AbstractIntroductionDue to technological changes, working time restrictions and the creation of specialized centers, surgical training has changed. A competence‐based learning technique of surgical skills is the sub‐step practice approach, which has been proven important in nationwide opinion surveys. The aim of this prospective multi‐center trial was to determine the status quo of the sub‐step concept in Germany.MethodsOver 6 months, the voluntarily participating centers evaluated the following index procedures: laparoscopic cholecystectomy (LCHE), laparoscopic and open sigmoid resection, minimally invasive inguinal hernia repair, thyroid resection and pylorus‐preserving pancreaticoduodenectomy (PPPD). Patients with private insurance were excluded. The detailed sub‐steps were documented as well as the reason why these were not performed. In addition, an online survey regarding the sub‐step concept was performed before and after the study.ResultsIn total, 21 centers included 2969 surgical procedures in 2018 for final analyses. While 24.4% of the procedures were performed by residents, sub‐steps were performed in 22.2%. LCHE was most often performed completely by residents (43.3%), and PPPD revealed the highest rate of performed sub‐steps (43.3%). Reasons for not assisting sub‐steps to residents were often organizational and other reasons. After an initial increase, the number of performed sub‐steps decreased significantly during the second half of the survey. The opinion survey revealed a high importance of the sub‐step concept. The number of resident procedures was overestimated, and the number of performed sub‐steps was underestimated. After the study, these estimations were more realistic.ConclusionEven though the sub‐step practice concept is considered highly important for surgical education, it needs to be put into practice more consequently. The current data suggest a low participation of surgical residents in the operating room, although the participating hospitals are most likely highly interested in surgical education, hence their voluntary participation. Conceptual changes and a control of surgical education are needed.