Structural Imbalances in EPA Perceptions: A Multi-Center Study of Cognitive Differences Between Faculty and Trainees in Chinese Surgical Residency Training

Objective To identify and quantify systematic cognitive discrepancies between Faculty and trainees about core competence requirements in the standardized training of surgical residents. This study is based on the Delegated Professional Activities (EPA) framework and aims to provide evidence for optimizing competency-oriented courses. Method In March 2025, a multicenter cross-sectional questionnaire survey was conducted. Anonymous online surveys were distributed to 42 supervisors and 68 surgical residents across three training bases in Guizhou. The questionnaire was based on the "Contents and Standards of Residency Training in China (2022 Edition)" and included 109 EPA items across five sub-specialties such as general surgery, orthopedics, and anesthesiology. Participants rated the importance and necessity of each item on a 4-point Likert scale. Reliability was assessed by Cronbach's α and ICC. Group differences were analyzed using independent Mann-Whitney U tests with Cohen's d effect sizes calculated. Kendall's W analysis evaluated consistency. Results 110 valid questionnaires (93.2%) were retrieved. The overall Cronbach's α of the questionnaire was 0.951, and the test-retest ICC was 0.89. Faculty and trainees demonstrated high agreement of EPA in general surgery and neurosurgery (consistency rate > 90%). Among the 19 items in orthopedics, significant differences were found in 10 items, with Cohen's d effect sizes ranging from 0.82 to 1.55 (P < 0.05). Trainees scored higher than Faculty on all these items.The teacher score of the three items of "Life Monitoring and Resuscitation" in the Anesthesiology department was 4.00 ± 0, while that of the trainees was only 3.36 ± 1.03 (d = 0.98, P < 0.01). Kendall's W 0.10–0.17, suggesting weak overall consistency. Faculty and trainees jointly called for strengthening the training of "soft skills" such as medical record writing and doctor-patient communication. Conclusion A consistent disconnect exists between Faculty and trainees regarding the importance of orthopedic procedural skills and anesthesia safety during surgical residency. To bridge this gap, it is essential to agree upon behavioral benchmarks for entrustment, incorporate soft skills as assessable tasks into the curriculum, and prioritize ongoing formative feedback. These measures are fundamental to advancing competency-based surgical training.