Specialised Training in Trauma Surgery and Orthopaedic Surgery - is the Curriculum up to Date?

The additional qualifications "Special Orthopaedic Surgery" and "Special Trauma Surgery" are well-established and recognised credentials for specialised care within the field of orthopaedics and trauma surgery. However, given the increasing prevalence of subspecialised care structures, the question arises as to whether the content and requirements of these additional qualifications remain up to date and relevant to clinical practice.The aim of this study was to conduct a systematic analysis of the content and requirements based on the Model Training Regulations (MWBO) of the German Medical Association (BÄK) from 2003 and 2018, as well as the current training regulations (WBO) of all regional medical chambers (LÄK). The number and types of required surgical procedures were examined, along with their distribution across subspecialised areas such as endoprosthetics, spine surgery, shoulder and elbow surgery, and foot and ankle surgery.The analysis reveals a general reduction in the total number of required surgical procedures in both additional qualifications and considerable harmonisation of requirements across regional chambers. In the "Special Orthopaedic Surgery" qualification, up to 49% of procedures involve endoprosthetics, particularly of the lower extremity. In contrast, subspecialised fields such as shoulder and elbow or foot and ankle surgery are underrepresented, despite their growing importance in clinical practice. Furthermore, modern minimally invasive techniques such as arthroscopy are still scarcely addressed.To address the gap between training content and the realities of clinical care-and to ensure high-quality training and long-term healthcare provision-reform of the current training regulations is needed. The Introduction of defined subspecialty tracks, such as shoulder and elbow surgery or foot and ankle surgery, could offer more differentiated and practice-oriented training, and help to ensure high-quality patient care in the future.