To investigate the synergistic effect of the "Four-Step" laparoscopic training method combined with the Up To Date evidence-based system in the standardized training for resident physicians and visiting physicians, and analyze the synergistic effect between stepped skill training and evidence-based decision-making support.

A prospective randomized controlled trial was conducted, involving 12 untrained physicians (with a 1:1 ratio of residents to fellows) from the Third Clinical Medical College of Capital Medical University. Participants were randomly assigned to either the experimental group or the control group. The study group received the staged "four-step" laparoscopic training integrated with the Up To Date evidence-based medical system, while the control group underwent traditional apprenticeship-style training. Independent-samples t-test or Chi-square test was used to compare the differences in theoretical assessment scores, Objective Structured Assessment of Technical Skills (OSATS) operation scores, clinical decision-making ability and complication management efficiency between the two groups of trainees, so as to evaluate the effects of different training modes.

The study group demonstrated significantly better performance than the control group in perioperative theoretical scores, total OSATS scores, and correct decision rate in emergency scenarios (92.4±3.1 vs 85.7±4.2, 28.6±2.3 vs 25.1, 89.5% vs 73.2%), and the differences were statistically significant (t=5.12, P<0.001; t=3.87, P=0.001; χ²=5.82, P=0.016). Within the study group, residents showed a greater improvement in operational fluency compared to fellows (Δ3.8±0.9 vs Δ1.2±0.7, t=3.42, P=0.003).

The "Four-Step" method significantly combined with the Up To Date evidence-based system enhances comprehensive laparoscopic skills among multi-level physicians, with particularly notable improvement in basic operational skills for junior physicians.