The hidden crisis: a multinational analysis of neurosurgical residency training in Latin America.

Neurosurgery residency in Latin America is a rigorous and demanding process, often characterized by prolonged working hours, variable access to academic resources and inconsistent institutional support. While global discussions on resident well-being, workload regulation and burnout prevention are advancing, there remains limited multicenter, region-specific data on these issues in Latin America. This study aimed to evaluate the training conditions, mental health, mentorship availability and access to educational resources among neurosurgery residents across the region. Multinational cross-sectional survey conducted July 3rd - August 8th 2025 among neurosurgery residents in Latin America. The survey was disseminated through institutional mailing lists, professional networks, WhatsApp groups, Telegram channels and direct outreach. Inclusion criteria were active enrollment in an accredited neurosurgery residency program within Latin America; exclusion criteria included neurosurgery residents from Latin America training outside the region. The questionnaire covered demographics, workload, academic opportunities, mentorship, technological access, mental health and perceptions of institutional support. Data were analyzed descriptively, with subgroup comparisons where relevant. A total of 511 neurosurgery residents from 20 Latin American countries completed the survey. Most residents assisted in 1-5 cases weekly (60.3%), but 42.7% performed at least one surgery per week as lead surgeon and 29.4% did so two to three times per week. 46.0% of them reported working over 80 h weekly and 12.1% exceeded 100 h. Self-reported burnout markers were widespread: emotional exhaustion (66.3%), sleep disturbance (71.0%) and loss of empathy (58.3%). Training in core procedures was universal for trauma craniotomy (98.2%) and spine surgery (94.1%), however subspecialty exposure was more restricted. Only 11.5% had regular access to cadaver labs or microsurgical simulation and digital/AR/AI-based surgical platform training was virtually absent with 79.6% reporting no exposure. Only 8.2% of residents were in programs where research was mandatory and 40.1% reported having no institutional support for research. This multicenter survey provides one of the most comprehensive insights to date into the working conditions, mental health, academic engagement and institutional support experienced by neurosurgery residents in Latin America. The findings depict a training environment characterized by excessive workloads, variable access to resources and limited structured mentorship, set against a backdrop where burnout and emotional distress are often normalized.