"Rising to the Level of Your Incompetence": What Physicians' Self-Assessment of Their Performance Reveals About the Imposter Syndrome in Medicine

Impostorism: An evolutionary concept analysis

AIM

The aim of this study was to explore the concept of impostorism as applied to nursing and other disciplines.

BACKGROUND

Impostorism has not been well defined or studied in nursing. Researchers have not studied connections between role transition stress of new graduates and impostorism, despite evidence that nursing students experience impostorism during undergraduate studies.

DESIGN

Rodgers' evolutionary concept analysis was the method used in this study.

DATA SOURCES

The databases used were Academic Search Complete, Cumulative Index to Nursing and Allied Health Literature, Health and Psychosocial Instruments, Health Source: Nursing/Academic Edition, Medical Literature Analysis and Retrieval System Online, PsycARTICLES, Psychology and Behavioral Sciences Collection, PsycINFO, SocINDEX, and Dissertations and Theses databases.

REVIEW METHODS

All nursing-specific citations were included in the literature sample. Of the remaining non-nursing citations, stratified random sampling provided 28 non-nursing citations. An additional purposive sampling of seminal impostorism publications resulted in 46 resources for analysis.

RESULTS

Concept analysis revealed that key attributes of impostorism include fear of failure and difficulty accepting praise. Impostorism antecedents relate to personality, attribution, family, workplace, and sociodemographic variables. According to concept analysis, a conceptual definition emerges of impostorism as a subjective, inaccurate self-assessment involving feelings of intellectual and professional incompetence and fraudulence despite external evidence of success.

CONCLUSION

Impostorism has undergone evolutionary changes in various disciplines. However, the nursing discipline needs more research related to nurses' experiences with impostorism in the workplace.

Tackling the imposter phenomenon to advance women in neurology

Recent literature documents that women comprise an increasing proportion of the neurology workforce but still lag behind male counterparts in publications and promotion. There are many reasons for gender disparities in neurology including family responsibilities, different career goals, lack of mentorship, cultural stereotypes, lack of institutional funding, biases, and professional isolation. Another contributing factor receiving relatively little recognition is the imposter phenomenon. This review highlights recent literature on gender differences in neurology, the definition of the imposter phenomenon, and research on the imposter phenomenon in academic medicine. Approaches for managing the imposter phenomenon are described including personal, mentoring, and institutional strategies. Further research is needed to understand the frequency of the imposter phenomenon at different levels of seniority and optimal strategies for prevention and management.

Striving While Accepting: Exploring the Relationship Between Identity and Implicit Bias Recognition and Management

PURPOSE

Implicit biases worsen outcomes for underserved and marginalized populations. Once health professionals are made aware of their implicit biases, a process ensues where they must reconcile this information with their personal and professional identities. The authors sought to explore how identity influences the process of implicit bias recognition and management.

METHOD

Using constructivist grounded theory, the authors recruited 11 faculty and 10 resident participants working at an academic health science center in Canada. Interviews took place from June to October 2017. Participants took an online version of the mental illness implicit association test (IAT) which provides users with their degree of implicit dangerousness bias toward individuals with either physical or mental illness. Once they completed the IAT, participants were invited to draw a rich picture and interviewed about their picture and experience of taking their IAT. Data were analyzed using constant comparative procedures to develop focused codes and work toward the development of a deeper understanding of relationships among themes.

RESULTS

Once implicit biases were brought into conscious awareness, participants acknowledged vulnerabilities which provoked tension between their personal and professional identities. Participants suggested that they reconcile these tensions through a process described as striving for the ideal while accepting the actual. Relationships were central to the process; however, residents and faculty viewed the role of relationships differently.

CONCLUSIONS

Striving for self-improvement while accepting individual shortcomings may provide a model for addressing implicit bias among health professionals, and relational dynamics appear to influence the process of recognizing and managing biases.

Shifting and Sharing: Academic Physicians' Strategies for Navigating Underperformance and Failure

PURPOSE

Medical practice is uncertain and complex. Consequently, even outstanding performers will inevitably experience moments of underperformance and failure. Coping relies on insight and resilience. However, how physicians develop and use these skills to navigate struggle remains underexplored. A better understanding may reveal strategies to support both struggling learners and stressed practitioners.

METHOD

In 2015, 28 academic physicians were interviewed about their experiences with underperformance or failure. Constructivist grounded theory informed data collection and analysis.

RESULTS

Participants' experiences with struggle ranged from patient errors and academic failures to frequent, smaller moments of interpersonal conflict and work-life imbalance. To buffer impact, participants sometimes shifted their focus to an aspect of their identity where they felt successful. Additionally, although participants perceived that insight develops by acknowledging and reflecting on error, they sometimes deflected blame for performance gaps. More often, participants seemed to accept personal responsibility while simultaneously sharing accountability for underperformance or failure with external forces. Paradoxically, participants perceived learners who used these strategies as lacking in insight.

CONCLUSIONS

Participants demonstrated the protective and functional value of distributing responsibility for underperformance and failure. Shifting and sharing may be an element of reflection and resilience; recognizing external factors may provide a way to gain perspective and to preserve the self. However, this strategy challenges educators' assumptions that learners who deflect are avoiding personal responsibility. The authors' findings raise questions about what it means to be resilient, and how assumptions about learners' responses to failure may affect strategies to support underperforming learners.

Evaluation Apprehension and Impression Management in Clinical Medical Education

Historically, clinical medical education has relied on subjective evaluations of students and residents to judge their clinical competence. The uncertainty associated with these subjective clinical evaluations has produced evaluation apprehension among learners and attempts to manage one's professional persona (impression management) among peers and supervisors. Such behavior has been documented from antiquity through the Middle Ages to the present, including in two new qualitative studies in this issue of Academic Medicine on the social psychology of clinical medical education. New approaches to medical education, including competency-based education, mastery learning, and assessment methods that unite evaluation and education, are slowly changing the culture of clinical medical education. The author of this Invited Commentary argues that this shift will bring greater transparency and accountability to clinical medical education and gradually reduce evaluation apprehension and the impression management motives it produces.