To characterize factors shaping surgery resident confidence and determine whether confidence is associated with future specialty training.Cross-sectional study.Survey administered at the 2008 American Board of Surgery In-Service Training Examination.All categorical general surgery residents.National Study of Expectations and Attitudes of Residents in Surgery survey.reported demographics and level of agreement for 46 items regarding confidence, training, and professional plans.Survey items "My operating skill level is appropriate" and "I may not feel confident enough to perform procedures independently before training completion." We compared demographics and responses among residents who did/not feel confident.Response rate was 77.4%. Residents who were female, single, or without children and at a lower postgraduate year had less confidence in their operating skill, as did residents at larger, university-based programs, in the northeastern United States. Residents worried about competence were more likely to believe specialty training was needed (71.2% vs 60.2%; P.001). After adjustment, residents dissatisfied with training were less likely to believe their skills were level appropriate (odds ratio, 0.13; P.001) as were residents not comfortable asking for help (odds ratio, 0.48; P.001). After adjustment, women were twice more likely than men to worry about competence after training; single residents were 1.36 times more likely than married residents to believe their skills were not level appropriate. Program location, type, and size remained associated with confidence, as did satisfaction and comfort asking for help. Residents worried about skills were more likely to plan for fellowship.Sex, marital status, children, and postgraduate year are predictors of confidence, as are program location, type, and size. Residency programs may target modifiable factors contributing to low surgical confidence.
