Current status and recommendations for pediatric residency training: a cross-sectional survey of 203 residents from a single training base in China

China faces a critical pediatric workforce shortage with only 118,000 pediatricians currently in practice. Despite the essential role of residency training in developing competent pediatricians, comprehensive data on residents’ training experiences, mental health status, and professional identity remain limited. To assess the current status of pediatric residency training in China, including training quality, professional identity, psychological well-being, and social support systems. A cross-sectional survey of 203 pediatric residents at a tertiary teaching hospital in China was conducted in 2026. A structured questionnaire assessed demographics, training motivation, training quality, professional identity, work stress, psychological status, social support, and improvement needs. Data were analyzed using descriptive statistics and logistic regression. Among 203 participants (72.91% female), training quality received positive ratings, with 94.09% reporting adequate clinical practice opportunities and 93.11% satisfied with teaching quality. However, professional identity was low: only 23.65% felt proud of their pediatric career, and 55.66% were willing to commit long-term to pediatrics. Mental health concerns were prevalent, with 70.94% experiencing negative emotions in the past three months, including anxiety (57.64%), burnout (42.86%), and depression (18.72%). Notably, 74.38% had considered leaving or changing careers. Major stressors included high workload (76.35%), tense patient-physician relationships (69.95%), and income-effort mismatch (67%). Multivariate analysis identified factors independently associated with negative emotions: insufficient social recognition (aOR = 2.89, p = 0.012), low professional pride (aOR = 2.44, p = 0.030), and high workload (aOR = 2.34, p = 0.027). Priority improvement areas included compensation and benefits (77.34%), training content optimization (60.59%), and psychological support (46.31%). Despite satisfactory clinical training quality, pediatric residents face significant psychological distress, low professional identity, and compensation-workload imbalance. The high prevalence of burnout and turnover intentions threatens pediatric workforce sustainability. Urgent interventions are needed targeting salary reform, psychological support infrastructure, training content optimization, career development services, and enhanced social recognition of pediatricians.