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Factors affecting the confidence of surgical trainees: a systematic review and thematic analysis

Published online by Cambridge University Press:  16 July 2025

Clare Perkins Open the ORCID record for Clare Perkins [Opens in a new window] ,
Matthew Steward ,
Matthew Allen ,
Madeleine Sian Dale Open the ORCID record for Madeleine Sian Dale [Opens in a new window]  and
Oliver McLaren
Clare Perkins*
Affiliation:
Department of Otolaryngology, Torbay and South Devon NHS Foundation Trust, Torquay, UK
Matthew Steward
Affiliation:
Department of Clinical and Biomedical Biosciences, University of Exeter, Exeter, UK
Matthew Allen
Affiliation:
Department of Trauma and Orthopaedics, University Hospitals Plymouth NHS Trust, Plymouth, UK
Madeleine Sian Dale
Affiliation:
Department of Otolaryngology, University Hospitals Plymouth NHS Trust, Plymouth, UK
Oliver McLaren
Affiliation:
Department of Otolaryngology, Torbay and South Devon NHS Foundation Trust, Torquay, UK Department of Otolaryngology, Royal Devon University Hospitals Foundation Trust, Exeter, UK
*
Corresponding author: Clare Perkins; Email: clare.perkins1@nhs.net
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Abstract

Objectives

Confidence among surgeons is required for complex decision-making and surgical ability. However, surgical trainees’ confidence is decreasing. This systematic review aims to explore factors that affect the confidence of surgical trainees.

Methods

A systematic review was performed following the PRISMA guidelines. Pubmed®, Embase™, Scopus, ClinicalTrials.gov and grey literature were searched for primary research on factors affecting surgical trainee confidence.

Results

Eleven studies were included. Key factors positively impacting trainee confidence were receiving regular positive feedback, working with a supportive trainer and having a calm working environment and effective team dynamic. The main factors negatively impacting trainee confidence were experiencing undermining behaviour from trainers and stressful, time-pressured environments. Female gender was also associated with reduced confidence. Greater confidence was associated with higher perceived performance.

Conclusion

This work assimilates the factors impacting surgical trainees’ confidence, which could guide training programmes to improve trainee self-confidence and therefore patient care.

Keywords

educationlearningself-conceptsurgeonsteaching

Information

Type
Review Article
Information
The Journal of Laryngology & Otology , First View , pp. 1 - 8
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED.

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Footnotes

Clare Perkins takes responsibility for the integrity of the content of the paper

References

Oxford English Dictionary. Self-confidence. In: https://www.oed.com/dictionary/self-confidence_n?tab=factsheet#23792921 [23 July 2025]Google Scholar
Fonseca, AL, Reddy, V, Longo, WE, Udelsman, R, Gusberg, RJ. Operative confidence of graduating surgery residents: a training challenge in a changing environment. Am J Surg 2014;207:797–80510.1016/j.amjsurg.2013.09.033CrossRefGoogle Scholar
Beamish, AJ, Johnston, MJ, Harries, RL, Mohan, HM, Fitzgerald, JEF, Humm, G, et al. Real-world use of workplace based assessments in surgical training: a UK nationwide cross-sectional exploration of trainee perspectives and consensus recommendations from the Association of Surgeons in Training. Int J Surg 2020;84:212–1810.1016/j.ijsu.2020.07.068CrossRefGoogle ScholarPubMed
Khan, M, Jordan, A, Strange, T, Vig, S. Post-EWTR: is the UK Still a centre of excellence for surgical training? Bull R Coll Surg Engl 2012;94:268–73CrossRefGoogle Scholar
Alabi, O, Hill, R, Walsh, M, Carroll, C. Introduction of an ENT emergency—safe boot camp into postgraduate surgical training in the Republic of Ireland. Ir J Med Sci 2022;191:475–710.1007/s11845-021-02581-8CrossRefGoogle ScholarPubMed
Smith, ME, Trinidade, A, Tysome, JR. The ENT boot camp: an effective training method for ENT induction. Clin Otolaryngol 2016;41:421–410.1111/coa.12533CrossRefGoogle ScholarPubMed
Anmolsingh, R, Abrar, R, Chandrasekar, B, Salem, J, Edmitson, R, Advani, R, et al. Higher speciality training boot camp in otolaryngology: a quantitative and qualitative analysis of the Northern National Formative Specialty Training 3 Induction Course. Cureus 2021;13:e20308Google ScholarPubMed
Hurreiz, H. The evolution of surgical training in the UK. Adv Med Educ Pract 2019;10:163–810.2147/AMEP.S189298CrossRefGoogle ScholarPubMed
Engelhardt, KE, Bilimoria, KY, Johnson, JK, Hewitt, DB, Ellis, RJ, Hu, YY, et al. A national mixed-methods evaluation of preparedness for general surgery residency and the association with resident burnout. JAMA Surg 2020;155:851–910.1001/jamasurg.2020.2420CrossRefGoogle ScholarPubMed
Miller, R, Hotton, M, Williamon, A, Kneebone, R, Goodacre, T, O’Leary, D, et al. Surgical performance anxiety and wellbeing among surgeons: a cross-sectional study in the United Kingdom. Ann Surg 2022;275:632–910.1097/SLA.0000000000005199CrossRefGoogle ScholarPubMed
Moher, D, Liberati, A, Tetzlaff, J, Altman, DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009;6:e100009710.1371/journal.pmed.1000097CrossRefGoogle ScholarPubMed
Thomas, J, Harden, A. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol 2008;8:45CrossRefGoogle ScholarPubMed
Flyckt, RL, White, EE, Goodman, LR, Mohr, C, Dutta, S, Zanotti, KM. The use of laparoscopy simulation to explore gender differences in resident surgical confidence. Obstet Gynecol Int 2017;2017:194580110.1155/2017/1945801CrossRefGoogle ScholarPubMed
Babchenko, O, Scott, K, Jung, S, Frank, S, Elmaraghi, S, Thiagarajasubramanian, S, et al. Resident perspectives on effective surgical training: incivility, confidence, and mindset. J Surg Educ 2020;77:1088–9610.1016/j.jsurg.2020.04.002CrossRefGoogle ScholarPubMed
Lees, MC, Zheng, B, Daniels, LM, White, JS. Factors affecting the development of confidence among surgical trainees. J Surg Educ 2019;76:674–8310.1016/j.jsurg.2018.10.016CrossRefGoogle ScholarPubMed
Kamali, D, Illing, J. How can positive and negative trainer feedback in the operating theatre impact a surgical trainee’s confidence and well-being: a qualitative study in the north of England. BMJ Open 2018;8:e01793510.1136/bmjopen-2017-017935CrossRefGoogle ScholarPubMed
Medline, A, Grissom, H, Guissé, NF, Kravets, V, Hobson, S, Samora, JB, et al. From self-efficacy to imposter syndrome: the intrapersonal traits of surgeons. J Am Acad Orthop Surg Glob Res Rev 2022;6:e2200051Google ScholarPubMed
Park, J, Ponnala, S, Fichtel, E, Tehranchi, K, Fitzgibbons, S, Parker, SH, et al. Improving the intraoperative educational experience: understanding the role of confidence in the resident-attending relationship. J Surg Educ 2019;76:1187–9910.1016/j.jsurg.2019.02.012CrossRefGoogle ScholarPubMed
Park, J, Parker, SH, Safford, S. Surgical trainees’ confidence in the operating room improves over time with a corresponding increase in responsibility. Am Surg 2017;83:e421–310.1177/000313481708301102CrossRefGoogle ScholarPubMed
Fonseca, AL, Reddy, V, Longo, WE, Gusberg, RJ. Graduating general surgery resident operative confidence: perspective from a national survey. J Surg Res 2014;190:419–2810.1016/j.jss.2014.05.014CrossRefGoogle ScholarPubMed
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;146:907–1410.1001/archsurg.2011.178CrossRefGoogle ScholarPubMed
Minter, RM, Gruppen, LD, Napolitano, KS, Gauger, PG. Gender differences in the self-assessment of surgical residents. Am J Surg 2005;189:647–5010.1016/j.amjsurg.2004.11.035CrossRefGoogle ScholarPubMed
Oxford English Dictionary. Imposter syndrome. In: https://www.oed.com/dictionary/impostor-syndrome_n?tl=true#:∼:text=The%20persistent%20inability%20to%20believe%20that%20one’s%20success%20is%20deserved,1982 [23 July 2025].Google Scholar
Iwai, Y, Yu, AYL, Thomas, SM, Fayanju, OA, Sudan, R, Bynum, DL, et al. Leadership and imposter syndrome in surgery. J Am Coll Surg 2023;237:585–9510.1097/XCS.0000000000000788CrossRefGoogle ScholarPubMed
Park, J, Ponnala, S, Fichtel, E, Tehranchi, K, Fitzgibbons, S, Parker, SH, et al. Improving the intraoperative educational experience: understanding the role of confidence in the resident-attending relationship. J Surg Educ 2019;76:1187–9910.1016/j.jsurg.2019.02.012CrossRefGoogle ScholarPubMed
Ahmad, C. Skill: 40 Principles that Surgeons, Athletes, and Other Elite Performers Use to Achieve Mastery. New York Lead Player LLC: 2015Google Scholar
Hall, JC, Ellis, C, Hamdorf, J. Surgeons and cognitive processes. Br J Surg 2003;90:10–1610.1002/bjs.4020CrossRefGoogle ScholarPubMed
Varban, OA, Thumma, JR, Carlin, AM, Ghaferi, AA, Dimick, JB, Finks, JF. Evaluating the impact of surgeon self-awareness by comparing self versus peer ratings of surgical skill and outcomes for bariatric surgery. Ann Surg 2022;276:128–3210.1097/SLA.0000000000004450CrossRefGoogle ScholarPubMed
Newman, TH, Parry, MG, Zakeri, R, Pegna, V, Nagle, A, Bhatti, F, et al. Gender diversity in UK surgical specialties: a national observational study. BMJ Open 2022;12:e05551610.1136/bmjopen-2021-055516CrossRefGoogle ScholarPubMed
Lim, WH, Wong, C, Jain, SR, Ng, CH, Tai, CH, Devi, MK, et al. The unspoken reality of gender bias in surgery: a qualitative systematic review. PLoS One 2021;16:e024642010.1371/journal.pone.0246420CrossRefGoogle Scholar
General Medical Council. National Training Survey 2024. 2024. https://www.gmc-uk.org/-/media/documents/national-training-survey-summary-report-2024_pdf-107834344.pdfGoogle Scholar
Sharoky, CE, Sellers, MM, Keele, LJ, Wirtalla, CJ, Karakousis, GC, Morris, JB, et al. Does surgeon sex matter?: Practice patterns and outcomes of female and male surgeons. Ann Surg 2018;267:1069–76CrossRefGoogle ScholarPubMed
CJd, Wallis, Ravi, B, Coburn, N, Nam, RK, Detsky, AS, Satkunasivam, R. Comparison of postoperative outcomes among patients treated by male and female surgeons: a population based matched cohort study. BMJ 2017;359:j4366Google Scholar
Trehan, A, Barnett-Vanes, A, Carty, MJ, McCulloch, P, Maruthappu, M. The impact of feedback of intraoperative technical performance in surgery: a systematic review. BMJ Open 2015;5:e00675910.1136/bmjopen-2014-006759CrossRefGoogle Scholar
Boyle, E, Al-Akash, M, Gallagher, AG, Traynor, O, Hill, ADK, Neary, PC. Postgrad Med J 2011;87:524–8CrossRefGoogle Scholar
Bing-You, RG, Trowbridge, RL. Why medical educators may be failing at feedback. JAMA 2009;302:1330–110.1001/jama.2009.1393CrossRefGoogle ScholarPubMed
Day, SC, Grosso, LJ, JJ, Norcini Jr, Blank, LL, Swanson, DB, Horne, MH. Residents’ perception of evaluation procedures used by their training program. J Gen Intern Med 1990;5:421–6010.1007/BF02599432CrossRefGoogle ScholarPubMed
General Medical Council. National Training Survey Results. 2023. https://www.gmc-uk.org/-/media/documents/national-training-survey-2023-initial-findings-report_pdf-101939815.pdfGoogle Scholar
Myers, MF. Abuse of residents: it’s time to take action. CMAJ 1996;154:1705–8Google ScholarPubMed
(PDF) Undermining and Bullying in Surgical Training. A consensus Statement of the Association of Surgeons in Training. http://www.asit.org/assets/documents/UB_Statement_ASiT_Final_No_tracking.pdfGoogle Scholar
Arora, S, Sevdalis, N, Aggarwal, R, Sirimanna, P, Darzi, A, Kneebone, R. Stress impairs psychomotor performance in novice laparoscopic surgeons. Surg Endosc 2010;24:2588–9310.1007/s00464-010-1013-2CrossRefGoogle ScholarPubMed
Moorthy, K, Munz, Y, Dosis, A, Bann, S, Darzi, A. The effect of stress-inducing conditions on the performance of a laparoscopic task. Surg Endosc 2003;17:1481–4Google ScholarPubMed
Perry, BD. Fear and learning: Trauma-related factors in the adult education process. New Directions for Adult and Continuing Education. John Wiley & Sons, Ltd, 2006:21–7Google Scholar
Sargeant, J, Lockyer, JM, Mann, K, Armson, H, Warren, A, Zetkulic, M, et al. The R2C2 model in residency education: how does it foster coaching and promote feedback use? Acad Med 2018;93:1055–6310.1097/ACM.0000000000002131CrossRefGoogle Scholar
Johnson, CE, Keating, JL, Molloy, EK. Psychological safety in feedback: what does it look like and how can educators work with learners to foster it? Med Educ 2020;54:559–70CrossRefGoogle Scholar
Torralba, KD, Jose, D, Byrne, J. Psychological safety, the hidden curriculum, and ambiguity in medicine. Clin Rheumatol 2020;39:667–7110.1007/s10067-019-04889-4CrossRefGoogle ScholarPubMed
Weber, EL, Leland, HA, Azadgoli, B, Minneti, M, Carey, JN. Preoperative surgical rehearsal using cadaveric fresh tissue surgical simulation increases resident operative confidence. Ann Transl Med 2017;5:30210.21037/atm.2017.06.28CrossRefGoogle ScholarPubMed
Rajaratnam, V, Rahman, NA, Omar, UF, Ng, HJH. Mental practice in surgical training. In: rcsbull.2021.145. 2021;103:403–8Google Scholar
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