Bridging the skill gap in breast ultrasound: a PDCA management for standardized reporting and accurate BI-RADS categorization in postgraduate medical education

Breast cancer is the most common malignant tumor in women; breast ultrasound is crucial for its diagnosis, but its accuracy and standardization (especially in BI-RADS application) are operator-dependent. Peking University Third Hospital faced challenges related to suboptimal ultrasound reporting compliance and excessively high positive predictive value (PPV) of BI-RADS 4 A lesions. This study aimed to evaluate the effectiveness of the Plan-Do-Check-Act (PDCA) cycle as a management tool in postgraduate medical education to bridge this skill gap. A retrospective study was conducted in a multi-campus academic institution. Throughout 2024, an educational intervention based on the PDCA cycle was implemented. Key educational outcome metrics, including BI-RADS categorization rate, reporting compliance rate, ultrasonographic-pathologic concordance rate, and PPV, were compared between the pre-PDCA and post-PDCA groups. The reporting compliance rate significantly increased from 87.18% to 94.96% (P < 0.001), exceeding the predefined target of ≥ 90%. Meanwhile, the PPV of BI-RADS 4 A lesions decreased significantly from 19.78% to 11.93% (P < 0.05), which not only met the goal of ≤ 15% but also more closely aligned with the recommended range of 2%–10%. The BI-RADS categorization rate and ultrasonographic-pathologic concordance rate remained high and unchanged. PDCA cycle effectively improves breast ultrasound reporting standardization and accuracy of BI-RADS 4 A categorization in radiologists’ postgraduate education, providing evidence for enhancing medical education quality and homogeneous healthcare.