Great Expectations: Psychosocial Inevitabilities in Medical Education

Rigorous. Stressful. Competitive. Before a prospective medical student submits the application or is even admitted to medical school, these words become all too familiar.

The views and opinions expressed in this collection are those of the authors and do not necessarily reflect the positions of the Association of American Medical Colleges.

Dr. Juanyce D. Taylor

Dr. Juanyce D. Taylor currently serves as Chief Diversity Officer at the University of Mississippi Medical Center. She leads the Office of Diversity and Inclusion and is an associate professor in the Doctor of Health Administration Program in the School of Health Related Professions.

 


 

Introduction

Rigorous. Stressful. Competitive. Before a prospective medical student submits the application or is even admitted to medical school, these words become all too familiar. The description may in fact undergird the realities of the medical school experience but neither do much for promoting long-term work-life symmetry. Undergraduate medical education is not marketed in a way that communicates purpose, fulfillment, or guaranteed success. The unexpected truth is that medical school has a higher potential of heightening insecurities and anxieties which may lead to feelings of self-doubt and fear of being discovered as an intellectual fraud. Even the most confident student may be subjected to being unable to internalize a sense of accomplishment, competence, or skill. This is known as impostor syndrome.

Origins of Impostor Syndrome

The term impostor phenomenon was introduced in 1978 in the article “The Impostor Phenomenon in High Achieving Women: Dynamics and Therapeutic Intervention” by Dr. Pauline R. Clance and Dr. Suzanne A. Imes. Clance and Imes defined impostor phenomenon as an individual experience of self-perceived intellectual phoniness. The researchers investigated the prevalence of this internal experience by interviewing a sample of 150 high-achieving women. Men also experience impostor syndrome, but not as much as it is manifested in women.

All of the participants had been formally recognized for their professional excellence by colleagues, and academic achievements by degrees earned, and top ranking scores on standardized testing.

Despite the consistent evidence of external validation, these women lacked the internal acknowledgement of their accomplishments. The participants explained how their success was a result of luck, and others simply overestimating their intelligence and abilities. Clance and Imes believed that this mental framework for impostor phenomenon developed from factors such as: gender stereotypes, early family dynamics, culture, and attribution style. 

The Hard Truth

The sense of not belonging coupled with insecurity about intellectual capabilities during medical training is experienced by many medical students. “Bottling up” insecurities, inaccurate comparisons, and anxiety contributes significantly to the growing isolation of medical students. 

Research indicates that there is a relationship between impostor syndrome and: (a) personality traits such as anxiety due to excessive uneasiness and apprehension about uncertain outcomes; (b) family or behavioral causes such as childhood memories of others earning better grades, and getting more attention thus feeling in order to be loved one has to be a high achiever. Also having overprotective parents or legal guardians (helicopter parents) who are strict on academic success tying it to the only way to a full life; creating a pursuit of perfectionism which never prevails; or (c) environmental or institutionalized discrimination by belonging to a marginalized group thus already feeling a sense of not belonging. 

Students. Take. Charge.

Students should take advantage of participating in peer mentoring programs to enhance their medical school experience. Programs such as these can support students experiencing impostor syndrome by fostering camaraderie and promoting professional identity formation (PIF), without sole dependence on instructors. If such program is not available, student leaders should take charge to create their own program, in partnership with offices of Student Affairs, Academic Support, or Health and Well-being or a well-established, student-led organization. This approach is both formal and informal in which medical students have access to faculty, administrative staff and experienced students to provide guidance on personal growth, professional development, and career planning. Peer mentoring also creates comfortable spaces and environments which acknowledge student well-being in a manner that is positive and without judgement. Peer mentors can help fellow students manage stress and anxiety by offering support and reminding them of their victories not typically praised for. Finally, peer mentors are able to knock down pedestals, especially around those suffering from impostor syndrome. Students must be reminded that we are all human and experience both triumphs as well as set-backs. Not failures, only lessons!

 

Juanyce D. Taylor, PhD, Chief Diversity and Inclusion Officer
Rashanda Booker, PhD, Director, Institutional Equity and Partnerships
University of Mississippi Medical Center (Jackson, MS)

 

References

Andre, C., Deerin, J. & Leykum, L. (2017). Students helping students: Vertical peer mentoring to enhance the medical school experience. Biomedical Central Research Notes, 10, 176.

Clance, P. R., & Imes, S. A. (1978). The imposter phenomenon in high achieving women: Dynamics and therapeutic intervention. Psychotherapy: Theory, Research & Practice, 15(3), 241.

Henning, K., Ey, S., & Shaw, D. (1998). Perfectionism, the impostor phenomenon and psychological adjustment in medical, dental, nursing and pharmacy students. Medical education, 32(5), 456-464.

Martin, J. L. (2018). Factors contributing to microaggressions, racial battle fatigue, stereotype threat, and imposter phenomenon for nonhegemonic students: Implications for urban education. Microaggression Theory: Influence and Implications, 102-120.

Smith, W., Hung, M., & Franklin, J. (2011). Racial battle fatigue and the miseducation of black men: Racial microaggressions, societal problems, and environmental stress. The Journal of Negro Education, 80(1), 63-82.

Wald, H. (2015). Professional identity (trans)formation in medical education: Reflection, relationship, resilience. Academic Medicine, 90(6), 701-706.