Kern’s or vicious cycle? Experience following implementation of a curriculum for structured postgraduate surgical training

Abstract

Abstract Objectives In the face of reduced working hours, rising patient safety expectations, and demands for transparent, competency-based education postgraduate surgical training needs to be adapted. We developed and implemented an evidence-based postgraduate surgical training curriculum at a tertiary university hospital in Germany using Kern’s six-step approach to curriculum development. Methods The curriculum incorporated six educational strategies: regular surgical seminars and workshops, mentoring, entrustable professional activities (EPAs), specialist outpatient clinic participation, structured operative performance feedback, and sub-step operative training. Longitudinal evaluation of the perceived quality of concept and execution of the respective educational strategy was conducted among residents and attendings at three points in time between December 2023 and July 2025 using anonymous online surveys with five-point Likert scales. Results Both residents and attendings agreed on the conceptual value of the curriculum. Regular surgical seminars and workshops were consistently rated most positively in both concept and execution. Other strategies, including mentoring, EPAs, specialist outpatient clinic participation, operative performance feedback, and sub-step operative training, were valued conceptually but rated less favourably in everyday execution. In general, attendings rated concepts more positively than residents, whereas perceived execution was more neutral or negative in both groups. Conclusions A locally tailored evidence-based curriculum developed following Kern’s cycle provides a valuable framework for structured postgraduate surgical training. However, sustained evaluation and iterative adaptation are essential, as successful implementation depends less on conceptual design than on integration into clinical routine and workplace learning culture.