177 - Impostor Phenomenon and Clinical Competency in Pediatric Residents

Publication Number: 177.5150

Allison Yu, Children's Hospital Los Angeles, Los Angeles, CA, United States; Hernandez M. Adriana, Children's Hospital Los Angeles, Los Angeles, CA, United States; Bryan T. LEI, Children's Hospital Los Angeles, Los Angeles, CA, United States

Background: Impostor phenomenon (IP) is the experience in which high-achieving individuals feel persistent self-doubt despite external success, such as obtaining a medical degree. It is associated with burnout, lower job fulfillment, and fewer pursuits of leadership roles. Data is needed to determine if impostor experiences are from true observations of falling behind peers versus inaccurate self-assessments. IP data is particularly needed in trainees, who are still building the skills to become independent providers.

Objective: To evaluate the prevalence of IP in pediatric residents and the association of IP with clinical competency.

Design/Methods: Pediatric residents were invited to complete an optional online survey of the Clance IP Scale (20 item validated scale) and demographic characteristics. Program competency scores were built from ACGME-required assessments of individual resident performance. Resident self-evaluations were completed based on the same ACGME pediatric subcompetencies. Survey responses were de-identified and linked to self and program evaluations.

Mann-Whitney U tests and Fisher’s exact tests were used to detect the differences in those with and without IP based on demographics and competency scores. Spearman’s correlations were used to examine associations between IP scores, self-evaluation scores, and program evaluation scores. P-values < 0.05 were considered statistically significant.

Results: 51/111 residents completed the survey with a response rate of 46% (Table 1). The mean IP score was 63.37 (SD 13.24), with 49% of respondents having high IP. No significant differences in IP scores were found by gender (p>0.9), LGBTQ status (p>0.9), training year (p>0.9), underrepresented in medicine status (p=0.11), college generation (p=0.11), medical school location (p=0.4), self-evaluated score (p=0.13), or program evaluated score (p=0.6). Total program competency scores increased with postgraduate year (p < 0.001).

A very weak negative correlation was found between IP score, self-evaluated score (r=-0.03, p=0.84), and program evaluated score (r=-0.06, p=0.70) (Figure 1). Strong positive correlation was found between self and program evaluated score (r=0.62, p< 0.001). Residents self-evaluated themselves higher than the program did (Figure 2). Those with low IP had greater discrepancies between self and program evaluated scores (p=0.015).

Conclusion(s): Pediatric residents have high rates of IP, yet those with and without impostorism had similar competency scores. IP amongst trainees may reflect inaccurate perceptions of one’s performance.

Table 1. Differences in Impostor Experiences by Demographics and Competency Scores
Table 1. Differences in IP scores based on demographic characteristics, program evaluated competency scores, and self-evaluated competency scores. Residents with IP scores greater than equal to 62 were considered to have high IP. Residents who listed their race/ethnicity as Black, Hispanic, Filipino/Pacific Islander/Southeast Asian, or American Indian were considered underrepresented in medicine (URM).

Figure 1. Association of Impostor Phenomenon Scores with Program-evaluated Competency Scores and Self-evaluated Competency Scores
Figure 1. Residents with higher IP scores tended to have lower self-evaluated scores (r=-0.03, p=0.84) and program-evaluated total scores (r=-0.06, p=0.70). This association was very weak and did not reach statistical significance.

Figure 2. Discrepancy between Resident Self-evaluated Score and Program-evaluated Score, Based on IP Status
Figure 2. Residents consistently self-evaluated themselves more favorably than the program's evaluation of them. Compared to those with high IP, residents with low IP scores scored themselves significantly higher relative to the program’s evaluation of them. However, the overall resident self-evaluations scores were not significantly different based on high and low IP scores.

Table 1. Differences in Impostor Experiences by Demographics and Competency Scores
Table 1. Differences in IP scores based on demographic characteristics, program evaluated competency scores, and self-evaluated competency scores. Residents with IP scores greater than equal to 62 were considered to have high IP. Residents who listed their race/ethnicity as Black, Hispanic, Filipino/Pacific Islander/Southeast Asian, or American Indian were considered underrepresented in medicine (URM).

Figure 1. Association of Impostor Phenomenon Scores with Program-evaluated Competency Scores and Self-evaluated Competency Scores
Figure 1. Residents with higher IP scores tended to have lower self-evaluated scores (r=-0.03, p=0.84) and program-evaluated total scores (r=-0.06, p=0.70). This association was very weak and did not reach statistical significance.

Figure 2. Discrepancy between Resident Self-evaluated Score and Program-evaluated Score, Based on IP Status
Figure 2. Residents consistently self-evaluated themselves more favorably than the program's evaluation of them. Compared to those with high IP, residents with low IP scores scored themselves significantly higher relative to the program’s evaluation of them. However, the overall resident self-evaluations scores were not significantly different based on high and low IP scores.