Background <p>Junior pediatric surgeons often experience marked anxiety when undertaking independent on-call duties for the first time, largely due to limited clinical experience, high decision-making pressure, and heightened sensitivity to patient safety. Traditional lecture-based teaching models may be insufficient in preparing trainees for complex, dynamic, and high-risk on-call situations. This study aimed to investigate whether a precision teaching model combining emergency-oriented standardized patient simulation (SPS) with online case-based learning (CBL) could alleviate on-call–related anxiety and enhance self-perceived clinical competence among junior pediatric surgeons.</p> Methods <p>This retrospective controlled study included junior pediatric surgeons enrolled in standardized residency training at Qilu Hospital of Shandong University who had not yet commenced independent on-call duties. Participants were assigned to an intervention or control group according to departmental teaching arrangements. The intervention group received SPS of emergency scenarios combined with structured online CBL, whereas the control group received traditional teaching primarily based on classroom lectures and routine clinical supervision. Primary outcomes included anxiety levels measured using the Self-Rating Anxiety Scale (SAS) and the Generalized Anxiety Disorder-7 (GAD-7). Secondary outcomes were assessed using the General Self-Efficacy Scale (GSES). Between-group comparisons were performed 1, 3, and 6 months after participants began independent on-call duties.</p> Results <p>A total of 25 participants were included (intervention group, <i>n</i> = 14; control group, <i>n</i> = 11). No significant differences were observed between groups in baseline demographic characteristics or anxiety scores. After the intervention, the intervention group demonstrated lower SAS and GAD-7 scores than the control group at early follow-up time points, particularly at 1 month after on-call initiation, indicating reduced anxiety levels. In addition, self-efficacy scores were significantly higher in the intervention group during the early post–on-call period. These findings suggest that the blended educational intervention had positive effects on reducing on-call–related anxiety and enhancing self-perceived clinical competence.</p> Conclusions <p>SPS combined with online CBL may partially alleviate early on-call anxiety among junior pediatric surgeons and promote improvements in self-perceived clinical competence. This blended teaching model demonstrates good feasibility and potential for wider implementation as an educational strategy to improve on-call preparedness and psychological well-being in pediatric surgical training.</p>