Evolving involvement: participatory governance in postgraduate medical education and residents’ role in quality management systems – insights from an Italian experience

Purpose – This paper illustrates how participatory governance is enacted through resident involvement in quality management within postgraduate medical education programs at an Italian university. It examines how such involvement is embedded into structured Quality Management Systems (QMS), how it varies according to organizational characteristics – such as program size, disciplinary field and training network complexity – and how it relates to performance outcomes, including resident satisfaction and audit results. Design/methodology/approach – The study employs a mixed-methods design combining qualitative feedback from institutional leaders and QMS auditors with statistical analysis of data from 47 postgraduate programs. It examines the relationship between resident involvement in ISO 9001-certified QMS, organizational characteristics and performance indicators such as audit outcomes and resident satisfaction. Findings – Qualitative evidence highlights improvements in communication, stakeholder engagement and overall quality management. Resident involvement contributes to coordination and operational efficiency across programs. Quantitative results confirm that involvement has become progressively more structured and widespread, particularly in programs with larger enrolment and complex training networks, and is positively associated with improved audit outcomes and, to a lesser extent, resident satisfaction. Research limitations/implications – As a single-institution study, generalizability is limited; further research should examine how leadership and organizational culture shape involvement across contexts. Practical implications – Structured involvement strengthens performance and can guide inclusive governance strategies in higher education. Originality/value – This paper presents a mixed-methods analysis of resident involvement in postgraduate education. It highlights key drivers and impacts of participatory governance, offering insights for academic leaders and higher education institutions.