Trainee Confidence Research Articles

In the Eye of the Beholder: A Stakeholder Analysis of the Value of the "Promotion in Place" Competency-Based Time-Variable Graduate Medical Education Pilot.

Competency-based time-variable (CBTV) graduate medical education (GME) has been implemented in Canada, Europe, and the United States, yet its perceived value has not been explored. Promotion in Place (PIP) is a CBTV GME program in which residents graduating early advance to attending status with "sheltered independence" until the standard graduation date. This study describes perceived value of CBTV GME and PIP at Mass General Brigham by capturing diverse stakeholder perspectives. In this stakeholder analysis using semistructured interviews (June 2022-August 2023), 49 participants were invited (44 representative members and 5 external stakeholders) from 11 GME programs: PIP eligible residents, program directors (PDs), chairs, service chiefs, and external national medical education organization leaders. Authors' understanding of value was informed by Harvey and Green's conceptualization of quality in higher education as "fit for purpose," "standards monitoring," "transformation," and "value for the money." Deductive codes and inductive subcodes captured diverse perspectives of value. Of the 49 invited stakeholders, 34 (69%) were interviewed across 5 stakeholder groups. Nearly all groups cited aspects of PIP that are "fit for purpose" as evidence of value; PIP supported "workforce readiness" and provided "sheltered independence" as intended. External stakeholders, PDs, service chiefs, hospital leadership, and faculty cited value aligning with "standards monitoring" (e.g., PIP must maintain or improve patient and resident outcomes). Nearly all groups cited aspects of PIP aligning with "transformation" as evidence of value. PIP promoted "independent decision-making" and enhanced trainee confidence. Chairs cited aspects of PIP aligning with "value for the money" (e.g., "cost neutral" as optimal for sustainability and avoidance of "hidden costs" such as assessment burden). Understanding perceptions of PIP and CBTV GME value is critical to engaging diverse stakeholders and extending CBTV GME to more programs and specialties. PIP's transformative nature underscores the added value of CBTV GME.

Abstract Su401: Confidence in performing CPR after training with traditional and female-breasted manikins

Introduction: Studies have documented that females experiencing an OHCA are significantly less likely to receive cardiopulmonary resuscitation (CPR) than males in public locations. Reasons for this disparity include bystanders fear of being perceived as sexualizing or assaulting females during CPR, concerns about physically injuring females, or low confidence in rendering CPR on females. This pilot study aimed to assess the confidence of CPR trainees who were trained on both traditional and female-breasted manikins. Methods: Participants were enrolled at a community bystander CPR training for teachers at an urban public school in 2024. Participants who consented to participate in the study were asked to complete surveys. All participants received a didactic on hands-only CPR, followed by two sets of hands-on practice, first with a traditional manikin, and then with a female-breasted manikin or vice versa. Results: Of the 112 participants enrolled in the study, 88.4% were women, and 14% were >50 years of age. The sample was almost all White participants, with high education status (88.4% with a Master’s or college education). The majority (86.6%) had prior CPR training, but most of them reported receiving training more than a year ago. After the two sets of practice (one with traditional manikin, and one with female manikin), 84.7% felt confident to perform CPR on both males and females, while 9.9% felt more confident to perform CPR on female and 5.4% on male. Men and women (84.6% and 84.7%, respectively) felt equally confident in performing CPR on both males and females. Although 28.4% felt either ‘slightly uncomfortable’ or ‘very uncomfortable’ with use of the female manikin, after practicing on a female manikin, 81.6% felt more comfortable with doing CPR on women (11.1% still felt uncomfortable and 7.3% were neutral). When asked which manikin made them feel more confident in performing CPR, 70.9% reported both, while 7.2% said neither, 10% said female manikin and 11.8% selected traditional manikin. 70% of women and 75% of men selected both manikins. Conclusion: Training with both types of anatomically accurate manikins is important in improving confidence of community lay responders in performing CPR and reducing community level gender disparities. Future analysis will evaluate change in confidence with each manikin type and assess confidence and knowledge retention 6 months after the training.

Enhancing cardiology trainee competence through simulation-based pericardiocentesis training: a pilot programme evaluation

Abstract Introduction Cardiology training requires trainees to manage clinical duties whilst developing practical skills. Changes to the UK curriculum have resulted in reduced time available for procedural teaching. Pericardiocentesis is one of many required competencies. The Joint Royal College of Physicians Training Board cardiology curriculum cites the importance of simulation-based education to teach procedures. Procedural training encompasses the development of clinical reasoning alongside motor skills. Gange (1962) and Carless (2010) emphasized the importance of expert-guided practice, interactive teaching, and instant feedback in motor skills teaching to maximize the educational experience. Aim Develop a simulation teaching programme to enhance trainees' confidence and competency in pericardiocentesis. Procedures form part of a summative Direct Observation of Procedural Skills, enabling trainees to learn in a safe environment and use as evidence at their Annual Review of Competence Progression (ARCP). Method We developed a pilot programme for pericardiocentesis facilitated through high-fidelity equipment between February 2023 and February 2024. Participants were recruited through medical education departments. The sessions were delivered on a one-to-one basis by a cardiology consultant to facilitate discussion and interactivity. The teaching involved a core knowledge presentation, discussion of trainee experiences, case studies as examples, including review of echocardiography features. This was followed by clinical skills teaching of pericardiocentesis, utilizing a model, and transthoracic echocardiography. Trainees were sent anonymous feedback forms after the session. Results 46 cardiology registrars participated; 48% were within their first few years of training. 87% reported difficulty in practicing this skill in clinical practice due to: lack of exposure, other clinical responsibilities taking priority, and the need for consultant-delivered care on patients requiring an urgent or emergency procedure. Mean trainee confidence before teaching was 3.24 out of 5 (SD = 1.14), with a significant improvement to 4.48 (SD = 0.59 p<0.001). 52% improved in confidence by 1 unit and, 31% improved in confidence by 2 or more units. Trainees reported the following themes regarding the session: knowledgeable trainer, high fidelity equipment, instant feedback to predict, prevent, and overcome challenges, and a multi-modal approach to teaching, incorporating presentation and discussion on pericardial effusion, tamponade, and drainage. Conclusion Our programme offers a unique multi-modal teaching approach, with dedicated time with an expert. We supported the progress of 46 trainees and enhanced their training competencies. We aim to expand the programme to incorporate more procedures in line with growing curriculum requirements. Tracking trainee progress until ARCP outcomes will reveal the impact of simulation teaching on their experience and professional development.

Professionalism lapses in health professions training: Navigating the 'Yellow Card' moments for transformative learning.

Health professions training programmes face increasing reports of professionalism lapses, which can delay, or end, trainee progression. How programmes respond to professionalism lapses to facilitate professional identity development has not been clarified. The objective of this study is to identify factors that facilitate and impair transformations around professionalism lapses in health professions training programmes. We conducted a qualitative study interviewing 5 faculty and 20 trainees with firsthand or secondhand experience with professionalism lapses from a range of health professions training programmes at McMaster University. Using reflexive thematic analysis, we coded verbatim transcripts informed by the lenses of social and transformative learning theories. We constructed themes through iterative and comparative analysis, seeking meaningful variation across professions and triangulating faculty and trainee perspectives. Four themes were constructed. First, lapses are in the eye of the beholder with personal definitions intersecting with institutional and situation norms. Difficulties exist in recognising and convincing trainees to respond to lapses that are perceived to be minor or subject to interpretation. Second, responses to professionalism lapses occurred within power hierarchies, which impacted how trainees reacted to the remediation process, risked superficial trainee responses to concerns and led to concerns around inequitable treatment in how standards were applied. Third, fostering transformation involves building trainee confidence, agency, trust and engagement. Focused support and advocacy for trainees can empower and promote agency in tackling disorienting lapses. Fourth, perspective shifts involve deep engagement over time, including but not limited to self-reflection, structured discussion and seeking support. Identifying and addressing professionalism lapses is complex and requires nuanced and contextual exploration of personal, institutional and situational dynamics at play. By fostering environments that promote genuine reflection and dialogue and focus on building trainee confidence, agency, trust and engagement, health professions training programmes can better support trainees in navigating these complex situations and contribute to the broader goal of socialising to a professional culture and practice.

A Low-Cost, Low-Tech Virtual Mass Casualty Training Simulation for Undergraduate Medical Education.

Mass casualty incident (MCI) training effectively increases trainees' knowledge and confidence when implemented in a live, in-person setting. In-person MCI training is resource-intensive, but virtual MCI training models are an alternative with similar effectiveness at a lesser cost. However, most of these validated virtual options are based on high-tech virtual reality (VR) programs. We designed and implemented a low-tech, low-cost virtual MCI training model for third-year medical students, using Google JamboardTM (Google, Mountain View, CA) and ZoomTM(Zoom Video Communications, Inc., San Jose, CA) as the primary technological platforms. Learners were instructed on the adult simple triage and rapid treatment (START) and the pediatric JumpSTART triage algorithms over ZoomTM. In small groups, students used a gameboard on Google JamboardTM to simulate a scene at an MCI where they were tasked with triaging 25 patients in 30 minutes, followed by a debriefing session. Students were surveyed on their perceived understanding of the triage algorithms and confidence before and after the event using a 5-point Likert scale (poor, fair, good, very good, and excellent). Pre- and post-event scores were compared using paired, two-sample, and two-tailed t-tests. We considered a p value of <0.01 significant to correct for multiplicity using the Bonferroni method. Learners reported an increased understanding of the triage algorithms (adult and pediatric), scene setup, andunderstanding of emergency medical servicetraining/transportation, as well as increased confidence in participating in an MCI (all p < 0.001). Virtual MCI training can be used as an alternative or supplement to in-person MCI training. Low-tech virtual MCI training models can increase the accessibility of these valuable training activities without sacrificing the quality of learning. Areas for further investigation include low-tech virtual MCI training models' ability to effectively recreate situational and environmental distractions and other challenges better simulated by in-person and high-tech VR training events.

Using simulated bronchoscopy to improve training on intensive care units in a north London NHS trust

Flexible bronchoscopy is a vital tool that is used for both diagnostic and therapeutic indications on the intensive care unit. During the COVID pandemic, training opportunities to perform such a skill were decreased and novel methods of teaching, including using bronchoscopy simulators, were explored out of necessity. The aim of this quality improvement project was to investigate how training on an intensive care unit prepared trainees for carrying out bronchoscopy, and whether a simulated bronchoscopy session with a high-fidelity simulator could be a useful adjunct to gain experience. Our pilot, although limited in patient numbers, suggested that current teaching methods might not be adequate for building trainee confidence and that a session with a bronchoscopy simulator could serve as a remedy to this with a significant increase in self-reported confidence. Moving forwards in a post-pandemic era, this serves as a lesson learnt from COVID and would benefit from further development in this area.

WP6.4 - General Surgery Bootcamp: Improving Induction for Higher General Surgery Training

Abstract Aim To create an introductory course or “bootcamp” to assist new ST3s transition from working at core trainee to General Surgical Registrar level. Method Using previous expertise of “bootcamps” delivered in the region in similar specialities, a 3-day programme was designed to offer training in areas aligned to the curriculum and considered useful to newly starting higher surgical trainees. The course involved a mix of simulation-based workshops, lectures and skill-based labs. The programme was delivered by a senior faculty directing activity with support from industry partners and medical education/simulation expertise. A range of skills were targeted using animal, virtual and augmented reality models, low and high-fidelity simulation, and non-operative technical skills (NOTSS) in simulated ward and theatre environments. Results 26 trainees (23 new General Surgery ST3s, 3 returning to training) completed the bootcamp. Feedback questionnaires using a likert scale demonstrated clear improvements in trainees’ own skill perception in endoscopy, laparoscopy, open surgery and NOTSS. 100% of responding trainees’ were confident or strongly confident post course, compared to 69% before. We also showed an increase in confidence in laparoscopic suturing (77%), duodenal ulcer repair (69%) and operating in a stressful environment. Conclusions A transitional “bootcamp” can provide both tangible and intangible benefits. This project showed clear improvement in trainee confidence both in key practical and non-practical skills such as communication. It also enabled registrars to familiarise themselves with new colleagues, facilitating an early welcome from the region and embedded support network.

FP5.2 - Skills-fade pilot study, inclusion of Return to Training Trainees in the ST3 General Surgical Bootcamp

Abstract Aims The concept of skills fade after time out of training is well recognised but there is a paucity of objective assessment of this in returning trainees. We sought to assess the utility of inclusion of returning trainees in a bootcamp by measuring performance and confidence. Methods In this pragmatic pilot study 8 General Surgery trainees returning from time out were offered a place on the ST3 Bootcamp of whom 3 agreed to participate. These trainees had been out of programme for a medical education fellowship, non-clinical research and parental leave respectively. Trainees received a 3 day period of intensive reskilling, covering open and laparoscopic skills, proctology, endoscopy, ward round managing the OP list and stressful environment. Their confidence and competence were assessed pre and post Bootcamp completion. Results Returning trainee confidence improved across the board. Trainees fed back that they found the open and laparoscopic simulation sessions most useful. All trainees objectively improved in laparoscopic skills although not in open skills or endoscopy and proctoscopy. The pressure of being assessed may have affected these finding or this may reflect a need for consistency of faculty and a more robust method of objectively assessing competence. Conclusion Inclusion of RTT trainees in surgical bootcamp improves confidence and enhances their return. Simulation should be included in a return to training programme. If objective assessment is used to evaluate their progress then this should be with predefined criteria or computer software to ensure that the evaluation is unbiased.

Face and content validity of a novel post-thyroidectomy haematoma simulation model

Can a new simulation model help increase confidence in trainees and reduce postoperative complications?

Comparing Male and Female Resident Physicians in Central Venous Catheter Insertion Self-confidence and Competency: A Retrospective Cohort Study.

Female physicians often report lower self-confidence in their procedural and clinical competency compared to male physicians. There is limited data regarding self-reported confidence of female versus male trainees and any relation to objective competency in central venous catheter insertion. To analyze differences between male and female trainees in self-confidence and skill-based outcomes in placing central venous catheters. Using data from a central venous catheter simulation training program at a large tertiary medical center, we performed linear regressions to analyze confidence difference pre- and post-training, number of restarts, and number of cannulation attempts while controlling for baseline demographic characteristics of the sample. PGY-1 physician residents in all residency specialties who insert central venous catheters in the clinical setting at a tertiary academic center with a sample size of 281 residents. Confidence difference pre- and post-training measured on a Likert scale 1-5, number of restarts (novel global assessment variable), and number of cannulation attempts during the competency evaluation. Female trainees had both lower pre-program confidence (1.35 versus 1.74 out of 5, p < 0.001) and lower post-program confidence (3.77 versus 4.12 out of 5, p = 0.0021) as compared to male trainees. There was no statistically significant difference in number of restarts (95% CI - 0.073 to 0.368, p = 0.185) or cannulation attempts (95% CI - 0.039 to 0.342, p = 0.117) between sexes in linear regressions controlled for age, specialty designation, prior central venous catheter training, prior ultrasound guided vessel cannulation training, and pre-training confidence level. Female trainees rated their confidence significantly lower than their male counterparts both before and after the training program, despite no significant difference in skill-based outcomes. We discuss potential implications for trainees acquiring procedural skills during residency and for physician educators as they design training programs and delegate procedural opportunities.

Near-Peer Coaching to Enhance Operative Learning: An Educational Innovation for Surgical Training.

To design, implement, and evaluate a near-peer coaching model to enhance operative learning in general surgery training. There is an urgent need to maximize operative learning in surgical education. Trainees find barriers to operative learning difficult to navigate and often sacrifice educational opportunities for the sake of impression management. A prospective cohort study was conducted over a 6-month period following design and implementation of a trainee-led near-peer coaching model; "SPICE" (Set goals, Plan, Imagine, Comment and feedback, Evaluate and reflect). Semistructured interviews were conducted to explore trainees' experiences of the model. Twelve trainees participated in the study. The near-peer coaching encounters provided trainees with the psychological safety to be honest about learning needs, validated insecurities, and mitigated the pressures associated with impression management that consistently shaped consultant-trainee relationships. Trainees described improved operative performance, increased self-confidence, and a greater ability to adapt to the unexpected. Trainees adapted the use of the SPICE model to conventional consultant-trainee dynamics, which facilitated learning conversations and negotiation of operative opportunities. On a broader scale, trainees noticed an improvement in the teaching culture of the unit, describing that the use of the model legitimized the importance of perioperative learning conversations and increased consultant enthusiasm for teaching. Near-peer coaching created a unique psychological safety that facilitated authentic reflection and goal setting and improved trainee confidence. The benefits of the SPICE model were translated to other contexts and facilitated entrustment in conventional consultant-trainee relationships.

141 Simulation Training: The Impact on the Confidence and Preparedness of Novice Otolaryngology ST3 Registrars

Abstract Aim This research employs the HoloLens2™ and a variety of models to evaluate the impact on the confidence and preparedness of ST3 trainees following their engagement in simulated otolaryngology cases. Method A total of 29 ST3 trainees engaged in ten 1-hour long simulation stations across a span of two days. The participants engaged in both technical and non-technical skills within elective, emergency, and ward-based scenarios. Questionnaires were used to document self-reported confidence and preparedness before and after each simulation. Primary outcomes included change in trainee confidence and preparedness pre- and post-station. Results The participants reported a significant increase in confidence (p&amp;lt;0.001) and preparedness (p&amp;lt;0.001) after all stations. The greatest improvements in comparison to all other stations were self-preparedness in the rigid bronchoscopy station and self-confidence in the sphenopalatine artery (SPA) ligation station. A significant improvement in self-confidence (p&amp;lt;0.001) and self-preparedness (p&amp;lt;0.0001) was observed after the non-technical HoloLensTM session. Conclusions The use of Otolaryngology simulation stations improved confidence and preparedness of managing common ENT presentations in the ward, elective, and emergency settings for ENT ST3 trainees. This approach serves as a valuable supplement to the conventional surgical apprenticeship, facilitating the acquisition of both technical and non-technical skills. The implementation of mixed reality technology creates an immersive environment to develop trainees’ non-technical skills. However, future work is required to assess the impact on the long-term benefits of trainee skill retention and clinical proficiency.

756 Impact of Hands-on Laparoscopic Simulation on Confidence and Skills in Medical Trainees: A Prospective Study

Abstract Aim The growing significance of minimally invasive procedures necessitates a shift in the traditional surgical training model towards a more apprenticeship-based approach. This requires the introduction of simulation training in surgical education to be more prominent. This study aimed to explore the effectiveness of a hands-on laparoscopic simulation on confidence in laparoscopic and surgical skills, giving insight into its use of teaching for doctors &amp; medical students, as well as the correlation between confidence and practical skills. Method 83 medical students and foundation year doctors attended a laparoscopic simulation hands-on session and completed pre- and post-event questionnaires using a 5-point Likert scale assessing their confidence in practical skills and ability to perform laparoscopic surgical procedures. Attendees also rated how important they believe laparoscopic simulators are for improving surgical skills. Statistical significance &amp; normality were determined using the one-tailed Shapiro–Wilk test and a follow-up T-test was conducted. Results Attendees had demonstrated a significant increase in confidence in the practical skills required in laparoscopic surgery after having done the simulation (average pre-event &amp; post-event 2.11, 3.69 respectively, p = p = 2.99 10-19); as well as confidence in the ability to perform the procedures (average pre-event &amp; post-event 1.71, 4.16 respectively, p = p = 2.99 10-23). Conclusions The study has shown that laparoscopic simulations are effective in increasing the confidence of attendees in the practical ability of laparoscopic simulations and skills required for laparoscopic surgery, showing a positive impact of introducing laparoscopic simulation into surgical training. Further studies are required with long-term follow-up in order to measure sustainability.

346 Transforming ENT Induction: Assessing the Impact of an AI Avatar Delivered Induction Course on Trainee Confidence at John Radcliffe Hospital, Oxford

346 Transforming ENT Induction: Assessing the Impact of an AI Avatar Delivered Induction Course on Trainee Confidence at John Radcliffe Hospital, Oxford

The Impact of High-Fidelity Simulator System on Bronchoscopy Operation Skills of Trainees Who Receive Refresher Training: A Teaching Study.

This study aimed to explore the impact of high-fidelity simulator (HFS) training on the bronchoscopy operation skills, confidence, stress, and learning satisfaction of trainees who further their training at endoscopy center in our hospital. The study also investigated the practical application effects of HFS training and provided a reference for the development of clinical teaching and training programs in hospitals. The 18 trainees who furthered their training at the endoscopy center were evaluated for their bronchoscopy operation skills, confidence, and stress levels before and after HFS training. A survey on learning satisfaction was conducted after the completion of HFS training. The scores of all evaluations were collected for comparison of differences before and after HFS training. HFS training improved the clinical operation skill levels and confidence of trainees who further their training at the endoscopy center, reduced their stress, and achieved 100% satisfaction from this training. Education level and department had no significant impact on trainees' operational skills and confidence improvement, and stress reduction (p > 0.05). The results of this study supported the influence of the history of endoscopy operations on the improvement of trainees' improved operational skills after HFS training, but it had no relation to the improvement of confidence and stress reduction. Trainees with a history of endoscopy operations had higher operation skill scores before and after HFS training (n = 5, 94.80 ± 2.95 and 97.60 ± 1.82, respectively) than those without a history of endoscopy operations (n = 13, 80.62 ± 2.53 and 86.38 ± 2.82, respectively), and the difference was significant (p < 0.05). HFS training is an effective clinical teaching method that can significantly improve trainees' bronchoscopy operation skills and confidence, reduce stress, and achieve high levels of satisfaction.

Changes in self-confidence in professional, personal, and scientific skills by gender during physician-scientist training at the University of Pittsburgh.

Persistence in physician-scientist careers has been suboptimal, particularly among women. There is a gender gap in self-confidence in medicine. We measured the impact of our physician-scientist training programs on trainee's confidence in professional, personal, and scientific competencies, using a survey measuring self-rated confidence in 36 competencies across two timepoints. Results were analyzed for the full survey and for thematic subscales identified through exploratory factor analysis (EFA). A mixed effects linear model and a difference in differences (DID) design were used to assess the differential impact of the programing by gender and career level. Analysis included 100 MD-PhD or MD-only medical student or resident/fellow trainees enrolled between 2020 and 2023. Five subscales were identified through EFA; career sustainability, science productivity, grant management, goal setting, and goal alignment (Cronbach's alpha 0.85-0.94). Overall, mean scores increased significantly for all five subscales. Women significantly increased their confidence levels in all five areas, whereas men increased only in science productivity and grant management. Mixed effects models showed significant increases over time for women compared to men in career sustainability and goal alignment. Residents and fellows had greater increases than medical students across all subscales. Physician-scientist trainees fellows increased their confidence in personal, professional, and scientific skills during training. Training had a greater impact on women than men in building confidence in sustaining careers and aligning their goals with professional and institutional priorities. The magnitude of increased confidence among residents and fellows exceeded that in medical students.

QIP Improving Trainee Confidence in Male Sexual Dysfunction History-Taking in an Acute Inpatient Unit

QIP Improving Trainee Confidence in Male Sexual Dysfunction History-Taking in an Acute Inpatient Unit

One-Off Focused Teaching Can Improve Trainee Confidence, Knowledge and Skillset in Understanding and Therapeutically Engaging People With a Diagnosis of Personality Disorder

One-Off Focused Teaching Can Improve Trainee Confidence, Knowledge and Skillset in Understanding and Therapeutically Engaging People With a Diagnosis of Personality Disorder

A survey on brachytherapy training of gynecological cancer focusing on the competence of residents in China.

The brachytherapy is an indispensable treatment for gynecological tumors, but the quality and efficiency of brachytherapy training for residents is still unclear. An anonymous questionnaire was designed to collect information on gynecological brachytherapy (GBT) training for radiation oncology residents from 28 training bases in China. The questionnaire content was designed based on the principle of competency based medical education (CBME). The Likert scale was employed to evaluate self-reported competence and comprehension regarding GBT. A total of 132 senior residents were included in the final analysis. 53.79% (71/132) of senior residents had experience in performing image-guided GBT, whereas 76.52% (101/132) had observed the procedure during their standardized residency training. The proportion of senior residents who reported having the self-reported competence to independently complete the GBT was 78.03% for intracavity GBT, 75.00% for vaginal stump GBT, and 50.03% for interstitial GBT, respectively. The number of successful completion of Interstitial, intracavity and vaginal GBT was correlated with the self- confidence of trainees after standardized training. In particular, the independent completion of interstitial GBT for more than 20 cases was an independent factor for the self-reported competence of senior residents. During the training period, 50.76% and 56.82% of the residents had not participated in the specialized examinations and professional GBT courses. The study revealed that the self-confidence of residents to independently complete brachytherapy was relatively high, and the specialized curriculum setting and training process assessment for brachytherapy training still need to be strengthened in the future.

Role of surgical simulation on self-reported confidence level on cardiothoracic surgical trainees.

Simulated self-practice using simulation models could improve fine motor skills and self confidence in surgical trainees. The purpose of this study is to evaluate on self-reported confidence level in cardiothoracic surgical trainees by using surgical simulation models. We conducted a cross-sectional study on all surgeons (n=10) involved in MIS simulation training. All surgeons are required to perform on three minimally invasive surgery (MIS) procedures (Mitral Valve Repair, Mitral Valve Replacement and Aortic Valve Replacement). A questionnaire was designed based on two existing scales related to self-confidence, the surgical self-efficacy scale [SSES] and the perceived competency scale [PCS]. We assessed their self-confidence (before and after training) in the use of simulation in MIS procedures using rating scales 1-5. The mean score was calculated for each domain and used as the predictor variable. We also developed six questions (PCS) using Objective Structured Assessment of Technical Skills (OSAT) related to each domain and asked participants how confident they were after performing each MICS procedure. The mean score was 4.7 for all assessed domains, except "knowledge" (3.8). Surgeons who had performed one or more MIS procedures had higher scores (P<0.05). There was no correlation between the number of MIS procedures performed and self-confidence scores. The results indicate that the cardiac surgery training based on MIS simulation improves trainees and consultants in terms of the level of self-confidence. Although surgeons generally have high levels of self-confidence after simulation training in MIS cardiac procedures, there is still room for improvement with respect to technical skills related to the procedure itself and its results.