I’m in! So why don’t I fit in? A cross-sectional exploration of imposterism within medical school cohorts

Background: Transitioning within medical school to new duties, roles and challenges represents a significant change in responsibility. Medical students may experience the imposter phenomenon, fearing exposure as a “fraud”. Identifying when imposterism could peak during training, the student’s historical social determinants and personal history that can lead to the overall imposter syndrome is very important, because during medical school, student wellness and professional identity typically decrease. This study aims to characterize the imposter phenomenon in medical students at a single institution as they transition from one academic year to the next. Methods: This study is a cross-sectional observational design. We constructed a 30-item survey using the Clance Imposterism Scale and selected demographic characteristics. Indicators of interest include: environment of upbringing, education, socioeconomic status, and race/ethnicity. We analyzed the data using Pearson’s Chi Square and Fisher Exact tests, and a two-tailed Type I error of less than 5% to assess statistical significance. Results: Out of 387 students, we received 89 responses, resulting in a 23% response rate. Fourth-year medical students reported experiencing feelings of imposterism more frequently or intensely than students in the first three years. Females had frequent/intense levels of imposterism more than males or non conforming individuals. More than 75% of individuals raised in rural areas experienced frequent to intense imposterism compared to those raised in suburban or urban environments. Completing an undergraduate degree with dedicated mentoring from physicians did not ameliorate feelings of not belonging. Conclusion: We characterized medical students by cohort to identify points of intervention. Our findings highlight the importance of addressing the imposter phenomenon, especially in environments like medical school, where the expectations to excel are intense. Recognizing that certain groups, such as females, underrepresented minorities, and first-generation college students, may be more susceptible to these feelings of inadequacy is an important step toward providing support and resources tailored to meet their needs.