Presentations

Abstract

Introduction:

The impostor phenomenon (IP), also called imposter syndrome, is characterized by the fear of being discovered as a fraud, despite objective success. This term was coined by Clance et al in 1978 in relation to high-achieving business women, but studies since have shown that the impostor phenomenon is not limited to those original demographics. Prevalence among medical students has been found to be as high as 54.5%. The disconnection between self-perception and accomplishment may provoke decline in student mental health and professional identity. Clance also developed the Clance Impostor Phenomenon Survey (CIPS) used to measure a person's experience of IP. The Patient Health Questionnaire 9-item (PHQ-9) is a screening tool used to assess the presence and severity of depression. The Generalized Anxiety Disorder 7-item (GAD-7) is a screening tool used to initially assess the presence and severity of anxiety. While studies have explored the relationship between depression and/or anxiety and the impostor phenomenon in medical residents and physicians, no studies have been completed in the medical student population.

Methods:

Our population includes EVMS medical students in all classes (MD 2024, 2025, 2026, 2027), as well as EVMS medical masters' students (MM 2024, 2025). Voluntary participants have been asked to complete the CIPS, PHQ-9, and GAD-7 in an anonymous survey on REDCap. Data collection began on 8/29/23 and is ongoing. Descriptive statistics were used to determine the prevalence of imposter phenomenon among participants. We used a Generalized Linear Model (GLM) to evaluate the effects of PHQ-9 and GAD-7 scores, age group, race, program type, and gender, on CIPS outcomes. We followed the GLM with a Pearson correlation test to evaluate the direction of the relationship between CIPS and PHQ-9 and between CIPS and GAD-7. Data was analyzed using SAS 9.4.

Results:

As of 8/30/23, 83 participants have started the survey and 15 were excluded as they have not yet completed the survey, leaving 68 participants included in these preliminary results. The majority of participants were ages 21 to 25 years (64.71%), White or Caucasian (54.41%), in the MD 2027 program (35.29%), and female (63.24%). About 15% of participants had moderate to severe depression and about 28% had moderate to severe anxiety based on PHQ-9 and GAD-7 scores, respectively. CIPS scores were significantly affected by PHQ-9 (p=0.027) and GAD-7 (p=0.034) scores, and age group (p=0.046). CIPS scores increased for participants ages 26 to 35 years compared to the youngest group (21 to 25 years), and were the lowest for the age group 36 to 40 years. There is a moderate, positive, linear relationship between PHQ-9 and CIPS (r=0.54) and between GAD-7 and CIPS (r=0.52) . Gender, race, and program variables did not affect CIPS outcomes (p>0.05). However, CIPS scores tended to be higher for females, persons in medical master's programs, and for the Native American/Alaskan Native race.

Conclusion:

The experience of IP in students completing medical school curriculum at EVMS is likely correlated with depression and/or anxiety. Therefore, efforts to alleviate the experience of IP should include emphasis on mental health care for medical students and medical masters students. There is also a trend of increased IP in less experienced medical students, with increased CIPS scores in the medical masters class participants and classes of 2027 and 2026 versus 2025 and 2024. Additionally, although there is no statistical correlation in our population between the experience of IP and vulnerable populations, the trend for such persons to experience IP to a greater degree is not negligible and should not be ignored. Current limitations include cross sectional design and uneven participation across categories. This is likely limited by demographics of EVMS students. Currently, there is only 1 participant each in the age groups 31 to 35 years and 36 to 40 years. Additionally, the majority of responses (63.23%) are from MD 2026 and 2027. An effort will be made to increase the participant numbers in these and other categories. Preliminary results are also limited by the total number of participants thus far. As more students provide complete responses, the power of our results will likely increase.