C. Marin1, P. M. Choi2, K. T. Flynn-O’Brien3, J. Zagory4, M. Henry5, N. A. Wilson1,6 1University Of Rochester, Surgery, Rochester, NY, USA 2Naval Medical Center, Pediatric Surgery, San Diego, CA, USA 3Medical College Of Wisconsin, Pediatric Surgery, Milwaukee, WI, USA 4Louisiana State University Health Sciences Center, Pediatric Surgery, New Orleans, LA, USA 5University Of Chicago, Pediatric Surgery, Chicago, IL, USA 6University Of Rochester, Pediatric Surgery, Rochester, NY, USA
Introduction: Imposter phenomenon (IP), or imposterism, reflects an inability to internalize success and a tendency to attribute achievement to external causes. IP has been linked to perfectionism, anxiety, and burnout, and significant IP rates have been found in surgical residents and attendings. We sought to examine rates of IP and to identify factors associated with imposterism amongst pediatric surgeons. We hypothesized that practicing pediatric surgeons experience significant IP rates, particularly in the first few years of independent practice.
Methods: An anonymous, voluntary survey, including the validated Clance IP Scale, was distributed to pediatric surgeons via email lists from the American Pediatric Surgical Association. Clance IP Scale scores indicated frequency of IP symptoms: “few” ≤40, “moderate” 41-60, “frequent” 61-80, and “intense” >80. Fisher’s exact test and ANOVA with Tukey’s post hoc were used to compare differences between groups with logistic regression and Pearson’s correlation used to understand associations.
Results: Imposterism was common among all respondents (29.7% response rate, n=335): 24.8% reported few, 25.1% moderate, 28.4% frequent, and 6.3% intense IP symptoms. IP rates decreased with years in practice (Figure). Junior attendings (Jr = practice <5 y) had increased odds (OR 19.2) of IP symptoms compared to senior attendings (Sr ≥5 y practice; p<0.001). Regardless of years in practice, female surgeons reported high IP symptoms (51.4%, IP score >60) more frequently than male surgeons (23.2%; p<0.001). Jr attending status (OR 2.15) and female gender (OR 3.05) were each independently associated with imposterism (p<0.001) using multiple logistic regression. Regression models including both factors were more predictive of high imposterism (AUC 0.72, p<0.001) than either factor alone (gender AUC 0.64, p<0.001; attending status AUC 0.58, p=0.015).
Conclusion: Our study reveals a significant prevalence of imposterism among pediatric surgeons, despite their high-achieving status. Junior surgeons with fewer than five years of experience and female surgeons are particularly affected, with the latter group facing a higher risk of imposterism regardless of experience. The findings underscore a confidence gap, especially among junior female surgeons. Further research is required to address this issue and potentially reduce attrition in pediatric surgery and other surgical subspecialties. However, our results highlight an opportunity for early career coaching and systemic interventions to mitigate imposterism among pediatric surgeons.
