title: The subjectively perceived quality of postgraduate medical training in integrative medicine within the public healthcare systems of Germany and Switzerland: the example of anthroposophic hospitals.
abstract: BACKGROUND
  Integrative medicine (IM) integrates evidence-based Complementary and Alternative Medicine (CAM) with conventional medicine (CON). Medical schools offer basic CAM electives but in postgraduate medical training (PGMT) little has been done for the integration of CAM. An exception to this is anthroposophic medicine (AM), a western form of CAM based on CON, offering an individualized holistic IM approach. AM hospitals are part of the public healthcare systems in Germany and Switzerland and train AM in PGMT. We performed the first quality evaluation of the subjectively perceived quality of this PGMT.
  
  
  METHODS
  An anonymous full survey of all 214 trainers (TR) and 240 trainees (TE) in all 15 AM hospitals in Germany and Switzerland, using the ETHZ questionnaire for annual national PGMT assessments in Switzerland (CH) and Germany (D), complemented by a module for AM. Data analysis included Cronbach's alpha to assess internal consistency questionnaire scales, 2-tailed Pearson correlation of specific quality dimensions of PGMT and department size, 2-tailed Wilcoxon Matched-Pair test for dependent variables and 2-tailed Mann-Whitney U-test for independent variables to calculate group differences. The level of significance was set at p < 0.05.
  
  
  RESULTS
  Return rates were: D: TE 89/215 (41.39%), TR 78/184 (42.39%); CH: TE 19/25 (76%), TR 22/30 (73.33%). Cronbach's alpha values for TE scales were >0.8 or >0.9, and >0.7 to >0.5 for TR scales. Swiss hospitals surpassed German ones significantly in Global Satisfaction with AM (TR and TE); Clinical Competency training in CON (TE) and AM (TE, TR), Error Management, Culture of Decision Making, Evidence-based Medicine, and Clinical Competency in internal medicine CON and AM (TE). When the comparison was restricted to departments of comparable size, differences remained significant for Clinical Competencies in AM (TE, TR), and Culture of Decision Making (TE). CON received better grades than AM in Global Satisfaction and Clinical Competency. Quality of PGMT depended on department size, working conditions and structural training features.
  
  
  CONCLUSIONS
  The lower quality of PGMT in German hospitals can be attributed to larger departments, more difficult working conditions, and less favorable structural features for PGMT in AM, possibly also in relation to increased financial pressure.
authors.affiliation: Gerhard Kienle Chair for Theory of Medicine, Integrative and Anthroposophic Medicine, Institute of Integrative Medicine, Witten/Herdecke University, Gerhard-Kienle-Weg 4, D-58313 Herdecke, Germany. peter.heusser@uni-wh.de.
authors.forename: Peter
authors.initials: P
authors.lastname: Heusser
authors.forename: Sabine
authors.initials: S
authors.lastname: Eberhard
authors.forename: Bettina
authors.initials: B
authors.lastname: Berger
authors.forename: Johannes
authors.initials: J
authors.lastname: Weinzirl
authors.forename: Pascale
authors.initials: P
authors.lastname: Orlow
mesh_terms: D000887:Anthroposophy / Q000523:psychology*; D004503:Education, Medical, Graduate / Q000379:methods; D005260:Female; D005858:Germany; D006282:Health Personnel / Q000523:psychology*; D006694:Holistic Health / Q000193:education / Q000592:standards; D006761:Hospitals / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D055048:Integrative Medicine / Q000193:education* / Q000592:standards; D008297:Male; D009313:National Health Programs; D011795:Surveys and Questionnaires; D013557:Switzerland