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AimMedical and performance units are integral components of player development programmes in elite football academies. Nevertheless, the nature of the operational processes implemented by practitioners within clubs and national federations remains unexplored. The aim of the present study, therefore, was to survey elite youth professional football academies from around the world regarding the operational processes adopted by their medical and performance units.MethodsOf the 50 organizations invited, 10 national federations and 25 clubs took part in the survey resulting in a response rate of 70% (95% confidence interval, 56%−81%). The respondents represented three groups: senior club and academy management, performance, and medical staff.ResultsThe majority (60%−90%) of clubs and national federations reported strategic alignment between senior and academy medical and performance units as well as between academy medical and performance units. Survey responses indicated substantial heterogeneity in the composition and number of medical and performance professionals employed in academies. The majority of respondents agreed their medical and performance departments were effective in utilizing staff knowledge and external sources of knowledge to inform their practice (56%−80%). Performance staff (40%−50%) and physiotherapists (30%−32%) were deemed most influential in injury prevention programmes. During the return-to-play process, the influence of specific practitioners in the medical and performance units was dependent upon the phase of return-to-play. Shared decision-making was common practice amongst performance and medical staff in injury prevention and return-to-play processes. Medical and performance data were generally centralized across the first team and academy in majority (50%−72%) of clubs and national federations. Data were integrated within the same data management system to a higher degree in clubs (68%) vs. national federations (40%). Research and development activity were reported for most academies (50%−72%), and generally led by the head of performance (37%) or team doctor (21%). Research activities were largely undertaken via internal staff (~100%), academic collaborations (50%−88%) and/or external consultants and industry partnerships (77%−83%) in the national federation and clubs.ConclusionCollectively, these findings provide a detailed overview regarding key operational processes delivered by medical and performance practitioners working in elite football academies.