article · BMC Medical Education
The expansion of minimally invasive surgery has transformed surgical practice and training worldwide. However, operative exposure to laparoscopic and open procedures may vary across healthcare systems. Comparative international data on operative autonomy and procedural experience during surgical residency remain limited. This study aimed to compare operative exposure, autonomy, and trainee perceptions regarding open and laparoscopic surgery among surgical trainees at selected centers in France and Morocco. A multicenter cross-sectional survey was conducted among surgical trainees at academic centers in France and Morocco. Participants were stratified by postgraduate year (PGY 1–8). Self-reported operative exposure and autonomy were assessed for common general surgical procedures (appendectomy, cholecystectomy, and inguinal hernia repair) and complex colorectal procedures (colectomy and proctectomy) performed using open and laparoscopic approaches. Trainee perceptions of preparedness for minimally invasive surgery and the value of prior training in open surgery were also evaluated. Comparisons were made according to country and level of training. A total of 131 trainees participated, including 67 from Morocco and 64 from France. Trainees at French centers reported significantly greater exposure to laparoscopic procedures across training levels ( p < 0.001), whereas trainees at Moroccan centers reported greater exposure to open appendectomy, inguinal hernia repair, and proctectomy ( p < 0.001). Operative autonomy increased with training seniority in both groups, although trainees at French centers reported greater autonomy in laparoscopic procedures. Trainees at Moroccan centers were significantly more likely to consider prior training in open surgery necessary before performing laparoscopic procedures ( p < 0.01). These findings support context-adapted curricula that preserve competence in open surgery while expanding access to structured, supervised training in minimally invasive surgery.
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DOI: 10.1186/s12909-026-10129-6
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