Training, Experiences and Factors Contributing to Learning Variability in Podiatry Residency and Fellowship Programs: A Systematic Review

Background/Objectives: Postgraduate training is an essential component for the development of professional skills in health sciences. Our research question was: How does the implementation of structured residency and fellowship programs in podiatry and foot and ankle surgery impact the acquisition of clinical and surgical skills, academic productivity, interprofessional integration, leadership development, and resident well-being compared to less structured or traditional programs? Methods: We conducted a systematic review of published research, between September and November 2025, selecting observational studies that evaluated structured training programs compared to traditional approaches. The studies included reported residency or fellowship programs in podiatry and foot and ankle surgery that described clinical, surgical or academic experiences, together with the factors that influence learning variability. Results: Eleven cross-sectional studies were included. Program structure, mentorship, clinical exposure, availability of educational resources, and individual motivation are determining factors in the variability of skills acquisition. Structured programs were associated with better academic and clinical performance, greater technical confidence, and professional leadership development. However, substantial heterogeneity was observed among programs, particularly regarding access to resources, which contributed to differences in the ultimate preparation of residents and fellows. The Newcastle–Ottawa Scale adapted assessed methodological quality, showing a low-to-moderate risk of bias. Conclusions: The literature suggests that although the programs generally achieve basic training objectives, the standardization and implementation of structured educational strategies could optimize skills acquisition and reduce variability across programs. Furthermore, multicenter research incorporating objective outcome measures would facilitate the development of internationally applicable standards for evaluation in health education.