Impostor syndrome among minority medical students who are underrepresented in medicine.

OBJECTIVES: Impostor syndrome (IS) is prevalent in medical professionals. However, little is known about the prevalence of IS among medical trainees and those who are underrepresented in medicine (UiM). Even less is known about the experiences of UiM students at predominantly white institutions (PWIs) and historically black colleges/universities (HBCUs) relative to their non-UiM peers. The purpose of this study is to investigate differences in impostor syndrome among UiM and non-UiM medical students at a PWI and a HBCU. We additionally explored gender differences in impostor syndrome among UiM and non-UiM students at both institutions. METHOD: Medical students (N = 278) at a PWI (N = 183, 107 (59%) women) and a HBCU (N = 95, 60 (63%) women), completed an anonymous, online two-part survey. In part one, students provided demographic information, and in part two, students completed the Clance Impostor Phenomenon Scale, a 20-item self-report questionnaire that assessed feelings of inadequacy and self-doubt surrounding intelligence, success, achievements, and one's inability to accept praise/recognition. Based on the student's score, the level of IS was measured and placed into one of two levels: few/moderate IS feelings, or frequent/intense IS feelings. We conducted a series of chi-square tests, binary logistic regression, independent sample t-tests, and analysis of variance to test the main aim of the study. RESULTS: The response rate was 22% and 25% at the PWI and HBCU, respectively. Overall, 97% of students reported moderate to intense feelings of IS, and women were 1.7 times more likely than men to report frequent or intense feelings of IS (63.5% vs 50.5%, p = 0.03). Students at PWI were 2.7 times more likely to report frequent or intense IS than HBCU students (66.7% vs 42.1%, p< 0.01). In addition, UiM students at PWI were 3.0 times more likely to report frequent or intense IS compared to UiM students at HBCU (68.6 % vs 42.0%, p = 0.01). Computation of a three-way ANOVA with gender, minority status, and school type revealed a two-way interaction indicating that UiM women scored higher on impostor syndrome than UiM men at the PWI and HBCU. This trend was not observed among non-UiM students. CONCLUSIONS: Impostor syndrome is informed by gender, UiM status, as well as environmental context. Efforts to provide supportive professional development for medical students should be directed towards understanding and combatting this phenomenon at this critical juncture of their medical career.

Midterm experience with modified Cabrol procedure: safe and durable for complex aortic root replacement.

OBJECTIVE: To evaluate the early and late outcomes of the modified Cabrol technique as a method of coronary reimplantation during complex composite graft replacement of the ascending aorta. METHODS: Between 1995 and 2012, 348 patients (mean age, 56 ± 14 years; 283 males and 65 females) underwent composite graft replacement of the ascending aorta, 40 of whom (mean age, 60 ± 12 years; 35 males and 5 females) had one or both coronary ostia reimplanted using a modified Cabrol technique with an 8- to 10-mm Dacron interposition graft. The mean clinical and radiologic (computed tomographic scan) postoperative follow-up was 39 months (range, 1-171 months), via our aortic database, patient interviews, and Social Security Death Index. RESULTS: Cabrol reimplantation was necessitated by reoperations with anatomically fixed coronary ostia (n = 16, 40%), severely displaced coronary arteries (n = 15, 37.5%), button calcification (n = 4, 10%), coronary anomalies (n = 3, 7.5%), and coronary aneurysm (n = 2, 5%). Of the operations, 20% (8 patients) were urgent interventions. Early mortality was 3 (7.5%) of 40, none related to the Dacron interposition graft. Total late mortality was 16.2%, also not related to the coronary graft. Actuarial survivals were 0.88 ± 0.05, 0.79 ± 0.07, and 0.73 ± 0.08 at 1, 3, and 6 years, respectively. Radiologic follow-up was available for 31 (83.8%) of the surviving patients and revealed that the interposition graft was widely patent in all. CONCLUSIONS: The modified Cabrol technique using a Dacron interposition graft showed good survival rates and excellent durability over time, confirmed radiographically. These data confirm that it is appropriate to use the Cabrol technique when technical complexity prevents bringing coronary buttons to the main aortic graft.