Procedural Confidence Among Graduating Emergency Medicine Residents: Implications for Training and Assessment of...

The current numerical standards for procedural competency in Emergency Medicine (EM) lack strong evidentiary support. In the absence of more validated competency standards, self-reported confidence has been used as a learner-centered measure of perceived procedural readiness. Characterizing procedural confidence, patterns across procedures, and factors associated with confidence may help inform improvements in residency curricula and assessment.

To characterize self-reported confidence in key emergency medicine procedures, identify patterns across procedures, and examine associated residency program factors among graduating EM residents.

A cross-sectional survey of graduating EM residents was conducted in June 2025, from 20 programs recruited to be intentionally diverse. The survey underwent content and response-process validity assessment and pilot testing before distribution. Residents rated their confidence in 17 essential EM procedures using a 5-point Likert-based scale; program contacts provided program-level characteristics through a separate questionnaire. Survey data was analyzed to determine procedure-specific confidence levels and examine associations between overall procedural confidence and select program characteristics. Additionally, hierarchical clustering was used to identify patterns of confidence across procedures.

A total of 103 residents (41%) from 20 programs completed the survey. Confidence was highest for intubation (100%) and central line placement (98.1%), and lowest for pericardiocentesis (33.0%). Program-level variables, including program length and emergency department volume, were not significantly associated with confidence. Hierarchical clustering identified three broad domains of procedural confidence: critical invasive procedures, core procedural skills, and resuscitation procedures.

Graduating residents reported near universal confidence in performance of select skills, but meaningful confidence gaps remained for rare procedures and some core procedures. Procedural confidence clustered into clinically recognizable domains, while examined program characteristics were not consistently associated with confidence. These findings identify potential targets for curricular and assessment efforts while reinforcing that self-reported confidence should complement, rather than replace, objective measures of procedural competence.