Addressing Impostor Phenomenon Within the First Year of Medical School

Purpose: Impostor phenomenon (IP) is characterized as the feeling of anxiety and self-doubt resulting from undervaluing one’s role in achieving success while falsely attributing one’s accomplishments to luck or other external forces. 1 IP can cause psychological distress leading to anxiety, depression, and burnout. 2,3 The overall prevalence for IP has been reported to be 22% to 60% for medical students. 4 Transitioning periods, such as the time of progressing from undergraduate to medical school, requires learners to better understand what they can and cannot do. Absence of guidance during these crucial time periods can exacerbate or lead to the development of IP. Currently, there is lack of research evaluating the effectiveness of interventions to support learners during their transitions. 4 For our first-year medical students (MS1), we developed a module to address IP and to provide tools and resources to combat IP and evaluated its effectiveness. Approach: The 1-hour IP module was created by the Baylor College of Medicine, School of Medicine’s Learning Community Advisors, with input from the upperclassmen medical students (MS2–MS4). The module was embedded in a yearlong “UnHidden Curriculum” course addressing dimensions of wellness. The main goals of the module were to raise learners’ metacognitive awareness of IP and develop a personal plan to manage IP. During the module, students completed the Clance Impostor Phenomenon Scale 5 and shared their results in small groups. Following watching a short video explaining IP, learners engaged in small-group discussions on 3 case scenarios that highlighted the subtypes of IP along with strategies to combat IP. The module culminated with a time of self-reflection, writing a positive note to oneself to read whenever feeling overwhelmed with IP and reviewing a list of institutional resources. Through E*Value, a mid-year evaluation was emailed to all MS1 students gauging the effectiveness of the Unhidden Curriculum, including a subset of items related to the IP module. Using a Likert scale, students were asked before and after completing the module, if they recognized the impact of IP on self/others, the management of IP for self/others, and whether an IP curriculum is important to their medical education (1 = strongly disagree, 5 = strongly agree). These items were analyzed using Wilcoxon signed-rank tests, with effect sizes (r) for significant findings. Outcomes: Of 182 students, 113 (62%) completed the survey. The percentage of learners who agreed with the recognized impact of IP on themselves/others increased significantly after the IP module (4.50 ± 0.55; 97% agree [A]/strongly agree [SA]), compared with before participation (3.90 ± 1.02; 74% A/SA); P < .001, r = 0.39. Similarly, students had higher agreement (3.97 ± 0.82; 78% A/SA) after participation on their ability to manage the effect of IP on themselves/others compared with before participation (3.54 ±.1.04; 57% A/SA); P < .001, r = 0.35. Most respondents agreed the IP module was important to their medical education at the current (MS1) stage of training (94% A/SA). Significance: By examining IP and providing resources to students at the beginning of medical school, they are armed with the tools to combat IP. We hope to revisit the IP module during transitional periods such as the start of clinical rotations or residency application and encourage learners to deliberately practice strategies to manage IP. A longitudinal analysis to evaluate the effect of the IP module is warranted.