Education and training of surgical residents in upper gastrointestinal surgery: a European survey

Educating and training young surgeons is a complex challenge that requires a structured pathway. Upper gastrointestinal (UGI) surgery is becoming a highly attractive subspecialty, yet it is not universally recognized. Currently, there are no standardized guidelines or curricula for UGI surgical training across Europe and a wide disparity among countries remains. This study aims to focus on the current European landscape from the perspective of both trainees and trainers, and to provide a foundation for developing effective guidelines for education and training of surgical residents. We conducted a cross-sectional survey study with targeted questions about various aspects of managing patients with UGI diseases, including preoperative investigations, surgical interventions, interventional endoscopy, and postoperative follow-up. We also assessed the availability of training resources and extracurricular activities. Distinct questionnaires were distributed independently to trainees and trainers. The overall response rate was 35.6%. Most trainees and trainers recognized the need for dedicated courses in UGI surgery and emphasized the importance of learning through video materials. The survey revealed that surgeons are often unfamiliar with UGI endoscopy and functional esophageal function studies. We analyzed residents' direct involvement in three surgical procedures: anti-reflux surgery, gastrectomy, and esophagectomy. Residents expressed a lack of confidence in executing certain surgical steps. Both trainers and residents expressed preference for extracurricular, hands-on courses focused on UGI surgery but reported insufficient opportunities for such training. This survey highlights significant gaps and limitations of UGI training for surgical residents in Europe. Efforts toward standardization and development of specific guidelines and recommendations are required to enhance education in UGI surgery.