|Year : 2020 | Volume
| Issue : 3 | Page : 105-109
Impostor phenomenon in veterinary medicine
Ryan Appleby1, Maria Evola2, Kenneth Royal3
1 Department of Clinical Studies, Ontario Veterinary College, University of Guelph, ON, Canada
2 Department of Molecular and Biomedical Sciences, NC State University College of Veterinary Medicine, Raleigh, North Carolina, USA
3 Department of Clinical Sciences, NC State University College of Veterinary Medicine, Raleigh, North Carolina, USA
|Date of Submission||12-May-2020|
|Date of Acceptance||06-Aug-2020|
|Date of Web Publication||6-Nov-2020|
Dr. Ryan Appleby
University of Guelph, 50 Stone Road E, Guelph, ON
Source of Support: None, Conflict of Interest: None
Background: Impostor phenomenon (IP), an internal perception of intellectual phoniness despite personal achievements, has been reported and evaluated in a number of professions, including doctors, dentists, pharmacists, and academic faculty. To date, this phenomenon has not been evaluated in the veterinary medicine. Methods: To examine the prevalence of IP in veterinary medicine, we surveyed veterinary students, house officers, and veterinarians at a large college of veterinary medicine. Survey measures included the Clance IP Scale (CIPS) and Young Impostor Scale (YIS). Results: The prevalence of IP in our population was 50%, 68%, and 34%, among students, house officers, and faculty, respectively, based on the responses to the CIPS. The prevalence of IP was 45%, 60%, and 26%, among students, house officers, and faculty, respectively, based on the responses to the YIS. Conclusion: Among veterinary students, house officers and faculty IP are experienced to a similar degree as that reported in other health professions.
Keywords: Imposter syndrome, interns, psychology, residents, veterinary medicine
|How to cite this article:|
Appleby R, Evola M, Royal K. Impostor phenomenon in veterinary medicine. Educ Health Prof 2020;3:105-9
| Introduction|| |
Impostor phenomenon (IP) was first described by Clance and Imes in 1978 as an internal perception of intellectual phoniness. This concept has been described with other terminology such as perceived fraudulence  and impostor syndrome; however, regardless of the nomenclature is characterized by feelings of self-doubt, a self-perception of being unintelligent or unqualified and a fear of being found out as a fake. Numerous prior studies have evaluated the prevalence of IP and its correlation with well-being in a large number of high achieving professions. In one report of graduate entry nurses, 70% of individuals experience frequent or intense impostor characteristics. Among medical students, gender was found to have a significant effect on the prevalence of IP with 49.4% of female students and 23.7% of male students responding with survey results consistent with IP. Similar changes were noted among medical, dental, and pharmacy students in a separate study where 37.3% of women and 22% of men had the scores consistent with IP. More students than expected in this study reported psychological distress (27.5%), and this was found to be correlated with scores on the administered IP survey among medical students. The results of other work suggest these feelings of fraud may continue following graduation, as approximately 30% of family medicine residents, including 41% of women and 24% of men were classified as experiencing IP. Among internal medicine residents 43.8% scored as having IP, and IP was more likely among foreign-trained residents. To the authors' knowledge, IP has not been evaluated among veterinarians or veterinary students to date. While occurring in both women and men, IP has in some instances been shown to be more prevalent among women,, a characteristic of importance to veterinary medicine given the large proportion of female graduates. Given the correlations with negative impacts on well-being, studying this phenomenon in the veterinary medicine is important to determine if IP exists in the veterinary community. If so, it may reflect an important target for intervention to improve possible negative impacts. As such, this study evaluates the prevalence of IP among students, house officers (interns and residents), and faculty at a large college of veterinary medicine.
| Methods|| |
This study protocol was reviewed and approved by the institutional review board of (NC State University). The Clance IP Scale (CIPS) was used with written approval through E-mail from Dr. Pauline Rose Clance.
An anonymous questionnaire was administered to students, house officers (residents and interns), and veterinary faculty at (NC State College of Veterinary Medicine) containing a series of demographic questions as well as the CIPS and Young Impostor Scale (YIS). The questionnaire was administered through E-mail link to student and veterinarian listservs using Qualtrics survey software (qualtrics.com) and was voluntary to respond without incentive or repercussion. The CIPS is a 20-item survey in which the respondent uses a 5-point Likert scale (not at all true to very true) to indicate how true the statements are of themselves. The CIPS has been previously validated  and is available for the personal use or for professional use with permission at paulineroseclance.com. The YIS is an 8-item survey with a binary yes or no response. Responding yes to at least 5 of 8 questions is consistent with IP, and this instrument has been used previously to examine the prevalence of IP in medical students.
During administration, one question from the CIPS was not presented to the respondents due to a technical error (Item 4 “When people praise me for something I've accomplished, I'm afraid I won't be able to live up to their expectations of me in future”). Therefore, 19 questions of the CIPS were presented, making the total possible score 95 instead of 100. While the CIPS is normally interpreted with scores of 40 or less indicating few impostor characteristics, scores between 41 and 60 indicating moderate IP experiences, scores between 61 and 80 indicating frequent impostor feelings; scores higher than 81 indicating intense IP experiences this was modified in the analysis of our questionnaire. To reflect the absent question, each category score was decreased by 1; therefore, 39 or fewer indicated few impostor characteristics, 40–59 moderate IP experiences, 60–79 frequent IP feelings, and >80 intense impostor experiences.
An analysis of variance (ANOVA) of the mean CIPS score comparing group, gender, race/ethnicity, age, and years of experience were performed using the SPSS (IBM, Armonk, NY, USA) (version 24) statistical software. A Tukey post hoc test was performed between the groups to identify which, if any, characteristics significantly differed from the others. YIS scores were determined by calculating the number of relevant groups that had 4 or fewer “yes” responses (minimal IP characteristics) and 5 or more “yes” responses (presence of IP).
| Results|| |
Of approximately 200 veterinarians and 400 students, there were 294 respondents to the questionnaire (148 students – 37% response rate and 146 veterinarians – 73% response rate). Of student respondents, 24 (16.3%) identified as male, 122 (82.4%) identified as female, and 2 (1.3%) identified as other. A majority of student respondents (n = 125, 86.5%) identified as white, as compared to other races and ethnicities (n = 12, 8.1%). Students were predominantly under the age of 35 with 76 (51.4%) respondents between 18 and 25 years of age, and 61 respondents between 26 and 35 years of age (41.2%). Nine students (6.0%) were between 36 and 45 years of age and 1 (0.1%) between 46 and 55 years of age.
Among veterinarians who responded, 67 (33.5%) were faculty members, 55 (27.5%) residents and 21 (10.1%) interns. Of these veterinarians 45 (31.4%) identified as male and 97 (67.8%) identified as female. Similar to students, a majority of veterinarians identified as white (n = 130, 87.8%) as compared to other races or ethnicities (n = 12, 8.1%). Of veterinarians, 2 (1.3%) were between the age group of 18–25 years, 76 (51.4%) between the age group of 26–35 years, 29 (19.6%) between 36 and 45, 11 (7.4%) between 46 and 55, 20 (13.5%) between 56 and 65 and 5 (3.4%) individuals 66–75. There was moderate-to-high correlation between the two instruments used (Spearman's rho = 0.813). The Cronbach's alpha reliability coefficient for the CIPS was 0.916 and for the YIS was 0.783.
Clance impostor phenomenon scale
Mean CIPS score among groups is presented in [Table 1]. ANOVA results indicate the mean CIPS score for faculty was significantly less than the mean score for interns and residents (P ≤ 0.0001). Interns had a mean score significantly greater than that of students (P = 0.014), but not of residents (P = 0.884). Residents similarly had mean a mean CIPS score greater than students (P = 0.006). The number of individuals per group experiencing few, moderate, frequent or intense impostor characteristics, based on the classification with the CIPS is presented in [Table 2]. A previously suggested cutoff value for IP, of scores 62 or higher using the CIPS, is similar to the score for those with frequent or intense impostor characteristics (scores of 61 or higher in the natural form of the CIPS and 60 or higher in our adapted scale). In our population, the percentage of those with impostorism (frequent or intense impostor characteristics) is 50% of students, 68% of interns and residents, and 34% of faculty. Intense feelings of impostorism were seen in large numbers for both interns and residents with 22% or residents and 28% of interns responding as such. Frequent feelings of impostorism were seen similarly across the groups with 32% of faculty, 43% of residents, 47% of interns, and 44% of students responding with frequent Impostor experiences. There were no intern respondents with few impostor feelings, that is, all intern respondents had scores of 40 or more. There was no significant effect of the year of the program, gender, race or ethnicity (P > 0.05). However, ANOVA results indicate that responses were statistically significantly different based on age and years of experience. More specifically, persons 46–55, 56–65, and 66–75 years of age had significantly lower scores than persons 26–35 years of age (P < 0.05), and persons with 11–15, 16–20 or 21+ years' experience had significantly lower scores (P < 0.05) than persons with 0–5 years' experience, and persons with 21 years or more experience had significantly lower scores than persons with 6–10 years' experience.
|Table 1: Classification of the mean Clance Impostor Phenomenon Scale* by demographic groups|
Click here to view
|Table 2: Number of respondents per category in the Clance Impostor Phenomenon Scale*|
Click here to view
Young impostor scale
The number of individuals responding with minimal impostor characteristics (answering “yes” to 4 or fewer questions) or a response suggestive of impostorism (answering “yes” to 5 or more questions) is presented in [Table 3]. The number of individuals with IP was similar to results of the CIPS with 45% of students, 60% of house officers, and 26% of faculty having a response consistent with IP. With respect to role, faculty reported significantly lower scores than residents, interns, and students (P < 0.05), although differences among the other groups were not significantly different. With respect to age, again older individuals (46 and older) reported significantly lower scores than younger respondents (18–45). With respect to years' experience, persons with 21 or more years reported significantly lower scores than all other experience groups. However, no differences were discernible among groups with <21 years' experience.
| Discussion|| |
This study reflects the first evaluation of the prevalence of IP in the veterinary community to the authors' knowledge. The prevalence as identified with both the CIPS and the YIS is similar to that noted in other professions and specifically in the medical field, which is in many ways similar to veterinary medicine.
One limitation of this study is the error in the presentation of the CIPS. While the CIPS has been previously validated, its use with only 19 items has not. Therefore, the effects of such an omission are not known. However, the approach of reducing the scores for each response category is considered by the authors to be an appropriate method of addressing this error. Similarly, as there were high mean CIPS scores and an overall large number of individuals with the frequent or intense impostor feelings, the overall results of the CIPS suggest prevalence similar to those in other professions. Finally, the high consistency between the CIPS and the YIS is further support that the findings remain valid.
The effect of age in our population is consistent with some prior reports of IP. In a recent systematic review, six studies evaluated the effect of age on IP. This review identified that 3 of these 6 studies demonstrated a negative correlation with age and prevalence of IP in at least part of their population. Given that our population, spanned a large age range including opposite ends of the educational spectrum with both students and faculty included, this may have increased the likelihood of identifying an effect of age when compared to studies which look at a more narrow cohort such as a population of students or residents alone. A similar inference is made by Bravata et al. in regards to the effect of age among working professionals when compared to undergraduate students which was identified in one study  included in their systematic review.
As IP has previously been shown to be related to burnout, depression, and psychological distress this phenomenon holds important implications for veterinary medicine. Recent work has highlighted the importance of considering well-being among veterinarians. In the Merck Animal Health Veterinary well-being study, two thirds of veterinary respondents reported the feelings of depression, compassion fatigue, burnout, anxiety, or panic attacks. Psychological distress among veterinarians has been reported as higher than the general population., In addition, veterinarians have been identified as a group at risk for suicidal ideation, a possible outcome of IP in its most severe manifestation. Given these factors, an understanding of the role of IP in veterinary medicine may have an important impact on the well-being of veterinarians.
The origins of IP have been described as multifactorial , and include “demographic, familial and environmental contributors.” Drs. Clance and Imes described origins which include familial settings in which the individual suffering from IP either experienced high expectations with high praise, or low expectations with relatively little praise as a child. As previously described for other health-care professions, veterinary medicine encorporates all the environmental factors contributing to IP, including serial learner status, constant evaluation, and being surrounded by other highly successful individuals. With these factors in mind, one can recognize veterinary medicine as a profession at high risk for a relatively high prevalence of IP.
Addressing IP among students and house officers may allow for a point of intervention to negate possible negative influences on mental health. While prior work has not evaluated the efficacy of different therapies or interventions, there are many suggested to help combat IP. Clinical counseling is often referenced as a strategy,,, and therefore, providing trainees with resources to access clinical counseling may be considered by educators in veterinary medicine. Similarly, Seritan and Mehta summarize numerous suggested strategies outlined by both scientific and lay literature. For veterinary educators, this includes providing educational workshops on IP, developing mentorship programs, offering leadership training, and fostering a culture which does not punish mistakes. Strategies for individuals suffering from IP include but are not limited to being aware of IP and its associated behaviors, accepting compliments, empirically evaluating the steps taken to accomplish successes, keeping record of positive feedback, celebrating accomplishments, seeking mentorship, and considering clinical counseling/therapy.
Future work may be directed at correlating IP with other factors such as burnout or psychological distress among veterinarians and veterinary students and investigating the role of interventions on alleviating either IP or the combination of IP and negative indicators of mental health.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Clance PR, Imes SA. The imposter phenomenon in high achieving women: Dynamics and therapeutic intervention. Psychother Theory, Res Pract 1978;15:241–247.
Kolligian J Jr., Sternberg RJ. Perceived fraudulence in young adults: Is there an “imposter syndrome”? J Pers Assess 1991;56:308-26.
Villwock JA, Sobin LB, Koester LA, Harris TM. Impostor syndrome and burnout among American medical students: A pilot study. Int J Med Educ 2016;7:364-9.
Aubeeluck A, Stacey G, Stupple EJ. Do graduate entry nursing student's experience 'Imposter Phenomenon'?: An issue for debate. Nurse Educ Pract 2016;19:104-6.
Henning K, Ey S, Shaw D. Perfectionism, the impostor phenomenon and psychological adjustment in medical, dental, nursing and pharmacy students. Med Educ 1998;32:456-4.
Oriel K, Plane MB, Mundt M. Family medicine residents and the impostor phenomenon. Fam Med 2004;36:248-52.
Legassie J, Zibrowski EM, Goldszmidt MA. Measuring resident well-being: Impostorism and burnout syndrome in residency. J Gen Intern Med 2008;23:1090-4.
Chrisman SM, Pieper WA, Clance PR, Holland CL, Glickauf-Hughes C. Validation of the clance imposter phenomenon scale. J Pers Assess 1995;65:456-67.
Holmes SW, Kertay L, Adamson LB, Holland CL, Clance PR. Measuring the impostor phenomenon: A comparison of Clance's IP Scale and Harvey's I-P Scale. J Pers Assess 1993;60:48-59.
Bravata DM, Watts SA, Keefer AL, Madhusudhan DK, Taylor KT, Clark DM, et al
. Prevalence, predictors, and treatment of impostor syndrome: A systematic review. J Gen Intern Med 2020;35:1252-75.
Brauer K, Proyer RT. Are impostors playful? Testing the association of adult playfulness with the impostor phenomenon. Pers Individ Dif 2017;116:57–62.
Volk JO, Schimmack U, Strand EB, Lord LK, Siren CW. Executive summary of the merck animal health veterinary wellbeing study. J Am Vet Med Assoc 2018;252:1231-8.
Nett RJ, Witte TK, Holzbauer SM, Elchos BL, Campagnolo ER, Musgrave KJ, et al
. Risk factors for suicide, attitudes toward mental illness, and practice-related stressors among US veterinarians. J Am Vet Med Assoc 2015;247:945-55.
Seritan AL, Mehta MM. Thorny laurels: The impostor phenomenon in academic psychiatry. Acad Psychiatry 2016;40:418-21.
[Table 1], [Table 2], [Table 3]