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.