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Aim <p>The COVID-19 pandemic highlighted the essential role of public health (PH) specialists while exposing weaknesses in residency programs. This study aimed to analyze recent trends in PH residency programs in Italy and to identify structural and contextual determinants of contract occupancy.</p> Subject and methods <p>We conducted a retrospective analysis of PH residency programs from 2018 to 2023 using national databases. Trends in available contracts, enrollment, and dropouts were described, and regional disparities were assessed. For 2023, determinants of contract occupancy (&gt; 60% vs. ≤ 60%) were examined through chi-square tests and logistic regression models.</p> Results <p>Residency contracts increased from 177 in 2018 to 576 in 2023, but enrollment fell to 46%, leaving 290 contracts unfilled. Regional disparities were substantial, with the sharpest decline in the North (39% assignment rate). Bivariate analyses showed that metropolitan schools (66.7% vs. 13.0% non-metropolitan, <i>p</i> &lt; 0.001), schools in the Center (62.5%) and South/Islands (46.7%) compared with the North (16.7%, <i>p</i> = 0.049), private universities (75.0% vs. 32.4% public, <i>p</i> = 0.093), and schools with high-speed rail access (57.1% vs. 25.9%, <i>p</i> = 0.049) were more likely to exceed the 60% threshold. Logistic regression confirmed metropolitan location (OR = 21.7, <i>p</i> = 0.003) and central (OR = 27.6, <i>p</i> = 0.024) and southern/island schools (OR = 9.6, <i>p</i> = 0.045) as independent predictors of high occupancy.</p> Conclusion <p>Italy faces the paradox of expanded training capacity but declining enrollment despite increased training capacity. Addressing both systemic and local determinants is essential to strengthen PH education, optimize workforce planning, and ensure a sustainable public health workforce.</p>

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Public health residency education in Italy: an analysis of trends, disparities, and institutional determinants of attractiveness

  • 期刊论文

  • 发表日期：

    2026年1月10日

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  • Flavia Pennisi,
  • Antonio Pinto,
  • Massimo Minerva,
  • Carlo Signorelli

摘要

Aim

The COVID-19 pandemic highlighted the essential role of public health (PH) specialists while exposing weaknesses in residency programs. This study aimed to analyze recent trends in PH residency programs in Italy and to identify structural and contextual determinants of contract occupancy.

Subject and methods

We conducted a retrospective analysis of PH residency programs from 2018 to 2023 using national databases. Trends in available contracts, enrollment, and dropouts were described, and regional disparities were assessed. For 2023, determinants of contract occupancy (> 60% vs. ≤ 60%) were examined through chi-square tests and logistic regression models.

Results

Residency contracts increased from 177 in 2018 to 576 in 2023, but enrollment fell to 46%, leaving 290 contracts unfilled. Regional disparities were substantial, with the sharpest decline in the North (39% assignment rate). Bivariate analyses showed that metropolitan schools (66.7% vs. 13.0% non-metropolitan, p < 0.001), schools in the Center (62.5%) and South/Islands (46.7%) compared with the North (16.7%, p = 0.049), private universities (75.0% vs. 32.4% public, p = 0.093), and schools with high-speed rail access (57.1% vs. 25.9%, p = 0.049) were more likely to exceed the 60% threshold. Logistic regression confirmed metropolitan location (OR = 21.7, p = 0.003) and central (OR = 27.6, p = 0.024) and southern/island schools (OR = 9.6, p = 0.045) as independent predictors of high occupancy.

Conclusion

Italy faces the paradox of expanded training capacity but declining enrollment despite increased training capacity. Addressing both systemic and local determinants is essential to strengthen PH education, optimize workforce planning, and ensure a sustainable public health workforce.