Struggling with Self-Doubt: Impostor Phenomenon and Mental Health among Medical Students at Universitas Sumatera Utara Medan, Indonesia

Impostor phenomenon (IP), where individuals attribute their success to external factors rather than their abilities, is prevalent in competitive environments like medical school. Research on how the onboarding medical school curriculum influences IP is limited, but recent studies suggest that situated learning theory (SLT) may help inform how we approach IP. This study sought the effects of an SLT-focused, specifically communities of practice and legitimate peripheral participation, workshop during orientation week on IP perception among first- and second-year medical students. Second-year students (MS2) facilitated the discussions with first-year students (MS1) about IP and identity formation, aiming to reduce IP through normalization of IP, shared experiences, and strategies to mitigate IP. A workshop was held during the orientation week at the Uniformed Services University, School of Medicine. The participants were organized into learning pods consisting of 4 students. An MS2 learning pod was paired with an MS1 learning pod to moderate the workshop activity. One MS2 from each learning pod received training to be moderators. Both MS1 and MS2 participants completed pre- and postworkshop surveys, which included the Clance Impostor Phenomenon Scale (CIPS), which was the primary measure of IP. A total of 222 medical students (n = 130 MS1; n = 92 MS2) were included in this study. Before completing the workshop, 53% of participants reported frequent or intense IP experiences versus 43% postworkshop. Overall, 71% of MS1s and 57% of MS2s had decreased (i.e., improved) absolute CIPS score postworkshop, with changes in the range of 1-30. However, 20% of MS1s and 34% of MS2s had increased CIPS score, with a range of 1-24 points. Additionally, proportion of MS1s who strongly disagreed or disagreed that they were admitted to medical school because of luck or chance rather than their skills and abilities increased from 65% before the workshop to 74% afterward. Those who strongly disagreed that they felt like an impostor (or did not belong) on campus also increased from 38% before the workshop to 47% afterward. The percentage of MS1s who strongly agreed or agreed that that comfort levels discussing their own, as well as their peers, IP experiences increased from 66% to 83% and 78% to 87%, respectively. In an open-ended response, participants reported appreciation of the open and safe peer-to-peer discussions as it enabled reflection and normalization of IP, shared best practices and strategies related to reducing IP, and promoted a sense of belonging with fellow military medical students. Using SLT as our guide, our workshop discussed IP in a near-peer and peer-peer setting that facilitated safe conversations that attempted to normalize IP, which then led to a decreased sense of IP for a majority of students. The workshop reduced feelings of isolation and empowered students to recognize and mitigate IP both in themselves and others, which could contribute to a more resilient and cohesive learning environment. Future research may want to explore why CIPS scores increased for some students after the workshop.

GLOOMY FACES BEHIND THE WHITE COATS: DEPRESSION IN MEDICAL STUDENTS CALLS FOR ACTION

impostor phenomenon (IP) is defined as an experience where individuals attribute their success to chance or luck and not to their mastery of skills, which is commonly experienced within competitive environments such as medical school. Building on a prior study on IP during onboarding, the purpose of this study is to examine IP experiences throughout the pre-clerkship curriculum and provide insights into the possible evolution of IP during the initial 16 months of a military medical school. The study participants were second-year medical students at a military medical school who had previously participated in an initial IP study at the beginning of their first year of medical school. Researchers conducted semi-structured interviews in December 2023 to explore how students' experience with the IP changed after their pre-clerkship education, and qualitative thematic analysis was conducted. Scores from the Clance Impostor Phenomenon Scale (CIPS) during onboarding and at the end of the pre-clerkship period were compared. Researchers interviewed 21 of the original 29 matriculated military medical students who completed the initial study. Fifteen students (71.4%) reported frequent or intense IP experiences on the CIPS indicating that IP remained present in the study sample. Average CIPS scores from onboarding and end of pre-clerkship were 68.3 and 68.1, respectively, suggesting that the intensity of IP remained stable. Thematic analysis of interview transcripts identified 6 themes that influenced students' experience with IP: academic progress, military medical expectations, self-comparison, relationship dynamics and building relationships, extracurricular engagement and roles, and navigating uncertainty. Theme saturation was reached at n = 15. Although the intensity of IP remained relatively stable from onboarding to the end of pre-clerkship, the underlying themes driving IP evolved as students transitioned into active participation in undergraduate medical training. Similar to the initial IP study, situated learning theory continued to offer a valuable framework for understanding these shifts, particularly through relationships with peers and upperclassmen. Future research incorporating mixed methods could further clarify how qualitative shifts in IP correspond to variations in CIPS scores. As participants advance into clerkship rotations, we anticipate continued evolution in IP experiences, warranting further longitudinal exploration.

University of Cincinnati College of Medicine

Background: Impostor phenomenon is described as an "internal experience of intellectual fraudulence" among high achievers, which include medical students who often doubt their ability to become good doctors in the future. This study sought to determine the prevalence of impostor phenomenon among medical students and how impostorism is correlated with other psychological distresses namely anxiety, depression and low self-esteem.
 Methods: To conduct this cross-sectional study, various scales were distributed to all 4th-year medical students in Melaka-Manipal Medical College (MMMC), Muar campus to measure impostorism, depression, anxiety and self-esteem. Clance Impostor Phenomenon Scale (CIPS) was used to measure impostorism and a score of 62 was set as the cut off value to classify a participant as an "imposter".
 Results: Out of 300, 256 (85.3%) students completed the questionnaires. 48% and 44% of male and female students respectively scored as ‘impostors’ with no significant difference between the two genders. Positive correlations were noted between impostor phenomenon with low self-esteem (rho=0.56), depression (rho=0.42) and anxiety (rho=0.41). Impostors significantly have stronger intentions of quitting medical school (p < 0.001) and felt that they were not ready to cope with challenges during housemanship (p < 0.05).
 Conclusion: Impostors suffer greatly from psychological distress. They are not confident to face the future challenges of housemanship and have stronger intentions of quitting the course. It is necessary for medical colleges to acknowledge this feeling and help the students to cope with it to ensure a smooth transition from medical school to housemanship period.

Theory Impostor phenomenon (IP) is a widely recognized experience in which highly performing individuals do not internalize success. Self-doubt toward one’s ability or intelligence is unexpectedly common. Prior research has associated IP with medical student perceptions, burnout, and demographic characteristics. However, understanding how student IP experiences are related to actual academic achievement could help medical schools better support student performance and resilience. Hypotheses: The purpose of this research was to examine whether there is a relationship between medical students’ USMLE Step 1 scores and experiences of IP. Because medical students receive frequent, objective feedback on exam performance, we hypothesized that students with lower Step 1 scores would experience higher levels of IP. Methods: In 2019, all M1–M4 students at the University of Louisville were invited to complete Clance’s (1985) Impostor Phenomenon Scale (CIPS), a previously validated, 20-item, Likert-style scoring instrument designed to reflect respondents’ IP experience. We categorized subjects into one of four levels based on CIPS scoring guidelines. For students who had completed Step 1 at the time of the survey, we conducted a Welch’s ANOVA test to identify relationships between a student’s level of experienced IP and Step 1 scores. We also completed an item analysis comparing individual CIPS item responses with Step 1 performance. Results: Per the CIPS scoring guidelines, we categorized the 233 respondents as experiencing few (10.3%), moderate (47.6%), frequent (31.8%), or intense (10.3%) characteristics of IP. Nearly 90% of our sample experienced at least moderate levels of IP, with over 40% experiencing frequent or intense IP. There were no statistically significant differences among CIPS groups and mean Step 1 scores [F (3, 59.8) = 1.81, p = 0.155], and total/inter-quartile Step 1 score ranges broadly overlapped among all four IP experience levels. Within-item response patterns among high and low-scoring students also varied across individual CIPS items. Conclusions: The association between IP experience and Step 1 performance was nonlinear in our cross-sectional sample: the group having the most intense IP experiences did not have the lowest score rank on Step 1, nor did the group with the fewest IP characteristics make up our highest performing group. This, along with the broad dispersion of scores within each of the four IP levels, suggests that students’ internalization of achievement and feelings of IP are not consistently aligned with their actual performance on this assessment. Response variation on individual CIPS items suggest that underlying factors may drive variation in IP and performance. These results highlight the need for additional work to identify the constructs of IP that influence medical students specifically so that medical education stakeholders may better understand IP’s impact on other facets of medical school and implement the resources necessary to support individuals who experience IP.

Medical student distress and mental health needs are critical issues in undergraduate medical education. The imposter phenomenon (IP), defined as inappropriate feelings of inadequacy among high achievers is linked to psychological distress. We investigated the prevalence of IP among first-year medical school students and its association with personality measures that affect interpersonal relationships and well-being. Two hundred fifty-seven students at a large, urban, northeastern medical school completed the Clance Impostor Phenomenon Scale (CIPS), Jefferson Scale of Empathy, Self-Compassion Scale, and Zuckerman-Kuhlman Personality Questionnaire immediately before beginning their first year of medical school. At the end of their first year, 182 of these students again completed the CIPS. Eighty-seven percent of the entering students reported high or very high degrees of IP. Students with higher IP scores had significantly lower mean scores on self-compassion, sociability self-esteem (P<.0001 for all), and getting along with peers (P=.03). Lower IP scores were related to lower mean scores on neuroticism/anxiety and loneliness (P<.001 for both). Women obtained a higher mean IP score than men. IP scores at the end of the school year increased significantly compared with the beginning of the year (P<.001), both in frequency and intensity of IP. IP was common in matriculating first-year medical students and significantly increased at year's end. Higher IP scores were significantly associated with lower scores for self-compassion, sociability, self-esteem, and higher scores on neuroticism/anxiety.

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Introduction: “Imposter syndrome” or “Imposter Phenomenon” is not a mental disorder but is considered as a psychological pattern in which people doubt their accomplishments and is associated with certain poor psychological functioning like low self-esteem can be detrimental to medical students. Objective: To find out the prevalence of Imposter phenomenon as well as it association with self-esteem among the final year medical students. Methods: A cross sectional study was carried-out among 249 medical students of a private medical college in the U.T of Puducherry using Clance Imposter Phenomenon scale. Results: 58.2% and 41.8% of the participants were in Part-1 and part-2 of final year respectively. It was observed that every participant had some degree of Imposter phenomenon. Low self –esteem, was found among 12.85% of the study participants. In this study there was no association between the low self-esteem and Imposter Syndrome. Conclusion: It is very clear that the burden of Imposter syndrome is quite high among the medical students as the reasons are varied. Extensive research to elaborate these is the need of the hour, as this information helps in designing the preventive measures for the students who are the future of the nation and the foundation stones of progress.

Byline: R. Murthy, S. Khandelwal Historical Development of Mental Health Services During the last three centuries, there has been major shifts in the way mentally ill are viewed and cared for all over the world. The changes during the last 50 years are most significant. From a situation of considering the "mad" as "bad" and incarceration in jails and asylums, there is now recognition of the human rights of the mentally ill. From jails and asylums, the care of the mentally ill persons has moved to the community. Another important development is the care providers. Current approach to care in the community includes, besides psychiatrists, other mental-health professionals, primary-care doctors, family members, volunteers and the ill persons. The driving forces towards these changes have been many: the recognition of the wide range of mental disorders, the high prevalence of mental disorders in the community, the availability of a variety of interventions (pharmacological and nonpharmacological), the demonstration of the effectiveness. Human Resources for Health Care There is an international focus on human resources for health care. The theme of the World Health Report 2006 (WHR 2006) was Working Together for Health. The WHR 2006 begins with the following observation: "In this decade of the 21[sup] st century, immense advances in human well-being coexist with extreme deprivation. In global health we are witnessing the benefits of new medicines and technologies. But there are unprecedented reversals. Life expectancies have collapsed in some of the poorest countries to half the level of the richest - attributable to the ravages of HIV/AIDS in parts of sub-Saharan Africa and to more than a dozen "failed states". These setbacks have been accompanied by growing fears, in rich and poor countries alike, of new infectious threats such as SARS and avian influenza and "hidden" behavioural conditions such as mental disorders (emphasis added) and domestic violence ."(xv) (emphasis added). Further, the report states The ultimate goal of health workforce strategies is a delivery system that can guarantee universal access to health care and social protection to all citizens in every country. There is no global blueprint that describes how to get there - each nation must devise its own plan. Effective workforce strategies must be matched to a country's unique situation and based on social consensus (emphasis added). (p.119) The human resources for mental health care are grossly inadequate in the developing countries, as presented by the WHO Atlas document in 2005. In the Indian context, the development of appropriate human resources for health in general is receiving serious attention. For example, the setting up of the Public Health Foundation of India in 2006 is a good example of this concern. Both authors come from a background of community mental health and experience of training and working with primary health-care doctors. The effort is to present the "world" perspective (from the World Health Report, the World Psychiatric Association (WPA) guidelines, experiences of different countries) and identify some issues relevant to undergraduate education in India. World Health Report 2001 The World Health Report 2001 makes 10 overall recommendations. The first of this is "Provide treatment in primary care." The management and treatment of mental disorders in primary care is a fundamental step which enables the largest number of people to get easier and faster access to services. It is to be recognized that many are already seeking help at this level. This not only gives better care but also cuts wastage resulting from unnecessary investigations and inappropriate and nonspecific treatments. For this to happen, however, general health personnel need to be trained in the essential skills of mental health care. Such training ensures the best use of the available knowledge for the largest number of people and makes possible the immediate application of interventions. …

The impostor phenomenon (IP) was defined in 1978 as an "internal feeling of intellectual phoniness felt by people with outstanding academic and professional achievements."This study aims to estimate the prevalence and predictors of IP among medical students. A cross-sectional study was conducted from November 2022 to May 2023. A total of 200 medical students from years one to five participated in the survey; the response rate was 82.5% (165). A stratified random sampling technique was used to select groups of male and female Jouf University medical students from the 1st, 2nd, 3rd, 4th, and 5th batches of the 2022 to 2023 academic year. An e-mail with a self-administered questionnaire comprising the Clance IP scale and a consent form was sent to all participants. The identities of the students were kept anonymous to eliminate response bias. Participation was voluntary. Data were presented in terms of numbers and percentages; a chi-square test was used to compare categorical variables; and multivariable analysis was used to determine predictors of IP using SPSS Statistics version 20 (IBM Corp., Armonk, NY, USA). A total of 165 students responded to the questionnaire, with a response rate of 82.531%; 47.30% were males, and 86 (52.10%) were females. The findings indicate that 12 (7.3%), 83 (50.30%), 59 (35.80%), and 11 (6.70%) medical students, respectively, suffered from few, moderate, frequent, and intense imposter features. Results also showed that 13 (56.50%) first-year students suffered from moderate IP experiences, and 10 (43.50%) had frequent IP experiences. It was observed that for students in the first year, the academic performance represented by a student's grade point average (GPA), monthly family income, father's educational level, mother's educational level, and marital status are predictors of impostor experience. The study's findings show that impostor syndrome is a common problem among medical students and that being in the first year of medical school can increase the incidence of suffering from it. The problem-based learning system in medical school can contribute to impostor syndrome among medical students. Both low-achieving and high-achieving students suffer from impostorism.

<h3>Context:</h3> The SARS-CoV-2 pandemic disrupted education, contributing to poor mental health among medical students. Primary care providers provide critical roles for maintaining wellness and good mental health and may be one key to address mental health issues among medical students during periods of crises. <h3>Objective:</h3> Examine depressive symptoms and medical school communication among US medical students during the COVID-19 pandemic. <h3>Study Design:</h3> Online convenience sample. <h3>Setting:</h3> National population-based survey. <h3>Population studied:</h3> Participants enrolled in a US medical school during the 2019-2020 academic year and who completed the survey were included. A total of 212 surveys were included. <h3>Instrument:</h3> Online survey included the Center for Epidemiologic Studies Depression (CESD-10) 10-item scale. We also included items to examine communication between medical schools and students. <h3>Outcome Measures:</h3> Primary outcome was a dichotomized measure of the risk of developing depression, with a CESD-10 score of &lt;10 at average risk and a score ≥10 at risk of developing depression. Multivariable logistic regression was used to examine associations between communication methods during the pandemic and risk of depression after controlling for potential confounders. <h3>Results:</h3> We found 48.6% of medical students were at risk of developing depression. Of students reporting that their depressive symptoms became worse between Spring 2020 and Fall 2020, 75.7% were at risk of depression in December 2020 when the survey was administered. Most students reported communication with their medical schools during the pandemic occurred via e-mail, but more interpersonal communication, such as through remote townhall meetings, was desired. Students who agreed that faculty and administration were readily available for questions had lower odds for risk of developing depression. <h3>Conclusions:</h3> Primary care practitioners play an important role in medical school education and prevention of mental health problems in patients. As medical students are at high risk of developing depression, primary care practitioners and educators could play an important role in reaching out to medical students using interactive communication strategies to provide them with resources to improve mental health, particularly during stressful situations such as the pandemic.

Impostor phenomenon (IP) is an experience where an individual believes that their success was because of chance or luck and was not associated with the mastery of skills. There is a gap in the literature in understanding what role, if any, onboarding (e.g., orientation weeks) into a military medical school plays into student experiences with IP. For many, onboarding serves as the first exposure to the climate, culture, and learning environment of both medical school and the military. Prevention, or early intervention, of IP may reduce potential effects on a medical trainee's confidence and competence in their profession, which may ultimately enhance health care team performance and impact patient outcomes. This study explores if and why military medical students experience IP during a 2-week-long orientation into a military medical school. The study participants were medical students at a military medical school. Researchers conducted semi-structured interviews in August 2022 to explore if and why students experienced IP and deployed the Clance IP Scale as a measure with validity evidence for ascertaining the presence and magnitude of IP. Researchers calculated total scores from the Clance IP Scale and thematically analyzed interview transcripts. Researchers interviewed 29 matriculating military medical students. Twenty-one (75%) students reported frequent or intense IP experiences on the Clance IP Scale indicating that IP was present in our study sample. Thematic analysis identified six themes that drove one's experience with IP: reevaluation of merit, individualized diversity and inclusion experiences, administrative and financial support, preconceived expectations, building relationships, and new community roles. Our identified themes provide us with a better understanding of if and why military medical students experience IP during onboarding. Our findings are also consistent with the situated learning theory, which places emphasis on the sense of belonging and may provide a unique and insightful lens through which IP can be further explored and studied, particularly at a military medical school where various identities, dynamics, and aspirations can converge simultaneously. Additionally, our findings suggest that existing practices may benefit from a number of improvements including, but not limited to, tailoring onboarding activities to entail more reflective discussion using small groups, especially for topics related to diversity and inclusion, revisiting areas where students may feel inadequately prepared to transition and perform well in a medical school, reevaluating administrative and financial support that can be roadblocks to a student's transition into the new environment and removing these barriers, and ensuring cultural coherence (organizational alignment of vision and mission) among faculty, staff, and upperclassmen. Future research directions include better understanding how developing single or multiple, identities can impact a medical students' experience with IP during onboarding, pre-clerkship, clerkship, or post-clerkship period, if at all.

Background: Imposter phenomenon (IP) is an internal experience of intellectual phoniness that those who feel fraudulence and worthlessness have in spite of outstanding academic or professional accomplishment. It is desirable for Medical students and interns to have high self-esteem and low impostor characteristics in order to become successful medical practitioners. This study was carried out among the medical interns of a tertiary care medical college, to determine the prevalence of Impostor Phenomenon and its association with self-esteem.Methods: The present cross-sectional study was conducted among 150 medical interns. Clance’s impostor phenomenon scale and Rosenberg self-esteem scale were used to assess Impostor characteristics and self-esteem respectively. Data was collected using online survey method.Results: The majority (44.7%) of study participants had moderate IP characteristics, followed by 41.3% with high IP characteristics. Hours of sleep was found to be significantly associated with IP characteristics (p value&lt;0.001). Self-esteem was found to be significantly and inversely correlated with age (r=-0.222), and positively correlated with hours of sleep (r=0.225). Impostor phenomenon and self-esteem were found to be moderately and inversely correlated (r=-0.519).Conclusions: A large number of medical interns were found to have high impostor phenomenon characteristics and low self-esteem. Impostor characteristics were found to be significantly associated with sleep, suggesting a relationship between feelings of fraudulence and skewed sleep patterns. A significant negative correlation between self-esteem and impostor phenomenon suggests that individuals with stronger IP characteristics had lower self-esteem, and vice versa. Low impostor phenomenon characteristics and high self-esteem are favourable for efficient medical practice. Measures to increase level of confidence and self-esteem among medical students and interns should be implemented.

IntroductionBurnout in medical students is extensive and a critical issue. It is associated with increased rates of depression, suicide, and poor perception of the educational environment. Enhancing resilience, the ability to adapt well in the face of adversity, is a potential tool to mitigate burnout and improve medical student wellness.MethodsOur resilience curriculum consisted of facilitated workshops to cultivate resilience in medical students during their core clerkship rotations. This curriculum served as an introduction to the concept of resilience and taught skills to cultivate resilience and promote wellness. The sessions allowed for identification of and reflection on stressors in the clinical learning environment, including straining team dynamics, disappointment, and uncertainty. Educational sessions included resilience skill-building exercises for managing expectations, letting go of negative emotions, dealing with setbacks, and finding meaning in daily work. Associated materials included lesson plans for small-group facilitators, learner pre- and postcurriculum surveys, and a social media activity guide.ResultsThis curriculum was delivered to 144 clerkship students at two academic institutions over the 2017–2018 academic year. Sessions were well received by medical students, with the majority of students stating that the sessions should continue. The majority of attendees found the sessions valuable and learned new ways to approach challenges.DiscussionStudents valued connecting with peers and feeling less alone through their participation. A challenge was constructing a setting conducive to comfortable reflection for all learners. Not all students found these sessions necessary. Sessions may have improved resilience levels.