|Year : 2022 | Volume
| Issue : 1 | Page : 1-3
Unmasking the student impostor: Remedies for the impostor phenomenon to promote student success in the clinic
Allison J Durham1, Stefanie Anderson2
1 School of Physical Therapy, Bowling Green State University, Bowling Green, OH, USA
2 School of Physical Therapy, University of Findlay, Findlay, OH, USA
|Date of Submission||15-Dec-2021|
|Date of Acceptance||12-Jan-2022|
|Date of Web Publication||23-May-2022|
Dr. Allison J Durham
School of Physical Therapy, 104 Health and Human Services, Bowling Green State University, Bowling Green, OH 43403
Source of Support: None, Conflict of Interest: None
Healthcare graduate students are constantly adapting to various practice settings and increased rigor to meet program expectations. This increasing level of high expectations and having to perform in front of competent clinicians often induce feelings of inadequacy, anxiety, and fraudulent characteristics of a student impostor. Individuals who identify with the impostor phenomenon may set high self-standards of performance to feel worthy, feel fraudulent, and lack a sense of belonging, and often attribute personal successes to external sources or situations. Identifying the student impostor is the initial step to fostering student success in the clinic. Clinical and academic faculty suspecting a student impostor should take immediate measures to intervene to prevent further decay of the student’s clinical experience. Unmasking the student impostor followed with swift interventions using suggested strategies provided in this paper will improve the student’s and preceptor’s overall clinical experience, leading to a positive outcome.
Keywords: Clinical education, impostor phenomenon, impostor syndrome, preceptor strategies
|How to cite this article:|
Durham AJ, Anderson S. Unmasking the student impostor: Remedies for the impostor phenomenon to promote student success in the clinic. Educ Health Prof 2022;5:1-3
|How to cite this URL:|
Durham AJ, Anderson S. Unmasking the student impostor: Remedies for the impostor phenomenon to promote student success in the clinic. Educ Health Prof [serial online] 2022 [cited 2022 Aug 14];5:1-3. Available from: https://www.ehpjournal.com/text.asp?2022/5/1/1/345791
As Directors of Clinical Education in Doctor of Physical Therapy Programs, we have found transitioning from the classroom to the clinic as a healthcare student can result in additional stressors and challenges negatively impacting mental well-being and performance in a clinical environment. With each subsequent clinical experience, students are faced with higher expectations to progress toward entry-level clinicians upon graduation. As a result, healthcare graduate students constantly adapt to various practice settings and progressive rigor to meet program expectations. This increasing level of high expectations and having to perform in front of competent clinicians often induce feelings of inadequacy, anxiety, and fraudulent characteristics of a student impostor. Although increased feelings of inadequacy and stress may be a normal response to entering clinical practice as a student, the impostor phenomenon becomes problematic when these feelings interfere with the student’s ability to progress into a competent clinician. This article introduces the impostor phenomenon, its prevalence, antecedents, student presentation, and impact on clinical performance and provides strategies to promote positive clinical outcomes and resiliency for students in healthcare professions.
The impostor phenomenon, commonly referred to as impostor syndrome, is characterized by a self-perception of incompetence and self-doubt that may not accurately reflect the individual’s performance or capabilities. Individuals who identify with the impostor phenomenon may set high self-standards of performance to feel worthy, feel fraudulent, and lack a sense of belonging, and often attribute personal successes to external sources or situations. The impostor phenomenon is not currently recognized by the American Psychiatric Association or classified as a diagnosis by the International Classification of Diseases.
The impostor phenomenon has various gender, race, socioeconomic background, and mental health comorbidities. The impostor phenomenon is associated with a higher prevalence in women, especially in early literature. Being that women are primarily dominant among students in healthcare education (70.3–80% of women in health and medical doctoral and master’s degrees), as reported by the American Enterprise Institute, this may give a reason as to why the impostor phenomenon is even more prevalent in healthcare. Furthermore, the impostor phenomenon has consistently been associated with minority groups across multiple studies, including African-, Asian-, and Latino/a-American college students. Possible contributing factors may be inadequate financial status, underrepresentation of race, feeling the need to “prove themselves,” and racial discrimination. Another group susceptible to the impostor phenomenon includes first-generation students. According to a 2015–2016 report by RTI International, 56% of undergraduate students are considered first-generation college students with parents without bachelor’s or terminal degrees (RTI). This group’s likely contributing factors include decreased family support/awareness, lower socioeconomic status, and other obstacles (working, relying on financial aid, racism, etc.). Other positive correlations to the impostor phenomenon include individuals experiencing depression, anxiety, low self-esteem, and social dysfunction.
We found that external factors also play a role in the risk of developing the impostor phenomenon. A higher prevalence of impostor phenomenon has been linked to transitional periods of life, putting students starting a healthcare-related graduate program and those entering clinical affiliations at higher risk. One study by Levant et al. reported that 112 of the 127 surveyed third-year medical students disclosed moderate-to-frequent impostor feelings. Increased feelings of impostorism is consistent with additional literature that has encompassed other health professions. A study by Henning et al. investigated impostor feelings in students across medical, dental, and pharmacy programs, finding an overall prevalence of 30.2%. In addition, research also supports that perceived scholarly membership (or sense of belongingness) is a significant predictor of the impostor phenomenon with a considerable impact on self-worth and overall well-being. This sense of belonging refers to both individual and social engagements in academic activities. Other external factors that can lead to the impostor phenomenon include the high demands of a professional environment, social inequalities, and added pressure from family.
Identifying the student impostor is the initial step to fostering student success in the clinic. The student impostor may present differently depending on their personality, situation, and other mental health comorbidities, often presenting with an extroverted or introverted persona. Thus, some student impostors tend to attribute their achievement to a lowering of standards, timing of opportunities, or personal charm and focus their efforts on maintaining what they believe to be a positive but false impression of themselves. The extroverted student may present as overprepared and very rehearsed when performing. They often respond by overworking or studying to address perceived knowledge or skill gaps. Extroverted students may also present as overly charismatic, offering lengthy responses to a patient’s or preceptor’s inquiries in an attempt to hide their insecurities. This type of student can lack innovation, often parroting the preceptor or other clinical faculty.
In contrast, impostor students with a more introverted persona may appear underachieving or disengaged, highly sensitive and defensive with constructive criticism, and impatient due to perceiving failure as inevitable. Examples of introverted impostor behaviors include procrastination, arriving underprepared or late, and anxiety. This type of student impostor often dreads supervised performance due to their anxiety, causing them to struggle with clinical skill demonstration and communication.
Clinical and academic faculty suspecting a student impostor should take immediate measures to unmask and intervene to prevent further decay of the student’s clinical experience. A study by Safaryazdi found the impostor-like feelings will be decreased by increasing resiliency. We have identified the following strategies that we feel promote resilience in the student impostor to promote successful outcomes in the clinic:
Inclusion: Inclusion can give students a sense of belonging in the clinic. Preceptors need to communicate the value students contribute to the team. Simple ways to promote inclusion are engaging students in small talks and clinical faculty/staff meetings, and asking for their opinions or suggestions.
Support: Destigmatizing academic advising, coaching, or mentoring upon entering the academic program and clinical experience will give the student a sense of being part of a “team” in their educational journey. Frequent and consistent open communication will help the clinical educator identify mental struggles their students may be experiencing and allow them to implement strategies or provide referrals to counseling that explicitly targets the impostor phenomenon.
Feedback: When direct observation and feedback are not part of the learners’ everyday clinical work, their sudden appearance may create, or even perpetuate, feelings of self-doubt. Providing consistent student observation with constructive and positive feedback from the very start of the experience is best recommended. Positivity will improve the student’s confidence and decrease feelings of fraudulence. Avoiding negative language when providing constructive feedback will promote a need for achievement within the student. Clinicians also need to express vulnerability during unintended experiences, shifting blame away from the student and analyzing errors as valuable learning experiences.
Open Communication: Clinicians need to take time to learn about the person behind the student identity. Inquiring about your student’s values, hobbies, and routine will build trust, easing open communication between the student and the preceptor. Reassuring students that insecurity is common and openly communicating such feelings can be an imperative coping strategy.
Students’ Self-Awareness/Education: Informing students of the prevalence of the impostor phenomenon and providing resources to students to help frame negative self-perceptions before entering clinical experiences can assist in reducing feelings of inadequacies. Additionally, hosting seminars and continuing education events that foster conversation regarding student cases can also help the educator (and the student) identify the student impostor. Directors or coordinators of clinical education should strongly consider educating their clinical faculty and offer resilience training programs to increase student confidence and positive control. Other methods to promote self-awareness may include journaling, setting valuable learning goals with progress tracking, and confidence assessments.,,
Students’ Self-Care: Encourage self-care among your students. Ask the student to continue their hobbies during their free time to help manage stress. Other stress management ideas may include web-based tools or apps to promote mindfulness and positive self-talk.,
We feel the impostor phenomenon may be mitigated in students with early identification and employing simple gestures of student inclusion, equity, positivity, and advocacy. It is imperative for preceptors to celebrate student successes and to promote student empowerment. We encourage preceptors to self-assess their passion for teaching and purpose before mentoring a student. Moreover, preceptors should evaluate their resources, including the time needed to mentor a student and communicate any concerns to the program. Unmasking the student impostor followed with swift interventions using our suggested strategies will likely improve the student’s and preceptor’s overall clinical experience, leading to a positive outcome.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Bravata D, Madhusudhan D, Boroff M, Cokley K. Commentary: Prevalence, predictors, and treatment of imposter syndrome: A systematic review. Journal of Mental Health & Clinical Psychology 2020;4:12-6.
Kupiec PH, Ornstein NJ, Barfield C. Women earned majority of doctoral degrees in 2017 for 9th straight year and outnumber men in grad school 137 to 100 [Internet]. 2018. Available from: https://www.aei.org/carpe-diem/women-earned-majority-of-doctoral-degrees-in-2017-for-9th-straight-year-and-outnumber-men-in-grad-school-137-to-100–2/
. [Last accessed on 2021 July 23].
RTI International. First-generation college students: Demographic characteristics and postsecondary enrollment. Washington, DC: NASPA; 2019. Available from: https://firstgen.naspa.org/files/dmfile/FactSheet-01.pdf
. [Last accessed on 2021 December 1].
Reyes G. Increasing college students’ awareness of imposter syndrome [Internet]. Monterey Bay, CA: California State University; 2020. Available from: https://digitalcommons.csumb.edu/caps_thes_all/921/
. [Last accessed on 2021 December 1].
Wiegand R, Barton A, Zakszeski B, Mackey I. Impostor syndrome: What it is and how to overcome it as a graduate student. National Association of School Psychologists 2021;48:35.
Levant B, Villwock JA, Manzardo AM. Impostorism in American medical students during early clinical training: Gender differences and intercorrelating factors. Int J Med Educ 2020;11:90-6.
Henning K, Ey S, Shaw D. Perfectionism, the imposter phenomenon and psychological adjustment in medical, dental, nursing and pharmacy students. Med Educ 1998;32:456-64.
Sverdlik A, Hall NC, McAlpine L. PhD imposter syndrome: Exploring antecedents, consequences, and implications for doctoral well-being. International Journal of Doctoral Studies 2020;15:737-58.
Seritan AL, Mehta MM. Thorny laurels: The impostor phenomenon in academic psychiatry. Acad Psychiatry 2016;40:418-21.
Safaryazdi N. Surveying the relationship between resilience and imposter syndrome. International Journal of Review in Life Sciences 2014;4:38-42.
LaDonna KA, Ginsburg S, Watling C. “Rising to the level of your incompetence”: What physicians’ self-assessment of their performance reveals about the imposter syndrome in medicine. Acad Med 2018;93:763-8.
Delany C, Miller KJ, El-Ansary D, Remedios L, Hosseini A, McLeod S. Replacing stressful challenges with positive coping strategies: A resilience program for clinical placement learning. Adv Health Sci Educ Theory Pract 2015;20:1303-24.
Murden F, Bailey D, Mackenzie F, Oeppen RS, Brennan PA. The impact and effect of emotional resilience on performance: An overview for surgeons and other healthcare professionals. Br J Oral Maxillofac Surg 2018;56:786-90.
Van Veld R, Slaven EJ, Reynolds B, Shupe P, Woolery C. First-year doctor of physical therapy students demonstrate change in coping with stress. Journal of Physical Therapy Education 2018;32:138-44.
Pospos S, Young IT, Downs N, Iglewicz A, Depp C, Chen JY, et al
. Web-based tools and mobile applications to mitigate burnout, depression, and suicidality among healthcare students and professionals: A systematic review. Acad Psychiatry 2018;42:109-20.