Impostor syndrome: Implications for medical professionals

A few years ago, I was asked to give a talk on impostor syndrome at a national conference. My initial thought was “I am not even remotely qualified to give this talk.” Upon reflection, I think that was the first time I acknowledged that I, too, suffer from this syndrome.

There are many definitions and designations (e.g., impostor phenomenon or fraud syndrome), but the one I use most often is high-achieving individuals who are marked by an inability to internalize their accomplishments and a persistent fear of being exposed as a fraud. People with high expressions of this syndrome believe that any success they achieve is due more to luck or error than to personal skill or accomplishment. They live in fear that their incompetence will be exposed and they will be revealed as a fraud both intellectually and within their job or role. First described by Clance and Imes in 1978,¹ the original authors observed that many highly respected and accomplished women did not experience an internal sense of success despite their education and evidence of academic achievement. Based in part on previous observations regarding the differential attribution of success in men and women,² the authors suggested that two general principles were found to be at the heart of this syndrome. The first was that an unexpected performance outcome will be attributed to a temporary cause. The second was that an expected performance outcome will be attributed to a stable cause. As such, the authors originally suggested that women tended to explain failure with lack of ability, whereas men attributed failure to luck or task difficulty. Furthermore, the authors emphasized environmental factors – such as mentorship, competition, and isolation – as the primary influence in the development of these tendencies.

Although originally described in women, this phenomenon can also affect men, as well as a wide variety of people from different occupations and cultures.^3-6 Furthermore, although environmental factors were originally linked as the primary driver of these tendencies, further research has suggested that personality factors play a larger role, and that up to 70% of people may experience this phenomenon in their lifetime.⁷ Personality traits such as perfectionism and neuroticism may be linked to the development of this phenomenon.^3,8

There are several online screening questionnaires that can be used to gauge whether individuals experience some or most of these traits. On one such questionnaire, the Clance IP Scale,⁹ poses such questions as: “I have often succeeded on a test or task even though I was afraid that I would not do well before I undertook the task” and “I am afraid people important to me may find out that I am not as capable as they think I am.” There are 20 questions scored from 1 to 5 and a score of 40 or below suggests few impostor tendencies, while a score of 80 or above suggests the respondent often has intense IP experiences. The higher the score, the more frequently and seriously the impostor syndrome interferes in a person’s life. What is unclear is whether this worsens, improves, or stays the same throughout one’s career. Of interest is that my personal score at this time is 43; however, it would have been 89 had I taken the test during college and medical school. What is unclear to me from the literature is what factors may play a role in a person’s perception of their abilities and their personal confidence over time.

Why is this important? Given that we are all professionals, impostor tendencies appear to have significant impact in the context of our work. This may have impact on us both as employers and as employees.¹⁰ Individuals with impostor syndrome tendencies often characterize themselves negatively and perform poorly on self-appraisals.¹¹ In a study of 201 Belgian white-collar workers, Vergauwe and colleagues found that impostor syndrome tendencies were negatively related to job satisfaction and organizational citizenship behavior; both of which could be influenced by a high degree of social support.¹⁰ Individuals with impostor syndrome tendencies do less career planning, explore career options less frequently, and are less inclined to lead.^12,13 These tendencies can be detrimental as the most qualified people for a position or opportunity may not step forward for consideration. Employers may tend to overlook these individuals for promotions or for pay raises which could negatively influence future earnings. Furthermore, a person may experience increased burnout as they continuously try to overcompensate for what they perceive as their shortcomings. They may feel concerned they are letting others down or not performing to standards. They may derive less enjoyment from life because of the constant focus on feelings of inadequacy.¹⁴ Research along these lines suggest impostor syndrome tendencies can have adverse personal and health-related consequences and may increase social anxiety, depression, and overall psychological distress.^15,16

 

What can we do about it? In a very interesting study by Zanchetta and colleagues, the authors studied 103 young employees and randomized them to receive coaching, training, or no intervention.¹⁷ Their findings showed that coaching was an effective mindset intervention which resulted in reduced impostor syndrome scores. Furthermore, fear of negative evaluation and the effect of coaching appeared to be significantly associated with a reduction in the impostor syndrome scores. Coaching appeared to improve self-enhancing attributions and self-efficacy with a reduction in the tendency of subjects to fear negative evaluation. The authors concluded that fostering a mindset shift by reducing the fear of negative evaluations through coaching demonstrated measurable and sustained improvements in overall impostor syndrome scores for participants.¹⁷

What do I suggest? It is clear this affects a significant percentage of physicians, health care professionals, and professionals in general. Harboring these tendencies can have a negative impact on health, professional achievement, income, and happiness. It is important to self-reflect, identify if you are at risk, and if so, take the opportunity to explore solutions. My recommendations are:

 

• Name it: Take the test and see how you score.
• Be mindful: Self-reflection will help you identify the behaviors that are interfering with your happiness and success.
• Write it down: Be strategic and document your plan for success to reinforce your accomplishments.
• Create a feedback group: Friends and colleagues can help to mitigate the negative effects of impostor syndrome tendencies.
• Speak up: Ask for help; coaching has been documented to reduce impostor syndrome scores and help lessen the burden of these tendencies.
• Step out of your comfort zone: Develop a mantra, break bigger challenges into smaller pieces, and acknowledge little wins along the way.

In conclusion, impostor syndrome appears to be highly prevalent in professionals including those of us in medicine. The experience can adversely affect our careers and ability to secure key leadership positions. As managers, we also must keep in mind our role in mentoring others and recognizing the potential impact of impostor syndrome on those who report to us. Recognition of this phenomenon – and understanding of the effects on oneself – is the first step in overcoming the negative effects and moving toward realization of one’s potential.
 

Dr. Brown is a professor of medicine at Wayne State University, division chief of gastroenterology and hepatology at Henry Ford Hospital, and associate medical director at the Henry Ford Hospital Transplant Institute, all in Detroit.

References

1. Clance PR, Imes S. Psychother Theory Res Pract. 1978 Fall;15(3):1-7.

2. Deaux D. In J.H.Harvey, W.J.Ickes and R.F. Kidd (Eds). New directions in attribution research. Vol. 1. New York: Halsted Press Division, Wiley. 1976; p 335-42.

3. Bernard NS et al. J Pers Assess. 2002;78(2):321-33.

4. Topping ME et al. Acad Psychol Bull. 1985;(7):213-26.

5. Langford J et al. Psychotherapy. 1993;30(3):495-501.

6. Chae JH et al. J Pers Assess. 1995;65(3):468-85.

7. Harvey JC et al. If I’m successful, why do I feel like a fake? New York: Random House, 1985.

8. Ross SR et al. Pers Individ Diff. 2001;31:1347-55.

9. Clance PR. The impostor phenomenon: When success makes you feel like a fake. Toronto: Bantam Books, 1985; p 20-2.

10. Vergauwe J et al. J Bus Psychol. 2015;30:565-81.

11. Leary MR et al. J Pers. 2000;68(4):725-56.

12. Neureiter M et al. Front Psychol. 2016;7:48.

13. Neureiter M et al. J Vocat Behav. 2017;98:56-69.

14. Duhigg C. The power of habit: Why we do what we do in life and business. New York: Random House, 2012.

15. Henning K et al. Med Educ. 1998 Sep;32(5):456-64.

16. Oriel K et al. Fam Med. 2004 Apr;36(4):248-52.

17. Zanchetta M et al. Front Psychol. 2020 May 15;11:405.

A few years ago, I was asked to give a talk on impostor syndrome at a national conference. My initial thought was “I am not even remotely qualified to give this talk.” Upon reflection, I think that was the first time I acknowledged that I, too, suffer from this syndrome.

There are many definitions and designations (e.g., impostor phenomenon or fraud syndrome), but the one I use most often is high-achieving individuals who are marked by an inability to internalize their accomplishments and a persistent fear of being exposed as a fraud. People with high expressions of this syndrome believe that any success they achieve is due more to luck or error than to personal skill or accomplishment. They live in fear that their incompetence will be exposed and they will be revealed as a fraud both intellectually and within their job or role. First described by Clance and Imes in 1978,¹ the original authors observed that many highly respected and accomplished women did not experience an internal sense of success despite their education and evidence of academic achievement. Based in part on previous observations regarding the differential attribution of success in men and women,² the authors suggested that two general principles were found to be at the heart of this syndrome. The first was that an unexpected performance outcome will be attributed to a temporary cause. The second was that an expected performance outcome will be attributed to a stable cause. As such, the authors originally suggested that women tended to explain failure with lack of ability, whereas men attributed failure to luck or task difficulty. Furthermore, the authors emphasized environmental factors – such as mentorship, competition, and isolation – as the primary influence in the development of these tendencies.

Although originally described in women, this phenomenon can also affect men, as well as a wide variety of people from different occupations and cultures.^3-6 Furthermore, although environmental factors were originally linked as the primary driver of these tendencies, further research has suggested that personality factors play a larger role, and that up to 70% of people may experience this phenomenon in their lifetime.⁷ Personality traits such as perfectionism and neuroticism may be linked to the development of this phenomenon.^3,8

There are several online screening questionnaires that can be used to gauge whether individuals experience some or most of these traits. On one such questionnaire, the Clance IP Scale,⁹ poses such questions as: “I have often succeeded on a test or task even though I was afraid that I would not do well before I undertook the task” and “I am afraid people important to me may find out that I am not as capable as they think I am.” There are 20 questions scored from 1 to 5 and a score of 40 or below suggests few impostor tendencies, while a score of 80 or above suggests the respondent often has intense IP experiences. The higher the score, the more frequently and seriously the impostor syndrome interferes in a person’s life. What is unclear is whether this worsens, improves, or stays the same throughout one’s career. Of interest is that my personal score at this time is 43; however, it would have been 89 had I taken the test during college and medical school. What is unclear to me from the literature is what factors may play a role in a person’s perception of their abilities and their personal confidence over time.

Why is this important? Given that we are all professionals, impostor tendencies appear to have significant impact in the context of our work. This may have impact on us both as employers and as employees.¹⁰ Individuals with impostor syndrome tendencies often characterize themselves negatively and perform poorly on self-appraisals.¹¹ In a study of 201 Belgian white-collar workers, Vergauwe and colleagues found that impostor syndrome tendencies were negatively related to job satisfaction and organizational citizenship behavior; both of which could be influenced by a high degree of social support.¹⁰ Individuals with impostor syndrome tendencies do less career planning, explore career options less frequently, and are less inclined to lead.^12,13 These tendencies can be detrimental as the most qualified people for a position or opportunity may not step forward for consideration. Employers may tend to overlook these individuals for promotions or for pay raises which could negatively influence future earnings. Furthermore, a person may experience increased burnout as they continuously try to overcompensate for what they perceive as their shortcomings. They may feel concerned they are letting others down or not performing to standards. They may derive less enjoyment from life because of the constant focus on feelings of inadequacy.¹⁴ Research along these lines suggest impostor syndrome tendencies can have adverse personal and health-related consequences and may increase social anxiety, depression, and overall psychological distress.^15,16

 

What can we do about it? In a very interesting study by Zanchetta and colleagues, the authors studied 103 young employees and randomized them to receive coaching, training, or no intervention.¹⁷ Their findings showed that coaching was an effective mindset intervention which resulted in reduced impostor syndrome scores. Furthermore, fear of negative evaluation and the effect of coaching appeared to be significantly associated with a reduction in the impostor syndrome scores. Coaching appeared to improve self-enhancing attributions and self-efficacy with a reduction in the tendency of subjects to fear negative evaluation. The authors concluded that fostering a mindset shift by reducing the fear of negative evaluations through coaching demonstrated measurable and sustained improvements in overall impostor syndrome scores for participants.¹⁷

What do I suggest? It is clear this affects a significant percentage of physicians, health care professionals, and professionals in general. Harboring these tendencies can have a negative impact on health, professional achievement, income, and happiness. It is important to self-reflect, identify if you are at risk, and if so, take the opportunity to explore solutions. My recommendations are:

 

• Name it: Take the test and see how you score.
• Be mindful: Self-reflection will help you identify the behaviors that are interfering with your happiness and success.
• Write it down: Be strategic and document your plan for success to reinforce your accomplishments.
• Create a feedback group: Friends and colleagues can help to mitigate the negative effects of impostor syndrome tendencies.
• Speak up: Ask for help; coaching has been documented to reduce impostor syndrome scores and help lessen the burden of these tendencies.
• Step out of your comfort zone: Develop a mantra, break bigger challenges into smaller pieces, and acknowledge little wins along the way.

In conclusion, impostor syndrome appears to be highly prevalent in professionals including those of us in medicine. The experience can adversely affect our careers and ability to secure key leadership positions. As managers, we also must keep in mind our role in mentoring others and recognizing the potential impact of impostor syndrome on those who report to us. Recognition of this phenomenon – and understanding of the effects on oneself – is the first step in overcoming the negative effects and moving toward realization of one’s potential.
 

Dr. Brown is a professor of medicine at Wayne State University, division chief of gastroenterology and hepatology at Henry Ford Hospital, and associate medical director at the Henry Ford Hospital Transplant Institute, all in Detroit.

References

1. Clance PR, Imes S. Psychother Theory Res Pract. 1978 Fall;15(3):1-7.

2. Deaux D. In J.H.Harvey, W.J.Ickes and R.F. Kidd (Eds). New directions in attribution research. Vol. 1. New York: Halsted Press Division, Wiley. 1976; p 335-42.

3. Bernard NS et al. J Pers Assess. 2002;78(2):321-33.

4. Topping ME et al. Acad Psychol Bull. 1985;(7):213-26.

5. Langford J et al. Psychotherapy. 1993;30(3):495-501.

6. Chae JH et al. J Pers Assess. 1995;65(3):468-85.

7. Harvey JC et al. If I’m successful, why do I feel like a fake? New York: Random House, 1985.

8. Ross SR et al. Pers Individ Diff. 2001;31:1347-55.

9. Clance PR. The impostor phenomenon: When success makes you feel like a fake. Toronto: Bantam Books, 1985; p 20-2.

10. Vergauwe J et al. J Bus Psychol. 2015;30:565-81.

11. Leary MR et al. J Pers. 2000;68(4):725-56.

12. Neureiter M et al. Front Psychol. 2016;7:48.

13. Neureiter M et al. J Vocat Behav. 2017;98:56-69.

14. Duhigg C. The power of habit: Why we do what we do in life and business. New York: Random House, 2012.

15. Henning K et al. Med Educ. 1998 Sep;32(5):456-64.

16. Oriel K et al. Fam Med. 2004 Apr;36(4):248-52.

17. Zanchetta M et al. Front Psychol. 2020 May 15;11:405.

A few years ago, I was asked to give a talk on impostor syndrome at a national conference. My initial thought was “I am not even remotely qualified to give this talk.” Upon reflection, I think that was the first time I acknowledged that I, too, suffer from this syndrome.

There are many definitions and designations (e.g., impostor phenomenon or fraud syndrome), but the one I use most often is high-achieving individuals who are marked by an inability to internalize their accomplishments and a persistent fear of being exposed as a fraud. People with high expressions of this syndrome believe that any success they achieve is due more to luck or error than to personal skill or accomplishment. They live in fear that their incompetence will be exposed and they will be revealed as a fraud both intellectually and within their job or role. First described by Clance and Imes in 1978,¹ the original authors observed that many highly respected and accomplished women did not experience an internal sense of success despite their education and evidence of academic achievement. Based in part on previous observations regarding the differential attribution of success in men and women,² the authors suggested that two general principles were found to be at the heart of this syndrome. The first was that an unexpected performance outcome will be attributed to a temporary cause. The second was that an expected performance outcome will be attributed to a stable cause. As such, the authors originally suggested that women tended to explain failure with lack of ability, whereas men attributed failure to luck or task difficulty. Furthermore, the authors emphasized environmental factors – such as mentorship, competition, and isolation – as the primary influence in the development of these tendencies.

Although originally described in women, this phenomenon can also affect men, as well as a wide variety of people from different occupations and cultures.^3-6 Furthermore, although environmental factors were originally linked as the primary driver of these tendencies, further research has suggested that personality factors play a larger role, and that up to 70% of people may experience this phenomenon in their lifetime.⁷ Personality traits such as perfectionism and neuroticism may be linked to the development of this phenomenon.^3,8

There are several online screening questionnaires that can be used to gauge whether individuals experience some or most of these traits. On one such questionnaire, the Clance IP Scale,⁹ poses such questions as: “I have often succeeded on a test or task even though I was afraid that I would not do well before I undertook the task” and “I am afraid people important to me may find out that I am not as capable as they think I am.” There are 20 questions scored from 1 to 5 and a score of 40 or below suggests few impostor tendencies, while a score of 80 or above suggests the respondent often has intense IP experiences. The higher the score, the more frequently and seriously the impostor syndrome interferes in a person’s life. What is unclear is whether this worsens, improves, or stays the same throughout one’s career. Of interest is that my personal score at this time is 43; however, it would have been 89 had I taken the test during college and medical school. What is unclear to me from the literature is what factors may play a role in a person’s perception of their abilities and their personal confidence over time.

Why is this important? Given that we are all professionals, impostor tendencies appear to have significant impact in the context of our work. This may have impact on us both as employers and as employees.¹⁰ Individuals with impostor syndrome tendencies often characterize themselves negatively and perform poorly on self-appraisals.¹¹ In a study of 201 Belgian white-collar workers, Vergauwe and colleagues found that impostor syndrome tendencies were negatively related to job satisfaction and organizational citizenship behavior; both of which could be influenced by a high degree of social support.¹⁰ Individuals with impostor syndrome tendencies do less career planning, explore career options less frequently, and are less inclined to lead.^12,13 These tendencies can be detrimental as the most qualified people for a position or opportunity may not step forward for consideration. Employers may tend to overlook these individuals for promotions or for pay raises which could negatively influence future earnings. Furthermore, a person may experience increased burnout as they continuously try to overcompensate for what they perceive as their shortcomings. They may feel concerned they are letting others down or not performing to standards. They may derive less enjoyment from life because of the constant focus on feelings of inadequacy.¹⁴ Research along these lines suggest impostor syndrome tendencies can have adverse personal and health-related consequences and may increase social anxiety, depression, and overall psychological distress.^15,16

 

What can we do about it? In a very interesting study by Zanchetta and colleagues, the authors studied 103 young employees and randomized them to receive coaching, training, or no intervention.¹⁷ Their findings showed that coaching was an effective mindset intervention which resulted in reduced impostor syndrome scores. Furthermore, fear of negative evaluation and the effect of coaching appeared to be significantly associated with a reduction in the impostor syndrome scores. Coaching appeared to improve self-enhancing attributions and self-efficacy with a reduction in the tendency of subjects to fear negative evaluation. The authors concluded that fostering a mindset shift by reducing the fear of negative evaluations through coaching demonstrated measurable and sustained improvements in overall impostor syndrome scores for participants.¹⁷

What do I suggest? It is clear this affects a significant percentage of physicians, health care professionals, and professionals in general. Harboring these tendencies can have a negative impact on health, professional achievement, income, and happiness. It is important to self-reflect, identify if you are at risk, and if so, take the opportunity to explore solutions. My recommendations are:

 

• Name it: Take the test and see how you score.
• Be mindful: Self-reflection will help you identify the behaviors that are interfering with your happiness and success.
• Write it down: Be strategic and document your plan for success to reinforce your accomplishments.
• Create a feedback group: Friends and colleagues can help to mitigate the negative effects of impostor syndrome tendencies.
• Speak up: Ask for help; coaching has been documented to reduce impostor syndrome scores and help lessen the burden of these tendencies.
• Step out of your comfort zone: Develop a mantra, break bigger challenges into smaller pieces, and acknowledge little wins along the way.

In conclusion, impostor syndrome appears to be highly prevalent in professionals including those of us in medicine. The experience can adversely affect our careers and ability to secure key leadership positions. As managers, we also must keep in mind our role in mentoring others and recognizing the potential impact of impostor syndrome on those who report to us. Recognition of this phenomenon – and understanding of the effects on oneself – is the first step in overcoming the negative effects and moving toward realization of one’s potential.
 

Dr. Brown is a professor of medicine at Wayne State University, division chief of gastroenterology and hepatology at Henry Ford Hospital, and associate medical director at the Henry Ford Hospital Transplant Institute, all in Detroit.

References

1. Clance PR, Imes S. Psychother Theory Res Pract. 1978 Fall;15(3):1-7.

2. Deaux D. In J.H.Harvey, W.J.Ickes and R.F. Kidd (Eds). New directions in attribution research. Vol. 1. New York: Halsted Press Division, Wiley. 1976; p 335-42.

3. Bernard NS et al. J Pers Assess. 2002;78(2):321-33.

4. Topping ME et al. Acad Psychol Bull. 1985;(7):213-26.

5. Langford J et al. Psychotherapy. 1993;30(3):495-501.

6. Chae JH et al. J Pers Assess. 1995;65(3):468-85.

7. Harvey JC et al. If I’m successful, why do I feel like a fake? New York: Random House, 1985.

8. Ross SR et al. Pers Individ Diff. 2001;31:1347-55.

9. Clance PR. The impostor phenomenon: When success makes you feel like a fake. Toronto: Bantam Books, 1985; p 20-2.

10. Vergauwe J et al. J Bus Psychol. 2015;30:565-81.

11. Leary MR et al. J Pers. 2000;68(4):725-56.

12. Neureiter M et al. Front Psychol. 2016;7:48.

13. Neureiter M et al. J Vocat Behav. 2017;98:56-69.

14. Duhigg C. The power of habit: Why we do what we do in life and business. New York: Random House, 2012.

15. Henning K et al. Med Educ. 1998 Sep;32(5):456-64.

16. Oriel K et al. Fam Med. 2004 Apr;36(4):248-52.

17. Zanchetta M et al. Front Psychol. 2020 May 15;11:405.