Impostorism in American medical students during early clinical training: gender differences and intercorrelating factors

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.

Sociodemographic disadvantage in the burden of stress and academic performance in medical school: implications for diversity in medicine

BACKGROUND

Nontraditional students bring to medicine inherent characteristics and perspectives that enrich the learning environment and contribute to expanding diversity in medicine. However, research has shown that these students, by virtue of their sociodemographic backgrounds, face unique challenges in medical education, which ultimately place them at a disadvantage compared to their peers. The purpose of this study is to explore relationships between sociodemographic characteristics, stress, and academic performance, in the context of outcomes that may be undermining efforts to diversify the physician workforce.

METHODS

Using a retrospective observational cohort methodology, we examined institutional and USMLE exam performance data in conjunction with Perceived Stress Scale-4 survey results from six cohorts of students at Kirk Kerkorian School of Medicine at UNLV (n = 358). Using independent samples t-test, mean stress and academic performance were compared between four sociodemographic groups: first-generation college students, underrepresented in medicine (URM), socioeconomically disadvantaged, and age 30 + at matriculation. Results were considered significant where P ≤ .05.

RESULTS

First-generation college students had significantly higher stress at the end of third year clerkships (mean 7.8 vs. 6.8, P* = .03). URM students had significantly lower scores on preclinical exams (mean 81.37 vs. 83.07, P* = .02). The students who were age 30 + at matriculation had significantly lower exam scores on all academic performance measures.

CONCLUSION

Our results echo historic trends in academic performance for racial and ethnic minority students, and we present recent evidence of academic performance disparities based on age at matriculation. Residency program directors continue to use test scores as a primary metric to screen applicants and thus, poor academic performance has profound consequences on career trajectory. Finally, significantly higher stress in the first-generation students may be evidence of underlying psychological distress. Expanding the sociodemographic diversity among physicians, and by extension, medical students, has long been recognized as fundamental to addressing inequities in healthcare. However, results from our study suggest that aspects of medical education are unfavorable and disadvantageous for first-generation, URM, and older medical students. A deeper understanding of the interplay between sociodemographic characteristics and success in medical school is paramount as we pursue diversity in medicine.

The prevalence of imposter syndrome and associated factors in Chinese medical students and residents: A single-center pilot study

PURPOSE

Here we aimed to define the prevalence of imposter syndrome (IS) and identify associated characteristics in Chinese medical students and residents enrolled at Peking Union Medical College Hospital (PUMCH).

METHODS

This was a single-center, cross-sectional study of medical students and residents enrolled at PUMCH conducted in September and October 2022. Participants were recruited to complete a 37-question survey on demographics, a Chinese version of the Clance Imposter Phenomenon Scale (CIPS), and self-assessments of anxiety, depression, burnout, sleep quality, challenges of clinical learning, and time allocation. IS prevalence and its associated factors were analyzed.

RESULTS

One hundred and forty-eight medical students and 89 residents completed the survey. IS was significant or severe in 62.8% of medical students and 57.2% of residents. Students enrolled in the eight-year program had significantly higher CIPS scores than those enrolled in the 4 + 4 program (66.4 vs. 60.7, p = .005). There were no gender differences in IS prevalence and severity. Participants with severe IS had significantly higher self-rated anxiety, depression, insomnia, and burnout than participants with mild/moderate IS. Participants significantly challenged by clinical learning had significantly higher CIPS scores.

CONCLUSIONS

IS is both prevalent and severe in Chinese medical students and residents. Classroom learning, an eight-year program, and being challenged by clinical learning are potentially associated with IS.

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.

Allyship to Advance Diversity, Equity, and Inclusion in Otolaryngology: What We Can All Do

Purpose of review

To summarize the current literature on allyship, providing a historical perspective, concept analysis, and practical steps to advance equity, diversity, and inclusion. This review also provides evidence-based tools to foster allyship and identifies potential pitfalls.

Recent findings

Allies in healthcare advocate for inclusive and equitable practices that benefit patients, coworkers, and learners. Allyship requires working in solidarity with individuals from underrepresented or historically marginalized groups to promote a sense of belonging and opportunity. New technologies present possibilities and perils in paving the pathway to diversity.

Summary

Unlocking the power of allyship requires that allies confront unconscious biases, engage in self-reflection, and act as effective partners. Using an allyship toolbox, allies can foster psychological safety in personal and professional spaces while avoiding missteps. Allyship incorporates goals, metrics, and transparent data reporting to promote accountability and to sustain improvements. Implementing these allyship strategies in solidarity holds promise for increasing diversity and inclusion in the specialty.

Health literacy profiles of medical students in an Australian Doctor of Medicine programme: A cross-sectional study using the Health Literacy Questionnaire

ISSUE ADDRESSED

With the emerging focus on designing health-literate organisations and health care systems, it is essential to understand the health literacy profiles of the medical workforce including medical students, as medical professionals play a key role in within these systems. Medical professionals contribute to good patient health outcomes through enabling access to appropriate health care, provision of quality health information and collaborative shared decision-making, which are fundamental health literacy competencies. The aim of this study is to identify health literacy strengths and weaknesses of medical students enrolled in an Australian Doctor of Medicine programme.

METHODS

Students from all 4 years of an Australian Doctor of Medicine programme were invited to complete an anonymous, online survey in January 2021. Health literacy profiles were identified using the 9-domain, 44-item multi-dimensional Health Literacy Questionnaire, a validated tool which comprehensively evaluates health literacy strengths and weaknesses from diverse perspectives. Demographic characteristics and social attributes were also recorded. The results were compared with Australian Bureau of Statistics data.

RESULTS

Eighty-six participants completed the survey. Most participants were female students (57%) who spoke English at home (88%) with tertiary-educated fathers (60%) and resided in locations associated with high socioeconomic status during adolescence (61%). Males scored significantly higher in three domains which explored health information access and appraisal, and ability to actively engage with health care providers. Students' scores were significantly lower than the Australian general population in Domain 6 (Ability to actively engage with health care providers) and Domain 7 (Navigating the health care system).

CONCLUSIONS

Medical students' health literacy profiles indicate areas of weakness in their ability to engage with health care providers and to navigate the health system. Medical educators will need to create opportunities to address these weaknesses within medical curricula. Gender differences identified in self-rated ability to access and appraise health information requires further exploration. SO WHAT?: Further understanding of health literacy profiles of medical students may influence design of medical school curricula.

Burnout and impostor phenomenon in nursing and newly licensed registered nurses: A scoping review

AIMS AND OBJECTIVE

To identify the prevalence and severity of impostor phenomenon and burnout in newly licensed registered nurses, map the current literature on impostor phenomenon in nursing, and identify related factors affecting the new nurse's transition to practice.

BACKGROUND

Impostor phenomenon is an internalised intellectual phoniness resulting in persistent self-doubt despite prior success. It can evoke feelings of emotional exhaustion associated with burnout, negatively affecting employee retention. Due to changes in nursing education resulting from COVID-19, self-doubt and uncertainty among new nurses are expected to be heightened, leading to burnout which adversely effects nurse well-being, patient care and retention.

DESIGN

The scoping review follows the methodological framework developed by Arksey and O'Malley (2005) and the Reporting Checklist for Scoping Reviews (PRISMA-ScR) guidelines.

METHODS

The literature search was conducted utilising PubMed, CINAHL and PsycINFO. Inclusion criteria were studies published between 2011 and 2021, written in English, peer-reviewed, and focused on newly licensed registered nurses. Eighteen articles were reviewed.

RESULTS

Studies on impostor phenomenon in nursing are limited to nursing students and clinical nurse specialists. Prevalence of impostor feelings in these populations range from 36% to 75%, and 12.3% to 46% of new nurses report burnout. Impostor feelings arise from role ambiguity, lack of self-compassion, transitions, and minimal clinical experience. Burnout was associated with stress, feeling unprepared, inadequate socialisation, and lack of self-compassion. Overlap in these factors could increase impostor feelings and burnout in new nurses.

CONCLUSIONS

Effects of impostor phenomenon and burnout can negatively impact the well-being of the new nurse. Currently, no studies simultaneously examine impostor phenomenon and burnout in new nurses. Further research on the relationship between these phenomena should be conducted.

RELEVANCE TO CLINICAL PRACTICE

Understanding the impact of impostor phenomenon and burnout on new nurses could help mitigate challenges they face transitioning into practice.

Impostor syndrome among minority medical students who are underrepresented in medicine

OBJECTIVES

Impostor syndrome (IS) is prevalent in medical professionals. However, little is known about the prevalence of IS among medical trainees and those who are underrepresented in medicine (UiM). Even less is known about the experiences of UiM students at predominantly white institutions (PWIs) and historically black colleges/universities (HBCUs) relative to their non-UiM peers. The purpose of this study is to investigate differences in impostor syndrome among UiM and non-UiM medical students at a PWI and a HBCU. We additionally explored gender differences in impostor syndrome among UiM and non-UiM students at both institutions.

METHOD

Medical students (N = 278) at a PWI (N = 183, 107 (59%) women) and a HBCU (N = 95, 60 (63%) women), completed an anonymous, online two-part survey. In part one, students provided demographic information, and in part two, students completed the Clance Impostor Phenomenon Scale, a 20-item self-report questionnaire that assessed feelings of inadequacy and self-doubt surrounding intelligence, success, achievements, and one's inability to accept praise/recognition. Based on the student's score, the level of IS was measured and placed into one of two levels: few/moderate IS feelings, or frequent/intense IS feelings. We conducted a series of chi-square tests, binary logistic regression, independent sample t-tests, and analysis of variance to test the main aim of the study.

RESULTS

The response rate was 22% and 25% at the PWI and HBCU, respectively. Overall, 97% of students reported moderate to intense feelings of IS, and women were 1.7 times more likely than men to report frequent or intense feelings of IS (63.5% vs 50.5%, p = 0.03). Students at PWI were 2.7 times more likely to report frequent or intense IS than HBCU students (66.7% vs 42.1%, p< 0.01). In addition, UiM students at PWI were 3.0 times more likely to report frequent or intense IS compared to UiM students at HBCU (68.6 % vs 42.0%, p = 0.01). Computation of a three-way ANOVA with gender, minority status, and school type revealed a two-way interaction indicating that UiM women scored higher on impostor syndrome than UiM men at the PWI and HBCU. This trend was not observed among non-UiM students.

CONCLUSIONS

Impostor syndrome is informed by gender, UiM status, as well as environmental context. Efforts to provide supportive professional development for medical students should be directed towards understanding and combatting this phenomenon at this critical juncture of their medical career.

Medical Students and the Impostor Phenomenon: A Coexistence Precipitated and Perpetuated by the Educational Environment?

People who experience the impostor phenomenon have intense thoughts of fraudulence regarding their intellect or professional activities. This perception of illegitimacy leads sufferers to believe that success in their lives is attributable to some form of error. Despite the phenomenon having been thoroughly researched in a plethora of professional and educational environments, there remains a relative lack of insight into the impostor phenomenon amongst medical students. This research aimed to better understand the relationship between medical students and the impostor phenomenon, and subsequently to investigate whether their coexistence is precipitated and perpetuated by the educational environment. A cross-sectional study of medical students was conducted using a pragmatist approach, integrating quantitative and qualitative data, via a questionnaire, focus groups and interviews. The main quantitative measure used was the validated Clance Impostor Phenomenon Scale (CIPS), where higher scores indicate more marked impostor experiences. A total of 191 questionnaire responses were received, and 19 students attended a focus group or interview. The average CIPS score for the cohort was 65.81 ± 13.72, indicating that the average student had "frequent" impostor experiences. Of note, 65.4% of students were classed as having "clinically significant" impostor experiences and females scored 9.15 points higher than males on average (p < 0.0001). Examination rankings were frequently cited as a major contributing factor to students' impostor feelings, and data revealed an increase of 1.12 points per decile that a student drops down the rankings (p < 0.05). Students' quotes were used extensively to underpin the quantitative data presented and offer an authentic insight into their experiences. This study provides new insights and contributes to our understanding of the impostor phenomenon amongst medical students, and eight recommendations for practice are presented, which are intended to provide medical schools with opportunities for pedagogical innovation.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-022-01675-x.

Fixed mindset and imposter phenomenon: Determining the correlation and prevalence among pharmacy students

INTRODUCTION

To determine the prevalence of fixed vs. growth mindsets and imposter phenomenon (IP) scores among pharmacy students at one institution, identify variables that explained variance in fixed mindsets and IP, and determine if a correlation exists.

METHODS

A survey was developed and administered to first- to fourth-year students at the University of Kentucky College of Pharmacy. The survey included demographic questions, the Clance Imposter Phenomenon Scale (CIPS), and the Implicit Theories of Intelligence Scale (ITIS). Descriptive and inferential statistical analyses were conducted to determine the prevalence of IP and fixed vs. growth mindsets, identify variables that explained variance in CIPS and ITIS scores, and investigate if a correlation exists.

RESULTS

Pharmacy students reported a high rate of IP experiences; mean (SD) CIPS score of 67.2 (14). Thirty percent of students reported at least moderate IP experiences and 68.2% reported frequent or intense IP experiences. The majority of students (59.6%) reported a growth mindset. Gender was the only tested variable that explained variance in CIPS or ITIS scores, as male gender respondents had lower CIPS score as compared to those reporting female gender (63.27 vs 68.87, p=.006). A correlation was found between lower ITIS and higher CIPS scores (r = -0.221, P < .001).

CONCLUSIONS

Pharmacy students surveyed exhibited a high rate of IP and growth mindsets. Understanding that fixed mindsets and high rates of IP are correlated can help educators make informed decisions regarding targeted interventions, with the goal to improve overall student wellbeing.

Intervening on impostor phenomenon: prospective evaluation of a workshop for health science students using a mixed-method design

BACKGROUND

Unaddressed impostor feelings that impede developing interest in science and self-efficacy in conducting research have a dispiriting effect that perpetuates unsatisfactory diversity in the health science workforce when such feelings are experienced more by those historically underrepresented in the workforce. This warrants effective interventions to reduce the impact of impostor feelings and related factors that diminish career resilience. We examined the effects of a 90-minute workshop on impostor perceptions and growth mindset to raise awareness of impostor phenomenon (IP) and develop skills to manage IP successfully for students attending a 10-week summer research experience program.

METHODS

Using a convergent mixed-methods design, data were analyzed from 51 racially and ethnically diverse students who participated in an interactive IP workshop. Using students' half-way and final progress reports about their summer experiences and pre- and post-summer online surveys, we identified how the workshop changed awareness of IP and helped students develop coping strategies.

RESULTS

Students strongly endorsed the workshop, remarking that its content and personal stories from peers validated their own IP experiences and relieved anxiety by revealing how common the experience was. Many reported applying mindset-changing solutions, including positive self-talk, focusing their thinking on facts about themselves and situation, and grounding themselves firmly against potentially persuasive and confidence-eroding impostor feelings. While students reported end-of-summer impostor feelings at levels similar to before the program, they described being able to manage their feelings better and persist towards goals and challenging tasks. One measure of IP appeared to be addressed through students' activation of a growth mindset, potentially explaining a specific mechanism for intervention. Discrepancies between qualitative responses and quantitative IP measures demand additional work on IP instruments.

CONCLUSIONS

A brief, theory-based IP workshop administered by research training programs, including those as short as 10-weeks, can have positive impact on subsequent IP experience and its successful management, with potential long-term impact on retention of a diverse biomedical research workforce.

Impact of the Early Phase of the COVID-19 Pandemic on Medical Student Well-Being: a Multisite Survey

BACKGROUND

The COVID-19 pandemic drastically impacted medical student experiences. Little is known about the impact of the pandemic on student well-being and protective factors for burnout.

OBJECTIVE

Assess US medical student burnout, stress, and loneliness during the initial phase of the pandemic, compare results to pre-pandemic data, and identify risk factors for distress and protective factors to inform support interventions.

DESIGN

Cross-sectional survey of medical students conducted between May and July 2020.

PARTICIPANTS

3826 students from 22 medical schools.

MAIN MEASURES

Burnout (MBI-HSS), stress (PSS-10), loneliness (UCLA scale), and student experiences. Compared burnout and stress to pre-pandemic studies (2010-2020).

KEY RESULTS

Of 12,389 students, 3826 responded (31%). Compared to pre-pandemic studies, burnout was lower (50% vs. 52%, P = 0.03) while mean stress was higher (18.9 vs. 16.0, P < 0.001). Half (1609/3247) reported high (≥ 6/9) loneliness scores. Significant differences were found in burnout and stress by class year (P = 0.002 and P < 0.001) and race (P = 0.004 and P < 0.001), with the highest levels in second- and third-year students and Black, Asian, or other racial minority students. Students experiencing financial strain or racism had higher burnout and stress (P < 0.001 for all). Respondents with COVID-19 diagnoses in themselves or family members had higher stress (P < 0.001). Nearly half (1756/3569) volunteered during the pandemic, with volunteers reporting lower burnout [48% (782/1639) vs. 52% (853/1656), P = 0.03].

CONCLUSIONS

While stress was higher compared to pre-pandemic data, burnout was significantly lower. Higher burnout and stress among Black, Asian, and other racial minority students and those who experienced financial strain, racism, or COVID-19 diagnoses likely reflect underlying racial and socioeconomic inequalities exacerbated by the pandemic and concurrent national racial injustice events. Volunteer engagement may be protective against burnout. Schools should proactively support vulnerable students during periods of stress.

Exploring reasons for MD-PhD trainees' experiences of impostor phenomenon

BACKGROUND

Acceptance into U.S. MD-PhD dual-degree programs is highly competitive, and the lengthy training program requires transitioning between multiple phases (pre-clinical-, PhD-research-, and clinical-training phases), which can be stressful. Challenges faced during MD-PhD training could exacerbate self-doubt and anxiety. Impostor phenomenon is the experience of feeling like a fraud, with some high-achieving, competent individuals attributing their successes to luck or other factors rather than their own ability and hard work. To our knowledge, impostor phenomenon among MD-PhD trainees has not been described. This study examined impostor phenomenon experiences during MD-PhD training and reasons trainees attributed to these feelings.

METHODS

Individuals in science and medicine fields participated in an online survey that included the 20-item Clance Impostor Phenomenon Scale (CIPS); higher scores (range 20-100) indicate more frequent impostor phenomenon. Some respondents who reported experiencing impostor phenomenon also voluntarily completed a semi-structured interview, sharing experiences during training that contributed to feelings of impostor phenomenon. Interview transcripts were coded and analysed using the constant comparative method and analytic induction to identify themes.

RESULTS

Of 959 survey respondents (students and professionals in science and medicine), 13 MD-PhD students and residents completed the survey, nine of whom (five male, four female; four white, five other race-ethnicity) also completed an interview. These participants experienced moderate-to-intense scores on the CIPS (range: 46-96). Four themes emerged from the interview narratives that described participants' experiences of IP: professional identity formation, fear of evaluation, minority status, and, program-transition experiences. All reported struggling to develop a physician-scientist identity and lacking a sense of belonging in medicine or research.

CONCLUSIONS

Impostor experiences that MD-PhD participants attributed to bias and micro-aggressions in social interactions with peers, faculty, and patients challenged their professional identity formation as physician-scientists. It is important to further examine how MD-PhD-program structures, cultures, and social interactions can lead to feelings of alienation and experiences of impostor phenomenon, particularly for students from diverse and underrepresented populations in medicine.

Impostor Phenomenon and Its Relationship to Self-Esteem Among Students at an International Medical College in the Middle East: A Cross Sectional Study

The atmosphere of constant scrutiny of academic ability that prevails in medical colleges may leave some students at risk of expressing feelings of intellectual fraudulence and phoniness. Impostor phenomenon (IP) traits have been associated with anxiety, depression, job dissatisfaction, and poor professional performance. Internationally trained junior doctors exhibit stronger IP feelings than colleagues trained within their own country of citizenship. These feelings may develop during student life. International universities are diverse and complex environments where students may be emersed in a cultural milieu alien to their societies of origin, leading to feelings of isolation. Individuals with IP traits often perceive themselves as the “only one” experiencing this phenomenon, resulting in further isolation and negative self-evaluation, especially among women and underrepresented minorities. IP has also been linked to low self-esteem among students. This study assessed the prevalence of IP and its relationship to self-esteem among students at a campus of a European medical college with a large international student body situated in the Middle East. The self-administered questionnaires: Clance's Impostor Phenomenon Scale (CIPS) and Rosenberg's Self-Esteem Scale (RSES) were completed by 290 medical students (58.3% females). Participants' median (range) age was 19 years (16–35). Students were of 28 different nationalities; the largest proportions were from Gulf Corporation Council (GCC) countries. The prevalence of low self-esteem was 18.6%, while 45.2% of the students demonstrated traits suggestive of IP. There was a strongly negative correlation between CIPS and RSES (r = −0.71). No significant gender differences were found in IP. Similarly, no differences in IP were found when comparing between age groups, previous experience in higher education or year of study. Multivariate analysis showed that students from GCC countries had higher levels of self-esteem relative to students from other regions. Low self-esteem was a strong predictor of IP. Country of origin may influence students' self-esteem studying in international university settings.

A Cultural Impostor? Native American Experiences of Impostor Phenomenon in STEM

Using a framework of colonization in science, technology, engineering, and mathematics (STEM), this U.S.-based study examined how seven Native American PhD students/postdoctoral scholars experienced impostor phenomenon. Participants were identified/contacted at a national conference on minorities in STEM through purposeful sampling. Surveys computed impostor phenomenon scores on a validated scale, while interviews documented how identity and culture contributed to impostor phenomenon in academia. Using a phenomenological approach, interviews were analyzed inductively using a constant comparative method. Surveys scores indicated high to intense impostor phenomenon. Interviews with the same participants further identified the following aspects of impostor phenomenon in relation to their minoritized identity: cultural differences and lack of understanding of Indigenous culture, lack of critical mass and fear of standing out, academic environment, family background and upbringing, and looks and diversity status. Developing a diverse and culturally competent STEM workforce requires a deeper understanding of what deters Native American individuals from pursuing a STEM career. They have the lowest college enrollment and retention rates compared with any race in the United States and could be vulnerable to racial bias and discrimination. Understanding impostor phenomenon through culturally relevant experiences would be crucial to broaden participation in STEM careers.

Evaluating the impact of a national strategic leader development programme for UK doctors: myth-busting, mind-changing, mood-enhancing

Background

The drive towards engaging UK doctors in clinical leadership and management has involved many initiatives at various levels.

Methods

This paper reports on the findings of an in-depth evaluation of a national medical leadership programme for doctors in the late stages of specialty or general practitioner (GP) training or have just become consultants or GPs.

Results

The evaluation clearly demonstrates the impact of this programme and the benefits for the individuals and organisations involved, particularly around stimulating a shift in mood and a major mindset shift in what medical leadership is (and is not) and what they can achieve as medical leaders. The programme structure and activities allowed participants to learn from a range of senior decision-makers about policy and strategic developments and processes. However, the evaluation also highlighted that some pervasive myths still exist around medical leadership and management which, if not addressed, will hamper efforts to fully engage doctors in taking on strategic leadership roles.

Conclusion

Clinical leadership programmes are valuable, but must be carefully managed to extract the full value from them.

Sources of work-related psychological distress experienced by UK-wide foundation and junior doctors: a qualitative study

OBJECTIVES

This paper reports findings exploring work cultures, contexts and conditions associated with psychological distress in foundation and junior doctors.

DESIGN

Qualitative study using in-depth interviews with 21 junior doctor participants. The interviews were audio-recorded, transcribed, anonymised and imported into NVivo V.11 to facilitate data management. Data were analysed using a thematic analysis employing the constant comparative method.

SETTING

NHS in England.

PARTICIPANTS

A purposive sample of 16 female and five male junior doctor junior doctor participants who self-identified as having stress, distress, anxiety, depression and suicidal thoughts, or having attempted to kill themselves.

RESULTS

Analysis reported four key themes: (1) workload and working conditions; (2) toxic work cultures-including abuse and bullying, sexism and racism, culture of blaming and shaming; (3) lack of support; (4) stigma and a perceived need to appear invulnerable.

CONCLUSION

This study highlights the need for future solutions and interventions targeted at improving work cultures and conditions. There needs to be greater recognition of the components and cumulative effects of potentially toxic workplaces and stressors intrinsic to the work of junior doctors, such as the stress of managing high workloads and lack of access to clinical and emotional support. A cultural shift is needed within medicine to more supportive and compassionate leadership and work environments, and a zero-tolerance approach to bullying, harassment and discrimination.

Admissions Is Not Enough: The Racial Achievement Gap in Medical Education

The achievement gap is a disparity in academic and standardized test performance that exists between White and underrepresented minority (URM) students that begins as early as preschool and worsens as students progress through the educational system. Medical education is not immune to this inequality. URM medical students are more likely to experience delayed graduation and course failure, even after accounting for science grade point average and Medical College Admission Test performance. Moreover, URM students are more likely to earn lower scores on licensing examinations, which can have a significant impact on their career trajectory, including specialty choice and residency competitiveness. After the release of preliminary recommendations from the Invitational Conference on USMLE Scoring (InCUS) and public commentary on these recommendations, the National Board of Medical Examiners and Federation of State Medical Boards announced that the United States Medical Licensing Examination (USMLE) Step 1 would transition from a 3-digit numeric score to pass/fail scoring. Given that another of InCUS's recommendations was to "minimize racial demographic differences that exist in USMLE performance," it is paramount to consider the impact of this scoring change on URM medical students specifically. Holistic admissions are a step in the right direction of acknowledging that URM students often travel a further distance to reach medical school. However, when residency programs emphasize USMLE performance (or any standardized test score) despite persistent test score gaps, medical education contributes to the disproportionate harm URM students face and bolsters segregation across medical specialties. This Perspective provides a brief explanation of the achievement gap, its psychological consequences, and its consequences in medical education; discusses the potential effect of the Step 1 scoring change on URM medical students; and provides a review of strategies to redress this disparity.