Background: Overall knowledge scores may obscure clinically important deficiencies in transfusion medicine. The objective is to assess the transfusion medicine knowledge among medical and surgical residents at the Lebanese University and identify knowledge gaps with potential implications for patient safety using a weighted score and a secondary risk-oriented item-level analysis.

Materials and Methods: A cross-sectional survey was conducted among 216 clinical residents who completed a 40-item electronic questionnaire between January and March 2024. Knowledge scores ranged from 0 to 60, with a score of ≥40 defined as the passing threshold based on expert consensus. Low-performing safety-related items were also identified, and factors associated with passing were analyzed using multivariable logistic regression.

Results: The mean knowledge score was 39.3 ± 7.4/60, with 54.2% of residents achieving the predefined passing threshold. Surgical residents had higher adjusted odds of passing than medical residents (aOR 2.36, 95% CI 1.15-4.86; p = 0.01). Postgraduate year was also significantly associated with passing overall (p = 0.008), with PGY III residents showing higher adjusted odds than PGY I residents (aOR 4.11, 95% CI 1.77-9.55; p = 0.001). Low performance levels were identified in post-transfusion monitoring (22.2%), transfusion thresholds for severe cardiac disease (22.7%), infectious screening requirements (25.5%), indications for irradiated components (44.4%), and haemovigilance reporting responsibilities (50.5%).

Conclusion: Moderate overall transfusion medicine knowledge coexisted with important deficiencies across different dimensions of transfusion safety, including bedside decision-making, blood safety and haemovigilance. These findings identify priorities for targeted, competency-based education but should be interpreted in light of the single-institution design and the non-validated, expert-derived scoring and secondary risk-oriented framework.