Background <p>Surgical training systems in the United States and Germany share historical roots but have evolved into distinct models with differing structures, educational philosophies, and outcomes.</p> Methods <p>A narrative review of the literature was conducted to compare surgical training in the United States and Germany across key domains, including educational pathways, residency structure and duration, competency assessment, work environment, research integration, and preparedness for independent practice.</p> Results <p>The United States employs a highly structured, competency-based training model with standardized curricula, rigorous evaluation systems, and strong integration of research. In contrast, Germany utilizes a decentralized, apprenticeship-based model emphasizing practical experience but lacking uniform national standards and consistent competency assessment. Both systems demonstrate limitations, including variability in training exposure in Germany and perceived gaps in autonomy and independent decision-making among U.S. graduates.</p> Conclusion <p>Both systems face challenges in preparing surgeons for independent practice. A hybrid approach integrating structured competency-based frameworks with enhanced operative autonomy, simulation, and mentorship may improve training outcomes and support global surgical education.</p>