The Role of University Diplomas in the Training of Young French Orthopaedic Surgeons: A Complement to Training or a Reflection of the Limitations of Theoretical Education? Results of a National Survey

Abstract Background: The training of young orthopaedic surgeons relies on university hospital theoretical education, complemented by clinical training. University and Inter-University Diplomas (UD and IUD) play an increasing role in this training pathway, but their role, enrollment motivations, and educational impact have never been evaluated on a national scale in orthopaedic surgery and traumatology. Objective: To assess the role of UD/IUDs in the training pathway of young French orthopaedic surgeons and to determine if they meet educational needs that are insufficiently covered by initial training. Materials and methods: A cross-sectional observational study was conducted using a national survey distributed between October 2024 and June 2025 among residents, junior doctors, fellows, and young practitioners in orthopaedic surgery and traumatology. The questionnaire explored perceptions of theoretical training, experience with UD/IUDs, reasons for enrolling, fundings, and barriers encountered. Data were analyzed using descriptive and comparative statistics. Results: Among the 326 respondents analyzed, 87.7% had already completed at least one UD/IUD. Only 39% reported being satisfied with the theoretical education received at their workplace, and this satisfaction was significantly associated with the time dedicated to theoretical training (p<0.001). The main reason for enrolling in UD/IUDs was to acquire knowledge considered insufficiently covered during residency (74.5%), followed by learning specific surgical techniques (43.3%) and improving career prospects (38.3%). Overall, UD/IUDs matched participants' expectations regarding theoretical knowledge (7.3/10), but their perceived impact on daily practice was more moderate (6.7/10). The main barriers identified were global costs (66.6%), geographical distance (53.1%), and administrative constraints (39.6%). Half of the participants preferred a blended educational model combining in-person and online learning. Conclusion: UD/IUDs currently represent a major complement to the training of young French orthopaedic surgeons. Their success seems to reflect a desire to compensate for perceived gaps in hospital-based theoretical education rather than a simple interest of sub-specialization. Improving their financial and organizational accessibility, combined with the development of hybrid formats integrating more practical training, could better satisfy the needs of future generations of orthopaedic surgeons. Level of evidence: IV