Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Jun 16;14:191.
doi: 10.1186/1472-6882-14-191.

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

Free PMC article

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

Peter Heusser et al. BMC Complement Altern Med. .
Free PMC article


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.

Conclusion: 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.


Figure 1
Figure 1
Global satisfaction with and quality judgment of competency training in conventional (CON) and anthroposophic (AM) aspects of postgraduate medical training in Germany and Switzerland. Rating by trainees (light bars) and trainers (dark). 1 indicates the highest, 6 the lowest possible degree of perceived satisfaction or quality. Means, standard deviations and valid numbers of respondents; statistically significant differences between indicated groups. (for U-values consult text).

Similar articles

See all similar articles

Cited by 2 articles


    1. Frass M, Strassl RP, Friehs H, Müllner M, Kundi M, Kaye AD. Use and acceptance of complementary and alternative medicine among the general population and medical personnel: a systematic review. Ochsner J. 2012;12(1):45–56. - PMC - PubMed
    1. Institut für Demoskopie Allensbach. [Natural Remedies 2010. Results of a Representative Population Survey]. Naturheilmittel 2010. Ergebnisse einer bevölkerungsrepräsentativen Befragung. [Internet] [accessed July 25, 2013].
    1. Leuenberger P, Longchamp C. In: Zukunft der Medizin Schweiz. Stauffacher W, Bircher J, editor. Basel: Schweizerischer Ärzteverlag; 2002. [What Does the Population Expect from Medicine? Results of a Survey of the GfS-Research Institute, Politics and State, Bern, Commissioned by the Swiss Academy of Medical Sciences] Was erwartet die Bevölkerung von der Medizin? Ergebnisse einer Umfrage des GfS-Forschungsinstitutes, Politik und Staat, Bern, im Auftrag der SAMW.
    1. Swiss Condeferation. Bundesverfassung der Schweizerischen Eidgenossenschaft [Federal Constitution of Switzerland], Art. 118a, Status of March 3, 2013, Page 3 [Internet] [accessed June 10, 2014].
    1. Dachverband Komplementärmedizin (Dakomed) [Internet] [accessed July 25, 2013].

LinkOut - more resources