Journal: Updates in Surgery
Giardino A, Bannone E, Frigerio I, Meniconi RL, Romeo C, Foschi D, Piemonte M, Chiantera V, Brausi M, Collegio Italiano dei Chirurghi (CIC). Surgery without surgeons: a national wake-up call on the state of surgical training in Italy. Updates Surg. 2026. doi: 10.1007/s13304-026-02681-z
Objective
This study examines the organisation, quality and perceived effectiveness of surgical training in Italy. It evaluates trainee satisfaction, operative exposure, teaching culture, mentorship, governance and support for reforms intended to improve surgical competency and workforce sustainability.
Setting
The study was conducted nationally across accredited surgical residency programmes in Italy. The survey was distributed through the Collegio Italiano dei Chirurghi, major Italian surgical societies and individual residency programmes between January and July 2025.
Study design
Nationwide, cross-sectional, anonymous online survey.
Participants
The analysis included 645 surgical residents and early-career surgeons who had completed residency within the previous three years. Respondents represented surgical specialties including general surgery, urology, gynaecology and obstetrics, cardiac surgery, otorhinolaryngology, orthopaedics and paediatric surgery.
Intervention
No clinical intervention was performed. Participants completed a survey covering overall satisfaction with surgical training, operative experience, teaching and mentorship, training programme governance, opportunities for external training and attitudes toward proposed reforms and post-residency fellowships.
Results
Overall, 68.7% of respondents reported dissatisfaction with their surgical training. The most frequently reported weaknesses were poor teaching attitudes among faculty (51.9%), a lack of incentives for high-performing training programmes (42.2%) and inadequate surgical volume (34.7%). Only 25.6% reported an adequate number of cases as the primary surgeon, while 29.5% reported a supportive teaching environment. Support for reform was high, with 87.8% considering reform necessary, 74.1% supporting mandatory logbooks, structured assessment and accreditation, and 70.4% supporting paid post-residency fellowships. Female trainees were significantly less likely than male trainees to report satisfaction after adjustment for age and geographic region.
Conclusions
Despite a nationally regulated system, surgical training in Italy is affected by inconsistent implementation, limited operative autonomy, inadequate competency assessment and substantial variation in teaching quality. The authors call for coordinated national reform focused on accreditation, objective competency tracking, accountable mentorship, merit-based progression and structured fellowships. Strengthening surgical training is presented as essential to patient safety, workforce retention and the long-term sustainability of surgical services.