Neurology training in italy: a perceived proficiency-based survey on Italian residency programmes and compliance with European training standards

Background: Since 2005, the European Training Requirements in Neurology (ETRN) have defined the clinical, practical, and research competencies expected in European neurology residency programmes. However, significant variability in training quality persists among Italian programmes. This survey, conducted by the Italian Section of Young Neurologists, aimed to assess how closely Italian neurology residency programmes with ETRN standards and to evaluate residents' and early-career neurologists' self-reported perceived knowledge, practical skills, and access to specialized training. Methods: An anonymous, online survey was distributed in November 2023 to neurology residents and recently qualified neurologists across Italy. The 39-item questionnaire covered four sections: demographics, residency programme structure, learning objectives, and out-of-network internship opportunities. Responses were evaluated using descriptive statistics and comparative analyses across institution sizes and training years. Results: Of 248 respondents (45.2% female, mean age 28.9 years), only 70.5% of ETRN's basic training objectives were met, with lower compliance observed for advanced competencies. Practical skills like lumbar puncture and history-taking were widely acquired, but advanced diagnostic techniques (e.g., EMG, neuro-sonography) and subspecialty training (e.g., neuro-oncology, palliative care) showed limited availability. Out-of-network internship participation was low (21.7%), mainly due to institutional constraints and lack of financial support, limiting exposure to diverse clinical environments. Conclusions: Residency programmes demonstrate moderate adherence to ETRN standards at the basic level, though significant gaps remain in advanced training, diagnostic techniques, and interdisciplinary skills. Enhanced standardization, improved funding for extra-network internships, and focused efforts on advanced training are essential to elevate Italian neurology residency programmes to meet European standards more fully.