Perceptions and Self-Reported Confidence in Paediatric Clinical Skills Among Medical Trainees: A Cross-Sectional Survey at a Tertiary Care Teaching Hospital

Abstract

Introduction: Paediatric clinical skill training is a cornerstone of medical education, yet how self-reported confidence evolves across the training continuum from undergraduate study through early and senior residency remains poorly characterised in the Indian context.

Objectives: To assess and compare self-reported confidence in core paediatric clinical skills among final-year MBBS students, first-year postgraduate (JR-1) residents and second/third-year postgraduate (JR) residents; to identify perceived barriers; to explore preferred teaching modalities; and to examine the correlation between self-reported confidence and objective OSCE performance in the postgraduate subgroup.

Methods: A cross-sectional, questionnaire-based survey was conducted among 113 medical trainees at CHRI: 60 final-year MBBS students, 20 JR-1 residents, and 33 JR residents (Batches 2023 and 2024). Confidence was assessed across six clinically-oriented domains on a 5-point Likert scale using group-appropriate versions of a structured tool. OSCE (OSCR) marks, available only for the JR subgroup, were correlated with self-reported scores. Kruskal-Wallis tests with Bonferroni-corrected post-hoc comparisons examined differences across the three trainee levels.

Results: The overall composite confidence score (N=113) was 3.80 ± 0.44. Growth and Developmental Assessment was consistently the highest-scoring domain across all three levels (4.07–4.11). While overall composite confidence did not differ significantly across levels (p=0.256), four of six domains varied significantly: Clinical Examination (p=0.007), Neonatal Assessment (p=0.002), Procedures and Resuscitation (p=0.004), and Caregiver Communication (p=0.001). JR-1 residents reported the lowest confidence of the three groups in five of six domains, most markedly in Procedures & Resuscitation (3.18 ± 0.85) and Neonatal Assessment (3.20 ± 0.83), with recovery evident by JR. Caregiver Communication showed the opposite pattern, declining from 3.76 in MBBS students to 3.03 in JR residents (p=0.001). Batch 2023 achieved significantly higher OSCR scores than Batch 2024 (29.5 vs 25.2; p=0.024), while composite confidence did not correlate with OSCR performance (r=0.332, p=0.063). Bedside teaching was the most preferred learning modality across all levels (87.6% overall).

Conclusion: Confidence trajectories across the paediatric training continuum are non-linear and domain-specific. A transient dip in procedural and neonatal confidence at the MBBS-to-residency transition (JR-1) recovers with experience, consistent with the internationally described "transition shock" phenomenon, whereas caregiver communication confidence paradoxically declines with seniority. Structured procedural simulation targeted at the transition to residency, alongside a dedicated communication-skills curriculum for senior residents, are recommended.