Postgraduate training in Pediatric Surgery 2024

By 1769 George Armstrong organized a clinic in London dedicated to caring for children’s diseases, called the Dispensary for the Infant Poor. Over the ensuing century, a number of clinics and hospitals devoted to children were founded internationally, with L’Hôpital des Enfants Malades opening in Paris in 1802, the Hospital for Sick Children in London in 1852, a 12-bed Children’s Hospital in Philadelphia in 1855, and a 20-bed Children’s Hospital in Boston in 1869. Further developments were seen in 1860, as the first textbook on children’s surgery was published by J. Cooper Forster. Additionally, the advent of anesthesia in 1846 enabled surgeons to perform more complex surgical procedures, further accelerating the development of the field of surgery⁽¹⁾. At the beginning of the 20th century, the first full-time paediatric surgeons were employed in hospitals.

In Switzerland, Prof. Max Grob was the first surgeon in Switzerland who worked exclusively in paediatric surgery as chief physician. In 1947 he carried out the first successful correction of a child's heart with tetralogy of Fallot in Europe and was also the first paediatric surgeon in Europe to complete a pull-through operation in Hirschsprung disease⁽²⁾. To this day, paediatric surgery includes the diagnosis and conservative and surgical treatment of malformations, clinical pictures and the consequences of accidents in growing people from the prenatal phase to the end of adolescence.

While the goal of surgical therapy used to be to reduce mortality, quality of life and cosmetic results are now being discussed. Comprehensive paediatric surgical care for children and adolescents aims to optimize development with a view to a high quality of life, taking into account and incorporating the family and social environment⁽³⁾.

Postgraduate training in Paediatric Surgery has faced the following changes and challenges in recent years:

1. Surgical expertise is required in various sub-areas (from neurosurgery to neonatal, thoracic, visceral, plastic and hand surgery to urology and traumatology). Rare cases are common in paediatric surgery and low case numbers are our daily bread.
2. Surgical subspecialties have evolved, especially in the area of minimally invasive surgery, where paediatric surgeons operate arthroscopically, laparoscopically, ventriculoscopically and robotically.
3. During their postgraduate training, doctors see and operate on fewer and fewer patients: The number of paediatric surgery service providers has currently increased to nine postgraduate training centers and four additional care centers. All centers require a paediatric surgical reserve that complies with labor law. This implies a large number of paediatric surgeons and led to a massive expansion of the number of postgraduate trainees.

In recent years, this has meant that postgraduate trainees often need nine or more years to become specialists in paediatric surgery in order to meet the minimum requirements of the postgraduate training program. This does not correspond to the requirements of the Weiterbildungsordnung/Réglementation pour la formation postgraduée⁽²⁾. 

In close collaboration with the SIWF, the postgraduate training commission of the Swiss Society for Paediatric Surgery SGKC developed a two-stage postgraduate training program with a specialist title (FA) for paediatric surgery and an advanced specialist title (SP) for specialized paediatric surgery.

Specialist title (FA) for paediatric surgery:

The revised specialist is the paediatric surgical “common trunk”: Over the course of six years, knowledge of the entire paediatric surgical spectrum is to be learned and the surgical skills for basic care are to be acquired. The FA is qualified to assess all paediatric surgical illnesses and injuries from the prenatal phase to young adults. The operation catalog requires the ability to treat common illnesses and injuries independently and to master common procedures (e.g. laparoscopy, laparotomy). A specialist is qualified to independently provide basic paediatric surgical care both in the clinic and in the practice. Through this limitation, the specialist qualification should be achieved effectively in six years. The FA enables further training to become SP specialized paediatric surgery⁽²⁾.

Advanced specialist title (SP) specialized paediatric surgery:

The SP enables in-depth training in two areas of paediatric surgery. 11 sub-areas are offered for further training:

Paediatric Visceral Surgery: Abdomen              

Paediatric Visceral Surgery: Thoracic                

Paediatric Urology: Upper Tract           

Paediatric Urology: Lower Tract and Genitalia                          

Paediatric Traumasurgery: Head, Trunk and Polytrauma

Paediatric Traumasurgery: Pelvis and Extremities

Paediatric Plastic Surgery: General, Head and Neck

Paediatric Plastic Surgery: Burns and Complex Wounds

Paediatric Handsurgery                                                

Paediatric Neurosurgery

Fetalsurgery

Although the training paths and specialization are individualized, they all have the same SP title. This reflects the current practice that most experienced paediatric surgeons only work in certain areas and does justice to the special/unique nature of paediatric surgery.

The requirements for training as an SP organized under private law is a specialist in paediatric surgery recognized in Switzerland. The training lasts three years and two thirds can take place abroad. The training can also take place at non-paediatric surgical centers in order to enable spezialisation that is structured differently abroad. For example, employment at a paediatric urology or paediatric trauma center abroad can also be recognized. Fulfillment of the operations catalog, completion of courses and a final exam enable the acquisition of the SP. Since the focus is organized under private law, it primarily represents a quality label and reflects specialization in Switzerland or abroad⁽²⁾.

Through this two-stage postgraduate training program, paediatric surgery meets today's postgraduate education/training requirements and creates the possibility of specialization, as has long been established in other surgical and non-surgical specialist areas.

The new postgraduate training program for the FA paediatric surgery came into force on January 1st, 2023. The training program for SP specialized paediatric surgery is expected to come into force in spring 2024. Due to the change in the Weiterbildungsordnung/ Réglementation pour la formation postgraduée and the shift of responsibility for the speciality title from the SIWF to the specialist societies, the processes were developed and the application forms created at high speed. In addition to the SP titles of traumatology and visceral surgery, the SP Specialized Paediatric Surgery will be one of the first SPs to come into force after this change.

The SGKC is ready for this new task and expects a smooth introduction. It will be exciting to see how many “old hands” will apply for the SP. Anyone who has met the conditions for obtaining the SP two years after the training program comes into force can acquire it without an exam. There are transitional provisions regarding the crediting of periods of activity or spezialized training before the training program comes into force.

Outlook

However, the development of postgraduate training in paediatric surgery does not stand still. Next, the SGKC aims to integrate the core surgical curriculum of the SCS into the postgraduate training program for the FA. This will be the first step in the further development of the paediatric surgery training program in the spirit of competency based medical education. In addition to the CSC's Entrusted Professional Activites (EPA), our own paediatric surgical EPAs are currently being developed in order to integrate them into the postgraduate training program.

The SGKC is confident that with these changes it will optimize postgraduate training in paediatric surgery for trainees and for Switzerland and thus create the conditions for high-quality surgical care for our 'little' patients, even for the future challenges of our society.