Imposter phenomenon: recognising and addressing it among nurses

Imposter phenomenon is described as persistently doubting one's accomplishments, leading to an internalised fear of being exposed as a 'fraud'. This article identifies the nature and prevalence of imposter phenomenon among nursing students, newly registered nurses and senior nurses. It also explores the effects of this phenomenon for nurses and healthcare organisations, including its potential association with burnout, suboptimal performance and a lack of career development. Evidence suggests that addressing imposter phenomenon is not something individuals can accomplish by themselves, but that it requires system-level interventions from healthcare organisations and higher education institutions. This could raise awareness, promote recognition and improve resources and training to mitigate the detrimental effects of this phenomenon on healthcare provision.

Exploring Impostor Phenomenon During Onboarding Into a Military Medical School

INTRODUCTION

Impostor phenomenon (IP) is an experience where an individual believes that their success was because of chance or luck and was not associated with the mastery of skills. There is a gap in the literature in understanding what role, if any, onboarding (e.g., orientation weeks) into a military medical school plays into student experiences with IP. For many, onboarding serves as the first exposure to the climate, culture, and learning environment of both medical school and the military. Prevention, or early intervention, of IP may reduce potential effects on a medical trainee's confidence and competence in their profession, which may ultimately enhance health care team performance and impact patient outcomes. This study explores if and why military medical students experience IP during a 2-week-long orientation into a military medical school.

MATERIALS AND METHODS

The study participants were medical students at a military medical school. Researchers conducted semi-structured interviews in August 2022 to explore if and why students experienced IP and deployed the Clance IP Scale as a measure with validity evidence for ascertaining the presence and magnitude of IP. Researchers calculated total scores from the Clance IP Scale and thematically analyzed interview transcripts.

RESULTS

Researchers interviewed 29 matriculating military medical students. Twenty-one (75%) students reported frequent or intense IP experiences on the Clance IP Scale indicating that IP was present in our study sample. Thematic analysis identified six themes that drove one's experience with IP: reevaluation of merit, individualized diversity and inclusion experiences, administrative and financial support, preconceived expectations, building relationships, and new community roles.

CONCLUSIONS

Our identified themes provide us with a better understanding of if and why military medical students experience IP during onboarding. Our findings are also consistent with the situated learning theory, which places emphasis on the sense of belonging and may provide a unique and insightful lens through which IP can be further explored and studied, particularly at a military medical school where various identities, dynamics, and aspirations can converge simultaneously. Additionally, our findings suggest that existing practices may benefit from a number of improvements including, but not limited to, tailoring onboarding activities to entail more reflective discussion using small groups, especially for topics related to diversity and inclusion, revisiting areas where students may feel inadequately prepared to transition and perform well in a medical school, reevaluating administrative and financial support that can be roadblocks to a student's transition into the new environment and removing these barriers, and ensuring cultural coherence (organizational alignment of vision and mission) among faculty, staff, and upperclassmen. Future research directions include better understanding how developing single or multiple, identities can impact a medical students' experience with IP during onboarding, pre-clerkship, clerkship, or post-clerkship period, if at all.

Implicit Biases and Racial Microaggressions: Examining the Impact on Black Social Work Students' Well-Being

This paper explores the concept of racial microaggressions, everyday slights and offensive behaviors experienced by people of color, particularly focusing on their manifestation within social work education programs. Black social work students, in particular, frequently encounter instances tied to stereotypes about their intellectual abilities, perpetuating historical prejudices and contributing to mental health challenges such as anxiety and impostor phenomenon (IP). The historical trauma endured by Black individuals adds a distinct layer to the struggles faced by Black, Indigenous, and People of Color (BIPOC) students in social work education. Despite the evident impact, there exists a significant gap in scholarship addressing these issues, emphasizing the urgent need for the social work profession to confront and comprehend how implicit biases and racial microaggressions impede the success of Black social work students. This theoretical exploration aims to spark vital dialogue on the manifestations of implicit biases and racial microaggressions, probing their link to feelings of IP and historical trauma. Central to this inquiry is the examination of the critical consciousness framework's efficacy in social work education, uncovering its role in raising awareness among professionals regarding their inadvertent perpetuation of oppressive systems. By leveraging this framework, the paper seeks to unearth structures of oppression and privilege, promoting awareness of unintentional complicity in upholding these structures. Recommendations align with the critical consciousness framework, advocating for future dialogues and the implementation of effective microaggression scales to incorporate and analyze frequencies and the impact of racism in social work research.

Impostor Phenomenon in Racially/Ethnically Minoritized Groups: Current Knowledge and Future Directions

In recent years there has been a surge of research conducted on the impostor phenomenon, with approximately half of all impostor phenomenon articles being published between 2020 and 2022 and growing interest in understanding how the impostor phenomenon affects racially and ethnically minoritized individuals. Questions around intersectionality remain about how to apply the impostor phenomenon to the experiences of minoritized individuals. In this review, we revisit the historical context of the impostor phenomenon. We address issues of nomenclature and current controversies regarding whether the impostor phenomenon (a) blames the victim, (b) should be included in the Diagnostic and Statistical Manual of Mental Disorders (DSM), and (c) is beneficial for individuals. In addition, we address the limitations of current research on racially and ethnically minoritized individuals, especially women of color. Finally, we conclude by discussing the need for a reconceptualized racialized impostor phenomenon as well as the need to establish new impostor phenomenon measures, conduct more quantitative research with diverse samples, and create culturally tailored interventions.

Mental Health-Related Barriers and Facilitators to PhD Program Retention among Underrepresented Racial and Ethnic Minoritized (UREM) Nursing Students: A Qualitative Inquiry

Mental health concerns among doctorate (PhD) nursing students may impact program retention, especially among underrepresented racial-/ethnic-minoritized (UREM) students. Understanding mental health concerns among UREM PhD students is necessary to develop retention strategies. We conducted a qualitative secondary data analysis of a descriptive study with focus groups and individual semi-structured interviews. Participants identified as actively enrolled UREM in PhD nursing programs. Conventional content analysis was utilized. Mental health informed retention through the following themes: PhD program pressure and expectations, help-seeking barriers, personal motivations to succeed, and it takes a village: fostering peer support. Implications for nursing faculty are discussed.

Factors and barriers that influence the matriculation of underrepresented students in medicine

Despite many initiatives over more than 4 decades, the diversity of United States physicians still does not reflect the diversity of the United States population. The present study undertakes a literature review of the last 30 years to investigate barriers and protective factors underrepresented college students encounter as applicants for medical school. Known barriers that influence matriculation into medical school were analyzed such as academic metrics and test scores. Additionally, elements that are less well studied were investigated such as factors perceived as barriers by underrepresented applicants in addition to protective factors that allow them to persist in their journey in the face of difficulties and adversity.

Faculty Experiences of the Impostor Phenomenon in STEM Fields

Successful people experiencing impostor phenomenon consider themselves less competent and less worthy of their positions or achievements. They attribute their success to luck, deceit, fraudulence, and others being kind to them instead of their own competence. Prior research has focused primarily on students in higher education; faculty experiences of impostor phenomenon in science, technology, engineering, and mathematics (STEM) fields are not well understood. The research question guiding this inquiry was: "What kind of academic events or activities could contribute to faculty experiences of impostor phenomenon in STEM?" Using a qualitative analysis of 56 interviews, this U.S.-based study examined occurrences and experiences among faculty who self-identified as experiencing impostor phenomenon. A prior survey from the same participants revealed that they were predominantly White and female, experiencing moderate, high, or intense impostor phenomenon. Thematic interview analysis revealed that impostor phenomenon could be related to the following: 1) peer comparison, 2) faculty evaluation, 3) public recognition, 4) the anticipatory fear of not knowing, and 5) a perceived lack of competency. A comparison with findings from the larger study revealed that there are commonalities among faculty, PhD student, and postdoctorate experiences of impostor phenomenon in STEM. This necessitates professional development opportunities that could address self-limiting beliefs across the academic pipeline.

Can academic dentistry become an anti-racist institution?: Addressing racial battle fatigue and building belonging

Racism, oppression, and marginalization are unfortunate hallmarks that Black individuals face in the United States. While dental schools serve as institutions of both learning and patient care, applying humanistic principles, they are not immune to racism, specifically anti-Black racism. In this paper, the theoretical framework of racial battle fatigue is applied to academic dentistry to consider how it may impact faculty who have experiences with racism and discrimination. The framework of racial battle fatigue allows for a critique of academic dentistry as an institution that may be toxic, neither welcoming Black faculty members nor supporting their professional and career advancement, despite accreditation standards that call on these institutions to be humanistic environments for diversity and inclusion. Black faculty members may face unique challenges in academic dentistry because of racial battle fatigue. The cumulative stress may warrant unique strategies to both recruit and retain them in academic dental institutions. Specifically, pathways may need to be funded to insure that they have support and time allocations for professional development and career promotion. With understanding the effects of racial battle fatigue, dental schools may want to adopt policies and practices that support the professional and personal well-being and success of faculty, especially those faculty members who are Black.

Supporting racial, ethnic minority, and disadvantaged undergraduate nursing students with honors projects

BACKGROUND

Underrepresented racial and ethnic minority (UREM) and disadvantaged background (DB) students often feel a lack of belonging and community in higher education. Participation in Honors Programs has been shown to build a sense of belonging and community associated with short and long-term benefits for both students and their academic institutions.

PURPOSE

To describe the program we implemented (the MM program) to increase UREM and DB student representation in a SON Honors Program.

METHOD

A prospective, descriptive study of SON UREM and DB honors students with a May graduation date of 2017-2020.

RESULTS

A total of 129 students completed honors with 23 MM UREM and DB students completing honors. Seven received highest honors award distinction that exemplifies exceptional work at a level beyond usually high expectations.

CONCLUSIONS

A supportive environment for UREM and DB students with resources are essential for students to consider and also complete an honors project.

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.

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.

Lawyering While Black: Perceived Stress as a Mediator of Impostor Feelings, Race-Related Stress and Mental Health Among Black Attorneys

Attorneys suffer from high rates of stress and mental health problems, and Black attorneys, who make up only five percent of all attorneys in the United States, are especially vulnerable due to underrepresentation and experiences of bias. The present study examined perceived stress as a mediator of the impostor phenomenon, race-related stress, and mental health among a sample of 142 Black attorneys (114 women, 25 men). Gender, age, impostor phenomenon, race-related stress, and perceived stress accounted for 51% and 57% of the variance in depression and anxiety, respectively. Perceived stress fully mediated the links between the impostor phenomenon and depression, cultural racism and depression, and impostor feelings and anxiety and partially mediated the link between cultural racism and anxiety. Results suggest that perceived stress is an important mechanism for understanding why the impostor phenomenon and race-related stress negatively impact the mental health of Black attorneys.

Maladaptive Perfectionism, Impostor Phenomenon, and Suicidal Ideation Among Medical Students

OBJECTIVE

Suicide is a leading cause of death for young adults, and medical students experience elevated rates of suicide and suicidal ideation. The present study uses mediation analysis to explore relationships between suicidal ideation and two dysfunctional mindsets common among medical students: maladaptive perfectionism, high standards accompanied by excessive self-criticism, and impostor phenomenon, pervasive feelings of inadequacy despite evidence of competence and success.

METHODS

Two hundred and twenty-six medical students at a single institution completed an online survey which assessed maladaptive perfectionism, impostor phenomenon, and suicidal ideation. After calculating measures of association between all study variables, linear regression was conducted to establish the relationship between maladaptive perfectionism and suicidal ideation. To evaluate whether impostor phenomenon mediated the relationship between maladaptive perfectionism and suicidal ideation as hypothesized, a series of regression models were constructed and the regression coefficients were examined. The statistical significance of the indirect effect, representing the mediated relationship, was tested using bootstrapping.

RESULTS

Significant positive associations between maladaptive perfectionism, impostor phenomenon, and suicidal ideation were observed. Impostor phenomenon score was found to mediate the relationship between maladaptive perfectionism and suicidal ideation.

CONCLUSIONS

Medical students who exhibit maladaptive perfectionism are at increased risk for feelings of impostor phenomenon, which translates into increased risk for suicide. These results suggest that an intervention targeted at reducing feelings of impostor phenomenon among maladaptive perfectionists may be effective in reducing their higher risk for suicide. However, interventions promoting individual resilience are not sufficient; systemic change is needed to address medicine's "culture of perfection."

Impostorism, subjective age, and perceived health among aging veterans

RATIONALE

Aging veterans often suffer from increased vulnerability, manifested among other things in old subjective age and poor perceived health. Though research has documented the contribution of trauma related variables to these negative appraisals, their associations with impostorism (i.e., the subjective experience that one is less adequate than others perceive) remain unexamined.

OBJECTIVE

Filling this gap, this study explored the relations between impostorism and subjective age and perceived health among aging combat veterans.

METHOD

The study was conducted among 146 Israeli veterans of the 1973 Yom Kippur War. Participants were assessed for combat exposure, Posttraumatic Stress Disorder (PTSD) symptoms, and health-related behaviors during middle adulthood (1991; T1), and for subjective age, perceived health, impostorism, PTSD symptoms, and depressive symptoms during old age (2018; T2).

RESULTS

The veterans' impostorism was associated with relatively old subjective age and poor perceived health, above and beyond the effects of age, health-related behaviors, combat exposure, depressive symptoms, and PTSD symptoms.

CONCLUSIONS

The current results suggest that impostorism may contribute to veterans' stress and negatively affect their evaluations regarding age and health.

Prevalence, Predictors, and Treatment of Impostor Syndrome: a Systematic Review

BACKGROUND

Impostor syndrome is increasingly presented in the media and lay literature as a key behavioral health condition impairing professional performance and contributing to burnout. However, there is no published review of the evidence to guide the diagnosis or treatment of patients presenting with impostor syndrome.

PURPOSE

To evaluate the evidence on the prevalence, predictors, comorbidities, and treatment of impostor syndrome.

DATA SOURCES

Medline, Embase, and PsycINFO (January 1966 to May 2018) and bibliographies of retrieved articles.

STUDY SELECTION

English-language reports of evaluations of the prevalence, predictors, comorbidities, or treatment of impostor syndrome.

DATA EXTRACTION

Two independent investigators extracted data on study variables (e.g., study methodology, treatments provided); participant variables (e.g., demographics, professional setting); diagnostic tools used, outcome variables (e.g., workplace performance, reductions in comorbid conditions); and pre-defined quality variables (e.g., human subjects approval, response rates reported).

DATA SYNTHESIS

In total, 62 studies of 14,161 participants met the inclusion criteria (half were published in the past 6 years). Prevalence rates of impostor syndrome varied widely from 9 to 82% largely depending on the screening tool and cutoff used to assess symptoms and were particularly high among ethnic minority groups. Impostor syndrome was common among both men and women and across a range of age groups (adolescents to late-stage professionals). Impostor syndrome is often comorbid with depression and anxiety and is associated with impaired job performance, job satisfaction, and burnout among various employee populations including clinicians. No published studies evaluated treatments for this condition.

LIMITATIONS

Studies were heterogeneous; publication bias may be present.

CONCLUSIONS

Clinicians and employers should be mindful of the prevalence of impostor syndrome among professional populations and take steps to assess for impostor feelings and common comorbidities. Future research should include evaluations of treatments to mitigate impostor symptoms and its common comorbidities.