The study, led by researchers at the University Medical Center Hamburg-Eppendorf, used a custom-developed anonymous online questionnaire to collect data from resident surgeons working predominantly at German university hospitals. The survey was designed to assess the quality of training experiences, perceptions of career progression, workload distribution, emotional well-being, and the allocation of time between administrative and patient care tasks. The authors followed the internationally recognized CHERRIES checklist for reporting internet e-surveys, and the study complied with the Declaration of Helsinki. The goal was explicitly exploratory: to provide a basis for discussing reform possibilities that better support current and future demands on surgeons, at a time when the medical system is facing increasing systemic workload pressures and a developing shortage of doctors.

The raw numbers on working time are striking. Among the 186 residents who responded fully to the survey, 44.1 percent reported working more than 55 hours per week, a workload that sits well beyond what most occupational health frameworks would consider sustainable for cognitive and manual performance. Surgical residency has always been demanding, but the survey suggests the demands are increasingly misaligned with the core purpose of surgical training. When asked to rank how their working time is distributed, 72.0 percent of respondents ranked administrative tasks first, while only 4.3 percent ranked surgical procedures first. In other words, the single largest claim on a young surgeon’s day is not the operating room but the desk, a distribution that raises uncomfortable questions about what residents are actually being trained to do and how much hands-on operative experience they can realistically accumulate.

That misalignment shows up directly in the training data. Structured training programs were lacking for 88.7 percent of respondents, meaning that the overwhelming majority of surgical residents in the sample are learning their craft without the benefit of a formalized curriculum, defined milestones, or systematic supervision structures. Surgical exposure fared little better: 74.2 percent reported insufficient surgical exposure, indicating that most residents feel they are not getting enough time in the operating room or enough hands-on procedural experience to develop the skills their specialty demands. For a discipline in which operative competence is built through repetition, graduated autonomy, and deliberate practice under expert guidance, these figures suggest that the apprenticeship model at the heart of surgical education is failing to deliver its most basic promise to a large fraction of trainees.

The survey also probed professional readiness, and the results were mixed in a revealing way. On one hand, 67.2 percent of residents felt confident in their ability to adapt to emerging technology, a reassuring signal that the incoming generation is not technophobic and expects to engage with innovations such as robotic and digital surgical platforms. On the other hand, 51.0 percent felt unprepared for independent research. This is a significant gap for an academic specialty in which university hospitals are expected to produce not only competent operators but also clinician-scientists who advance surgical knowledge. If half of the residents training at Germany’s premier academic centers feel unequipped to design, conduct, and publish research, the pipeline of future surgical innovators and faculty may be at risk, with downstream consequences for the pace of surgical progress itself.

The career outlook data may be the most consequential part of the study. 42.9 percent of respondents said they were considering leaving their position within three years, and 67.7 percent expressed pessimism about their future work-life balance. These are not marginal sentiments; they represent a potential exodus of nearly half the surveyed cohort within a single training cycle. The authors connect this directly to the broader context of a developing shortage of doctors, arguing that the well-being of resident surgeons is a critical factor for sustainable healthcare delivery. Attrition at this scale would not merely inconvenience hospital staffing planners; it would compound existing workforce shortages precisely in a specialty that already struggles to fill positions, and it would do so at the moment when demographic change is increasing demand for surgical care across an aging population.

Perhaps most sobering is what residents think about the system itself. 81.1 percent disagreed that the healthcare system is prepared for surgical innovation, and 88.7 percent cited insufficient staffing to meet demographic changes. The residents’ assessment of the healthcare system’s readiness for future challenges was, in the authors’ words, poor. This is a remarkable verdict from the people who will inherit the system: the very trainees who are expected to carry surgical practice into an era of robotics, artificial intelligence, and minimally invasive techniques do not believe the institutions training them are structurally ready for that transition. Combined with the staffing concerns, the data suggest that residents perceive a widening gap between what the healthcare system will need and what it is currently building capacity to deliver.

The study’s methodology deserves a note of caution as well as confidence. As a cross-sectional questionnaire-based survey, it captures a snapshot in time and reflects the perceptions of those who chose to respond, predominantly at university hospitals, so the findings are exploratory rather than definitive and may not generalize to every German hospital or every surgical specialty. The authors are transparent about this, framing the work as a direct questionnaire-based effort to highlight surgical residents’ perspectives and provide an exploratory basis for discussing reform possibilities. The survey was conducted anonymously through an online platform, and participants provided consent for participation and data publication on completion of the questionnaire, with responses of those who declined publication omitted. The study was determined not to require ethical consultation under the Hamburg Chamber Act for the Medical Professions, and the authors declare no funding and no competing interests.

What makes the findings resonate beyond Germany is that they echo a global conversation about surgical training reform, burnout, and workforce sustainability. The specific numbers may be German, but the underlying tensions, excessive hours, administrative burden crowding out clinical and operative time, the absence of structured curricula, and the erosion of work-life balance, are recognizable to surgical educators worldwide. The authors argue that the gaps they identified in structured training programs and surgical exposure could lead to staff shortages and insufficient preparation for independent research and professional fulfillment in the future. In a field where the training pipeline takes more than a decade from medical school to independent surgical practice, delays in reform today translate into shortages a decade from now, when the demographic wave of aging patients will be at its peak.

The study’s publication comes at a moment when health systems across Europe are grappling with how to sustain specialist care under mounting demographic and economic pressure. By giving surgical residents a direct voice, the Hamburg-Eppendorf team has produced data that hospital administrators, surgical societies, and policymakers can use to argue for concrete changes: protected operative training time, structured curricula with defined milestones, reduced administrative load, and realistic staffing plans. Whether those reforms materialize will determine whether the 186 residents who answered this survey represent a warning that was heeded, or the leading edge of a quiet exodus from one of medicine’s most demanding and most essential specialties.

Subject of Research: Workload demands, surgical education and training among resident surgeons in Germany: a cross-sectional questionnaire-based study

Article Title: Workload demands, surgical education and training among resident surgeons in Germany: a cross-sectional questionnaire-based study

Article References: Schmidt, H. C., Le, M., Sennert, M., Meißner, K., Hampe, L., Preukschas, A. A., Nickel, F., Goetz, M., Wise, P. A., & Cizmic, A. (2026). Workload demands, surgical education and training among resident surgeons in Germany: a cross-sectional questionnaire-based study. BMC Medical Education. https://doi.org/10.1186/s12909-026-10519-w

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10519-w

Keywords: surgical residency, medical education, workload, burnout, Germany, university hospitals, surgical training, workforce shortage, healthcare policy, resident surgeons, career attrition, BMC Medical Education