Ready or Hesitant? Pediatric Sedation Confidence Among Senior OMS Residents.

PURPOSE/OBJECTIVES: To describe self-reported confidence of final-year oral and maxillofacial surgery (OMS) residents in managing pediatric sedation and to explore associated training-related factors. METHODS: A prospective, cross-sectional, multicenter electronic survey was distributed to all CODA-accredited OMS residency programs in the United States during 2025-2026, using an instrument adapted from two validated OMS resident confidence tools. Of 108 confirmed eligible final-year residents reached across 25 programs, 61 responded (56.5%; 22.4% of 272 eligible residents nationally). Primary analyses were descriptive and nonparametric; ordinal logistic regression was exploratory. RESULTS: Mean overall confidence was 3.54 (SD 0.96; scale 1-5). IV sedation showed the highest self-rated proficiency (54.1% at expertise level) and IM sedation showed the lowest (13.1%). At least one adverse event during training was reported by 72.1% of residents; 23.0% reported insufficient pediatric anesthesia education. Autonomy as primary operator showed the strongest bivariate association with confidence (ρ = 0.651; p < 0.001), and mean confidence differed by perceived training quality (4.32, 3.47, and 2.00 for training exceeding, meeting, and falling below residents' needs; p < 0.001). Procedural volume correlated with confidence across all four modalities (ρ = 0.256-0.412). Early responders reported higher confidence than late responders (3.83 vs. 3.26; p = 0.027). CONCLUSIONS: Senior OMS residents report moderate confidence in pediatric sedation, with IM sedation proficiency and educational sufficiency being the most prominent gaps. These descriptive findings are hypothesis-generating. Confidence developed within supervised, hospital-based residency training should not be equated with readiness for independent single-operator practice or with objective competence.