Training of Italian residents: lights and shadows of the Calabria Decree

The Calabria Decree (Law No. 145 of 2018) and its subsequent amendments introduced reforms aimed at improving the employment and training conditions of medical residents in Italy. Notably, the decree allowed for the early hiring of residents, starting from their second year of specialization, with permanent contracts upon completion of their training. This study explores the impact of these reforms on neurosurgery residents, specifically examining the effects on their professional development, education, and well-being.

A survey was conducted by the Italian Society of Neurosurgery (SINCH) and distributed to neurosurgery residents, as well as heads of university and non-university hospital departments. The survey gathered data on residents' demographic information, satisfaction with their employment contracts, preparedness for clinical responsibilities, and perceived effects on their training, particularly in terms of surgical and academic activities. Hospital and university leaders were asked to share their perspectives on the impact of early employment on resident training, research activities, and the overall functioning of healthcare institutions.

A total of 32 neurosurgery residents participated in the survey. Half of the respondents were employed under fixed-term contracts, while the other half had permanent contracts. Residents expressed high satisfaction with surgical activities, with 71.9% feeling well-prepared for managing surgical emergencies. However, 28.1% reported concerns over a perceived loss of essential training, particularly in research. From the university perspective, 86% of institutions viewed early employment as detrimental to resident education, particularly in academic and research activities. In contrast, hospitals reported positive effects, especially regarding human resource management, patient care, and resident enthusiasm.

Early employment under the Calabria Decree has several advantages, particularly in terms of clinical exposure and operational efficiency in hospitals, however, it raises concerns about the potential impact on academic training and scientific research. To ensure comprehensive training, it is essential to foster collaboration between universities and hospitals, emphasizing the importance of maintaining a strong academic foundation alongside clinical practice. The study highlights the need for ongoing adjustments to the training structure to achieve a balance between practical and theoretical education for neurosurgery residents.