Not all 'impostors' are created equal: A dimensional, person-centered, and theory-based analysis of medical students

Abstract

Purpose: Research on the impostor phenomenon (IP) is rapidly growing in medical education due to its relationship with distress and burnout. How IP is theoretically conceptualized and analyzed has been inconsistent, however, which limits our understanding of results and how to act on them. We hypothesized that a person-centered analysis, in combination with a robust theoretical framework, would provide a more specific 'profile' of medical student IP and help to optimize supports for their well-being.

Materials & methods: We used exploratory factor analysis to assess the factor structure of the Clance Impostor Phenomenon Scale (CIPS) in medical students, followed by cluster analysis to identify distinct 'impostor' profiles, based on the identified factors. We then used self-determination theory's (SDT) framework of motivation to explore how students in each profile differed in their general causality orientation, autonomous motivation towards going to medical school, and psychological need satisfaction in the medical program - factors that SDT identifies as predictors of engagement, performance, and well-being.

Results: Factor analysis yielded three main IP factors - feeling like a fake, attributing success to luck, and discounting achievement - in line with Clance's original definition of IP. The cluster analysis then identified four distinct IP profiles based on individual differences in these factors, each varying in aspects of their self-determination.

Conclusions: This study sheds light on the ways that medical students may experience IP, further reinforcing the notion that not all 'impostors' are created equal. Findings support the three-factor structure of the CIPS among medical students, and that most students will fall into one of four IP profiles. These profiles and their implications are discussed.

Keywords: CIPS; Impostor phenomenon; medical students; self-determination.