During the transition from medical school to independent practice, residency training is critical for the development of physician confidence. According to recent studies, confidence in one’s own capabilities during surgery residencies increases significantly during the internship year. That is largely because interns have greater clinical responsibility for patient care than senior medical students. Other investigations have suggested that a developed sense of confidence may play a role in residents’ career satisfaction as well as the decisions to change specialties or professions during residency or to pursue additional specialty training.
Characterizing Residents’ Confidence
“Confidence is important in surgical residencies because it encompasses several personal attributes that may lead to professional satisfaction and success,” says Julie Ann Sosa, MD, MA, FACS. “The key is that these attributes—things like enthusiasm, assertiveness, independence, trust, handling criticism, and emotional maturity—must be channeled properly. These factors all have implications for job satisfaction and performance.” Little has been studied with regard to what is being done to develop surgical confidence during surgical residency training. There is a paucity of research reporting the confidence levels of general surgery residents across all postgraduate training years, Dr. Sosa explains. “Characterizing residents’ confidence and residency program factors that influence confidence among surgical residents is important to understand the decisions residents make regarding their training, especially with regard to attrition and further specialization.”
New Study Data on Resident Confidence
In the August 2011 Archives of Surgery, Dr. Sosa and colleagues sought to characterize factors that shaped surgery resident confidence and determine whether confidence was truly associated with future specialty training. In a cross-sectional study, the research team surveyed general surgery residents on 52 items regarding confidence, training, and professional plans.
“This should serve as a wakeup call to the disparities that potentially exist across the country.”
According to the study results, more than two-thirds of general surgery residents felt confident with their operating skills, but several resident- and program-level factors were linked to greater trainee confidence (see Table 1 and Table 2). These included male sex, being a more senior resident, being married, and having children. Residents of training programs at community hospitals, those with fewer chief residents, and programs that did not have fellowships were more confident than residents at programs without these attributes.
In addition, the study revealed that residents who worried about competence were more likely to believe specialty training was needed. Residents who were dissatisfied with training and those not comfortable asking for help were less likely to believe their skills were level appropriate. “Ultimately, it appears as though gender, marital status, children, and postgraduate year—in addition to program location, type, and size—are predictors of confidence,” says Dr. Sosa. “This should serve as a wakeup call to the disparities that potentially exist across the country. Residency programs can use this information to perhaps target modifiable factors that contribute to low surgical confidence.”
Confidence Improves Resident Performance
Practical learning experiences have been shown to help increase confidence levels. “As residents progress from their internship to chief residency, they accumulate surgical experience,” Dr. Sosa says. “This experience is likely to enhance confidence in their skills. To achieve this, it’s important to have a culture in place where residents feel comfortable and confident about asking their attending surgeons for help.” She adds that the importance of mentorships cannot be undervalued.
Dr. Sosa also says that confidence is essential for optimal performance in the operating room. “Critical decisions must often be made rapidly and under pressure during operations. Many times, residents won’t have the luxury of having time to solicit additional data or a colleague’s opinion. The good news is that confidence can be acquired. It comes by creating an environment in which residents are not overly criticized or undermined and by giving them opportunities to act independently.”
Residency Programs Looking Forward
To reduce the variation in confidence levels of residents, Dr. Sosa says that residency programs should strive to standardize operative experiences and clinical responsibilities based on the individual and program factors identified in her study. “Programs can encourage close, collegial, and respectful relationships between trainees and surgical faculty. This requires facilitating resident-attending interactions and improving communication around cases. The more comfortable residents are with discussing failures with attending surgeons, the more likely it is that residents will learn from setbacks and become more resilient. The end result of such efforts can be a bolstering of residents’ sense of involvement and importance. It also promotes more independent thought. As confidence increases, so too should the level of care provided by residents as they move onward and upward in their careers while simultaneously increasing their job satisfaction along the way.”
Readings & Resources (click to view)
Bucholz EM, Sue GR, Yeo H, Roman SA, Bell RH, Sosa JA. Our trainees’ confidence: results from a national survey of 4136 US general surgery residents. Arch Surg. 2011;146:907-914. Available at: http://archsurg.ama-assn.org/cgi/content/full/146/8/907.
Foulkrod KH, Field C, Brown CV. Trauma surgeon personality and job satisfaction: results from a national survey. Am Surg. 2010;76:422-427.
Binenbaum G, Musick DW, Ross HM. The development of physician confidence during surgical and medical internship. Am J Surg. 2007;193:79-85.
Naylor RA, Hollett LA, Castellvi A, Valentine RJ, Scott DJ. Preparing medical students to enter surgery residencies. Am J Surg. 2010;199:105-109.
Yeo H, Viola K, Berg D; et al. Attitudes, training experiences, and professional expectations of US general surgery residents: a national survey. JAMA. 2009;302:1301-1308.