Factors Affecting the Development of Confidence Among Surgical Trainees.

Objective: The objective of this study was to explore and better characterize the factors affecting confidence during surgical training.

Design: This was a qualitative research study in which we conducted semistructured interviews with surgical residents to explore factors affecting their confidence.

Setting: This study was conducted at the University of Alberta Hospital, a tertiary care center located in Edmonton, Alberta, Canada.

Participants: Residents from the University of Alberta General Surgery residency program were invited to participate from each postgraduate year (PGY) 2, 3, and 4 for a total of 7 participants (3 PGY-2, 3 PGY-3, and 1 PGY-4; 3 male, and 4 female). We excluded residents who had completed or were currently enrolled in dedicated research years.

Results: Resident confidence was found to be influenced by internal and external factors operating before, during, and after a particular surgical task. Internal factors incorporated personal experiences (including operative experience), personal expectations, self-perception, and individual skill development. External factors involved feedback, patient outcomes, relationships with staff, and working within a supportive environment. Interestingly, residents discussed external social factors more than case volume, technical skills, or underlying knowledge. Residents did not feel that their personal lives (e.g. marital status or having children) directly affected their surgical confidence. Regardless of the factor itself, positive experiences helped build and maintain confidence by providing feelings of reassurance, encouragement, comfort, and acceptance.

Conclusions: Surgical confidence is influenced by a range of internal and external factors. Understanding these factors can help educators improve learning experiences for residents and accelerate their progress towards being confident, independent surgeons.