Table 2. Subjects of breast surgery training programme. Core components.

Subject	Learning objectives	Pedagogical strategies	Functioning criteria	Assessment
Breast clinic outpatient clinic for breast screening, as well as diagnostic and follow-up of breast disease patients.	To comprehend all aspects of breast diseases and provide comprehensive management. To evaluate the indications for and demonstrate proficiency in the performance and interpretation of common in-office procedures. To promote the best standard of resource-stratified breast care and screening methods. To identify and advise patients at risk of developing breast cancer. To demonstrate proficiency in pre-surgical evaluation, treatment planning, perioperative management and postoperative follow-up.	Two days per week, attending together with a specialist breast surgeon who advises, guides and supports them in the patient’s diagnostic workup, management and treatment.	Assess history and clinical symptoms and signs of benign and malignant breast disease as well as risk lesions. Apply evidence from clinical studies and guidelines in clinical work. Select, recommend and interpret imaging examinations of the breast. Performance of breast needle biopsies and interpret the results. Understand patients’ cultural environment and socio-economic disparities to explain their treatment options and facilitate their decision-making process. Identify resources available for care testing and advise patients regarding its indications. Communication with/and education to the community. Communication and interaction with cancer support groups.	Electronic recordkeeping (Logbook) to document and record the trainee’s clinical experiences, with regular progress reviews. Assessment of competences and performance feedback in the outpatient clinic. Evaluations from nurses and staff.
Operating room	To understand the surgical anatomy of the breast and axilla. To select, recommend and perform breast surgical techniques to improve cosmetic outcomes, minimise trauma and attain the best surgical outcome in major breast procedures and breast biopsies.	Operating lists per week to breast surgery, by attending together with a specialist breast surgeon, whether as the surgeon or assistant. Breast specialists pre-brief the trainees, and during the case, they observe and provide assistance to trainees as requested/required from a technical and non-technical perspective. In the end, the trainee debriefs them in a structured manner.	Perform surgical treatment with an understanding of the breast’s surgical anatomy. In-depth knowledge of indications for surgical techniques to optimise the cosmetic outcome, minimise trauma, and achieve the best oncological outcome. Management of pre-, peri- and postoperative follow-up.	Electronic recordkeeping (Logbook) to document and record trainee operative experiences, with regular reviews of progress. Assessment of competences and performance feedback in the operating room. Evaluations from nurses and staff.
Multidisciplinary team meeting	To have a handle on the multidisciplinary approach of breast patient care. To recognise the importance of interdisciplinary assessment in pre-and post-surgical treatment planning.	Trainees must attend and participate in multidisciplinary meetings once per week. Trainees must present and discuss each case – present relevant literature by choosing and reviewing it previously with mentors and presenting it in a specific format.	Cases presentation: Design of the decision-making process. Adequate preparation of educational material for other fellows, residents, students and lay audience. Evaluate literature critically.	Assessment of competences and performance feedback in cases presentation. Performance /participation in selected readings and literature review.
Rotations	To coordinate interdisciplinary management of breast care. To understand the integration of oncologic specialities and palliative care in the treatment of breast cancer patients.	Regular rotations to interact with breast companion speciality services (radiology, pathology, radiation oncology and medical oncology) and provide depth understanding and exposure to each discipline’s principles and practice.	Understand the indications (including Breast Imaging and Reporting Data System nomenclature) for and limits of breast diagnostic imaging in different age groups. Acquirement of depth knowledge of: Breast pathology benign and malignant. The use of chemotherapy, hormone therapy, biological agents, palliative care and radiotherapy for breast cancer.	Faculty summative evaluations. Assessment of competences and performance feedback for each rotation.
Research	To generate value and improve care through the strategic application of data and analytics. To provide the required data to identify solutions. To develop sound evidence-based interventions locally tailored. To generate protocol-driven care.	Participation in or observation of clinical and primary care-based research.	Collect and review a database. Design of clinical protocols Manuscript preparation and submission. Attend meetings on breast diseases.	Assessment of competences: mentorship and performance feedback. Oral presentation of a research project.