Trainees Rate Postgraduate Medical Training in Bulgaria Highly, Survey Finds

A survey of 418 healthcare professionals enrolled in postgraduate specialty training at the Medical University of Sofia has found a high level of satisfaction with the core components of medical specialization in Bulgaria, while also exposing clear weak points: the material and technical conditions at training sites, the practical focus of some courses, and confidence that training develops the full range of competencies needed for independent practice.

The research was conducted in Sofia between May 2026 and August 2026 and involved 418 medical trainees, of whom 39.2 percent were men and 60.8 percent were women. The authors employed a combination of sociological and statistical methods, including the documentary method, a direct survey administered through the Google Forms online platform, descriptive analysis, analysis of variance, the Pearson chi-square test, and graphical analysis to visualize the results. Statistical indicators were evaluated at a significance level of 0.05, and the quantitative analyses were performed using the SPSS v. 17.0 statistical software package, with Microsoft Office products used for tabular and graphical presentation.

The context for the study is a specialty training system regulated primarily by the Bulgarian Health Act and Ordinance No. 1 of 22 January 2015 on Acquiring a Specialty within the Healthcare System. The ordinance establishes the conditions and procedures for conducting and financing specialty training, as well as the nomenclature of specialties within the healthcare system. Training takes place at higher education institutions and approved training centers and combines theoretical instruction with practical training, culminating in a state examination. Training in a medical specialty is conducted over the period specified in the nomenclature of specialties and follows a framework curriculum for each specialty approved by the Minister of Health.

The survey began by examining the entry point to specialization: the enrollment process. A total of 65.1 percent of respondents rated the administrative procedure as excellent, at 38.3 percent, or very good, at 26.8 percent, while 14.8 percent rated it as good. A combined 20.1 percent provided a satisfactory or unsatisfactory rating. The authors interpret these figures as indicating generally good organization of the administrative process, while noting that the roughly one-fifth of respondents giving lower ratings highlights opportunities for further optimization.

Perceptions of the objectivity of the enrollment assessment were similarly favorable. According to 78.9 percent of those surveyed, their knowledge and skills were assessed objectively during the selection process, whereas 7.7 percent expressed the opposite view and 13.4 percent were unable to judge. The researchers describe the high proportion perceiving the assessment as objective as an important indicator of confidence in the selection procedure, while the negative and undecided responses point to the need to maintain clear and transparent assessment criteria as an essential component of quality in the organization of postgraduate training.

Among the strongest results in the survey were the ratings of specialization supervisors. The relationship with the supervisor was rated as excellent by 62.7 percent of respondents and as very good by 16.3 percent, bringing the combined proportion of the two highest ratings to 79 percent. Ratings of the supervisors’ scientific background and professionalism were even higher: 78 percent rated these qualities as excellent and 10.5 percent as very good, a combined 88.5 percent. The authors emphasize the supervisor’s pivotal role in theoretical instruction, the practical acquisition of professional skills, the provision of feedback, and the gradual development of professional autonomy, making this level of satisfaction particularly significant for training quality.

Practical involvement and workplace climate also scored well. Nearly half of the respondents, 46.9 percent, rated their level of involvement in the activities of the training unit as excellent, while 29.2 percent rated it as very good, for a combined 76.1 percent, and a further 13.9 percent described their involvement as good. Active involvement in day-to-day work, the authors note, is crucial to the practical orientation of specialization because it allows trainees to apply theoretical knowledge in a real professional environment and gradually acquire field-specific competencies. On the microclimate within training units, 57.4 percent of respondents unequivocally confirmed the existence of an atmosphere of cooperation and support, 25.8 percent selected tend to agree, and the total proportion of positive assessments reached 83.2 percent. A negative assessment was expressed by 13.9 percent, while 2.9 percent were unable to judge.

Greater variability emerged in the ratings of material and technical facilities. An excellent rating was given by 27.8 percent of respondents, very good by 23.9 percent, and good by 20.1 percent, totaling 71.8 percent within the good-to-excellent range. At the same time, 12.9 percent described the facilities as satisfactory and 13.4 percent considered them unsatisfactory. Compared with the ratings of supervisors, integration into unit activities, and team climate, the assessment of material and technical resources showed a wider distribution of responses and a higher proportion of critical evaluations. The authors identify this area as one with potential for improvement, given that access to modern equipment and appropriate conditions for practical work is relevant to trainees’ ability to acquire and refine the skills specific to their specialties.

Curriculum content and mandatory courses received largely positive marks. Specifically, 29.2 percent of respondents rated the curriculum as excellent, 28.2 percent as very good, and 23.4 percent as good, for a total of 80.8 percent positive ratings, while 10.5 percent gave a satisfactory rating and 6.7 percent rated it unsatisfactory. On the mandatory courses included in specialization programs, 56 percent of respondents rated them as very useful, 28.2 percent as partially useful, and 7.7 percent did not find them useful. The proportion rating the courses as only partially useful points, according to the authors, to the need for periodic evaluation of their content, practical orientation, and alignment with the specific training requirements of each specialty, just as the satisfactory and unsatisfactory curriculum ratings highlight the need for periodic updates to keep educational content aligned with advances in medical science and practice.

Perhaps the most consequential finding concerns competency development for independent practice. According to 46.4 percent of respondents, the specialization process develops all the necessary competencies, while 39.7 percent believe that only core competencies are acquired. A further 9.1 percent feel that specialization fails to develop the necessary competencies, and 4.8 percent are unable to make a judgment. The authors draw attention to the discrepancy between the favorable assessment of training content and the more limited confidence in the full development of competencies required for independent professional practice, noting that fewer than half of respondents believe the full range of such competencies is developed during specialization. They argue that the data highlight the need to clearly define expected competencies, ensure their systematic development throughout the training period, and provide sufficient opportunities for their practical application. This aligns with the international shift toward competency-based medical education, in which the primary criterion for completing training is the demonstration of the required knowledge, skills, and professional attributes rather than merely the completion of a prescribed training period. In Bulgaria, the authors conclude, the existing regulatory framework provides a basis for gradual development in this direction, but full implementation of a competency-based approach would require assessment to move beyond adherence to the curriculum and the final state examination toward systematic monitoring and documentation of professional competency development throughout the specialization period.

Subject of Research: Organization and quality of postgraduate medical specialty training in Bulgaria as assessed by trainees

Article Title: Postgraduate training of healthcare professionals in Bulgaria: Quality and organization from the perspective of trainees at the Medical University of Sofia

Article References: Kirkov, V., & Deliverska, E. (2026). Postgraduate training of healthcare professionals in Bulgaria: Quality and organization from the perspective of trainees at the Medical University of Sofia. Pharmacia, 73, Article e218989. https://doi.org/10.3897/pharmacia.73.e218989

Image Credits: AI Generated

DOI: 10.3897/pharmacia.73.e218989

Keywords: postgraduate medical training, specialty training, Bulgaria, Medical University of Sofia, trainee survey, competency-based education, medical education, healthcare professionals, training quality, supervisors, curriculum, state examination