"Jensen","year":"2024","journal-title":"J. Grad. Med. Educ."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1302","DOI":"10.1016\/j.jsurg.2023.06.023","article-title":"Quality Metrics and Indicators for Surgical Training: A Scoping Review","volume":"80","author":"Shaban","year":"2023","journal-title":"J. Surg. Educ."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1001\/jamapediatrics.2013.25","article-title":"Influence of Surgeon Experience, Hospital Volume, and Specialty Designation on Outcomes in Pediatric Surgery: A Systematic Review","volume":"167","author":"McAteer","year":"2013","journal-title":"JAMA Pediatr."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e772","DOI":"10.3109\/0142159X.2012.687485","article-title":"Dissatisfaction with Residency: A Discrepancy between Preferences and Expectations?","volume":"34","year":"2012","journal-title":"Med. Teach."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1007\/s00268-020-05844-0","article-title":"Factors Associated with Attrition and Performance Throughout Surgical Training: A Systematic Review and Meta-Analysis","volume":"45","author":"Hope","year":"2021","journal-title":"World J. Surg."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1001\/jamasurg.2016.4086","article-title":"Prevalence and Causes of Attrition Among Surgical Residents: A Systematic Review and Meta-Analysis","volume":"152","author":"Khoushhal","year":"2017","journal-title":"JAMA Surg."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1607","DOI":"10.1097\/ACM.0000000000003351","article-title":"Pregnancy and Parenthood Remain Challenging During Surgical Residency: A Systematic Review","volume":"95","author":"Todd","year":"2020","journal-title":"Acad. Med. J. Assoc. Am. Med. Coll."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Gregory, S., and Demartini, C. (2017). Satisfaction of Doctors with Their Training: Evidence from UK. BMC Health Serv. Res., 17.","DOI":"10.1186\/s12913-017-2792-0"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"248","DOI":"10.3390\/surgeries3030027","article-title":"Challenges of the COVID-19 Pandemic for the Work\u2013Family Balance of Pediatric Surgeons","volume":"3","author":"Schmedding","year":"2022","journal-title":"Surgeries"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1016\/j.avsg.2025.09.010","article-title":"Trainee Autonomy Is Associated with Well-Being","volume":"122","author":"Cui","year":"2026","journal-title":"Ann. Vasc. Surg."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1007\/s00104-025-02269-0","article-title":"Time for change: What must the high-quality surgical training network of tomorrow offer?: Perspectives and demands of the Young Forums of the Surgical Societies in Germany","volume":"96","author":"Schlottmann","year":"2025","journal-title":"Chirurgie"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1111\/j.1440-1754.2006.00803.x","article-title":"Determinants of Good Outcome in Pyloric Stenosis","volume":"42","author":"Allan","year":"2006","journal-title":"J. Paediatr. Child Health"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"388.e1","DOI":"10.1016\/j.jpurol.2016.05.034","article-title":"Increased Pediatric Sub-Specialization Is Associated with Decreased Surgical Complication Rates for Inpatient Pediatric Urology Procedures","volume":"12","author":"Tejwani","year":"2016","journal-title":"J. Pediatr. Urol."},{"key":"ref_59","unstructured":"Weyersberg, A., Roth, B., and Woopen, C. (2026, April 07). P\u00e4diatrie: Folgen der \u00d6konomisierung. Available online: https:\/\/www.aerzteblatt.de\/archiv\/paediatrie-folgen-der-oekonomisierung-5c040162-6e91-4605-a49a-88138f9040ab."},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Knowlin, L.T., Laskay, N.M.B., Jules, N.P., Godzik, J., Chang, T.P., and Spurrier, R.G. (2024). Advances in Pediatric Surgery Simulation-Based Training. Children, 11.","DOI":"10.3390\/children11010034"},{"key":"ref_61","first-page":"203","article-title":"The Role of Simulation in Mastering Highly Specialized Pediatric Surgery: Current Trends and Future Perspectives","volume":"10","author":"Schuffert","year":"2025","journal-title":"Innov. Surg. Sci."},{"key":"ref_62","first-page":"Doc57","article-title":"Establishing an Online Training Program for Pediatric Surgery Residents during and after the COVID-19 Pandemic\u2014Lessons Learned","volume":"41","author":"Gnatzy","year":"2024","journal-title":"GMS J. Med. Educ."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"KC061","DOI":"10.1055\/s-0035-1559451","article-title":"Viszeralchirurgische Weiterbildungseingriffe Und Teilschritte\u2014Die Erste Situationsanalyse","volume":"53","author":"Huber","year":"2015","journal-title":"Z. Gastroenterol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1007\/s00104-024-02082-1","article-title":"The new continuing education regulations-A challenge for visceral surgery: Results of a survey among DGAV members and solution strategies of the Young Surgeons","volume":"95","author":"Schardey","year":"2024","journal-title":"Chirurgie"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1007\/s00104-026-02474-5","article-title":"Quality indicators for advanced surgical training: An analysis of current concepts and implementation options from the Young Surgeons\u2019 Forum of the German Society of Surgery","volume":"97","author":"Schlottmann","year":"2026","journal-title":"Chirurgie"}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/4\/554\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T09:23:29Z","timestamp":1776331409000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/4\/554"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,16]]},"references-count":65,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["children13040554"],"URL":"https:\/\/doi.org\/10.3390\/children13040554","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,16]]}}}