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

Translation and psychometric evaluation of the Clance impostor phenomenon scale in Arabic-speaking individuals: Study of validity and reliability

BACKGROUND

Imposter Syndrome (IS), or Imposter Phenomenon (IP), is marked by persistent self-doubt and fear of being exposed as a fraud despite success. It's prevalent in high-achieving fields like medicine and is linked to anxiety and perfectionism. The Clance Imposter Phenomenon Scale (CIPS) is the most common assessment tool. This study aims to translate and validate an Arabic version of CIPS for Arabic-speaking populations.

METHODS

This cross-sectional study was conducted at King Saud University, Riyadh, from August to September 2024, using a convenient sampling method. The survey gathered demographic details and included the Arabic version of the CIPS, the General Self-Esteem Scale (GSES), and The Big Three Perfectionism Scale (BTPS). Data were analyzed using IBM SPSS 22 (p < 0.05). Construct validity was assessed through Exploratory and Confirmatory Factor Analysis. Internal consistency (Cronbach's alpha ≥0.7), test-retest reliability (ICC >0.75), and discriminant validity were evaluated. Concurrent validity was examined using structural equation modelling and Pearson's correlation with GSES and BTPS.

RESULTS

A total of 477 participants (66.5 % female, mean age 21.1 ± 2.0 years) completed the questionnaire. The Arabic CIPS demonstrated a three-factor structure in exploratory factor analysis (KMO = 0.936, Bartlett's test p < 0.001), with confirmatory factor analysis supporting good model fit (CFI = 0.87, RMSEA = 0.07). Internal consistency was excellent (Cronbach's α = 0.90), and test-retest reliability was acceptable (ICC = 0.71). Discriminant validity was supported by significant score differences across quartiles. CIPS correlated negatively with general self-efficacy (r = -0.39, p = 0.001) and positively with self-critical perfectionism (r = 0.68, p = 0.001) and rigid perfectionism (r = 0.46, p = 0.001), confirming its construct validity.

CONCLUSION

The Arabic CIPS is valid and reliable for use among medical and non-medical populations.

From understanding to embracing: A guide on emotions in medical education research: AMEE Guide No. 184

Emotions refer to conscious and subjectively experienced mental reactions that are often associated with physiological and behavioral changes. In the context of medical education research, emotions have a pervasive influence on how various types of information are perceived and processed, and therefore, can influence how research is designed, conducted, and implemented. While there is considerable research on how emotions affect learning, there is little guidance for researchers on how to recognize and potentially leverage emotions while conducting and disseminating medical education research. Emotions can be potentially beneficial for fostering a stronger connection to research, increasing motivation to conduct sensitive research, and enhancing reflexivity and rigor. In this guide, the authors describe how emotions may influence medical education research while assisting researchers on how to recognize and manage emotions during the research process. This guide builds upon existing research to provide a framework for emotional reflexivity in the context of medical education research.

The impostor phenomenon among surgeons and surgeons in training: a scoping review

BACKGROUND

The impostor phenomenon (IP), is a condition in which people think they are incapable of success and tend to attribute their success to external causes such as luck, error, or knowing the appropriate individuals. It has been confirmed as a contributor to burnout for practicing physicians, residents, and medical students. The purpose of this scoping review is to describe the prevalence and scope of IP among surgeons and surgeons in training, in order to determine gaps that can be addressed in future research.

METHODS

Searches were conducted in the following databases: Embase, PubMed, Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane Library, Web of Science, PsycINFO, Google Scholar, and ProQuest from inception to 30 June 2024. Two investigators independently assessed the articles based on the inclusion and exclusion criteria. All titles and abstracts meeting the inclusion criteria were carefully reviewed for the full text. The individual screening results were compared, and any discrepancies were discussed with a third investigator and a final consensus for further analysis.

RESULTS

The Clance Impostor Phenomenon Scale (CIPS) was used to assess the prevalence in the included studies. The prevalence of IP among surgeons and surgeons in training ranged from 27.5 to 100%. Women were more prone to suffer from IP when compared to their male counterparts. Most literature also showed that female surgeons reported statistically higher in IP scores than males. Level of education and academic achievements were also associated with IP.

CONCLUSIONS

This scoping review identified the published literature on IP among surgeons and surgeons in training and focused on the existing research objects to discover the gaps in the current research. Future directions may focus on early interventions aimed at identifying and managing IP.

Investigating feelings of imposterism in first-year medical student narratives

INTRODUCTION

Imposter phenomenon (IP), feeling as if a person does not belong, has been reported in medical students at various rates. In medical literature, this phenomenon has often been defined as a 'syndrome', but other studies have described it as a dynamic experience that can have various impacts on different people at different time points. Although studies have linked IP with other phenomena such as burnout in residents and physicians, no studies have examined its aetiology nor how these feelings are experienced by medical students.

METHODS

With the use of social identity theory as a framework, the authors analysed 233 reflective essays for elements of IP across eight cohorts of medical students from two institutions. Students responded to a prompt that asked: 'What was one part of your identity that you thought you would have to change in order to become a physician?' Included reflections were analysed using the framework method.

RESULTS

Elements of IP were identified in 121 reflections (52%) and were categorised into three major themes: (1) Comparing oneself to an idealised image of a medical student, (2) Comparing oneself to an idealised image of a physician and (3) Concerns about presentation of self to others. Each theme contained two or more sub-themes. Commonly, students discussed how their own personality traits, experiences, backgrounds and identities cast doubt on their sense of belonging in medicine.

DISCUSSION

The results of this study were consistent across both institutions, suggesting that imposter feelings are common among all first-year medical students. However, the extent of the impact of these feelings on their identity formation depends on the individual lived experiences of students and the context in which these feelings arise. Encouraging reflective journaling and sharing of stories from all stages of education can normalise imposter feelings during the development of the professional identity as a physician.

Self-Reported Medical Errors and Primary Care Physicians' Performance and Confidence in Delivering Care: A Multilevel Empirical Study in China

Background/Objectives: Patient safety is fundamental to primary healthcare, and medical errors impose a considerable burden on patients globally. However, the impact of medical errors on primary healthcare physicians remains understudied, especially in developing countries. This study aimed to examine the associations between self-reported medical errors and physicians' performance and confidence in Chinese primary care practice. Methods: A cross-sectional survey was conducted from November 2021 to May 2022 with 224 primary care physicians from 38 community health centers (CHCs) across four large cities in China. The quality of clinical and preventative care, and confidence in managing commonly occurring diseases, multimorbidity, and common mental health disorders served as indicators of performance and confidence, respectively. Hierarchical linear regression and linear regression with cluster-robust standard errors were employed. Results: Clinical care quality (β = -0.159, SE = 0.075, p < 0.05), preventive care quality (β = -0.165, SE = 0.068, p < 0.05), confidence in managing multimorbidity (β = -0.175, SE = 0.074, p < 0.05), and confidence in managing common mental health disorders (β = -0.189, SE = 0.076, p < 0.05) were negatively associated with self-reported medical errors, with scores of 4.08 (SD 0.95), 3.59 (SD 0.87), 3.63 (SD 1.04), and 3.10 (SD 1.21) out of 5 (where 5 represents the best possible score), respectively. The association between self-reported medical errors and confidence in managing commonly occurring diseases (β = -0.063, SE = 0.075, p > 0.05) was not statistically significant, with a score of 3.81 (SD 1.00) out of 5 (where 5 represents the best possible score). Conclusions: This study offers new insight into the associations between self-reported medical errors and primary healthcare physicians' performance and confidence. It is crucial for CHCs to be aware of the impact of self-reported medical errors on physicians' performance in delivering clinic and preventative care, and confidence in managing multimorbidity and common mental health disorders. Strategies such as strengthening organizational support should be developed to maintain performance and rebuild confidence in delivering care for physicians who were involved in medical errors.

Navigating Uncharted Territory: A Qualitative Analysis of Challenges and Advantages Experienced by Early Career Medical Educators

With the growing demand for medical educators, it is increasingly important that institutions implement practices to recruit, retain, and promote the well-being of early career medical educators (ECMEs). However, the specific needs of this group remain somewhat unclear. The current study aimed to address this gap by utilizing qualitative analysis to identify challenges and advantages associated with ECME status. An anonymous, voluntary survey was administered on forums of professional societies for medical education and on social media platforms, and emailed to professional societies. The survey collected demographic information and qualitative data regarding ECMEs' experiences. Data were collected from 39 participants who met the ECME criteria of having less than or equal to 10 years of teaching experience since obtaining a terminal degree. Thematic analysis revealed that the challenges of early career faculty were difficulty balancing responsibilities, lack of research and educational support, perceived inadequacies as a faculty member, and development of workplace friendships. The advantages were the ability to understand students, possessing specific knowledge and skills, and the ability to innovate. ECME professional development needs focused on development of skills, networking, and support. In conclusion, ECMEs encounter similar struggles faced by all medical educators; however, they have the least amount of experience navigating the hurdles of academia. To aid ECMEs, institutions and departments can focus on the implementation of meaningful professional development opportunities, support systems, and encouraging ECMEs' strengths.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-024-02205-7.

Surgeon's imposter syndrome: a systematic review

INTRODUCTION

Imposter syndrome (IS) refers to the psychological experience of imagining that one's achievements do not originate from one's own authentic competence. Surgeons are constantly faced with life-threatening decisions and can easily feel inadequate or insecure despite their years of training and experience. Imposter syndrome can distress surgeons at all career stages and has profound psychological and professional consequences. We aimed to review imposter syndrome in surgeons.

METHODS

A systematic search was performed in compliance with The PRISMA checklist. Search was performed in the PubMed and ScienceDirect databases. We included articles about IS in surgeons. We excluded narrative articles, commentaries and studies involving medical students or other specialties. Citations were quality assessed by MERSQI and evidence graded (GRADE). Risk of bias was assessed among the included citations.

RESULTS

The search revealed 695 citations, from which a final list of 12 was compiled after applying the inclusion and exclusion criteria. Participants included trainees and consultant surgeons across various surgical specialties. The following research questions were answered: Are surgeons with IS predisposed to mental or physical challenges? Do surgeons experience gender differences in IS? Can the feeling of IS be reduced?

CONCLUSION

There is a high prevalence of imposter syndrome among surgeons. Surgeons with IS are predisposed to experience mental or physical challenges. Female surgeons experience IS more frequently than their male counterparts. Feelings of IS can decline with increasing age but also with other included methods. Risks and multiple preventative measures were explored. The key to reducing IS is to train oneself to discern fact from fiction, thereby undermining distorted thoughts that perpetuate feelings of being an imposter.

Gender Differences in Self-Assessment Among Clerkship Medical Students Despite Equivalent Academic and Clinical Performance

OBJECTIVE

The authors aimed to determine if medical students' self-assessment of abilities and performance differed by gender during the psychiatry clerkship and if these differences were reflected objectively in test scores or clinical evaluations from educators.

METHODS

Data from mid-clerkship self-assessments completed during the psychiatry core clerkship were reviewed from two classes of medical students. Students rated their performance on 14 items across five domains: knowledge/clinical reasoning, differential diagnosis, data presentation, studying skills, and teamwork as "below," "at," or "above expected level." Ratings were coded numerically, and statistical analysis was performed using Student's T-test. National Board of Medical Examiners (NBME) Subject Exam scores and clinical evaluations served as measures of actual performance.

RESULTS

Female students (n = 123) rated their performance significantly below male peers (n = 114) in medical knowledge (female - 0.05 vs male 0.13), clinical reasoning (- 0.02 vs 0.06), differential diagnosis (- 0.09 vs 0.00), balancing work and studying (- 0.02 vs 0.11), keeping up with clerkship assignments (0.03 vs 0.13), understanding role on the team (0.11 vs 0.23), interacting with other team members (0.15 vs 0.31), and functioning as part of the team (0.13 vs 0.25). Clinical evaluation scores and NBME Subject Exam scores showed no significant difference (evaluation scores 138.1 vs 136.0; NBME scores 163.8 vs 162.2) in performance between students.

CONCLUSIONS

Female medical students tend to underrate their performance compared to male peers in clinical knowledge, studying skills, and teamwork, despite equivalent academic and clinical performance. This study highlights gender disparities in self-assessment during medical training.

Caring for patients with substance use disorders: a qualitative investigation of difficulties encountered by hospital-based clinicians

Background: Caring for patients with substance use disorders (SUD) is held in low regard and many clinicians resist treating them. To address this situation, numerous research projects assessed training program gaps and professional attitudes. In contrast, this study explored the actual clinical difficulties that a variety of hospital-based professionals encounter when treating patients with SUD. Methods: Qualitative multiple method design including: (1) individual semi-structured interviews with SUD experts and educators; (2) video-elicited, cross self-confrontation interviews with clinicians working in a specialist addiction unit; (3) paired semi-structured interviews with clinicians working in non-specialist units. Participants were recruited within one university hospital. Data collected at stages (1) and (3) relied on an interview guide and were analyzed using conventional content analyses. Data collected at stage (2) consisted of discussions of video recorded clinical interviews and were analyzed based on a participatory approach. Results: Twenty-three clinicians from seven hospital units participated. Forty-four difficulties were reported that we classified into six categories: knowledge-based; moral; technical; relational; identity-related; institutional. We identified seven cross-category themes as key features of SUD clinical complexity: exacerbation of patient characteristics; multiplication of medical issues; hybridity and specificity of medical discipline; experiences of stalemate, adversity, and role reversal. Conclusions: Our study, providing a comprehensive analysis of the difficulties of caring for patients with SUD, reveals a highly challenging clinical practice for a diversity of healthcare providers. They represent a complementary approach to addressing resistance as an important feature of a complex clinical system, and valuable material to discussing professional preparedness.

The Prevalence of Impostor Phenomenon in Medical Students in Slovenia: Effects of Gender, Year of Study, and Clinical Work Experience

Phenomenon: Impostor syndrome (IS) is manifested in the fear of failing and being exposed as incompetent, despite exceptional professional performance. IS has been recognized in many professions, including medicine. Understanding IS prevalence and risk factors is critical to ensure the well-being of medical students and, by extension, future physicians. Approach: It was expected that IS is highly prevalent in medical students, higher in women and associated with year of study and prior clinical experience. The Clance Impostors Phenomenon Scale (CIPS) was used to collect the responses from of medical students in May 2023. Questionnaires were distributed online to both public medical faculties in Slovenia. Findings: 207 medical students (157 women, 50 men; mean age: 23.2 ± 2.6 years) completed the questionnaire (response rate = 13.1%). Women exhibited higher CIPS scores (66.0 ± 13.9) compared to men (58.8 ± 15.1) (p = 0.005). Neither age (r = 0.05; p = 0.464) nor year of study (r = 0.03; p = 0.653) was correlated with CIPS score. There were also no differences in CIPS score between students with (63.4 ± 15.2) and without (64.7 ± 13.9) prior clinical work experience (p = 0.531). Insights: The results of the present study suggest that IS can occur at any stage of medical education, with a slightly higher prevalence in women. This study contributes to the understanding of IS among medical students and calls for addressing environmental factors and taking supportive measures to mitigate the impact of IS and promote medical students' well-being and success.

Analysis of the relationship between medical achievement self-efficacy perception and impostor phenomenon in the postgraduate education process: a cross-sectional study

BACKGROUND

This study aimed to assess the correlation between the impostor phenomenon and the level of academic self-efficacy. The secondary aim was to determine the sociodemographic variables affecting these two conditions. Based on the acquired findings, it is possible to take supportive and preventive measures.

METHODS

This descriptive study was carried out at the xxx University Faculty of Medicine. A total of 1133 residents were invited to participate in the study. Participants completed a range of scales, including the Medical Achievement Self-Efficacy Scale (MASS) and the Clance Impostor Phenomenon Scale (CIPS). The data were collected by using Google Forms. The response rate was 23.04% (n = 261).

RESULTS

The age and gender did not significantly correlate with the MASS or the CIPS scores. The participants were divided into five groups at 12-month intervals according to the time completed in their departments. The median CIPS score of the 0-12 month group was 62 (Q1:53,Q3:70), and the median MASS score was 55 (Q1:44,Q3:67). A significant correlation was found between the time spent in the department and the CIPS score and the MASS score (p < 0.001 and p < 0.001, respectively). A strong negative correlation was detected between the impostor level and the MASS score (R= -0.738, p < 0.001). CIPS scores showed a moderately significant relationship with the MASS scores in multivariable regression analyses (adjusted R2 = 0.585 p < 0.001, standardized B= -0.668).

CONCLUSIONS

There is a strong relationship between academic self-efficacy and the impostor phenomenon (IP). Residents in the early stages of their academic careers feel a strong sense of IP, while they perceive a low sense of self-efficacy. The lack of needed competencies can explain the main reason for this. The present study found that as the level of IP increases, academic self-efficacy perception decreases, and there is a strong negative correlation between them. Individuals with positive core self-evaluation will have low levels of IP and high academic self-efficacy because they see themselves as sufficient and valuable. As in the results of the current study, the increase in academic experience will lead to an increase in self-efficacy perception and a decrease in IP.

Training technical or non-technical skills: an arbitrary distinction? A scoping review

INTRODUCTION

Medical education often aims to improve either technical skills (TS) or 'non-technical skills' (NTS) and how these skills influence adverse events and patient safety. The two skill sets are often investigated independently, and little is known about how TS and NTS influence each other. In this scoping review, we therefore aim to investigate the association between TS and NTS.

METHOD

We conducted a scoping review of four databases in order to summarize, analyse, and collate findings from the included studies.

RESULTS

In total, 203 of 2676 identified studies were included in the final analysis. The first study was published in 1991, but the majority of studies were published in the last decade. The majority were intervention studies including 41 randomized controlled trials. The the objective structured assessment of technical skills (OSATS) was the most common assessment tool with strong validity evidence within TS, but many variations without validity evidence were used. Conversely, Non-Technical Skills for Surgeons (NOTSS) was the most used tool with strong validity evidence for assessing NTS. However, the majority of studies used non-validated self-assessment tools to investigate NTS. The correlation between TS and NTS was assessed in 46 of 203 studies, whereof 40 found a positive correlation.

DISCUSSION

Our findings echo previous literature suggesting that empirical literature investigating the interaction between TS and NTS lack methodological depth. In this review only a minority of the identified studies (n = 46) investigated this correlation. However, the results strongly indicate a correlation between TS and NTS skills, suggesting that physicians who are proficient in their NTS, also perform well on their TS. Thus, the distinction between them in learning designs may seem arbitrary. While this result is promising, the limited methodological rigour indicates a lack of proper understanding of NTS and how to properly assess them.

Revisiting the conceptualisation and implications of medicine's 'hidden curriculum'

In medical training and practice, our professional attributes, attitudes, perceptions, character traits and identities are fundamentally shaped by our lived experiences and observations in clinical and para-clinical settings instead of being inculcated through formal curriculum or classroom teaching. For instance, clinical acumen, communication skills and bedside manners are learnt through role modelling and experiential learning in the course of clinical rotations. Likewise, one's attitudes, professional behaviours and inclinations are often also influenced by direct/indirect observations of the actions of others in the medical fraternity in various clinical and non-clinical settings. This is also what is often termed as the 'hidden curriculum' of medicine. In this article, we sought to provide a practical conceptualisation of the hidden curriculum in medical training, which we describe as lived experiences and personal observations of medical trainees and residents in clinical and para-clinical spaces, which shape their perceptions of the medical profession (vocational identity and purpose), patients (patient-physician relationship) and colleagues (intra- and inter-professional relationships), with downstream implications on physician well-being and clinical decision-making. Although this idea of a 'hidden curriculum' has conventionally carried predominantly negative connotations in medical literature, we suggest that it is an inevitable part of medical education and practice, which, through deliberate regulation, can potentially be shaped to create more positive and meaningful effects in the professional development of medical trainees.

Making the transition from medical student to junior doctor

The transition between medical students and junior doctors is known to be a notoriously challenging period of time, contributed by heavy clinical responsibilities, steep learning curves, poor working conditions and various psychological stressors. In addition, there is often a significant lack of support at the organisational or health systems level for fledgling junior physicians in their transition to work life. In this article, I hope to offer several important guiding principles from the perspectives of a medical resident-in-training that I hope will be useful for graduating medical students to ease their transition into the foundational year of practice, such that they can optimise their training and work experience within what is in their control and maintain a sense of purpose even in difficult times.

The effectiveness of online educational interventions on impostor syndrome and burnout among medical trainees: a systematic review

BACKGROUND

Impostor syndrome and burnout are highly prevalent among medical students and trainees, significantly impacting their mental health and professional development. The advent of online educational interventions provides a promising solution, offering accessibility and flexibility to tackle these issues. This systematic review aims to evaluate the effectiveness of online educational interventions in alleviating impostor syndrome and burnout among medical learners.

METHODS

A comprehensive literature search was conducted across PubMed, Cochrane Library, Embase, Scopus and PsycInfo, identifying relevant studies published up to March 2024. Studies focusing on online interventions targeting impostor syndrome and burnout among medical students, residents, and fellows were included, and their quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI).

RESULTS

Among the screened studies, six met our inclusion criteria, comprising four randomized controlled trials, one qualitative study, and one mixed-methods study. Their mean MERSQI score was 14.67 (SD 1.23), indicating a high methodological quality. The interventions adopted in these studies varied, including group coaching sessions, workshops, and provision of educational resources. Notably, two randomized trials demonstrated significant reductions in impostor syndrome symptoms after online interventions, compared with the control groups. On the other hand, results for burnout outcomes were equivocal, with some studies reporting improved emotional exhaustion scores and decreased burnout risk, while others found no significant differences.

CONCLUSIONS

Current evidence suggests that structured online educational interventions, particularly those incorporating coaching and cognitive reframing strategies, can effectively reduce impostor syndrome among medical trainees. However, the impact on burnout remains inconclusive. Further research is needed to optimize online program components and implementation strategies to comprehensively address both impostor syndrome and burnout in this population.

CLINICAL TRIAL NUMBER

As this is a systematic review rather than a clinical trial, no clinical trial number is applicable. Nonetheless, this systematic review has been prospectively registered with PROSPERO (registration number: CRD42024541034), in line with best practice recommendations for systematic reviews.

Workforce Diversity and Equity Among Critical Care Physicians

Health disparities persist among minoritized populations. A diverse clinician workforce may help address these disparities and improve patient outcomes; however, diversity in the critical are workforce (particularly among women and those historically underrepresented in medicine (URiM)) is lacking. This review describes factors contributing to low respresentation of women and URiM in critical care medicine, and proposes strategies to overcome those barriers.

Finding Themselves, Their Place, Their Way: Uncertainties Identified by Medical Students

Phenomenon: Navigating uncertainty is a core skill when practicing medicine. Increasingly, the need to better prepare medical students for uncertainty has been recognized. Our current understanding of medical students' perspectives on uncertainty is primarily based on quantitative studies with limited qualitative research having been performed to date. We need to know from where and how sources of uncertainty can arise so that educators can better support medical students learning to respond to uncertainty. This research's aim was to describe the sources of uncertainty that medical students identify in their education. Approach: Informed by our previously published framework of clinical uncertainty, we designed and distributed a survey to second, fourth-, and sixth-year medical students at the University of Otago, Aotearoa New Zealand. Between February and May 2019, 716 medical students were invited to identify sources of uncertainty encountered in their education to date. We used reflexive thematic analysis to analyze responses. Findings: Four-hundred-sixty-five participants completed the survey (65% response rate). We identified three major sources of uncertainty: insecurities, role confusion, and navigating learning environments. Insecurities related to students' doubts about knowledge and capabilities, which were magnified by comparing themselves to peers. Role confusion impacted upon students' ability to learn, meet the expectations of others, and contribute to patient care. Navigating the educational, social, and cultural features of clinical and non-clinical learning environments resulted in uncertainty as students faced new environments, hierarchies, and identified challenges with speaking up. Insights: This study provides an in-depth understanding of the wide range of sources of medical students' uncertainties, encompassing how they see themselves, their roles, and their interactions with their learning environments. These results enhance our theoretical understanding of the complexity of uncertainty in medical education. Insights from this research can be applied by educators to better support students develop the skills to respond to a core element of medical practice.

High Impostors Are More Hesitant to Ask for Help

Help-seeking behavior requires both components of metacognition-monitoring (being aware of the need for help) and control (initiating the help-seeking action). Difficulties in initiating help-seeking, therefore, can be indicative of a metacognitive breakdown, for instance, when a student believes that a gap in knowledge is something to hide. To explore the relationship between knowing that one needs help and actually seeking it, we examined the potential influences of impostorism, which refers to the feeling of being a "fraud", despite one's objective accomplishments. Participants were asked to solve math reasoning and verbal reasoning insight problems, while also being given a "help" button that could be pressed at any time in order to get the solution. Results showed that, overall, students were more likely to ask for help with math than verbal reasoning problems-help also correlated with boosted performance. There was also a slight indication that individuals who scored relatively high on impostorism were numerically less likely to seek help and waited longer to do so for the math problems. Our findings suggest that a fear of being exposed as an impostor may hinder one's help-seeking behaviors, especially in more challenging subjects, such as math.

Impostor Phenomenon and Impact on Women Surgeons: A Canadian Cross-Sectional Survey

BACKGROUND

This project aims to characterize the extent and nature of impostor phenomenon (IP) among women surgeons in Canada. IP is well documented among medical professionals and trainees. It is known to have significant impacts on mental health and career trajectory.

STUDY DESIGN

We conducted a cross-sectional survey of self-identifying women who have completed a surgical residency and currently or most recently practiced in Canada.

RESULTS

Among 387 respondents, 98.7% have experienced IP. Median IP score corresponded to frequent impostor feelings or high impostorism. Self-doubt affects most women surgeons for the first time during training. It tends to be most intense in the first 5 years of practice and lessens over time. One hundred twelve (31.5%) surgeons experience self-doubt in the operating room (OR). Due to self-doubt, 110 (28.4%) respondents preferred to work with a more experienced assistant in the OR, whereas 40 (10.4%) stated that they would only operate with an experienced assistant. Few surgeons take on less OR time due to self-doubt (29 [7.5%]), but 60 (16.5%) take on fewer complex cases due to self-doubt. A small but important number of surgeons (11 [2.8%]) had given up operating altogether due to self-doubt. Due to feelings of self-doubt, 107 (21.4%) respondents were hesitant to take on a leadership role in the workplace.

CONCLUSIONS

IP is a nearly universal experience among women surgeons and is influential in their professional lives. This study contributes to scientific knowledge that can advance gender equity in medicine and leadership.

Exploring challenges in learning and study skills among first-year medical students: a case study

BACKGROUND

Despite being high-achieving students, many medical students face academic challenges, particularly during their first year of study. Research indicates that self-regulated learning, involving metacognitive processes and adaptive strategies, can positively influence academic achievement. This study aimed to assess the early learning and study skills of first-year medical students in an international medical school with the goal of developing a learner-centered educational intervention to promote self-regulated learning.

METHODS

We conducted a retrospective analysis of the Learning and Study Skills Inventory (LASSI) questionnaire that was administered annually each August to first-year medical students from 2019 to 2022. The distribution of students across different percentile ranges for each selected variable was determined for each year and all years collectively. Students were counted within distinct percentile brackets (50th and below, between 51st and 75th, and above 75th ) for each variable.

RESULTS

A total of 147 students completed the LASSI questionnaire over the 4-year time period. Using academic resources was the greatest concern, with 67% of students in the 50th or below percentile, followed by selecting the main idea (56%), motivation (51%), and concentration (50%). Attitude scored highest across all cohorts, scoring between 21.55 ± 0.73 and 26.49 ± 0.34. In comparing mean scores of LASSI variables across all cohorts, attitude, motivation, test-taking strategies, time management, and the use of academic resources differed significantly (p < 0.05).

CONCLUSION

LASSI data can provide an early picture of students' support needs. We posit that early identification of student learning and study skills and areas of struggle can inform personalized educational interventions and programs to support first-year medical students.

Test-reduced teaching for stimulation of intrinsic motivation (TRUST): a randomized controlled intervention study

BACKGROUND

The anatomy dissection course is a major part of the first two years of the traditional medical curriculum in Germany. The vast amount of content to be learned and the repeated examination is unanimously perceived by students and teachers as a major stress factor that contributes to the increase of psychosocial stress during the first two years of the course of study. Published interventions for specific stress reduction are scarce.

METHODS

In a randomized, controlled design two intervention groups were compared with a control group (CG) over the whole dissection course (nine measuring points before, during and after first and second semester). The 'Stress Management intervention (IVSM)' targeted at the setting of personal standards, the 'Friendly Feedback intervention (IVFF)' at the context of frequent testing. Quantitative surveys were distributed at nine measuring points. The questionnaire comprised validated instruments and self-developed items regarding stress, positive and negative affect, anxiety, intrinsic and extrinsic motivation, self-efficacy, and perceived performance.

RESULTS

Out of 195 students inscribed in the dissection course, 166 (85%) agreed to participate in the study. The experience of stress during the dissection course was significantly higher in the CG than in the IVFF. Anxiety and negative affect were lower in students of the IVFF while positive affect, intrinsic motivation, and self-efficacy were higher than in the CG. For anxiety and negative affect in the IVSM this was especially seen at the end of the second semester. The self-perceived increase in both knowledge and preparedness for the first big oral and written examination did not differ between the study groups. About three quarters of the participants would choose the intervention 'Friendly Feedback' if given the choice.

CONCLUSIONS

Replacing formal tests with friendly feedback has proven to be an effective measure to reduce stress and negative affect and foster positive affect, self-efficacy, and intrinsic motivation, while it did not impair self-perceived academic performance.

The Untapped Power of "We Don't Know": Epistemological Humility in the Era of COVID-19

The SARS-CoV-2 (COVID-19) pandemic introduced many challenges and nuances that have transformed medical practice and research. The uncertainty caused by COVID-19 led to inevitable challenges to patient-provider relationships. The ever-changing landscape of COVID-19 research and policy proved to be challenging for the medical community and patients. These challenges also exacerbated long-standing issues regarding patient-provider communication and trust. On the other hand, these challenges gave voice to a burgeoning patient advocacy community. Through social media, advocacy and patient organizing, patients harnessed their power and organized over challenges relating to COVID-19 fears and concerns, ramifications of "Long COVID," and much more. During this unprecedented pandemic, there was a realization that the science and research surrounding COVID-19 is evolving and that there may be a benefit to embracing the dynamic nature of research and the scientific process. We propose that providers and the medical community should consider epistemological humility, which acknowledges insufficiencies related to the state of medical knowledge with a sense of understanding and respect for not having all of the answers. We argue that there is untapped potential in saying, "We don't know" and explaining why. There is an implicit culture that providers should be responsible for knowing everything and solving every problem. Epistemological humility challenges this culture, and inherently gives credence and voice to patient perspectives. We assert that epistemological humility is necessity when addressing contemporary health challenges such as COVID-19.

Do You See What I See? A Comparison of CCC and Self-Assigned Milestones Across Military Medical Specialties

BACKGROUND

The Accreditation Council for Graduate Medical Education (ACGME) requires residency programs to complete competency-based assessments of medical trainees based on nationally established Milestones. Previous research demonstrates a strong correlation between CCC and resident scores on the Milestones in surgery, but little is known if this is true between specialties. In this study, we investigated a variety of specialties and sought to determine what factors affect self-assessment of milestones. In addition, a post-hoc analysis was completed on the COVID-19 pandemic effects on self-evaluation.

METHODS

This is an IRB approved observational study on prospectively collected self-evaluation milestone data that is used within each ACGME program's Clinical Competency Committees. Medical trainees within the San Antonio Uniformed Services Health Education Consortium were approached for possible participation in this study with permission from program directors.

RESULTS

There was no significant difference between self-assessments and CCC-assessments based on self-identified gender or residency type (surgical versus nonsurgical) for any milestone domain. Within the postgraduate year (PGY) groups, the PGY5 and PGY6 tended to rate themselves higher than CCC. Chiefs (Internal Medicine PGY2/3, and General Surgery PGY5/6) tended to be more accurate in scoring themselves than the interns (PGY1) within the milestone of Interpersonal Skills and Communication (chiefs 0.5 vs. interns 0.62, p = 0.03). On post hoc analysis of self-rating, during the first wave of the COVID 19 pandemic, Post-Covid residents were more likely to underrate themselves in Systems-Based Practice compared to the Pre-Covid cohort (-0.49 vs 0.10; p = 0.007) and more likely to rate themselves higher in Professionalism (-0.54 vs. -0.10, p = 0.012).

CONCLUSION

Unique to this study and our institution, there was no gender difference found in self vs CCC evaluations. With the change in learning environment from COVID, there was also a change in ability for some learners to self-assess accurately. As medical educators, we should understand the importance of both encouraging learners to practice self-assessment as well as give feedback to trainees on their progress. We also need to educate our faculty on the use of milestones for assessment to create a true gold standard in the CCC.

Identity influences on medical students' orientation to feedback during third year clinical rotations

Medical students' feedback orientation (their attitudes about and preferences for feedback from preceptors) may change over the course of the third year of medical school and is likely influenced by identity-related factors. This study proposed that both how students view themselves personally (i.e., impostor syndrome) and how they view themselves in relation to the group (i.e., identification with the profession) are identity factors related to related to feedback orientation during clinical rotations. 177 third-year medical students enrolled in a four-phase longitudinal survey study beginning at the start of clinical rotations and continuing every twelve weeks of the academic year thereafter. Feedback orientation was conceptualized and measured as comprising aspects of utility (i.e., feedback is valuable and useful), sensitivity (i.e., feeling intimidated or threatened by corrective feedback), confidentiality (i.e., public/private context of feedback), and retention (i.e., feedback remembered). Results indicated that these aspects of feedback orientation did not significantly change during the third year. Instead, impostor syndrome was at least marginally, significantly associated with all aspects of feedback orientation across phases. Group identity was associated with feedback utility and retention, and female-identifying students reported significantly greater feedback confidentiality and feedback retention. Interventions may be needed to improve medical students' attitudes about feedback, particularly for those who experience impostor syndrome. Fostering group cohesion among medical students may influence how well students remember feedback and find it useful.

Impostor phenomenon: Prevalence among 1st year medical students and strategies for mitigation

Impostor phenomenon (IP) is described as a pattern typified by doubting one's accomplishments and a persistent fear of being exposed as a fraud. These feelings of self-doubt are pervasive along the medical education continuum, beginning with medical students where IP has been associated with emotional stress, physical exhaustion, depression, and anxiety. We, therefore, conducted an interactive workshop with first-year medical students to educate them about the manifesting patterns and risk factors of IP and strategies to mitigate these feelings. The 60-min workshop began with participants voluntarily completing the Young Imposter Scale (YIS) followed by an interactive presentation that reviewed the literature related to IP and its prevalence in medicine. Participants were then assigned to small groups where they discussed three cases of IP in academia and the medical profession. Medical school faculty acted as facilitators and utilized pre-designed prompt questions to stimulate discussion. Students re-convened for a large group report out, where each group shared main discussion points. The session ended with facilitators discussing IP mitigation strategies that can be implemented at the individual, peer, and institutional levels. Participants were also invited to complete a post-workshop evaluation. Fifty first-year medical students participated in the session. A total of 49 (96 %) completed the YIS and post-workshop evaluation. Nineteen (40 %) participants obtained scores on the YIS to indicate a positive finding of IP. The percentage of female medical students meeting the threshold for IP was significantly higher (84 %, n = 41 vs 16 %, n = 7) than male medical students. The workshop was effective at identifying IP and associated risk factors and providing mitigation strategies, with 95.8 % of participants agreeing or strongly agreeing. In qualitative feedback, participants reported that the workshop was "very interactive", "provided strategies to manage impostor syndrome" and "helped me become more vulnerable with my peers." This workshop provided a novel interactive and effective method to increase medical students' awareness about IP which can be employed as a strategy to enhance student's wellness.

Alienation in the Teaching Hospital: How Physician Non-Greeting Behaviour Impacts Medical Students' Learning and Professional Identity Formation

Introduction

Clinical workplaces offer unrivalled learning opportunities if students get pedagogic and affective support that enables them to confidently participate and learn from clinical activities. If physicians do not greet new students, the learners are deprived of signals of social respect and inclusion. This study explored how physicians' non-greeting behaviour may impact medical students' participation, learning, and professional identity formation in clinical placements.

Methods

We analysed 16 senior Norwegian medical students' accounts of non-greeting behaviours among their physician supervisors in a reflexive thematic analysis of focus group interview data.

Results

The main themes were: A) Descriptions of non-greeting. Not being met with conduct signalling rapport, such as eye contact, saying hello, using names, or introducing students at the workplace, was perceived as non-greeting, and occurred across clinical learning contexts. B) Effects on workplace integration. Non-greeting was experienced as a rejection that hurt students' social confidence, created distance from the physician group, and could cause avoidance of certain workplace activities or specific medical specialties. C) Impact on learning. Non-greeting triggered avoidance and passivity, reluctance to ask questions or seek help or feedback, and doubts about their suitability for a medical career.

Conclusion

Medical students' accounts of being ignored or treated with disdain by physician superiors upon entering the workplace suggest that unintended depersonalising behaviour is ingrained in medical culture. Interaction rituals like brief eye contact, a nod, a "hello", or use of the student's name, can provide essential affective support that helps medical students thrive and learn in the clinic.

Higher degree of impostor characteristics relates to lower self-perceived teaching ability and emotional intelligence

BACKGROUND

Emotional intelligence (EI) has been previously associated with teaching ability and impostor phenomenon (IP) in medical education; however, studies have demonstrated mixed findings and have largely focused on trainees only. Therefore, we sought to explore the potential association between the degree of IP characteristics, EI and teaching ability in obstetrics and gynaecology (Ob/Gyn) faculty physicians.

METHODS

A cross-sectional, survey-based pilot study was completed at a single academic institution. Ob/Gyn attending (faculty) physicians were queried using surveys related to IP, EI and teaching ability. Resident (trainee) physicians also completed anonymous evaluations of faculty teaching ability.

FINDINGS

The degree of IP characteristics correlated negatively with self-perceived teaching ability, with no significant differences in resident assessment of faculty teaching. IP also correlated negatively with EI. Although there were no statistically significant differences in resident assessment of teaching ability based on EI, both EI and IP demonstrated inverse relationships to faculty assessment of teaching ability compared with resident assessment.

CONCLUSION

IP appears to relate to lower perceived teaching ability in Ob/Gyn faculty that does not correspond to resident evaluation of teaching performance. The demonstrated negative correlation between the degree of impostor characteristics and EI suggests that EI could potentially play a protective role in the development of IP and burnout, as well as influence teaching. This relationship may have implications for faculty willingness to continue in academic medicine.

From magical thinking to suicide: Understanding emergency physicians' psychological struggle

Recent literature has explored the psychological well-being of physicians, addressing conditions like perfectionism, imposter phenomenon/syndrome (IP), depression, burnout, and, less frequently, magical thinking. But recognizing the connections among these psychological factors is vital for developing targeted interventions to prevent or alleviate their impact. This article examines the often-sequential emergence of these five conditions within a physician's career, with a specific emphasis on their prevalence among emergency physicians (EPs), who must manage a diverse array of acute illnesses and injuries. The descent into psychological distress initiates with magical thinking-in this case, the belief that perfection is possible despite evidence to the contrary-leading to the pursuit of maladaptive perfectionism. If unaddressed, this trajectory may lead to depression, burnout, and in some cases, suicide. Understanding this continuum lays the groundwork for devising a systematic approach to enhance physicians' mental health. The article delves into detailed descriptions of these psychological conditions, encompassing their prevalence, individual impact, how they are integrated into this continuum and potential preventive or corrective methods. Recognizing unrealistic expectations as a major contributor to burnout, depression, and even suicide within the medical profession, the article advocates for the development of targeted interventions and support structures to assist medical students and professionals in managing IP. Practical strategies involve acknowledging unrealistic expectations, setting attainable goals, seeking support, taking breaks, and prioritizing self-care. Addressing this pervasive issue aims to cultivate a culture where medical professionals can thrive, ensuring optimal care for patients.

Interventions addressing the impostor phenomenon: a scoping review

Introduction

The Impostor Phenomenon (IP) refers to a psychological experience characterized by unjustified feelings of intellectual and professional fraud, accompanied by the fear of not maintaining performance and of being exposed. IP is receiving increasing attention in the fields of psychological health at work and occupational psychology as well as among the general public, since it affects the functioning of both individuals and organizations. The aim of this scoping review is to map the range of interventions that have been conducted to address IP among individuals experiencing it in a professional context.

Methods

The search and selection process to identify relevant reports was conducted using the PRISMA-ScR methodology and JBI recommendations and resulted in the selection of 31 studies.

Results

The results reported concerning the characteristics of the studies, the interventions described, and the effects identified are heterogeneous. More than half of the studies used research designs (experimental, pre-experimental, exploratory, etc.). Two major types of intervention emerge: training and counseling. The effectiveness of the interventions varies according to the evaluation methodology that was used, although most authors conclude that the proposed intervention is relevant.

Discussion

In light of these results, recognizing and educating individuals regarding the various manifestations of IP, as well as offering support in a group context, appear to be primary intervention levers. Future intervention proposals should explore psychosocial and educational influences as well as the impact of the immediate environment on IP-related beliefs.

'Insight' in medical training: what, why, and how?

The term 'insight' is generically defined in English language as the ability to perceive deeper truths about people and situations. In clinical practice, patient insight is known to have important implications in treatment compliance and clinical outcomes, and can be assessed clinically by looking for the presence of illness awareness, correct attribution of symptoms to underlying condition, and acceptance of treatment. In this article, we suggest that cultivating insight is actually a highly important, yet often overlooked, component of medical training, which may explain why some consistently learn well, communicate effectively, and quickly attain clinical competency, while others struggle throughout their clinical training and may even be difficult to remediate. We herein define 'insight' in the context of medical training as having an astute perception of personal cognitive processes, motivations, emotions, and ability (strengths, weaknesses, and limitations) that should drive self-improvement and effective behavioural regulation. We then describe the utility of cultivating 'insight' in medical training through three lenses of (i) promoting self-regulated, lifelong clinical learning, (ii) improving clinical competencies and person-centred care, and (iii) enhancing physician mental health and well-being. In addition, we review educational pedagogies that are helpful to create a medical eco-system that promotes the cultivation of insight among its trainees and practitioners. Finally, we highlight several tell-tale signs of poor insight and discuss psychological and non-psychological interventions that may help those severely lacking in insight to become more amenable to change and remediation.

Educational interventions for imposter phenomenon in healthcare: a scoping review

BACKGROUND

Imposter Phenomenon (IP) is a subjective feeling of intellectual fraudulence and self-doubt experienced by individuals in goal-orientated high-achieving professions. The impact of IP within healthcare has been associated with individual physical and mental health and concerns around training, career progression and DEI at an institutional level. To effectively address IP in healthcare, this scoping review aims to explore educational interventions designed to empower high-achieving individuals with the tools needed to confront and overcome IP.

METHODS

The scoping review adhered to a predetermined protocol informed by the JBI methodology and PRISMA-ScR guidelines in order to identify educational interventions addressing IP in high-achieving industries. Articles were searched across multiple databases, including MEDLINE (Ovid), PsychINFO, SCOPUS, and Web of Science, alongside grey literature, without imposing any time constraints. A systematic approach including a thematic analysis allowed for a nuanced exploration and interpretation of the identified educational interventions and their impact on addressing IP.

RESULTS

Seventeen articles were incorporated into the review, with the majority originating from the USA and majority being published since 2020. Ten studies targeted healthcare professionals, undergraduate and postgraduate healthcare students. Majority of studies aimed at addressing IP, featured a larger number of female participants than males. Workshops with self-reflection and group-guided exercises to overcome IP were the most popular educational interventions. Coaching and structured supervision were also suggested. Across all papers, three themes emerged for coping strategies: individual, peer-to-peer, and institutional.

CONCLUSIONS

This scoping review suggests how group and individual interventions such as workshops, small group discussions and coaching can be used to overcome IP in healthcare. Institutional changes like diversity promotion, supervisor education, and support networks are crucial in addressing IP. Further long term and speciality specific assessments are needed to measure impact. Overall, the review highlights how educational awareness and a variety of strategies can be implemented to create a supportive environment for professionals dealing with IP, promoting their well-being and success.

Moving Past the Status Quo: Redefining the Feedback Landscape for Junior Clinician-Educator Career Development

This perspective piece addresses the challenges junior clinician-educators face as they navigate career development within academic medical centers. In addition to understanding local promotion and tenure processes and seeking mentorship, we argue that faculty feedback is an often neglected, but essential, component in clinician-educator development. We repurpose and use the MISCA model-Message, Implementation, Student, Context, and Agents-as a framework to better understand and improve feedback for faculty. Crafting effective feedback messages, nurturing holistic growth, understanding contextual dynamics, acknowledging diverse feedback agents, and recognizing learner characteristics are key components of this model. Within each element of MISCA, we interpret how this model applies to clinician-educators and provide practical examples. We propose that combining insights around feedback derived from MISCA, with mentorship and frameworks for faculty competence, offers individuals and institutions opportunities to transform how they grow and develop faculty.

'Am I a good enough therapist?': Self-doubt among speech and language therapists

BACKGROUND

The therapeutic process is fraught with various feelings. This research focused on a specific type of negative feeling, namely self-doubt (SD).

AIM

To explore and characterize the nature of SD among speech and language therapists (SLTs) (the frequency of SD, situations that trigger SD, emotions and thoughts related to SD, and coping strategies) in various stages of occupational experience.

METHODS & PROCEDURES

A total of 267 SLTs answered an online survey. Respondents represented SLTs in all stages of vocational experience, with varying academic degrees, from a variety of employment settings. The survey addressed situations that trigger SD, thoughts, and emotions associated with SD and the background information of the respondents. Frequency distributions of the responses of the participants were determined, and independent-samples Kruskal-Wallis tests were conducted to examine if there were differences between groups that differed in their occupational experience on the frequency of SD, attitudes towards SD and emotions related to SD.

OUTCOMES & RESULTS

Differences were found between SLTs in various stages of professional development in several aspects of SD. Novice SLTs reported significantly higher levels of SD compared with experienced SLTs. In the face of SD, novice SLTs consider career abandonment significantly more than do experienced SLTs. They perceive themselves as a failure when experiencing SD to a significantly greater extent than do more experienced SLTs. In addition, SD is associated with various negative emotions.

CONCLUSIONS & IMPLICATIONS

Self-doubt is a natural professional feeling. It may be harmful especially in the early stages of professional development. Our findings call for support and guidance in the face of SD.

WHAT THIS PAPER ADDS

What is already known on the subject Healthcare professionals report feeling SD. This feeling may have deleterious effects on well-being and career satisfaction and is especially harmful in young therapists. What this paper adds to existing knowledge This study characterizes the nature of SD among SLTs in various stages of occupational experience. Our findings indicate that SD is reported among SLTs at all career stages, especially in novice SLTs. Self-doubt is associated with a range of negative thoughts and emotions, and it may be triggered by various situations. Nonetheless, it is a topic that our respondents rarely learn about. What are the potential or actual clinical implications of this work? Normalising and validating SD is important to SLTs' resilience and may facilitate coping. This may be achieved by learning about the subject of SD in graduate programmes. In addition, mentors should create a safe learning culture to allow sharing SD and challenging situations, especially in the first years of occupational experience.

Exploring Factors Affecting Impostor Syndrome among Undergraduate Clinical Medical Students at Chiang Mai University, Thailand: A Cross-Sectional Study

Impostor syndrome is a psychological condition that inhibits individuals' ability to recognize their achievements such that they fear being exposed as forgers. It is common in medical students, particularly in the early stages of clerkship training while transitioning from preclinical to clinical training. This cross-sectional study assessed the prevalence and associated factors of the imposter phenomenon among medical clinical students using the Clance Impostor Phenomenon Scale (CIPS), focusing on sociodemographic characteristics, mental health status, and occurrence of the impostor phenomenon. Out of 228 undergraduate clinical-year medical students, 108 (47.4%) reported experiencing the impostor phenomenon. The results from the multivariable analysis showed that high levels of stress (adjusted odds ratio = 2.315; 95% confidence interval = 1.105-4.853), anxiety (6.462; 1.374-30.392), and depression (4.219; 1.448-12.290) were significantly associated with an increased risk of experiencing the impostor phenomenon. We found no difference between participants in the early or later years of clerkship training. The study highlights the prevalence of impostor syndrome among medical students and its link to mental health issues. Addressing this issue through education, mentorship, systemic problem solving, normalizing failure, and monitoring and treating mental health issues could help students reach and realize their full educational and professional potential.

Set Up to Fail? Barriers Impeding Resident Communication Training in Neonatal Intensive Care Units

PURPOSE

Learning to navigate difficult clinical conversations is an essential feature of residency training, yet much of this learning occurs "on the job," often without the formative, multisource feedback trainees need. To generate insight into how on-the-job training influences trainee performance, the perspectives of parents and health care providers (HCPs) who engaged in or observed difficult conversations with Neonatal Intensive Care Unit (NICU) trainees were explored.

METHOD

The iterative data generation and analysis process was informed by constructivist grounded theory. Parents (n = 14) and HCPs (n = 10) from 2 Canadian NICUs were invited to participate in semistructured interviews informed by rich pictures-a visual elicitation technique useful for exploring complex phenomena like difficult conversations. Themes were identified using the constant comparative approach. The study was conducted between 2018 and 2021.

RESULTS

According to participants, misalignment between parents' and trainees' communication styles, HCPs intervening to protect parents when trainee-led communication went awry, the absence of feedback, and a culture of sole physician responsibility for communication all conspired against trainees trying to develop communication competence in the NICU. Given beliefs that trainees' experiential learning should not trump parents' well-being, some physicians perceived the art of communication was best learned by observing experts. Sometimes, already limited opportunities for trainees to lead conversations were further constricted by perceptions that trainees lacked the interest and motivation to focus on so-called "soft" skills like communication during their training.

CONCLUSIONS

Parents and NICU staff described that trainees face multiple barriers against learning to navigate difficult conversations that may set them up to fail. A deeper understanding of the layered challenges trainees face, and the hierarchies and sociocultural norms that interfere with teaching, may be the start of breaking down multiple barriers trainees and their clinician supervisors need to overcome to succeed.

Personal Actions to Create a Culture of Inclusion: Navigating Difficult Conversations With Medical Colleagues

Microaggressions between members of a team occur often in medicine, even despite good intentions. Such situations call for difficult conversations that restore inclusivity, diversity, and a healthy work culture. These conversations are often hard because of the unique background, experiences, and biases of each person. In medicine, skillful navigation of these interactions is paramount as it influences patient care and the workplace culture. Although much has been published about difficult interactions between providers and patients, significantly less information is available to help navigate provider-to-provider interactions, despite their critical role in improving multidisciplinary patient care teams and organizational environments. This article is intended to serve as a guide for medical professionals who are interested in taking personal responsibility for promoting a safe and inclusive culture by engaging in and modeling difficult conversations with colleagues. The article outlines important considerations to assist with intentional preparation and modulation of responses for all parties involved: conversation initiators, observers of the incident, and conversation receivers. Although these interactions are challenging, together as medical professionals we can approach each other with humility and compassion to achieve our ultimate goal of promoting humanity, not only for our patients but for ourselves and one another.

When Feedback is Not Perceived as Feedback: Challenges for Regulatory Body-Mandated Peer Review

PURPOSE

Safe and competent patient care depends on physicians recognizing and correcting performance deficiencies. Generating effective insight depends on feedback from credible sources. Unfortunately, physicians often have limited access to meaningful guidance. To facilitate quality improvement, many regulatory authorities have designed peer-facilitated practice enhancement programs. Their mandate to ensure practice quality, however, can create tension between formative intentions and risk (perceived or otherwise) of summative repercussions. This study explored how physicians engage with feedback when required to undergo review.

METHOD

Between October 2018 and May 2020, 30 physicians representing various specialties and career stages were interviewed about their experiences with peer review in the context of regulatory body-mandated programs. Twenty had been reviewees and reviewers and, hence, spoke from both vantage points. Interview transcripts were analyzed using a 3-stage coding process informed by constructivist grounded theory.

RESULTS

Perceptions about the learning value of mandated peer review were mixed. Most saw value but felt anxiety about being selected due to being wary of regulatory bodies. Recognizing barriers such perceptions could create, reviewers described techniques for optimizing the value of interactions with reviewees. Their strategies aligned well with the R2C2 feedback and coaching model with which they had been trained but did not always overcome reviewees' concerns. Reasons included that most feedback was "validating," aimed at "tweaks" rather than substantial change.

CONCLUSIONS

This study establishes an intriguing and challenging paradox: feedback appears often to not be recognized as feedback when it poses no threat, yet feedback that carries such threat is known to be suboptimal for inducing performance improvement. In efforts to reconcile that tension, the authors suggest that peer review for individuals with a high likelihood of strong performance may be more effective if expectations are managed through feedforward rather than feedback.

The Making of an Educator: Professional Identity Formation Among Graduate Medical Education Faculty Through Situated Learning Theory

INTRODUCTION

Professional identity formation (PIF) is a foundational element to professional medical education and training. Given the impact of faculty role models and mentors to student and trainee learning, mapping the landscape of PIF among faculty takes on increased importance. We conducted a scoping review of PIF through the lens of situated learning theory. Our scoping review question was: How is situated learning theory used to understand the process of PIF among graduate medical educators?

METHODS

The scoping review methodology described by Levac et al served as the architecture for this review. Medline, Embase, PubMed, ERIC, CINAHL, PsycINFO, and Web of Science Core Collection were searched (from inception) using a combination of terms that describe PIF among graduate medical educators.

RESULTS

Of the 1434 unique abstracts screened, 129 articles underwent full-text review, with 14 meeting criteria for inclusion and full coding. Significant results organized into three main themes: importance of using common definitions; evolution of theory over time with untapped explanatory power; identity as a dynamic construct.

DISCUSSION

The current body of knowledge leaves many gaps. These include lack of common definitions, need to apply ongoing theoretical insights to research, and exploration of professional identity as an evolving construct. As we come to understand PIF among medical faculty more fully, twin benefits accrue: (1) Community of practices can be designed deliberately to encourage full participation of all graduate medical education faculty who desire it, and (2) Faculty can more effectively lead trainees in negotiating the ongoing process of PIF across the landscape of professional identities.

A Call to Action to Address Well-Being Within Experiential Education

There is a significant lack of literature exploring or describing pharmacy student well-being during experiential learning even though students spend 30% of their doctor of pharmacy curricula in this environment. Drawing on inspiration from literature describing well-being challenges and solutions for pharmacy residents and other health disciplines, this commentary explores the unique challenges of supporting pharmacy student well-being during experiential education. Approaches for interventions are described along with a call to action for the academy.

Feeling like an imposter: are surgeons holding themselves back?

Imposter syndrome is a psychological phenomenon where people doubt their achievements and have a persistent internalized fear of being exposed as a fraud, even when there is little evidence to support these thought processes. It typically occurs among high performers who are unable to internalize and accept their success. This phenomenon is not recognized as an official mental health diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; however, mental health professionals recognize it as a form of intellectual self-doubt. It has been reported that imposter syndrome is predominant in the high-stakes and evaluative culture of medicine, where healthcare workers are frequently agonized by feelings of worthlessness and incompetence. Imposter syndrome can lead to a variety of negative effects. These can include difficulty concentrating, decreased confidence, burnout, anxiety, stress, depression, and feelings of inadequacy. This article will discuss the prevalence of imposter syndrome among surgeons, its associated contributing factors, the effects it can have, and potential strategies for managing it. The recommended strategies to address imposter syndrome are based on the authors' opinions.

Post-CSCST fellowships: beyond subspecialization

The transition from higher training to consultanthood is a crucial point in the medical training pathway. Despite comprehensive higher training programs, studies of new consultants have reported a disparity in their sense of preparation for non-clinical and clinical duties. Post- "Certificate of Satisfactory Completion of Specialist Training" (CSCST) fellowships have traditionally been undertaken as a means to access subspecialty clinical training which is otherwise unavailable in higher training programs. However, fellowships have a role beyond this subspecialization model, particularly in meeting the non-clinical training needs of new CSCST graduates.The design and goals of fellowship posts should be considered in this context, to align them with the reported needs of new consultants. Special consideration should be given to defining roles of independence for the fellow and to the nature of the mentorship relationship, distinguishing these posts from higher specialist training. Well-designed post-CSCST fellowships have an important role in facilitating the successful transition to consultanthood.

Impostor phenomenon in registered dietitians: an exploratory survey

BACKGROUND

Impostor phenomenon, also referred to as imposter syndrome or impostorism, was initially identified among high achieving women who felt undeserving of their successes because they felt they were earned through luck or chance, rather than skill or experience. It's prevalence has been identified in many health professions; however, there are no known studies of Registered Dietitians' (RDs) perceptions of impostor phenomenon. This study assesses the following among RDs: [1] prevalence of impostor phenomenon and differences in impostor phenomenon levels, if any, based on [2] highest educational level achieved and [3] years of experience as an RD.

METHODS

A cross-sectional survey was sent electronically to 5,000 RDs credentialed by the Commission on Dietetic Registration in the United States. Respondents' agreement with 20 impostor phenomenon statements from the Clance Impostor Phenomenon Scale were measured. The sum score from the scale was used to classify levels of impostor phenomenon. Descriptive statistics and chi square analyses for comparison were evaluated.

RESULTS

Of the 445 (9%) who began the survey, 266 (5%) completed it and were included in analyses. Over 76% of 266 individuals reported at least moderate impostorism (score of 40 or fewer points out of 100). No difference was seen based on educational level (p = .898); however, those with less than five years' experience reported higher impostor phenomenon (p < .05). Among those with five to 39 years' experience, over 40% reported moderate impostorism.

CONCLUSION

Impostor phenomenon is prevalent among RDs. Moderate impostorism was pervasive among all those with less than 40 years' experience and could potentially negatively impact these respondents. Future research could explore ways to reduce impostor phenomenon in RDs.

Examining Impostor Phenomenon Through the Lens of Humility: Spotlighting Conceptual (Dis)Connections

Impostor phenomenon has gained increasing attention within the health care and health professions education literature. Although consistently depicted as a debilitating socioemotional experience, studies also suggest a strategic aspect to impostor phenomenon - denoting a conceptual ambiguity to impostor phenomenon that has yet to fully examined. Within this paper, we use humility as a conceptual sparring partner with impostor phenomenon to examine the similarities and differences between the concepts, as well as explore the various nuances associated with impostor phenomenon. By comparing and contrasting impostor phenomenon and humility from interdisciplinary perspectives and within the context of health professions specifically, we not only further refine their meaning and usage within the literature, but also spotlight key areas for future research.

Imposter Syndrome Among Surgeons Is Associated With Intolerance of Uncertainty and Lower Confidence in Problem Solving

BACKGROUND

Feelings of imposter syndrome (inadequacy or incompetence) are common among physicians and are associated with diminished joy in practice. Identification of modifiable factors associated with feelings of imposter syndrome might inform strategies to ameliorate them. To this point, though, no such factors have been identified.

QUESTION/PURPOSE

Are intolerance of uncertainty and confidence in problem-solving skills independently associated with feelings of imposter syndrome after accounting for other factors?

METHODS

This survey-based experiment measured the relationship between feelings of imposter syndrome, intolerance of uncertainty, and confidence in problem-solving skills among musculoskeletal specialist surgeons. Approximately 200 surgeons who actively participate in the Science of Variation Group, a collaboration of mainly orthopaedic surgeons specializing in upper extremity illnesses primarily across Europe and North America, were invited to this survey-based experiment. One hundred two surgeons completed questionnaires measuring feelings of imposter syndrome (an adaptation of the Clance Imposter Phenomenon Scale), tolerance of uncertainty (the Intolerance of Uncertainty Scale-12), and confidence in problem-solving skills (the Personal Optimism and Self-Efficacy Optimism questionnaire), as well as basic demographics. The participants were characteristic of other Science of Variation Group experiments: the mean age was 52 ± 5 years, with 89% (91 of 102) being men, most self-reported White race (81% [83 of 102]), largely subspecializing in hand and/or wrist surgery (73% [74 of 102]), and with just over half of the group (54% [55 of 102]) having greater than 11 years of experience. We sought to identify factors associated with greater feelings of imposter syndrome in a multivariable statistical model.

RESULTS

Accounting for potential confounding factors such as years of experience or supervision of trainees in the multivariable linear regression analysis, greater feelings of imposter syndrome were modestly associated with higher intolerance of uncertainty (regression coefficient [β] 0.34 [95% confidence interval (CI) 0.16 to 0.51]; p < 0.01) and with lower confidence in problem-solving skills (β -0.70 [95% CI -1.0 to -0.35]; p < 0.01).

CONCLUSION

The finding that feelings of imposter syndrome may be modestly to notably associated with modifiable factors, such as difficulty managing uncertainty and lack of confidence in problem-solving, spark coaching opportunities to support and sustain a surgeon's mindset, which may lead to increased comfort and joy at work.

CLINICAL RELEVANCE

Beginning with premedical coursework and throughout medical training and continuing medical education, future studies can address the impact of learning and practicing tactics that increase comfort with uncertainty and greater confidence in problem solving on limiting feelings of imposter syndrome.

Fitting In While Standing Out: Professional Identity Formation, Imposter Syndrome, and Burnout in Early-Career Faculty Physicians

PURPOSE

Professional identity formation (PIF) is a dynamic process by which an individual internalizes the core values and beliefs of a specific profession. Within medical education, PIF begins in medical school and continues throughout training and practice. Transitions affect PIF, with a critical transition occurring between medical training and unsupervised practice. This study aims to characterize PIF during the transition from resident to early-career faculty physician and explores the relationship between PIF and burnout during this transition.

METHOD

The authors conducted a qualitative study using constructivist grounded theory. They conducted semistructured interviews with early-career faculty physicians (defined as practicing for ≤ 5 years) from the Department of Medicine, Mayo Clinic. Deidentified interview transcripts were processed through open and axial coding. The authors organized themes and identified relationships between themes that were refined through discussion and constant comparison with newly collected data. During data analysis, the authors identified self-determination theory, with the concepts of autonomy, competence, and relatedness, as a framework to support the organization and analysis of the data.

RESULTS

Eleven early-career faculty physicians participated in the interviews. Their PIF was characterized by the dual desires to fit in and stand out. Striving for these desires was characterized by imposter syndrome, driving physicians to question their decision making and overall competence. Participants associated imposter syndrome and academic pressures with burnout. Autonomy support by the institution to pursue opportunities important for career development helped mitigate burnout and support PIF.

CONCLUSIONS

Early-career faculty physicians face identity challenges when transitioning from training to unsupervised practice, including striving to fit in and stand out. They link this tension to imposter syndrome, which they associated with burnout. Institutional awareness and support, including addressing structural and cultural contributors to imposter syndrome, are paramount as new faculty explore their identities and navigate new challenges.

Can you hear me now? Tools for cultivating a culture of respect, value, and appreciation within pediatric hematology, oncology, and cellular therapy

The American Society of Pediatric Hematology/Oncology (ASPHO) conducted a workshop "Can you hear me now? Cultivating a culture of respect, value, and appreciation within pediatric hematology/oncology" at their annual meeting in May 2022 in hopes of exploring how the members can enhance wellness in a climate of increasing diversity. Initiatives in the past have focused on personal care, but it has been widely shown that administrative and institutional driven initiatives are essential to create an environment of wellness. In this interactive workshop, we discovered that 22% of participants felt their institution does not instill a culture of respect. We offered tools to the audience on multiple levels: graceful self-promotion, diversity and inclusion, and leadership perspective on creating a culture of respect to address the individual, local community, and top-down leadership approaches. Here, we offer a summary on the content of the workshop, and expand upon many of the discussion points that were raised during the workshop. We bring forth novel information on each topic individually from diverse points of view, specific to the field of pediatric hematology/oncology (PHO). We aim to highlight the importance of creating a diverse and respectful work environment in PHO in hopes of ensuring motivated, satisfied, and fulfilled healthcare providers who feel appreciated and valued.

Why Do We Feel Like Intellectual Frauds? A Self-Determination Theory Perspective on the Impostor Phenomenon in Medical Students

Theory: Impostor phenomenon (IP) refers to people's feelings of intellectual fraudulence and fear of being "discovered," despite contradicting evidence of success. Due to its association with burnout and distress, it is progressively being studied in medicine. While various explanations for IP have been discussed in the literature, the role of motivation has largely been neglected. Hypotheses: Using self-determination theory (SDT) as a lens, it was hypothesized that different general causality orientations (impersonal, control, autonomy), domain-specific types of motivation (autonomous vs. controlled) toward going to medical school, and levels of satisfaction of basic psychological needs (autonomy, competence, relatedness) in the medical program, would each predict severity of IP symptoms. Method: A total of 1,450 medical students from three Canadian institutions were invited to complete a survey containing the Clance Impostor Phenomenon Scale and scales derived from SDT's mini theories: basic psychological needs theory, causality orientations theory, and organismic integration theory. We explored the prevalence of IP among the students and used regression to capture variable relationships, accounting for gender effects. Results: Data from 277 (19.1%) students were assessed, 73% of whom reported moderate or worse IP symptoms. Having an impersonal general causality orientation, more controlled motivation toward going to medical school, and lower need satisfaction in the medical program, each related to increased IP severity. Together, these motivational factors accounted for 30.3%, 13.6%, and 21.8% of the variance in students' IP severity, respectively. Conclusions: Findings from this study suggest that students who are more self-determined (both in general and in medical school), and whose basic psychological needs are more supported in their medical program, will experience less frequent and severe IP symptoms. Preliminary explanations and implications of these findings are discussed within the medical education context.

Understanding and Addressing Microaggressions in Medicine

Microaggressions are directed unconsciously to people of color or other minority groups, and the accumulated experience of multiple microaggressions over a lifetime have detrimental effects on mental health. In the clinical setting, both physicians and patients can commit microaggressions. Patients experiencing a microaggression from their provider suffer emotional distress and distrust resulting in decreased service utilization, reduced adherence, and poorer physical and mental health. Physicians and medical trainees, particularly those of color, women and LGBTQIA members, have increasingly experienced microaggressions committed by patients. Learning to recognize and address microaggressions in the clinical setting creates a more supportive and inclusive environment.