Prevalence and Impact of Imposter Syndrome in Cardiothoracic Trainees and Early Career Surgeons

J. C. Boudreaux¹, R. High², R. Van Haren³, N. Lui⁴, M. Antonoff⁵, C. M.. Bhamidipati⁶, A. Siddique^2
1University of Iowa Hospitals and Clinics, Tiffin, Iowa ²University of Nebraska Medical Center, Omaha, Nebraska ³University of Cincinnati, Cincinnati, Ohio ⁴Stanford University, Stanford, California ⁵The University of Texas MD Anderson Cancer Center, Houston, Texas ⁶Oregon Health and Science University, Portland, Oregon

Purpose: Imposter syndrome (IS), the phenomenon of feeling inadequate despite having the qualifications to succeed, is prevalent among physicians in multiple fields.1-2 IS is often comorbid with anxiety, depression, and burnout.3-4 We sought to characterize the prevalence of imposter syndrome and its associated conditions amongst cardiothoracic trainees and early career surgeons.

Methods: A multi-section survey instrument was distributed to cardiothoracic surgery trainees in the US and practicing early career (EC) cardiothoracic surgeons within their first 7 years after training. Demographics and career-based characteristics were collected and summarized using descriptive statistics. The survey included the 20-question Clance imposter scale, a validated instrument measuring from 1-100, with scores greater than 60 considered significant imposter syndrome. Additionally, instruments to detect depression, anxiety, and burnout and to measure social support were administered. Categorical variables were compared using a Chi-Square test; continuous variables were compared with a two-sample T-test. Univariable and multivariable logistic regression analysis was performed to identify respondent characteristics associated with significant imposter syndrome. Associations between imposter syndrome and anxiety, depression, and burnout were explored using Pearson correlation coefficients.

Results: A total of 1077 subjects were contacted; complete responses were received from 143 (13.2%), of which 64 (44.7%) were from trainees and 79 (55.3%) from EC surgeons. Significant imposter syndrome was present in 88 subjects (61.6%), and it was more common among trainees than EC surgeons (71.9 vs. 53.2%, p=0.01). Mean imposter scores were significantly higher in trainees (70.5 vs 62; P< 0.01- Figure), females (71.4 vs. 59.5; P< 0.01), those who were not married (69.2 vs. 61.8; P=0.01), and those who did not have children (68.3 vs. 60.2; P< 0.01). On multivariable analysis, female gender (odds ratio (OR) 6.9, 95% CI 2.8-19.1; P< 0.01) was predictive of significant IS, while a thoracic training track (OR 0.26, 95% CI 0.08-0.72; P=0.01) was protective. Anxiety (n=50, 34.9%) and burnout (n=118, 82.5%) were prevalent among trainees and EC surgeons (Table). Anxiety (52% versus 7.2%; P< 0.001) and depression (19.3% versus 1.8%; P=0.003) were more common in those with significant IS. There was a strong positive correlation between imposter syndrome and anxiety (r-value 0.63, 95% CI 0.51-0.71; P< 0.001). Imposter syndrome severity was predictive of subjective missed career opportunities (OR 1.54, 95% CI 1.15-2.14; P< 0.01).

Conclusion: Imposter syndrome was common amongst respondents, both cardiothoracic trainees and early career cardiothoracic surgeons. The prevalence may be impacted by gender, marital status, presence of children, as well as training track. Imposter syndrome was associated with anxiety and depression. Imposter syndrome may negatively impact career progression.

Identify the source of the funding for this research project: none