#KeyLIMEPodcast 287: Am I a Fraud?

Do you secretly worry that others will find out that you’re not as bright and capable as they think you are? Do you sometimes shy away from challenges because of nagging self-doubt? Do you tend to chalk your accomplishments up to being a “fluke,” “no big deal,” or the fact that people just “like” you? Do you hate making a mistake, being less than fully prepared, or not doing things perfectly? Do you tend to feel crushed by even constructive criticism, seeing it as evidence of your “ineptness”? When you do succeed, do you think, “Phew! I fooled them this time, but I may not be so lucky next time”? Do you believe that other people (students, colleagues, competitors) are smarter and more capable than you? Do you live in fear of being found out, discovered, or
unmasked?

If you answered yes to many of these questions you may have impostor syndrome (IS) – but don’t worry – you are not alone! Up to 70% of successful people may have it at some point. For this week’s episode, Linda selects a scoping review that looks at existing literature on IS.

Listen to the episode to learn more.

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KeyLIME Session 287

Listen to the podcast

Reference

Gottlieb et. al., Impostor syndrome among physicians and physicians in training: A scoping review. Med Educ. 2020 Feb;54(2):116-124

Reviewer

Linda Snell (@LindaSMedEd)

Background

Impostor Syndrome (IS) –is ‘characterised as an inability to internalise success and the tendency to attribute success to external causes such as luck, error or knowing the appropriate individuals, leading to a sense of fraud.’ May be more prevalent in women and minorities.

Outside medicine IS has effects on self efficacy (a la Bandiera) and ability to succeed, and can influence a variety of outcomes, including both academic success and psychological wellness. Can lead to an increased motivation and drive to succeed, positively impacting career; OR have negative consequences, emotional exhaustion, increased work–family conflict, negative feelings, job dissatisfaction, depression, low self-esteem, humiliation, guilt, anxiety, dissatisfaction, perfectionism, burnout and suicidality.

IS seems to be prevalent in medicine and trainees, and may contribute to high rates of burnout. So understanding IS within the context of physicians and physicians in training is critical.

Purpose

The authors aimed to evaluate all available published studies discussing IS among physicians and physicians in training, with a goal to describe the prevalence and scope of IS to identify current trends and define future areas of research. They conducted a scoping review to summarise and synthesise the existing literature on IS among physicians and physicians in training.

Key Points on the Methods

Is the question appropriate for a scoping review(SR)? SRs are used used to: (a) examine the extent, range and nature of research activity; (b) determine the value of undertaking a full systematic review; (c) summarise and disseminate research findings, and (d) identify gaps in the existing literature.

Followed Arksey and O’Malley’s stages: (a) identifying the research question [focused on physicians and trainees as a unique population]; (b) identifying relevant studies [9 data bases]; (c) selecting studies [screened with appropriate criteria]; (d) charting the data [4 themes: prevalence of IS among these populations; factors contributing to IS; factors protecting against IS; extent that IS directly contributes to physician burnout]; (e) collating, summarising and reporting the results [qual, quan], and (f) consultation
with topic experts.

Key Outcomes

  • 162 studies found, after exclusion 18; majority published past 5 years [perhaps as increasing attention to wellness] and most related to med students; prevalence of IS in students 22-60%, residents 33-44%.
  • Factors contributing to IS: gender (?); level of learner, self esteem, perfectionism, hierarchy and culture in medicine.
  • Factors protecting against IS: social support, validation of success, positive affirmation and institutional support,
  • Personal reflections and shared common experiences; a combination of individual and system-level changes e.g. workshops on IS, mentorship and support programmes, fostering a culture that does not punish mistakes.
  • Extent that IS directly contributes to physician burnout: majority of studies demonstrated that feelings of IS associated with increased rates of anxiety, depression, burnout. IS correlated with emotional exhaustion, depersonalization, cynicism, decreased job satisfaction.

IS occurs more during transitions and also IS may affect identity formation – guidance and support at critical times may help.
Gaps: no good tools validated for medicine. Little lit on influences of sex, gender, race and ethnicity. Little on practicing MDs. Role IS may play in developing and fostering physicians’ career paths. What are enabling and protective factors and how can these be used to address the problem. Which interventions are effective. How to provide feedback when thinking of IS.

Key Conclusions

The authors conclude “IS is a phenomenon that is increasingly recognized in medicine. This review summarises the existing literature with respect to its prevalence, causes and potential interventions. We intend this to be a starting point for those interested in better understanding this phenomenon and as a nidus for future research.”

Spare Keys – other take home points for clinician educators

A good example of a scoping review.

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