Procedural anxiety, self-efficacy and fear of malpractice during invasive procedures among emergency medicine residents: a cross-sectional study

Abstract

Background: Emergency medicine residents perform invasive procedures under time pressure, clinical uncertainty, and medico-legal risk, which can generate substantial anxiety among residents themselves. In this study, anxiety refers specifically to the practitioners’ own emotional and cognitive responses while performing invasive procedures, rather than to patient-related anxiety. Although fear of malpractice and general anxiety have been studied, their relationship with procedure-specific anxiety and perceived clinical competence has not been examined in an integrated manner among emergency medicine residents. Methods: This two-phase cross-sectional study included 168 emergency medicine residents from emergency departments across Türkiye. An online survey assessed procedure-related anxiety, perceived procedural difficulty, procedural self-efficacy, fear of malpractice, and trait anxiety across nine invasive procedures. Descriptive statistics were calculated, gender differences were examined using independent samples t-tests, and associations among variables were analyzed using Pearson correlation coefficients. Results: Higher perceived procedural difficulty was strongly associated with higher procedure-related anxiety, while higher self-efficacy was strongly associated with lower anxiety. Greater training duration was linked to lower perceived difficulty and anxiety and to higher self-efficacy. Trait anxiety showed moderate positive associations with perceived difficulty and procedure-related anxiety and a negative association with self-efficacy. Fear of malpractice was only weakly associated with procedure-related anxiety and was unrelated to training duration or self-efficacy. Female residents reported higher general and procedure-specific anxiety than male residents. Lack of experience and fear of complications were the most frequently reported sources of anxiety, and supervision by more experienced physicians was the most commonly used and valued coping strategy. Conclusions: Procedure-related anxiety among emergency medicine residents is closely related to perceived difficulty, self-efficacy, and clinical experience, whereas fear of malpractice appears to be a relatively stable background concern. These findings suggest that procedural anxiety is a modifiable educational outcome that can be addressed through structured supervision, simulation-based training, and supportive learning environments. Trial registration: Not applicable. This study is an observational cross-sectional survey and was not registered.