Emergency medicine residency places physicians in high-pressure environments where they must perform complex invasive procedures and make rapid decisions under uncertainty. Procedural anxiety is the stress experienced during the performance of medical procedures. It emerges as a critical psychological factor that can influence both clinical performance and learning. Fear of malpractice adds another stress that contributes to defensive medical practices. Although these challenges are well recognized, their combined impact on residents’ experience, confidence, and decision-making has not been fully explored within a unified framework. This study addresses that gap by examining how procedural anxiety, self-efficacy, perceived difficulty, trait anxiety, and malpractice fear interact among emergency medicine residents in Türkiye.
A study published in BMC Med Educ aimed to evaluate the relationship between procedural anxiety and fear of malpractice and to explore how factors like perceived procedural difficulty, self-efficacy, trait anxiety, and residency experience influence anxiety levels. This study also sought to detect residents’ perceived sources of anxiety and their coping strategies, with the goal of informing interventions to improve resident well-being and patient safety.
Researchers conducted a two-phase cross-sectional study that involved 168 emergency medicine residents from Türkiye. Data was collected anonymously by online survey distributed via professional networks. Validated and study-specific instruments were used to measure fear of malpractice, procedural self-efficacy, procedural anxiety, trait anxiety, and perceived procedural difficulty. Statistical analyses included descriptive statistics, independent t-tests for gender comparison, and Pearson correlation analyses to examine relationships between variables.
The results show that procedural anxiety is influenced by clinical experience, perceived difficulty, and self-efficacy. Residents with longer training durations reported lower anxiety and perceived difficulty, along with higher confidence to perform procedures. Perceived procedural difficulty was strongly positively associated with anxiety and a negative relationship with self-efficacy. It highlights the importance of skill development. Trait anxiety was moderately linked to higher procedural anxiety and lower confidence, but it did not fully explain anxiety levels, which suggests that situational factors play a larger role.
Fear of malpractice showed only weak correlations with procedural anxiety, which indicates that it functions more as a background concern instead of a primary driver. Female residents reported higher levels of procedural and trait anxiety compared to males, although no differences were found in perceived competence or difficulty. Residents identified lack of experience as the most significant source of anxiety, followed by fear of complications and patient-related challenges. Time pressure, despite being a defining feature of emergency medicine, was reported less frequently. It suggests that it may be normalized during training.
In terms of coping strategies, most residents relied on structural approaches, specifically performing procedures under the supervision of experienced physicians and engaging in thorough preparation. Psychological strategies like relaxation techniques were less commonly used. Residents perceived supervision, improved working conditions, reduced malpractice pressure, and increased simulation-based training as the most effective ways to reduce anxiety.
The study has several limitations. Its cross-sectional design prevents casual conclusions, and reliance on self-reported data introduces potential bias. The lack of objective performance measures limits the ability to determine whether anxiety directly impacts clinical outcomes. The sample may not be fully representative because of self-selection bias and limited national demographic data. Additionally, some measurement tools were newly developed and lack external validation, which may affect generalizability.
Overall, procedural anxiety among emergency medicine residents is a dynamic and modifiable phenomenon shaped mainly by experience, perceived difficulty, and self-efficacy rather than fixed personality traits or malpractice fear alone. These findings highlight the importance of structured training, supervision, and simulation-based learning to reduce anxiety and improve clinical performance. By addressing systemic and educational factors, residency programs can better support trainees, enhance patient safety, and foster more confident and competent clinicians.
Reference: Şahin Y, Şahin C, Polat PÖ. Procedural anxiety, self-efficacy and fear of malpractice during invasive procedures among emergency medicine residents: a cross-sectional study. BMC Med Educ. 2026;26(1):591. doi:10.1186/s12909-026-08915-3
