European orthopaedic and traumatology residency is predominantly integrated, with substantial variability in...

The aim of this study was to describe and compare the structure and organization of orthopaedic and traumatology residency training across European countries.

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.

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%).

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 IV.