Knowledge Without Confidence: Internal Medicine Residents' Preparedness for Oncologic Emergencies and Goals-of-Care Communication.

Internal medicine (IM) residents frequently provide frontline care for hospitalized patients with cancer, requiring competence in managing oncologic emergencies and conducting end-of-life communication. We evaluated resident preparedness by examining knowledge, confidence, clinical exposure, and perceived educational needs. We conducted a cross-sectional survey of all IM residents at a university-affiliated community teaching hospital (October-November 2025). The survey, developed through literature review, expert input, and pilot testing, included vignette-based knowledge questions, confidence ratings (0-10 scale), and items assessing oncology exposure and perceived barriers. Thirty-three of 58 residents participated (57%). Although 81.8% had not completed a hematology-oncology rotation, 45.5% had cared for ≥ 3 patients with cancer in the preceding month. Residents demonstrated high knowledge (mean 13.0/14; SD 1.0) but lower confidence in oncologic emergency management (mean 5.78; SD 2.09) and end-of-life communication (mean 5.84; SD 2.48). Higher postgraduate year and greater oncology exposure were associated with increased confidence. Residents identified system-level barriers and emphasized the need for greater structured oncology exposure and supervised practice. Despite strong knowledge, IM residents demonstrated a marked knowledge-confidence gap. These findings highlight opportunities to strengthen experiential learning, oncology exposure, and communication training within residency curricula to better prepare residents for frontline cancer care.