Establishment of a milestone-driven training system for surgical competency of surgical residents and implementation of a homogenized training pathway

Weng Xiaoyu; Chen Junyan; Geng Lei; Lü Zhen; Hu Qida; Chen Shaohua; Shen Yan; Bai Xueli; Liang Tingbo

doi:10.3760/cma.j.cn116021-20251215-02264

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Establishment of a milestone-driven training system for surgical competency of surgical residents and implementation of a homogenized training pathway

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- Establishment of a milestone-driven training system for surgical competency of surgical residents and implementation of a homogenized training pathway
- Chinese Journal of Medical Education Research Pages: 1-6(2026)
- 作者机构：
  
  1.浙江大学医学院附属第一医院外科教研室，杭州 310003
  2.浙江大学医学院附属第一医院教学部，杭州 310003
- 作者简介：
  
  Liang Tingbo, Email: liangtingbo@zju.edu.cn
- 基金信息：
  
  2025 Zhejiang University School of Medicine Education Reform Project(jgzd2025010)
- DOI：10.3760/cma.j.cn116021-20251215-02264
  CLC： R-05
- Received：15 December 2025，
  
  Online First：27 April 2026，
- 稿件说明：
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Weng Xiaoyu, Chen Junyan, Geng Lei, et al. Establishment of a milestone-driven training system for surgical competency of surgical residents and implementation of a homogenized training pathway[J/OL]. Chinese Journal of Medical Education Research, 2026, 1-6.
DOI：

Weng Xiaoyu, Chen Junyan, Geng Lei, et al. Establishment of a milestone-driven training system for surgical competency of surgical residents and implementation of a homogenized training pathway[J/OL]. Chinese Journal of Medical Education Research, 2026, 1-6. DOI： 10.3760/cma.j.cn116021-20251215-02264.

摘要

目的

构建并评价以里程碑为导向的外科住院医师手术能力培养体系，探索实现同质化培养的有效路径。

方法

采用历史对照研究设计。浙江大学医学院附属第一医院外科专业基地自2023年起实施以里程碑为导向的手术能力培养体系。该体系以胜任力导向医学教育（competency-based medical education，CBME）和里程碑评价体系为理论基础，包含分阶段能力目标、系统化培养课程、多元化评估方法（形成性评价、阶段性评估与终结性评价相结合）和标准化培养教程4个核心要素。以2020至2022年传统模式培养的231名住院医师为对照组，以2023至2024年新模式培养的220名住院医师为观察组。采用结业考核通过率及成绩、技能竞赛得分、教学满意度等指标评价培养效果。组间比较采用

检验和卡方检验。

结果

观察组结业考核理论首考通过率为99.09%（218/220），高于对照组的96.54%（223/231），差异无统计学意义（

²=2.32，

=0.128）。观察组平均成绩为（435.32±13.01）分，高于对照组的（430.73±13.92）分，差异有统计学意义（

=3.62，

0.001）。在2024年本基地学员技能竞赛中，学员在开放手术技能（81.66±1.58 vs. 75.96±2.15）及腔镜手术技能（62.68±3.11 vs. 47.12±4.11）2项成绩均显著优于全省参赛者平均水平（

均

0.05）。教学满意度调查显示，各培训模块的满意率均超过89%。

结论

以里程碑为导向的外科手术能力培养体系可有效提升住院医师培训质量，为实现同质化培养提供了可操作的实践路径。

Abstract

Objective

To establish and evaluate a milestone-driven training system for the surgical competency of surgical residents

and explore an effective pathway for achieving homogenized training outcomes.

Methods

A historical control study design was adopted. Since 2023

the surgical specialty base at The First Affiliated Hospital

Zhejiang Univer

sity School of Medicine

has implemented a milestone-driven surgical competency training system. This system is theoretically grounded on competency-based medical education and a milestone evaluation system and includes four core elements: phased competency objectives

systematic training courses

diversified assessment methods (integrating formative

interim

and summative evaluations)

and standardized training tutorials. The control group consisted of 231 residents trained under the traditional model from 2020 to 2022

while the observation group included 220 residents trained under the new model from 2023 to 2024. Training effectiveness was evaluated using graduation examination pass rates and scores

skills competition scores

and teaching satisfaction. Inter-group comparisons were performed using

-test and chi-square test.

Results

The first-attempt pass rate for the graduation theoretical examination was higher in the observation group than in the control group

but the difference was not significant [99.09% (218/220) vs. 96.54% (223/231)

=2.32

=0.128

]

. The mean score of the observation group was significantly higher than that of the control group (435.32±13.01 vs. 430.73±13.92

=3.62

0.001). In the 2024 skills competition

trainees from our institution scored significantly higher than provincial averages in both open surgery skills (81.66±1.58 vs. 75.96±2.15

0.05) and laparoscopic surgery skills (62.68±3.11 vs. 47.12±4.11

0.05). Teaching satisfaction survey showed that satisfaction rates exceeded 89% across all training modules.

Conclusions

The milestone-driven surgical competency training system can effectively improve the quality of resident training and provides a practical and operational pathway for achieving homogenized training outcomes.

关键词

Keywords

references

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