European surgical residency training: a scoping review of operative exposure, assessment, wellbeing, and practice...

European surgical training is delivered within heterogeneous regulatory and institutional arrangements, with consequences for how operative exposure, assessment, wellbeing, and readiness for independent practice are organised, measured, and reported. We aimed to describe and map the European empirical literature on these four domains and to identify conceptual, geographic, and methodological gaps that limit cross-national comparability. The primary purpose was descriptive evidence mapping; any implications for practice or policy are framed as hypothesis-generating rather than as evaluations of training systems or as a proposed European framework. We conducted a scoping review using Joanna Briggs Institute methodology and reported it per the PRISMA extension for Scoping Reviews (PRISMA-ScR). MEDLINE, Embase, Scopus, and Web of Science were searched from January 2000 to March 2026. Two independent reviewers screened records in two stages and assessed full texts. All included studies were dual-coded on five variables (domain coverage, explicit construct definition, validated-instrument use, cross-domain analysis, theory engagement); inter-rater agreement was quantified with Cohen's κ. Detailed 22-field charting was performed on a purposively selected subset using a maximum-variation strategy. Of 21,727 deduplicated records screened, 533 studies were included, spanning 32 countries. Five national literatures contributed the bulk of evidence - the United Kingdom (n = 271, 50.8%), France (108, 20.3%), Germany (102, 19.1%), Ireland (77, 14.4%), and Italy (72, 13.5%); multinational studies were tagged to each contributing country, so country counts overlap. Cross-sectional designs predominated. Assessment was the most frequently addressed domain (291, 54.6%), followed by wellbeing (176, 33.0%), operative exposure (134, 25.1%), and practice readiness (15, 2.8%). Inter-rater agreement was substantial (Cohen κ = 0.71). Explicit construct definition (2.8%) and named theory (3.6%) were uncommon; validated-instrument use was 11.1% overall (20.5% within wellbeing); 13.3% examined cross-domain relationships. European surgical training research is substantial, but its measurement architecture remains underdeveloped: the field largely measures what is easy to count, while autonomy, entrustment, and integrated wellbeing assessment remain under-operationalised. A shared minimum dataset linking validated operative-autonomy and entrustment indicators with progression and wellbeing outcomes is a precondition for cross-national comparability.