Purpose: Competency-based training (CBT) emphasises progression based on demonstrated competence rather than time-based exposure. Regional hospitals offer procedural volume and continuity but require structured assessment frameworks to support safe trainee autonomy. This study describes the implementation of a CBT model incorporating procedural assessment to guide graduated autonomy. Methodology: A prospective observational study was conducted over two training terms within one calendar year in a regional general surgery unit at Goulburn Valley Health. Participants included two General Surgery Education and Training (GSET) trainees and one Surgical Education and Training (SET) trainee. A structured CBT framework was implemented incorporating procedure-specific workplace-based assessments, defined supervision levels, and entrustment decisions. Data collected included procedural exposure, assessment completion rates, level of intra-operative autonomy, and supervisor and trainee feedback. Results: Across the study period, trainees participated in 186 operative cases, including 124 core general surgery procedures suitable for competency-based assessment. A total of 98 procedural assessments were completed (median 32 per trainee), with 87% rated as meeting or exceeding expected competence. Progression to reduced supervision occurred in 72% of assessed procedures following repeated satisfactory assessments. No adverse patient outcomes were attributable to trainee autonomy. Supervisors reported increased confidence in entrustment decisions, while trainees reported improved clarity regarding expectations, feedback, and progression. Conclusion: Competency-based training supported by structured procedural assessment and graduated autonomy is feasible and effective in a regional general surgery unit. Regional training environments, with appropriate supervision and governance, are well suited to CBT implementation and may enhance trainee development while maintaining patient safety.