Imposter syndrome (IS), or unrelenting self-doubt despite objective evidence to the contrary, is pervasive in the competitive culture of medicine. People who suffer from IS are convinced they are unworthy of their environment, forcing them to wrestle with a constant worry of impending failure. Not surprisingly, IS is highly correlated with exhaustion and cynicism1 and may contribute to anxiety, burnout1, and suicide2. Medical students are especially vulnerable to IS, with recent studies estimating that 22-60% of medical students experience IS.3 As with most mental health phenomena, these reports are likely to be significantly underestimated. Addressing medical student IS is pivotal to maintaining a healthy and safe physician workforce. Unfortunately, discussions of IS are stigmatized and are rarely addressed in medical curricula.
Because IS is a manifestation of logical and emotional incompatibility, one potential mechanism to mitigate the anxiety that results from IS is to borrow from the mindfulness techniques used in Cognitive Behavioral Therapy. Previous work has demonstrated that mindful peer sharing normalizes vulnerability, provides support, and combats sequelae of IS.4 Furthermore, art therapy is a mechanism of attentively relieving stress by creating visual media, such as photography and printing. Participation in art therapy has been correlated with decreased burnout amongst healthcare workers.5 The MyScope project combines art therapy and peer sharing to help trainees mindfully reflect on and work through their experiences with IS.
What Is the MyScope Project?
MyScope is a novel, creative approach combining photographic, verbal, and written media to combat medical student IS. The MyScope project involved first- and second-year medical students at the University of Pittsburgh who volunteered to reflect on their personal IS experience through one-time, peer-led interviews. Each interview lasted 20 minutes and was composed of one interviewee and two peer interviewers. One of the interviewers asked the interviewee the following questions to initiate their reflection:
1) What are qualities in good physicians that you admire?
2) What intrinsic qualities can you identify in yourself that will make you a good physician one day?
3) What is your personal relationship with IS?
While the interviewee was answering a question, the other interviewer took candid, mid-sentence photographs of the interviewee, aiming to capture authentic emotion and expression. With permission, quotes from the interviews were printed and paired with a photograph of each interviewee. Ultimately, the final work was displayed as an exhibit at a local art gallery, generating thoughtful conversations about the role of mindfulness in combatting IS. The gallery opening was attended by medical students and the general public, and the exhibit ran for four months.
Medical Students Reflect on Imposter Syndrome through Art and Discussion
Nearly every student that was interviewed for MyScope revealed that they had at some point suffered IS during medical school. Triggers of IS ranged from academic (e.g., feeling insufficient) to cultural (e.g., coming from a different upbringing). Some students endorsed that their self-doubt was exacerbated by peer-peer interactions in the classroom. They saw their peers as “people who are absolutely brilliant” and, in response, felt that they were “not doing enough” and comparatively underachieving in their studies. Other interviewees reported their IS was triggered by identifying with a different background than their peers (e.g., not having family or friends in healthcare, pursuing a non-biology major in college, or coming from a family of immigrants). As a result of their background, these students described feeling inferior and disadvantaged compared to their peers—“I wish I could’ve had privileges that other people have.”
Many students reported that participating in MyScope provided them significant relief from IS. Participants noted that reflection combined with art therapy, as utilized in MyScope, was a helpful strategy for practicing positive self-thought and normalizing IS. For one student, the MyScope interview “was a necessary ‘stop and reassess’ point.” The interview helped another student feel that they had permission and space to “start to fully process my thoughts,” enabling the exploration of IS in a mindful way. Multiple students reported that MyScope helped them reflect on the irrationality of IS. One student said, “it’s possible not every thought I have is rational,” and then went on to describe that recognizing this helped to stop the downward IS spiral in real time. Many students valued the novelty of diffusing IS with art, stating that it was “calming to see IS so normalized” and that “this was the first time in all of my educational training that I felt like imposter syndrome was discussed in a public setting.”
Recommendations for Curating an Artistic Intervention to Combat Medical Student IS
The MyScope project was a pilot initiative that explored and attempted to combat medical student imposter syndrome with art therapy. This project was not research, and thus cannot produce evidence of its efficacy. However, MyScope was received positively by the student body and could be easily implemented in other institutions as an attempt to combat IS. The following are some recommendations on implementation:
- Recognize that some students may have reservations about sharing private thoughts in a public display. Make sure to obtain consent and reassure participants that they may opt out of anything that creates personal discomfort (e.g., being interviewed but not photographed).
- Create a safe, welcoming environment that allows students to share imposter feelings, if they exist. Considerations include participation being voluntary, working in a space that is quiet and separate from passers-by, and starting off the interview with affirmational language such as “thank you for choosing to share your feelings with us.”
- Help students separate fear from fact during their reflections. The goal is to stop the “spiral” of illogical thought. Considerations include asking questions that focus on self-affirmation and respectfully pointing out when interviewees’ self-criticism is discordant with fact.
- Provide students ample space (and encouragement) to reflect on their positive traits.
- Be prepared to show grace and support for the interviewee, because the interviews may trigger strong emotions for participants as they process their thoughts.
- Secure a long-term space to display the art, like a medical school lobby or a public art gallery, such that the physical art product can be a continuous reminder of combatting IS.
Imposter syndrome contributes to medical student burnout and must be combatted to maintain a healthy and active physician workforce. The MyScope project suggests that art therapy successfully allows students to address and normalize IS feelings and creates a physical product to continuously reinforce student mindfulness.
- Villwock JA, Sobin LB, Koester LA, et al. Impostor syndrome and burnout among American medical students: a pilot study. Int J Med Educ. 2016;7:364-369.
- Lester D, Moderski T. The imposter phenomenon in adolescents. Psychol Rep. 1995;76(2):466.
- Gottlieb M, Chung A, Battaglioli N, et al. Impostor syndrome among physicians and physicians in training: A scoping review. Med Educ. 2020;54(2):116-124.
- Slade SJ. Empathy rounds: Residents combating impostor syndrome. J Grad Med Educ. 2020;12(3):351-352.
- Reed K, Cochran KL, Edelblute A, et al. Creative arts therapy as a potential intervention to prevent burnout and build resilience in health care professionals. AACN Adv Crit Care. 2020;31(2):179-190.
Medical Education, Medical Ethics, SGIM, Social Determinants of Health, Vulnerable Populations, Wellness
Ms. Pressimone (email@example.com) is a third-year medical student at the University of Pittsburgh School of Medicine and a scholar in the Physician-Scientist Training Program. Ms. Murali (firstname.lastname@example.org) is a third-year medical student at the University of Pittsburgh School of Medicine and a scholar in the Physician-Scientist Training Program. Dr. McNeil (email@example.com) is a professor of medicine and of obstetrics, gynecology, and reproductive science at University of Pittsburgh School of Medicine, and vice chair of education in the department of medicine at University of Pittsburgh School of Medicine. Dr. Merriam (firstname.lastname@example.org) is a clinical assistant professor of medicine at the University of Pittsburgh School of Medicine and VA Pittsburgh Healthcare System and assistant director for degree
granting programs in Medical Education for University of Pittsburgh Institute for Clinical Research and Education.
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