It was the first investigation about gynecological tumor brachytherapy training for residents in China. The current study revealed that among senior residents, 78.03%, 75%, and 50.03% of participants had the self-reported competence to perform intracavity, vaginal stump and interstitial brachytherapy on their own. 46.99% of the residents passed the special GBT ability assessment. The results further suggested that for residents to gain confidence in GBT, a minimum of 10, 5, 20 cases respectively for intracavity, vaginal stump, interstitial GBT practice were required. To enhance the quality of GBT training, the special and comprehensive curriculum along with assessment for entrustability is necessary.

The incidence of gynecological tumors, including cervical cancer, remained high in China [15]. The GBT workload for gynecological tumors investigated in this study’s training institutes ranged from 180 to 1200 cases per year, offering ample opportunities for trainees to engage in operations and observe clinical procedures. Therefore, the self-confidence in completing the GBT of cervical or endometrial cancer is relatively high when compared to other studies [9, 10]. According to EMBRACE research, image-guided GBT can enhance the local control rate and survival [16]. GBT is considered an indispensable method for the treatment of cervical cancer in international treatment guidelines. According to Chinese expert consensus [17], patients in units without GBT procedures must be promptly referred to department capable of performing GBT. In this survey, 91.67% and 89.39% of residents believed that the application of GBT for cervical cancer and endometrial cancer would not decrease in the future. 96.48% of the residents strongly believed that the GBT training was extremely valuable for the standardized treatment of gynecological tumors.

A positive correlation was discovered between the number of cases in GBT practice and the self-reported competence of residents. The residents training for radiation oncology in China were mandated to care more than 40 patients who required radiotherapy, being more than 10 with gynecological tumors among them [7]. The Accreditation Council for Graduate Medical Education (ACGME) mandates that residents in radiation oncology must carry out a minimum of 5 interstitial and 15 intracavitary procedures throughout their residency training. The survey conducted in the United States reveals that individuals with 15 or more experiences of treatment have significantly high confidence in finishing brachytherapy [10]. European studies also revealed that while 50% of the residents believed that individuals who completed 15 cases of intracavitary brachytherapy could have high confidence, 87% of the residents acknowledged that those who practice 5 cases of interstitial implantation could not independently accomplish such complex brachytherapy [9]. The current study discovered that providing training on finishing more than 10 cases of intracavity, 5 cases of vaginal stump, and 20 cases of interstitial brachytherapy could aid residents in developing substantial self-reported competence.

The ideas behind competency-based training held immense significance for medical education. The competencies should be specific, comprehensive, and trainable [4]. The competence of brachytherapy was a crucial element of the ACGME milestones for radiation oncology medical residents [18, 19]. Performing GBT well requires not only knowledge and skill related, but also professional quality, empathetic patient care, communication, and cooperation. In China, there are textbooks specifically written for residents in the field of radiotherapy including the knowledge of GBT [20]. Our research also indicates that reading more papers and observing more GBT process can enhance confidence to finish interstitial operation, albeit without statistical difference.

The assessment of competence is a fundamental aspect of EPAs [21,22,23]. The purpose of formative assessment is to identify any problems that exist in students’ knowledge, skills, and attitudes. According to results of studies about medical training [24, 25], implementing high-quality formative evaluation according to a schedule and criterion can enhance the outcome of summative assessment and improve the competence of residents. The assessment of EPAs can also assist supervisors in determining the entrustability of their trainees. Despite this, our study found that 50.76% of individuals did not participate in the special assessment for GBT training. Establishing a standardized test system special for GBT training and supervising the procession in the future is an urgent problem.

There are numerous methods available for clinical skill training, including Chart-stimulated recall, direct observation, clinical vignettes, and multisource feedback. The method of simulator training is highly efficient [26, 27]. For instance, the seven-hour endoscopic simulation operation training has considerably enhanced the ability of the actual operation in the operating room [28]. In the European study, only 36% of the residents were found to have operated on more than 5 cases of cervical cancer’s brachytherapy. Our research indicated that despite the high workload of GBT in training bases, 21.97% of residents believed that they did not get sufficient GBT operational opportunities. Due to the limited rotation time in the radiotherapy department, it was impossible to utilize actual patients to enhance the confidence of all residents in operating. Hence, the development of a simulation phantom for training is highly imperative. Campelo and his team designed and produced a simulation phantom for the GBT training by utilizing 3D printing technology [29]. The phantom well exhibited human histological characteristics and was suitable for exercising intracavitary and interstitial brachytherapy, as well as for teaching and practicing image-guided brachytherapy. The phantom training is expected to enhance the resident` s competence and training efficiency.

There are certain limitations present in this study. Firstly, small sample size and selection bias should be found in this study. However, considering the actual number of residents and training bases (workload of 180–1200 cases per year) investigated, the result of the study was somewhat representative. Secondly, only self-evaluation indicators are employed to demonstrate competence in completing GBT in the study. In the future, we aim to create a detailed collection of assessment criteria and teaching quality control measures special for the theory and practice of brachytherapy training. Thirdly, the impact of trainer-related elements on the training outcome was not investigated and analyzed. Recently, there have been numerous trainings and seminars conducted for teachers, with a focus on residency training across the country. It is expected that the quality and efficiency of training will be enhanced in the future by implementing normative training system for both the trainer and the trainee.