Beyond Surgical Skills: Modernizing Vascular Surgery Residency Training in Italy, Considerations and reflections after 20 years of experience.

Vascular surgery has undergone a profound transformation over the last two decades. Technological innovation, demographic changes, the widespread adoption of endovascular therapies, and increasing patient complexity have progressively expanded the competencies required of vascular surgeons. Consequently, residency programmes can no longer focus exclusively on operative training but should provide a comprehensive educational framework integrating technical, diagnostic, medical, and professional competencies. Drawing on more than twenty years of experience in the organization and management of an Italian residency programme in Vascular Surgery, this Brief Note discusses the evolution of postgraduate training in Italy and highlights the major challenges that continue to affect educational quality. Although important reforms have improved the organization of residency programmes through structured training networks, standardized curricula and competency requirements, considerable heterogeneity persists regarding operative exposure, resident selection, educational opportunities and progressive autonomy. Furthermore, the contemporary vascular surgeon is expected to master not only open and endovascular procedures but also vascular imaging, duplex ultrasound, perioperative medicine, cardiovascular prevention, multidisciplinary decision-making and long-term patient management.