Governance, sostenibilità e qualità della formazione in chirurgia generale: risultati di un consenso nazionale tra i direttori delle scuole di specializzazione italiane

Residency training in General Surgery in Italy currently faces increasing challenges, including declining interest in the discipline, workforce shortages within the National Health Service (NHS), tensions between educational goals and service demands, and the effects of emergency regulatory measures introduced during the COVID-19 pandemic. In response, a national consensus initiative was launched to systematically analyze key issues and identify reform priorities. A modified Delphi method (Expert Forecasting Technique, EFTE) was used, involving Directors of all accredited General Surgery Residency Programs in Italy, who were convened during the First National Conference held in Pavia in December 2025. The process was organized into five sequential phases: defining the conceptual framework and reviewing relevant literature; conducting structured plenary consultations; iterative feedback rounds on specific themes (governance, training quality and consistency, workforce sustainability, wellbeing and mentoring, technological innovation); anonymous synthesis and collective discussion; and final validation of consensus. Major concerns identified included the declining attractiveness of the specialty, variability in the implementation of national training standards, reduction of protected training time, the impact of emergency regulations on academic supervision, and the limited use of simulation-based training and digital monitoring systems. The panel recommended priority actions, including strengthening university–hospital partnerships, safeguarding academic governance, standardizing mentoring models, investing in advanced simulation tools and digital logbooks, and implementing organizational and economic measures to improve the sustainability and appeal of surgical careers. These findings emphasize the importance of coordinated efforts between educational policies, hospital organization, and workforce planning to ensure quality, equity, and long-term sustainability of General Surgery training in Italy.