Building self-efficacy in medical trainees working in high stakes environment

BACKGROUND: Self-efficacy refers to an individual's belief in their ability to influence outcomes through their actions. Its application to ventilator management (VM) is a critical component of a clinician's competence in the intensive care unit (ICU). It remains unclear how the training of the ICU facilitates self-efficacy inputs in VM. This study examined final-year internal medicine residents' perceptions of the conditions that facilitated these inputs during their three-month ICU rotations. METHODS: This convergent parallel mixed method study recruited 20 participants who completed their rotations at Tan Tock Seng Hospital, Singapore. Quantitative data were collected using the General Self-efficacy Scale and a six-item proxy measure developed to assess the perceived availability of self-efficacy inputs in VM. Qualitative data were collected through eight focus group discussions exploring experiences that shaped self-efficacy inputs in VM. Both strands were analysed independently and integrated at the point of interpretation. Transcripts were analysed using reflexive thematic analysis. RESULTS: Participants demonstrated moderate to high perceived general self-efficacy. Item-level frequencies indicated that self-efficacy inputs of mastery experiences, vicarious learning, and positive affective states were perceived as available, although social persuasion in the form of timely feedback was limited. Qualitative analysis revealed seven themes organised into three conceptual categories. Fear of the Vent captured initial apprehensions towards VM. Despite this, Reassuring Mentorship and Work-Place Based Pedagogy were perceived as facilitating self-efficacy inputs. Joint display integration revealed convergence across three of the four self-efficacy inputs and divergence in the social persuasion domain, where limited timeliness of feedback contrasted qualitative accounts of feedback that was formative, consistently available, and situationally responsive. CONCLUSION: Mentorship and workplace affordances were perceived as providing the necessary self-efficacy inputs in VM despite initial apprehension. These findings highlight the role of active workplace participation as a key feature of the ICU training culture for confident participation in critical care. TRIAL REGISTRATION: National Health Group Ethics Board (2022/00565).