To assess confidence in resuscitation skills among pediatric residents and its relationship to training and experience, all pediatric residents at one institution were surveyed regarding their confidence in technical and leadership resuscitation skills and their prior experience with real and mock codes. Respondents (61/82, 74%) reported participation in 4.9 +/- 3.6 mock and 3.9 +/- 5.0 real codes. Confidence score for all skills was 2.7 +/- 0.6 (scale 1-5). Senior residents were more confident than interns (2.8 +/- 0.5 vs 2.3 +/- 0.5). Residents were more confident in basic (3.9 +/- 0.6) than in advanced (2.6 +/- 0.6) or expert resuscitation skills (1.6 +/- 0.7). Confidence correlated with mock codes (r = 0.52) and to a lesser degree with real codes attended (r = 0.36). Performance of active roles and debriefing occurred more commonly with mock than with real codes. The data indicate that pediatric residents have limited confidence in resuscitation skills and that mock code training with active participation and debriefing may be an effective educational tool.