Surgery without surgeons: a national wake-up call on the state of surgical training in Italy.

Abstract

Concerns regarding surgical training quality and workforce sustainability are increasing across Europe. In Italy, despite a nationally regulated framework, growing dissatisfaction among trainees and rising numbers of unfilled surgical residency positions suggest systemic shortcomings. We conducted a nationwide, cross-sectional, anonymous online survey coordinated by the Collegio Italiano dei Chirurghi (CIC) and disseminated through surgical societies and residency programs (January-July 2025). Respondents were surgical residents and early-career surgeons across specialties. Primary endpoint was overall training satisfaction; key secondary endpoints included perceived operative exposure and teaching climate, mentorship/governance, and support for specific reforms. Multivariable analysis evaluated associations with dissatisfaction, including sex, age, and geographic macro-area. Among 645 valid responses, 68.7% reported dissatisfaction with surgical training. The most frequently cited weaknesses were poor teaching attitudes (51.9%) and inadequate operative exposure (34.7%). Only 25.6% reported adequate primary-operator case volume and 29.5% a supportive teaching environment. Support for reform was high (87.8%), including endorsement of standardized accreditation/competency tracking and structured, paid post-residency fellowships (70.4%). Female trainees reported lower satisfaction than men independent of age and geographic macro-area (adjusted OR 0.68, 95% CI 0.47-0.98), while regional differences were modest. Despite a formally regulated training system, surgical education in Italy is undermined by fragmented implementation, limited quality assurance, and delayed acquisition of operative autonomy. These deficiencies threaten workforce retention, equity, and long-term healthcare sustainability. Coordinated national reform focusing on governance, accreditation, mentorship, and merit-based progression is urgently needed to align surgical training with contemporary European health-care delivery standards.