Early resident perceptions of clinical readiness in Italy: associations with demographic and educational factors

The transition from undergraduate medical education to residency is a critical phase that demands rapid adaptation to clinical responsibilities, institutional cultures, and complex healthcare systems. Despite curricular reforms, many graduates report feeling underprepared, particularly in procedural and systems-based domains. The aim of the study was to evaluate self-perceived clinical readiness among first-year residents and identify educational and demographic factors they believe influenced their transition into postgraduate training. A retrospective survey was conducted at Humanitas University and affiliated hospitals between 2024 and 2025. Sixty first-year residents across 27 specialties completed a structured survey eight months into residency training, assessing their readiness at the start of residency and at the time of survey completion. Quantitative data were analyzed using descriptive statistics and multivariate regression to identify potential influencers of readiness. Residents reported a significant increase in perceived readiness over the first eight months (mean score: 2.2 to 3.3, p < 0.001). Confidence was highest in non-technical domains (e.g., teamwork, feedback) and lowest in procedural skills. International exchanges were positively associated with initial perceived readiness (β = 0.47, p = 0.046), while prior internships in the same specialty and graduation from state universities were negatively associated (β = − 0.63 and − 0.50, respectively; p < 0.05). Simulation-based training was rated less useful than clinical internships and exchanges. Readiness for clinical practice appears to be a dynamic perception that evolves during the early months of residency and is influenced by how trainees interpret their prior educational experiences. These self-reported associations highlight potential areas for further investigation, underscoring the need for studies using longitudinal and performance-based measures. • Self-perceived readiness significantly improves within the first 8 months of residency. • International exchanges positively impacted initial readiness. • Procedural competence remains a key area of perceived weakness.