Greater Objective and Perceived Competence for Clinics is Associated with Reduced Stress but No Change in Impostorism in Medical Students <sup><a class="tippyShow" data-tippy-arrow="true" data-tippy-content="A portion of this work was published in abstract form and presented at the 25<sup>th</sup> annual meeting of the International Association of Medical Science Educators, June 12-17, 2021 [1]" data-tippy-interactive="true" data-tippy-theme="light-border" style="cursor:pointer">a</a></sup>

Abstract

Impostorism is prevalent in medical students and negatively impacts wellness, contributing to stress and burnout. Perceived competence is noted as one attribute underlying impostorism. A curricular change that resulted in improved United States Medical Licensing Examination (USMLE) Step 1 scores and student self-perceptions of preparedness for clinical training was used as a natural experiment to assess the effects higher competence/preparedness, based on an objective indicator and self-perceptions, on impostorism, stress, and burnout during early clinical training. Third-year medical students in the last class of the old “Legacy” curriculum and the first class of the revised “ACE” curriculum completed a voluntary, anonymous survey that included the Clance Impostor Phenomenon Scale, the Perceived Stress Scale, and the abbreviated Maslach Burnout Assessment. USLME Step 1 scores and data on students’ self-perception of their preparedness for clinics were collected as part of routine curricular monitoring. Both groups of students had highly similar entering demographics. Compared to Legacy students, ACE students had higher USMLE Step 1 scores (p < 0.001) and perceived themselves to be better prepared for clinical clerkships (p < 0.001). Stress scores were 15% lower in ACE students (p < 0.05). However, impostor scores were nearly identical between these groups and the proportions of students endorsing burnout were not different. This suggests that impostorism and burnout during the transition to clinical training are not attenuated by improved competence and are not directly related to stress.