Imposter Syndrome Among General Surgery Residents: Prevalence, Impact, and Psychological Considerations

Imposter syndrome (IS) is a psychological phenomenon characterized by persistent self-doubt, despite evidence of competence and achievement. Among general surgery residents, IS has been identified as a significant contributor to burnout, anxiety, and emotional distress. Recent research underscores the high prevalence of IS in this population, with studies indicating that the majority of surgical trainees experience feelings of inadequacy, fear of being exposed as unqualified, and diminished confidence in their clinical abilities. These psychological stressors can influence professional development, performance, and overall well-being. This article synthesizes the findings from recent peer-reviewed studies on IS among general surgery residents, focusing on its prevalence, contributing factors, associated psychological outcomes, and potential implications for mental health and career progression.

The Clance Impostor Phenomenon Scale (CIPS), a validated tool for measuring IS, has been utilized in multiple studies to assess the extent of self-doubt among surgical trainees. Findings from these assessments suggest that IS is not an isolated experience but a common and often severe phenomenon within this high-pressure environment. Female residents, in particular, tend to report more intense symptoms of IS compared to their male counterparts, highlighting the gendered dynamics of self-perception in surgical training. Peer interactions and institutional culture also play a role in shaping these feelings, with residents often citing comparisons to colleagues and high academic expectations as key triggers.

Beyond the emotional toll, IS has been linked to lower confidence in problem-solving and decision-making, which are essential skills in the surgical setting. This association raises concerns about its impact on clinical performance and long-term career satisfaction. Given the implications of IS for mental health and professional functioning, it is imperative to address this issue through targeted interventions, supportive training environments, and further research into mitigating its effects.

Prevalence of Imposter Syndrome in Surgical Training

Imposter syndrome is alarmingly common among general surgery residents, with several studies highlighting its widespread nature. A 2021 study published in the Journal of the American College of Surgeons found that a significant proportion of surgical trainees experience IS, with many reporting intense feelings of self-doubt and fear of exposure. The study utilized the Clance Impostor Phenomenon Scale (CIPS), a widely recognized instrument for measuring the extent of impostor feelings, to assess IS among residents. The findings revealed that 71% of respondents reported significant or intense IS, underscoring the severity of the issue within this population.

A 2022 study in Medical Teacher also explored the relationship between IS and burnout among resident physicians, including those in general surgery. The research demonstrated a clear association between high levels of IS and increased burnout, anxiety, and emotional exhaustion. These findings suggest that IS is not merely a transient feeling but a persistent psychological challenge that can affect the overall well-being of surgical trainees. Another study published in Frontiers in Psychology emphasized the role of internal and external factors in shaping IS, with a focus on how career development is influenced by the phenomenon.

Gender differences in IS symptoms have also been documented in the literature. A 2023 study in Clinical Orthopaedics and Related Research noted that female residents tend to experience more severe IS compared to male residents. This disparity may be attributed to societal expectations, gendered biases in the medical field, and the pressure to prove one's competence in a traditionally male-dominated specialty. The study also highlighted that residents who felt a stronger sense of belonging and had access to prior IS training reported less severe symptoms, indicating that institutional support and education can play a mitigating role.

The role of microaggressions in exacerbating IS symptoms has also been explored in recent research. A 2024 study in BMC Medical Education found that residents who experienced a higher incidence of microaggressions—subtle, often unintentional discriminatory comments or behaviors—were more likely to report intense feelings of IS. These findings underscore the importance of addressing institutional culture and fostering inclusive environments in surgical training programs.

Psychological and Professional Implications

Imposter syndrome not only affects the mental health of surgical residents but also has measurable consequences on their professional performance and career satisfaction. A 2023 study in Trauma Surgery & Acute Care Open explored the relationship between IS and self-efficacy among surgeons, finding that individuals with high levels of IS tend to have lower confidence in their problem-solving abilities. This lack of confidence can influence decision-making in high-stakes clinical settings, potentially impacting patient care. The study also suggested that IS is associated with higher levels of anxiety and a reduced sense of accomplishment, which can affect long-term career motivation.

The emotional burden of IS is further compounded by its association with burnout. A 2021 study in the Journal of Surgical Education examined burnout rates among general surgeons and residents, identifying IS as a contributing factor. The research found that residents who reported higher levels of IS were more likely to experience emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment—key indicators of burnout. These findings highlight the need for mental health support and early intervention strategies within surgical training programs.

In addition to its psychological effects, IS can influence the way residents perceive their own competence and career trajectory. A 2022 qualitative study in BMC Medical Education explored the personal narratives of internal medicine residents who experienced IS, finding that many described feeling unworthy of their positions and feared being exposed as unqualified. These sentiments can affect motivation, job satisfaction, and long-term career planning. The study also emphasized the role of peer support and mentorship in mitigating the effects of IS, suggesting that fostering a supportive training environment can help residents build confidence and resilience.

Contributing Factors and Institutional Influence

Imposter syndrome among surgical residents is influenced by a complex interplay of personal, interpersonal, and institutional factors. Peer interactions and comparisons are frequently cited as key triggers for IS symptoms. A 2022 study in Medical Teacher found that residents often attribute their feelings of inadequacy to interactions with other residents rather than with faculty or patients. This suggests that the competitive nature of surgical training and the emphasis on high performance may exacerbate self-doubt and insecurity.

Faculty and institutional culture also play a significant role in shaping residents' experiences with IS. A 2023 study in BMC Medical Education highlighted the importance of mentorship and supportive feedback in reducing the severity of IS symptoms. Residents who felt that their achievements were acknowledged and supported by senior colleagues reported lower levels of self-doubt. In contrast, those who experienced a lack of recognition or constructive feedback were more likely to internalize negative self-perceptions.

The role of prior training and educational interventions in mitigating IS has also been explored in the literature. A 2024 scoping review in BMC Medical Education examined educational interventions aimed at addressing IS in healthcare professionals. The review found that structured interventions, such as workshops and peer-led discussions, can help residents develop a more accurate self-assessment and build confidence in their abilities. These findings suggest that incorporating IS awareness and coping strategies into surgical training curricula may help reduce its prevalence and impact.

Gender and Institutional Factors in Imposter Syndrome

Gender disparities in the experience of imposter syndrome among general surgery residents are a growing area of research. Studies consistently show that female residents report higher levels of IS compared to their male counterparts. A 2023 study in Clinical Orthopaedics and Related Research found that female residents experienced more intense feelings of self-doubt, often attributed to gendered expectations and the pressure to prove their competence in a traditionally male-dominated field. This disparity may be further exacerbated by microaggressions and implicit biases within the surgical training environment.

In addition to gender, the sense of belonging and institutional support significantly influence the severity of IS symptoms. A 2024 study in BMC Medical Education found that residents who reported a stronger sense of belonging were less likely to experience intense IS. Institutional interventions, such as mentorship programs, inclusive training environments, and open discussions about IS, can help foster a sense of belonging and reduce the psychological burden on surgical trainees.

The role of prior IS training and educational interventions in mitigating IS has also been explored. A 2024 scoping review in BMC Medical Education examined educational interventions aimed at addressing IS in healthcare professionals. The review found that structured interventions, such as workshops and peer-led discussions, can help residents develop a more accurate self-assessment and build confidence in their abilities. These findings suggest that incorporating IS awareness and coping strategies into surgical training curricula may help reduce its prevalence and impact.

Conclusion

Imposter syndrome is a prevalent and often severe psychological phenomenon among general surgery residents, with significant implications for mental health, professional performance, and career satisfaction. Research consistently shows that the majority of surgical trainees experience feelings of self-doubt, inadequacy, and fear of exposure, often triggered by high academic expectations, peer comparisons, and institutional pressures. Female residents tend to report more intense symptoms of IS compared to their male counterparts, highlighting the gendered dynamics of self-perception in surgical training. The association between IS and burnout, anxiety, and lower confidence in problem-solving underscores the need for targeted interventions and supportive training environments.

Addressing imposter syndrome in surgical training requires a multifaceted approach that includes mentorship, institutional support, and educational interventions. Residents who feel a stronger sense of belonging and have access to prior IS training report less severe symptoms, indicating that fostering inclusive and supportive environments can mitigate the psychological burden of IS. Future research should continue to explore the long-term effects of IS on career development and mental health, as well as the effectiveness of interventions in reducing its impact. By acknowledging and addressing imposter syndrome within surgical training programs, institutions can help residents build confidence, resilience, and a more accurate self-assessment, ultimately supporting their professional growth and well-being.