# Hidden barriers to leadership: a cross-sectional survey of prevalence and predictors of Imposter Phenomenon in Trauma and Orthopaedic surgery in the UK

## TL;DR

This study finds that many UK orthopaedic surgeons experience high levels of self-doubt, especially women and trainees, which may hinder their leadership and career growth.

## Contribution

The study is the first to investigate Imposter Phenomenon in UK Trauma and Orthopaedic surgery and its impact on leadership and career progression.

## Key findings

- 92% of UK orthopaedic surgeons reported moderate to severe Imposter Phenomenon symptoms.
- Female surgeons and trainees experienced significantly higher levels of self-doubt.
- Imposter Phenomenon discouraged 49% from applying for leadership roles and hindered 45% from career progression.

## Abstract

Imposter Phenomenon is characterised by persistent self-doubt despite objective success. It has been associated with anxiety, burnout and reduced job satisfaction. Little is known about imposter phenomenon’s presence and impact in Trauma and Orthopaedic surgery. This study aims to determine the prevalence and predictors of Imposter Phenomenon among UK orthopaedic surgeons, further mapping domains that affect leadership and professional development.

Cross-sectional survey using the validated Clance Imposter Phenomenon Scale (CIPS).

The survey was distributed to UK orthopaedic surgeons between 20 October 2023 and 28 February 2024 via Training Programme Directors and the British Orthopaedic Association.

Orthopaedic trainees and consultant surgeons (n=441)

Imposter Phenomenon severity measured using CIPS (mild: 41–60, moderate: 61–80 and severe: 81–100). Univariate and multivariate analyses identified predictors of this severity. Self-reported impact of Imposter Phenomenon assessed across personal and leadership domains.

92% of respondents reported moderate to intense Imposter Phenomenon symptoms (mean CIPS=65.17). Trainees had significantly higher mean scores (70.64±13.85) compared with consultants (59.82±15.71). Female surgeons reported significantly higher mean scores (72.57±13.35) than male surgeons (61.19±15.74). Female gender, non-consultant training grade and time out of training were predictors of severity (p<0.01). 90% reported negative impacts, with 49% discouraged from applying for leadership roles and 45% experiencing hindered career progression.

The Imposter Phenomenon is highly prevalent among UK orthopaedic surgeons; disproportionately affecting women, trainees and those taking career breaks. Imposter Phenomenon significantly impacts leadership aspirations and career development, potentially contributing to reduced diversity in surgical leadership. Targeted interventions addressing Imposter Phenomenon are needed to support equitable leadership development in Trauma and Orthopaedic surgery.