European orthopaedic and traumatology residency is predominantly integrated, with substantial variability in competency‐based models and duty hours: A survey of 33 countries

PURPOSE: The aim of this study was to describe and compare the structure and organization of orthopaedic and traumatology residency training across European countries. METHODS: A descriptive, cross-sectional survey (31 items) of national teaching experts across Europe (≥10 years of experience in training residents) focused on: specialty integration, training model (time-based/competency-based/hybrid), program duration and duty hours was conducted from October 2023 to February 2025. Standardized extraction by three blinded reviewers was done and the answers were transformed into a consensus dataset. RESULTS: Responses were obtained from 33/40 countries (82.5%). In 31/33 countries (94%), orthopaedic surgery and musculoskeletal traumatology form a unified specialty. Only 9/33 (27%) countries delineate fixed elective-orthopaedics versus trauma blocks during the course of the residency. Training models were predominantly hybrid-having both features of competency and time-based learning criteria (26/33; 78%), with 7/33 (21%) time-based and none fully competency-based. Program length was mostly 5 years (16/33; 48%) or 6 years (11/33; 33%) long. Extremes ranged from 2 to 8 years. Average weekly hours varied from 37 to 70+, with nearly half of countries reporting practice that exceeds the European Working Time Directive 48-h limit via legal exceptions or weak enforcement by hospital. Flexible (less than full time training) pathways exist in 19 (58%) countries (unrestricted in 8; restricted in 11), but remain unavailable in 14 (42%). CONCLUSIONS: European orthopaedic and trauma training programs show great similarity in terms of training duration and being a unified specialty. However, there still is a relevant difference in training models, duty hours and flexibility of prolonged training duration. There is a clear movement toward competency-based training in most of the European countries. LEVEL OF EVIDENCE: Level IV.

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Journal
Knee Surgery Sports Traumatology Arthroscopy
Published
2026-05-10
DOI
https://doi.org/10.1002/ksa.70419
Primary Topic
Hospital Admissions and Outcomes
Type
article
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article

European orthopaedic and traumatology residency is predominantly integrated, with substantial variability in competency‐based models and duty hours: A survey of 33 countries

Mislav Jelić, Mirza Biščević, Ana Čizmić, Jasper Lambrechts et al.
Knee Surgery Sports Traumatology Arthroscopy
Hospital Admissions and Outcomes
article

European orthopaedic and traumatology residency is predominantly integrated, with substantial variability in competency‐based models and duty hours: A survey of 33 countries

Mislav Jelić, Mirza Biščević, Ana Čizmić, Jasper Lambrechts, Vladan Stevanović, Leho Rips, Blaž Mavčič, Tin Karakaš, Edvin Selmani, Nikola Bulatović, Mustafa Karahan, Tomislav Smoljanović, Pier Francesco Indelli, Michele Mercurio, Marko Ostojić, Nikolai Ramadanov, Marco Ezechieli, Rami Madanat, Joan Leal Blanquet, С. И. Бондаренко, Salvatore Risitano, David Limb, Teija Lund, Mihovil Plečko, Andreas Tanos, Pietro Ruggieri, Hassan Tarek Hakam, Roman Seil, Berte Bøe, Karl Eriksson, Theofilos Karachalios, Tomasz Piontek, Michael T. Hirschmann, Rob Nelissen, Nanni Allington, Bjarke Viberg, Jorge Mineiro, Vojtech Havlas, Jonathan Lettner, Roland Becker, Plamen Kinov, Robert Prill, Zahar Akos, Razvan Ene, James Harty, Fabijan Cukelj, Catharina Chiari, Cen Bytiqi, Panayotis Megaloikonomos, Philippe Van Overschelde, Mikhail Salzmann, Neil Sheth
article en

Abstract

PURPOSE: The aim of this study was to describe and compare the structure and organization of orthopaedic and traumatology residency training across European countries. METHODS: A descriptive, cross-sectional survey (31 items) of national teaching experts across Europe (≥10 years of experience in training residents) focused on: specialty integration, training model (time-based/competency-based/hybrid), program duration and duty hours was conducted from October 2023 to February 2025. Standardized extraction by three blinded reviewers was done and the answers were transformed into a consensus dataset. RESULTS: Responses were obtained from 33/40 countries (82.5%). In 31/33 countries (94%), orthopaedic surgery and musculoskeletal traumatology form a unified specialty. Only 9/33 (27%) countries delineate fixed elective-orthopaedics versus trauma blocks during the course of the residency. Training models were predominantly hybrid-having both features of competency and time-based learning criteria (26/33; 78%), with 7/33 (21%) time-based and none fully competency-based. Program length was mostly 5 years (16/33; 48%) or 6 years (11/33; 33%) long. Extremes ranged from 2 to 8 years. Average weekly hours varied from 37 to 70+, with nearly half of countries reporting practice that exceeds the European Working Time Directive 48-h limit via legal exceptions or weak enforcement by hospital. Flexible (less than full time training) pathways exist in 19 (58%) countries (unrestricted in 8; restricted in 11), but remain unavailable in 14 (42%). CONCLUSIONS: European orthopaedic and trauma training programs show great similarity in terms of training duration and being a unified specialty. However, there still is a relevant difference in training models, duty hours and flexibility of prolonged training duration. There is a clear movement toward competency-based training in most of the European countries. LEVEL OF EVIDENCE: Level IV.

Knee Surgery Sports Traumatology Arthroscopy
University of Sarajevo (BA), Poznan University of Medical Sciences (PL), Oslo University Hospital (NO), University of Medicine Tirana (AL), University of Helsinki (FI), University of Padua (IT), University Hospital Centre Zagreb (HR), University of Thessaly (GR), Carol Davila University of Medicine and Pharmacy (RO), Centre Hospitalier de Luxembourg (LU), Atos (France) (FR), University of Zagreb (HR), University of Basel (CH), National and Kapodistrian University of Athens (GR), Charles University (CZ), University College Cork (IE), Paracelsus Medical University (AT), Leeds Teaching Hospitals NHS Trust (GB), Leiden University Medical Center (NL), Helsinki University Hospital (FI), Ghent University Hospital (BE), Ljubljana University Medical Centre (SI), Odense University Hospital (DK), Tartu University Hospital (EE), Karolinska Institutet (SE), Kodolányi János University of Applied Sciences (HU), Acıbadem University (TR), Magna Graecia University (IT), Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT), Althaia (ES), Stockholm South General Hospital (SE), University Hospital in Motol (CZ), Mercy University Hospital (IE), University Specialized Hospital for Active Treatment of Endocrinology (BG), Institute of Orthopedics Banjica (RS), Sytenko Institute of Spine and Joint Pathology of the National Academy of Medical Sciences of Ukraine (UA), Evangelische Hochschule Ludwigsburg (DE), Orthopaedic Hospital Speising (AT), Krankenhaus Brixen (IT), Hippocrateon Private Hospital (CY), Kantonsspital Baselland Standort Bruderholz (CH), Etelä-Karjalan sosiaali ja terveyspiiri (FI), Universitätsklinikum Brandenburg an der Havel (DE), Centre hospitalier régional de la Citadelle (BE), Rehasport Clinic (PL), Hospital do Desterro (PT), University of Montenegro (ME), University of Prishtina (XK), University of Pennsylvania (US)
Openalex Percentile: Top 4%
Hospital Admissions and Outcomes
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