Training characteristics, perceived proficiency, and facilitators of intubation among emergency medicine residents in Saudi Arabia: a multi-center cross-sectional study

Background Endotracheal intubation is a critical life-saving procedure in emergency medicine. However, data on training characteristics, perceived proficiency, and educational gaps among emergency medicine residents in Saudi Arabia remain limited. This study aimed to describe the demographic and training characteristics of emergency medicine residents in Saudi Arabia, including their self-estimated first-pass success rates, device preferences, and perceived facilitators of intubation, and to compare these factors across postgraduate year levels. Methods A multi-center cross-sectional study was conducted among emergency medicine residents enrolled in the Saudi Board of Emergency Medicine training program across multiple centers in Saudi Arabia. Data were collected using a structured electronic survey distributed between mid-June and mid-September 2025. Results A total of 100 residents completed the survey, with an even distribution across postgraduate year (PGY) levels. The median self-estimated first-pass success rate was 80% (IQR = 70%–90%). Video laryngoscopy was the preferred device (66%), and the most frequently cited facilitators were proper positioning (85%) and video laryngoscope use (71%). Notably, 19% of residents reported lacking confidence in intubating alone, and 24% perceived insufficient supervised opportunities. A significant association was found between PGY level and intubation confidence ( p  < 0.001), with 36.7% of PGY-1 residents lacking confidence compared to none among PGY-3 and PGY-4 residents. The perceived importance of good supervision declined significantly with advancing training ( p  < 0.001), from 66.7% among PGY-1 to 12.5% among PGY-4. Significant differences were also observed in perceptions of sufficient supervised opportunities across PGY levels ( p  = 0.048), with PGY-2 residents reporting the lowest satisfaction (60.9%) and PGY-3 the highest (95.7%). Conclusion This study provides a preliminary characterization of intubation training among emergency medicine residents in Saudi Arabia. Although most residents ultimately develop confidence, a notable minority lack confidence and perceive insufficient supervised opportunities. The findings suggest the PGY-2 year may be a transitional phase that could benefit from targeted support. Video laryngoscopy is strongly preferred, though device versatility appears to increase with seniority. It is important to note that these results reflect residents’ self-reported perceptions and should not be equated with objective measures of procedural competence.