Introduction In 2005, competency based training was introduced into the curriculum of the postgraduate training of Dutch medical residents. The role as manager is one of the seven competencies and, compared to the other roles, it is presently thought to receive little attention during training. The goal of this study was to investigate medical residents' understanding of this competency and how they perceive their role as manager. Methods In October 2009, 506 residents from different specialties in four teaching hospitals were invited via email to participate in the study. A 29-item Likert scale questionnaire was designed to investigate residents perceived healthcare management skills and knowledge in four management areas. Results 177 of 506 residents (35%) responded to the survey. More than half of the residents (106/177, 60%) did not feel confident in their (contract) negotiating skills and 56% (98/175) stated that they lacked sufficient knowledge of how the Dutch healthcare system is financed and organised. The residents were most confident in their ability to handle feedback (151/177, 85%), medical information data registration (168/173, 97%), and how to allocate healthcare resources based on evidence based principles (143/173, 83%). Conclusion These results demonstrate that residents in the Netherlands perceive their knowledge and skills in certain essential medical management concepts to be inadequate. The results suggest that a course in medical management should be considered as a mandatory part of the curricula of residency training programmes.