Even now the further training in surgery faces considerable challenges. The planned hospital structural reform will result in new bureaucratic and organizational hurdles, which could lead to aconsiderable loss of quality in advanced surgical training across all disciplines. The aim of this position paper is to describe the current and future challenges for advanced surgical training and to identify possible approaches and opportunities for the further development against the background of the planned hospital structural reform. For the development of this position paper acommittee of representatives of the Young Forums of the German surgical societies identified and critically discussed current problems and challenges of the present residency training system and formulated alist of demands for asustainable residency training concept. The planned shift to outpatient treatment and centralization were identified as central challenges for surgical residency training. Surgical training must be considered consistently and from the outset in all political reform efforts. In addition to a transparent and cost-appropriate financing of residency training, we call for the involvement of all German surgical societies in the reform process. Furthermore, the social framework conditions for junior surgeons should be considered. The structural change in the hospital landscape in Germany, which is being forced by politicians, harbors the risk of afurther loss of quality and experience in surgical treatment and training. At the same time, the planned hospital reform offers aunique opportunity to address existing problems and challenges in surgical training and to consider them as astarting point for structural changes which are fit for the future.