Exploring the interplay of Imposter Syndrome and vulnerability in the medical learning environment
Creators: name: Tayem, Abdel
name: Ataa Diabe
name: Surina Grover
name: Do, Victor
name: Goldstein, Cheryl
Publisher: name: F1000 Research Limited
Year: 2023

description: <b>Background/Relevance:</b> Imposter Syndrome (IS), a phenomenon where individuals attribute successes to external factors aside from themselves, is reported to be high amongst medical students, with correlations to decreased wellbeing. Despite significant discussion on IS, little work has been done to understand how medical students experience IS, the interplay of IS with how vulnerability is perceived in the learning environment, and how IS may shape individuals’ experiences and perceptions of failure. <br> <br> <b>Purpose:</b> The purpose of this study was to further explore how medical students experience IS, while also considering the interplay with vulnerability and failure in the medical education learning environment. Secondly, the study also sought to highlight opportunities for intervention that students proposed to mitigate harmful effects of IS.<br> <br> <b>Methods:</b> We conducted virtual semi-structured individual qualitative interviews lasting 30-60 minutes with 13 medical students from all four years across Canada. An interview guide was developed to facilitate conversations that draw on lived experiences of the participants. Interviews were then transcribed, coded, and analyzed independently using thematic analysis by three researchers who met with a fourth to review codes and resolve any conflicts.<br> <br> <b>Results:</b> Three main themes were identified - <br> 1) Learners experience IS as a lack of belonging and a fear of being seen as incompetent.<br> Students felt that they were undeserving of their roles - despite their achievements and education, they worry about receiving unearned trust. Learners fear that preceptors and patients may view them as incompetent if they fail, leading them to see themselves as imposters that do not belong in this environment. <br> 2) Feelings of IS are heightened by a lack of vulnerability in the existing medical learning environment.<br> The existing medical learning environment discourages expressions of vulnerability in practitioners and learners, while maintaining expectations of perfectionism. Learners emphasize that environments which encourage vulnerability are actively and intentionally created by preceptors and peers that embrace failure and share personal experiences. <br> 3) Preceptor modeling guides students’ perceptions of failure and how to navigate it.<br> Failure is not clearly defined in medical education, with ambiguity that heightens IS. However, preceptors that identify moments of failure and then demonstrate how they respond to it can help learners gain a better understanding of how they can navigate failure in their future.<br> Learners identified interventions like storytelling, preceptor modeling, and vulnerability-promoting environments to mitigate harmful effects of IS. <br> <br> <b>Conclusion:</b> In conclusion, our qualitative study explored how medical students experience IS and the influence of vulnerability and failure. Personal and environmental factors instigate IS, while the lack of vulnerability and ambiguity of how failure is defined perpetuate IS. More opportunities for story-telling between learners and preceptors would encourage reciprocal sharing and promote vulnerability in the learning environment. Preceptors are crucial in modeling responses to failure, and can help reduce expectations of perfectionism while aiding students in developing their own approach to failure. These interventions can help mitigate and decrease harmful IS effects, while also contributing to health promoting learning environments.