A laddered training model for breast surgery specialists: development and validation of a CBME-based precision education framework

OBJECTIVE: This study aimed to develop a stepwise training model for breast surgery residents and evaluate its efficacy in improving operative skills, clinical decision-making, and patient management competencies within a Competency-Based Medical Education (CBME) framework. METHODS: The study was conducted in the Breast Surgery Department of the Second Affiliated Hospital, Zhejiang University School of Medicine. Twenty surgical residents in their second or third year of standardized training were enrolled and randomly allocated to an experimental group (n = 10, receiving stepwise training) or a control group (n = 10, receiving conventional training). The stepwise training program consisted of three progressive levels: basic skills (L1), minor procedures (L2), and advanced procedures (L3), spanning a 6-month period. Outcome measures included the pathological concordance rate of mass puncture biopsies (L1), catheterization success rate of venous access port implantation (L2), and operative time for breast-conserving surgery performed under supervision (L3). Statistical analyses were performed to compare outcomes between the two groups. RESULTS: The pathological concordance rate for mass puncture biopsies was 98.0% in the experimental group, significantly higher than 86.0% in the control group (P = 0.009). The catheterization success rate was 96% in the experimental group compared to 80% in the control group (P = 0.012). Operative time for supervised breast-conserving surgery was significantly shorter in the experimental group (120 ± 15 min) than in the control group (180 ± 20 min, P < 0.001). CONCLUSION: The stepwise training model significantly enhanced clinical competencies, surgical performance, and training outcomes among breast surgery residents through its structured, competency-based approach. This model offers a scalable and effective pathway for specialized training in breast surgery.