Confidence In Clinical Skills Research Articles

Awareness of Senior and Specialist Dental Student Toward the Importance of Cost Analysis and Business Practice Management: Cross Sectional Study from a Public University in Indonesia

Background: Dental students not only develop practical skills but also management skills. Dental students
 must be able to understand how to determine cost analysis, which is a measure of the relationship between
 costs and output. Objective: to determine the awareness of senior dental student toward the importance
 of cost analysis and business practice management. Materials and Method: A cross-sectional study was
 conducted using a questionnaire with closed-ended questions. The study sample included 119 participants
 in Airlangga Dental College, Surabaya. Statistical analysis was performed by descriptive statistical analysis
 and chi square tests. Results: One hundred nineteen questioners were returned and analyzed. BDS 95
 students while the specialist was 24 students. It was seen that there are 79% of specialist students who have
 a good level of confidence while in BDS students only 51% have a good level of confidence. BDS students
 (42%) and specialist students (33%) indicated that their knowledge was sufficient about the costs of practice
 management or business management. Conclusion: students have confidence in clinical skills but are not
 quite sure about practice management knowledge. Students are also interested in increasing the range of
 knowledge about business and practice management.

Exploring the meaning of undergraduate nursing students' experiences and confidence in clinical skills using video

BackgroundStudents and health care faculty staff report a lack of confidence in graduating nurses' clinical skills practice. Traditional approaches to support nursing students' clinical skills development have relied on small group, face-to-face, practice-based learning in clinical laboratories. However, with changing curricula, increased numbers of students, and pressure on laboratory timetables and availability, alternate methods of delivery are necessary to ensure students gain confidence in the development of their clinical skills. Video podcasting is an innovative approach that is being used to stimulate active and ongoing learning of clinical skills. DesignA hermeneutic phenomenological approach. MethodData were collected through in-depth interviews with 10 second-year, undergraduate nursing students about their experiences using three clinical skills video podcasts and their perceptions of how this impacted on their learning of these clinical skills and confidence in practice. FindingsThree themes emerged from the data: ‘Accessibility for learning the skill’; ‘Preparation for learning and practice’; and ‘Student-directed learning’. These themes provided an insight into the students' engagement with video podcasts, demonstrating their sense of confidence was increased in clinical skills development. ConclusionThe findings of this study provide an insight into the students' engagement with video podcasts in relation to their confidence in clinical skills development, and indicate that undergraduate nursing students value the use of video podcasts in their learning of clinical skills. However, it was evident that students still value face-to-face delivery to guide their study, which suggests that video podcasts could be used as an adjunct to teaching to support learning.

Simulation-based education improves student self-efficacy in physiotherapy assessment and management of paediatric patients

BackgroundThe Australian Physiotherapy Council mandates that physiotherapy clinical education be sufficient to produce graduates who are competent to practice across the lifespan. Due to a lack of opportunities for paediatric clinical placements, there is a risk of graduates not having the opportunity to develop competency in paediatric physiotherapy. To address this risk, simulation-based education (SBE) has been proposed as an educational strategy to address the placement shortfall. Despite encouraging evidence for its use in physiotherapy education, there is limited evidence supporting its use specifically in paediatric populations. The aims of this research were to investigate the effect of SBE on student self-efficacy in the physiotherapy assessment and management of paediatric clients, and to determine student satisfaction with SBE as a learning strategy.MethodsThree interactive SBE sessions were run during the undergraduate paediatric physiotherapy unit at the campus of one Australian university. Self-efficacy was surveyed before and after each session, to determine confidence in clinical skills, clinical decision-making, treatment preparation and planning, communication skills; evaluating and modifying interventions, and interprofessional practice. Student satisfaction with SBE as a learning strategy was surveyed after the final SBE session.ResultsFor the 164 participants included in this study, self-efficacy survey response rate varied from 77 to 96% for each session. Significant increases in mean student self-efficacy were recorded for all questions (p < 0.001). A total of 139 (85%) responded to the learning reactionnaire with 78.6% indicating they were very satisfied with SBE as a learning strategy. Written comments from 41 participants identified ‘experience’ as the primary theme.ConclusionSBE had a significant positive effect on student self-efficacy in the physiotherapy assessment and management of paediatric patients. Students also perceived SBE to be a valuable learning experience. Future research is needed to investigate whether the improvement in self-efficacy achieved through SBE translates into improved student performance during workplace-based clinical placements.

Evaluation of a staged case-based discussion curriculum in standardized residency training.

The standardized residency training in China is continuous medical education for postgraduates, which is designed to master basic knowledge, theory, and clinical skills. Case-based discussion (CBD) is one of the main formative curricula used in standardized residency training. The aim of this study was to assess the impact of a novel CBD curriculum on residents' participation, satisfaction, and confidence in clinical skills. This was a prospective study that included 28 internal medicine residents. The traditional CBD contents were adjusted. The innovative approach let residents at different stages prepare and organize the CBD cases by themselves according to different levels of complexity. The surveys were designed to measure conference occurrence and residents' attendance, participation, and satisfaction, as well as their confidence in their clinical skills. Faculty could further engage the residents at any point to deepen the discussion and learning. The surveys indicated that the residents had a high satisfaction rate with the novel-staged CBD teaching method. Our curriculum improved conference occurrence, attendance, and participation; increased residents' self-report of participation in learning; and raised their confidence in their clinical skills, so the CBD was well received by residents and faculty preceptors. In addition, this study demonstrated that the staged CBD increased the knowledge and evidence usage of internal medicine residents. We expect wider application of this kind of CBD in clinical practice, medical education, residency training, and patient education in the future.

Improving Medical Student Confidence in Clinical Skills through a Peer-Facilitated Workshop

University of Maryland, School of Maryland’s (UMSOM) curriculum does not provide training in physical exam skills to first year medical students (MS1s). A peer assisted learning model offered a unique way to address this deficiency. We aimed to design, implement, and evaluate a clinical skills workshop facilitated by upper-level medical students (upper MSs) that could be replicated by other medical schools. Faculty provided a one-hour training session to upper MSs. These students then facilitated a two-hour workshop for MS1s providing instruction on select elements of the physical exam. We theorized that upper MSs would have increased confidence in their abilities to perform the physical exam by learning to teach these skills. Additionally, we hypothesized that MS1s would have increased confidence in their abilities to perform the same skills after participating in the peer-facilitated workshop. We tested these hypotheses using a paired pre- and post-survey model and used paired sample t test analyses to determine statistical significance. We used thematic analyses to analyze free response answers. After training, upper MSs (n = 43) reported a significant improvement (p < .01) in self-reported confidence for each item: measure radial pulse, respiratory rate, and blood pressure, and auscultate lung fields and heart valves. There was a significant improvement (p < .01) in self-reported confidence by MS1s (n = 47) for the same items after the workshop. Students reported positive feedback regarding the use of peer assisted learning. Implementing a peer-facilitated workshop led to increased self-confidence in performing clinical skills by MS1s and upper MSs with minimal faculty demand. Similar models could be feasibly implemented at other institutions.

Job Club: A Program to Assist Occupational Therapy Students’ Transition to Practice

Transition to practice can be identified as the change from the role of student to the role of practitioner. This period of transition is a time of intense professional and personal development. Typically, it can take anywhere between six months to two years before an entry-level therapist feels competent in the workplace. A number of factors affect the transition process, including role uncertainty, inadequate supervision, and an overall lack of confidence in clinical skills. This paper discusses a case example of a Job Club, provided by a Western Australian Occupational Therapy university program. The concept was initially set up to support students through the process of seeking and gaining employment. Over time, the club developed a broader scope based on the needs of attendees. This example illustrates the needs of students for greater support in this important transition, and lays the groundwork for formal research in future.

Examining the Experiences of Athletic Trainers as they transition into their First Full-Time Position

Transition to clinical practice is an important topic in athletic training, as it can be a period of time that presents challenges for the athletic trainer. Most of the research pertaining to transition to practice focuses on the skills and knowledge necessary for clinical practice, yet we know that stress can manifest from not only being an independent practitioner but also from learning how to balance one’s roles. We wanted to understand the perspective of today’s novice athletic trainers and how they feel in their first full-time position, specifically relating to their professional development and establishment or maintenance of work-life balance (WLB). Using a qualitative paradigm, we phone interviewed athletic trainers who were categorized as career starters by the National Athletic Trainers’ Association. Using a purposive recruitment strategy we were able to recruit 20 (12 female, 8 male) athletic trainers meeting this classification. General inductive analyses were used to code the data from our interviews, and we satisfied credibility though saturation of the data, peer review, and researcher triangulations during the coding process. Our findings suggest that while confidence in clinical skills is apparent, some of the more administrative aspects of clinical practice present challenges. We found that various employment settings offered various expectations or challenges that had the potential to impact WLB. A blend of professional and organizational processes helped transition the athletic trainer, and although both were helpful each also could be bolstered to improve transitioning for the newly credentialed athletic trainer. Employers of early career starters should be aware of the stress related to transition to practice, and the time it can take to acclimate.

Comparing a longitudinal integrated clerkship with traditional hospital-based rotations in a rural setting

Context: Longitudinal integrated clerkships (LIC) are widely used as an educational method, particularly in rural areas. They are good for facilitating hands-on learning and deep relationships between student, patients, and supervisors.Objectives: This study sought to examine and compare learning experience of third-year rural medical students studying specialties (women’s health, aged care, child and adolescent heath, mental health, general practice) by either a traditional hospital-based rotation or a LIC in a rural general practice setting.Methods: Data was collected from two groups of rural students (LIC; traditional hospital-based) over two academic years, utilizing focus groups to investigate general experiences of living and learning rurally, within the different educational models.Results: Results reaffirmed that there was no perceived academic disadvantage to studying medicine rurally. Studying medicine in a rural area provides increased access to patients, more hands-on experience, and close relationships with patients and colleagues. LIC students reported increased confidence in clinical skills, felt better prepared for internship, however experienced more social isolation than students in hospital-based rotations.Conclusions: Students undergoing a rural LIC feel more confident in their clinical skills and preparedness for practice than other rural students. This study supports the use of LICs as a powerful educational tool.

Development and Assessment of an HIV-focused E-learning Flipped Classroom Curriculum in an Infectious Diseases Fellowship Program

BackgroundMost of the care of HIV-infected patients is now provided in the clinic where there is less time for bedside teaching than in the inpatient setting. We sought to augment the clinical experience by developing an HIV-focused e-learning flipped classroom curriculum in our ID fellowship program.MethodsSix e-learning modules were developed using Articulate Storyline. Topics included: HIV Diagnosis, Evaluation of the HIV-infected Patient, When to Start Antiretroviral Therapy, What to Start, HIV Resistance, and HIV Drug-Drug Interactions. Modules were made available 1 week in advance, lasted 20 minutes, and included interactive questions. Class time was spent discussing clinical cases related to the module. The IDSA “HIV Medicine in Clinical Practice” exam and pre and post-course surveys were administered to measure changes in both objective and self-perceived knowledge before and after completion of the curriculum. Wilcoxon-signed rank test was used to compare test results between the 2 periods.ResultsSeven fellows participated in the curriculum and 10 fellows completed the pre and post-tests (3 fellows tested only with pretest as they were finishing fellowship, 4 fellows took both pre and post- test, and 3 fellows only took the post-test). Overall scores between pre-and post-test were not significantly different between pooled pre- and post-test results (7 fellows took each test) (P = 0.8). Among the 4 fellows who completed both tests, there was a trend to improved scores (P = 0.06). 7 of 7 fellows completed the pre- and post-curriculum surveys. All agreed or strongly agreed that the flipped classroom model enhanced their learning of the material and self-perceived knowledge improved in all assessed areas following participation in the curriculum (see Figure).ConclusionThe introduction of the e-learning modules in a flipped classroom format was well received by fellows and allowed for better preparation and discussion of HIV-related topics. Although pre-and post-test results were unchanged, self-perceived confidence in clinical skills improved for all fellows. The flipped classroom might be a promising method to enhance HIV-focused clinical education for fellows.Disclosures All authors: No reported disclosures.

Interprofessional Collaboration between Physical Therapist and Nursing Students Using an Acute-Care Simulation: A Pilot Study

Aim: The primary aim of the study was to describe an interprofessional experience between physical therapist and nursing students involving an acute-care laboratory setting using simulated patients. A secondary aim was to present findings on student’s level of confidence in treating patients in an acute care setting. Methods: A convenience sample (N=51) was used for this within groups study to explore self-reported confidence and perceived benefits/challenges among physical therapist and nursing students at baseline and following a 90-minute acute-care simulated laboratory experience. Debriefing sessions took place immediately after the simulation. Students were provided a survey via Survey Monkey one-week prior to and within one-week postacute- care simulation. Questions were slightly modified from previously used scales assessing student confidence in simulated experiences and working interprofessionally. Results: A Wilcoxon signed-rank test determined that on average the students significantly improved their level of confidence from pre-test to post-test with all p values <0.05, ranging from p<0.001 to 0.019. Statistical analysis determined that students statistically improved their perception of working interprofessionally following an acute-care simulation. Conclusion: Interprofessional education that consists of active learning between professions is vital to improve quality of patient care. The results of our pilot study suggest that an acute-care simulation between physical therapists and nursing students demonstrated improved confidence in clinical skills and a better understanding of interprofessional care.

Encouraging Specialty Certification: How Multilevel Support Can Help.

Professional development through specialty certification is positively associated with nurses' increased confidence in clinical skills, commitment to learning, empowerment, and professional credibility. This translates to improved patient outcomes, with higher organizational reimbursement, in addition to nurse retention and job satisfaction. Despite the call for lifelong learning from the Institute of Medicine, certification rates, especially among nurses in direct patient care, remain low. This article provides a three-tiered approach for organizational leaders and administrators of continuing education programs to establish resources and support for nurses seeking specialty certification.

Near-peer role modeling: Can fourth-year medical students, recognized for their humanism, enhance reflection among second-year students in a physical diagnosis course?

IntroductionHumanism is cultivated through reflection and self-awareness. We aimed to employ fourth-year medical students, recognized for their humanism, to facilitate reflective sessions for second-year medical students with the intention of positively influencing reflective process toward humanistic development.Methods/AnalysisA total of 186 students were randomly assigned to one of three comparison arms: eight groups of eight students (64 students) were facilitated by a fourth-year student who was a Gold Humanism Honor Society member (GHHS); eight groups (64 students) by a volunteer non-GHHS student; and seven groups (58 students) were non-facilitated. Before sessions, second-year students set learning goals concerning interactions with patients; fourth-year students received training materials on facilitation. Groups met twice during their 10 clinical site visits. At the last session, students completed a reflective assignment on their goal progress. Comparative mixed method analyses were conducted among the three comparison arms on reflection (reflective score on in-session assignment) and session satisfaction (survey) in addition to a thematic analysis of responses on the in-session assignment.ResultsWe found significant differences among all three comparison arms on students’ reflective scores (p=0.0003) and satisfaction (p=0.0001). T-tests comparing GHHS- and non-GHHS-facilitated groups showed significantly higher mean reflective scores for GHHS-facilitated groups (p=0.033); there were no differences on session satisfaction. Thematic analysis of students’ reflections showed attempts at self-examination, but lacked depth in addressing emotions. There was a common focus on achieving comfort and confidence in clinical skills performance.Discussion/ConclusionsNear peers, recognized for their humanism, demonstrated significant influence in deepening medical students’ reflections surrounding patient interactions or humanistic development. Overall, students preferred facilitated to non-facilitated peer feedback forums. This model holds promise for enhancing self-reflection in medical education, but needs further exploration to determine behavioral effects.

The role of simulation in developing clinical knowledge and increasing clinical confidence in first-year radiography students

Background: First-year radiography students at Monash University participate in simulation learning activities using role-play, x-ray phantom imaging, and pre- and post-clinical placement. Simulation-based learning is commonly used across Australia in radiography and medical imaging teaching programs. However, little research about its role in radiography education has been undertaken. This study aimed to measure knowledge gained by radiography students from simulation activities and how they perceived that simulation activities developed their knowledge and confidence in clinical skills and decision-making. Methods: Pre-and post-tests were conducted to measure students’ knowledge acquisition after the simulation learning activities. Students’ perceptions of the simulation activities were evaluated by a 40-item paper-based survey using a 5-point Likert scale. Results: Fifty-five students participated in the pre-and post-tests, and simulation learning activities increased knowledge as shown by a significant increase in the post- test scores compared with the pre-test scores (p &lt; 0.001). All 51 students completed the survey. Results indicated that the simulation activities increased students’ confidence in aligning the x-ray equipment, patient positioning and giving verbal instructions to patients. During the simulation activities, students learnt from errors they made, feedback given by tutors and through observing their peers. Conclusion: Simulation-based learning can enhance students’ radiographic knowledg

Using Facebook to enhance commencing student confidence in clinical skill development: A phenomenological hermeneutic study

The purpose of this study was to explore commencing nursing students' experience of Facebook as an adjunct to on-campus course delivery to determine its impact as a learning strategy for improving confidence in clinical skill development. Approaches supporting nursing students in the development of clinical skills have relied on 'real-life' clinical placements and simulated on-campus clinical laboratories. However students continue to report a lack of confidence in their clinical skills for practice. Social networking sites including Facebook are being used as a learning strategy to stimulate active and collaborative learning approaches. A hermeneutic phenomenological approach was used to provide an understanding of the experience of confidence in clinical skills development for nursing students. Data were collected through in-depth interviews with commencing students about their experience as learners using Facebook and their perceptions of the impact on their clinical skill development. Ten first-year student nurses at one university in south-east Queensland, Australia. Four themes emerged from the data including: 'We're all in this together'; 'I can do this'; 'This is about my future goals and success'; and, 'Real time is not fast enough!'. These themes provide new meaningful insights demonstrating students' sense of confidence in clinical skills was increased through engagement with a dedicated Facebook page. The findings of this study have relevance to academics in the design of learning strategies for clinical courses to further support student confidence and engagement through peer collaboration and active learning processes.

Demographic and practice characteristics of pathologists who enjoy breast tissue interpretation

Physician attributes, job satisfaction and confidence in clinical skills are associated with enhanced performance and better patient outcomes. We surveyed 252 pathologists to evaluate associations between enjoyment of breast pathology, demographic/clinical characteristics and diagnostic performance. Diagnostic performance was determined by comparing pathologist assessments of a set of 60 cases with consensus assessments of the same cases made by a panel of experienced pathologists. Eighty-three percent of study participants reported enjoying breast pathology. Pathologists who enjoy breast interpretation were more likely to review ≥10 cases/week (p = 0.003), report breast interpretation expertise (p = 0.013) and have high levels of confidence interpreting breast pathology (p < 0.001). These pathologists were less likely to report that the field was challenging (p < 0.001) and that breast cases make them more nervous than other types of pathology (p < 0.001). Enjoyment was not associated with diagnostic performance. Millions of women undergo breast biopsy annually, thus it is reassuring that although nearly a fifth of practicing pathologists who interpret breast tissue report not enjoying the field, precision is not impacted.

Simulation-based neonatal resuscitation training of medical students: is Peyton’s 4-stage approach more effective than traditional 2-stage technique?

Resuscitation of newborns is a critical procedure and requires refined skills. The contents of resuscitation guidelines and their implementation should be crucial in education of medical students. The traditional 2-stage (“see one, do one”) instruction is theory-loaded and does not provide sufficient hands-on training needed to give trainees the necessary practical experience or confidence in clinical skills. We aimed to evaluate whether simulation-based skill training by Peyton’s 4-step approach can improve the performance of medical students in neonatal resuscitation compared to traditional front-side 2-step teaching. In a prospective trial design, 49 fourth-year medical students were randomized in traditional and 4-stage groups. According to the “see one, do one” principle in the traditional group the teacher at first explained the ERC-algorithm and demonstrated the neonatal resuscitation procedure before the practitioners could train on manikins. In the “Peyton” group students were divided in small-groups with 4 trainees each and received 4-step approach training. Three days after the initial neonatal resuscitation training all students passed a standardized simulation-based scenario with newborn manikins to assess the effect of both teaching methods by an objective structured clinical examination (OSCE) and binary checklist. We modified the OSCE with a practical (pOSCE, maximal score 118) and a theoretical part (tOSCE, maximal score 74). Students in 4-stage group scored significantly higher than traditional trained participants: 113±5 vs. 68±23 (pOSCE) and 66±5 vs. 40±23 (tOSCE), all p<0.001. In conclusion, our study demonstrates that simulation-based training by Peyton’s 4-stage approach is effective to increase the performance of medical students in neonatal resuscitation.

Tracing the evolution of chiropractic students’ confidence in clinical and patient communication skills during a clinical internship: a multi-methods study

BackgroundAnecdotal evidence points to variations in individual students’ evolving confidence in clinical and patient communication skills during a clinical internship. A better understanding of the specific aspects of internships that contribute to increasing or decreasing confidence is needed to best support students during the clinical component of their study.MethodsA multi-method approach, combining two large-scale surveys with 269 students and three in-depth individual interviews with a sub-sample of 29 students, was used to investigate the evolution of change in student confidence during a 10-month long internship. Change in levels of confidence in patient communication and clinical skills was measured and relationship to demographic factors were explored. The interviews elicited students’ accounts and reflections on what affected the evolution of their confidence during the internship.ResultsAt the start of their internship, students were more confident in their patient communication skills than their clinical skills but prior experience was significantly related to confidence in both. Initial confidence in patient communication skills was also related to age and prior qualification but not gender whilst confidence in clinical skills was related to gender but not age or prior qualification. These influences were maintained over time. Overall, students’ levels of confidence in patient communication and clinical skills confidence increased significantly over the duration of the internship with evidence that change over time in these two aspects were inter-related. To explore how specific aspects of the internship contributed to changing levels of confidence, two extreme sub-groups of interviewees were identified, those with the least increase and those with the highest increase in professional confidence over time. A number of key factors affecting the development of confidence were identified, including among others, interactions with clinicians and patients, personal agency and maturing as a student clinician.ConclusionThis study provides insight into the factors perceived by students as affecting the development of professional confidence during internships. One particularly promising area for educational intervention may be the promotion of a pro-active approach to professional learning.

Evaluation of a Case-Based Primary Care Pediatric Conference Curriculum

Our goal was to assess the impact of a standardized residency curriculum in ambulatory pediatrics on residents' participation, satisfaction, and confidence. A case-based curriculum for weekly primary care conference was developed to replace the existing free-form review of topics at the Yale Pediatrics Residency Program. Before the curricular switch, faculty preceptors and members of the academic year 2005-2006 intern class completed surveys designed to measure conference occurrence and resident attendance, participation, satisfaction, and confidence in clinical skills. One year after the curricular switch, identical surveys were completed by faculty preceptors and members of the academic year 2006-2007 intern class. Faculty surveys indicated that conferences took place significantly more often after the curricular switch. The number of residents at conference each day (3.18 vs 4.50; P < .01) and the percentage who actually spoke during conference (45% vs 82%, P < .01) significantly increased. There were 18 demographically similar interns in each of the 2 classes. Members of the academic year 2006-2007 intern class, having trained exclusively with the standardized curriculum, were significantly more likely to respond favorably to survey items about participation, satisfaction, and confidence. In addition, they were more likely to endorse survey items that reflected explicit goals of the standardized curriculum and the Accreditation Council for Graduate Medical Education core competencies. Implementation of a structured curriculum for ambulatory care improved interns' self-reported participation, satisfaction, and confidence. The primary care conference occurred more dependably after the curricular change, and improvements in attendance and participation were documented. Pediatric residency programs may make better use of conference time in the ambulatory setting through the use of structured, case-based educational material.

Level of Confidence among Nursing Students in the Clinical Setting

Confidence level among nursing student is an important factor to enable them to carry out their duties competently in the clinical area. Most of the time nursing students lacked confidence in clinical skills. Data was collected from the month of February to April 2008 using a tool adopted from Beech, 2003 on 189 nursing students in a nursing college. The results revealed that 90.5% (n=171) were not confident in providing and managing care for patients. Changes in the nursing curriculum that encourages more of student centered study activities can cause a change in the students’ confidence level in the clinical setting.

Australasian emergency physicians: A learning and educational needs analysis. Part six: Differences in confidence, exposure to learning and expressed learning needs by subgroups of Australasian emergency physicians

To determine differences in the confidence and learning needs between subgroups of Fellows of the Australasian College for Emergency Medicine (FACEM), according to sex, type of hospital of principal employment, region of practice in Australasia, year of obtaining the fellowship and percentage of hours worked clinically. Mailed survey of all FACEM with multiple Likert scale options. Male emergency physicians (EP) more often expressed confidence in 14 of 58 tasks, but female EP more often expressed a strong desire for continuing professional development (CPD) in 8. EP working in private hospitals were more likely to find lack of conference in their contracts a barrier to participation in CPD (28% [CI 14.1-47.8]vs 7.3% [CI 5.2-10.1]; P = 0.003). EP obtaining their fellowship before 1990 were more confident in 13 of 25 non-clinical tasks than others but had similar confidence in clinical skills. Although EP who spent 30% or less on clinical work expressed confidence more frequently in a range of non-clinical skills, they were less confident for paediatric emergencies, central lines, orthopaedics and tube thoracostomy. There were few variations between Australian states and territories and New Zealand in confidence of EP. EP in regional and rural centres nominated geographical factors (31.3% [CI 21.2-43.4]vs 17.2% [CI 13.9-21.3]; P = 0.012), other colleagues being at the same conference (46.9% [CI 35.2-58.9]vs 28.3% [CI 24.2-32.9]; P = 0.005) and inability to use their conference leave (48.4% [CI 36.6-60.4]vs 33.1% [CI 28.7-37.8]; P = 0.024) as significant barriers more frequently than their city colleagues. These findings might assist planning CPD for EP.