In our study, the prevalence of the Imposter phenomenon (IP) among medical students at Sultan Qaboos University College of Medicine and Health Sciences is 52%, keeping up with rates reported elsewhere in the Arabian Peninsula. Prior published studies support the results of our study. According to a study conducted in Saudi Arabia, approximately 58% of young adults are found to have IP.16 A cross-sectional descriptive study conducted in the Bahrain campus of the Royal College of Surgeons in Ireland (RCSI) shows that 45% of medical students are labeled to have IP.12 Our study shows a high prevalence of IP which is consistent with previous literature reviews in the United States.17 However, even with a relatively high prevalence of IP in our study, only 13% have a more frequent and intense course of the characteristics based on the Clance Impostor Phenomenon Scale (CIPS), which is lower in comparison with the study conducted in Bahrain Campus of RCSI, it is possible that this finding because they studied the relationship between self-esteem and imposter syndrome in which they found CIPS score is higher among students with low self-esteem.12 A study done at Dickinson University School of Pharmacy & Health Sciences, New Jersey, among pharmacy residents shows that more than half of the cohort have a CIPS score of ≥ 62. They correlated this finding with long work hours, low self-esteem, and depression.18
In the present study, it was clearly shown that almost 68% of the IP group is female. However, the P value is insignificant, which can be explained by several reasons. First, 66% of responses are from females because our college's male-to-female ratio is 3:1. Second, in our society, females tend to have more support from family and friends' support. Third, the number of married female medical students is more compared to male students, and marriage was associated with less IP as it works as a buffer.12 Corresponding findings are reported from Saudi Arabia, in which 64% of the IP group are females. However, it is statistically significant because nearly a similar number of males to females ratio were involved in their study.16 On the other hand, a study in Bahrain shows no significant gender differences in IP.12 Previous literature conducted among American medical students shows that the female gender is significantly associated with IP, with more than double the percentage of females displaying IP than their male counterparts.17 The significance of gender implications and its association in the development of IP is explained to be more in high achieving women due to introjection of social gender-role stereotyping and particular family dynamics, despite the academic and professional accomplishments.
We studied the correlation between cumulative grade point average (GPA) and the presence of impostorism, which is statistically insignificant, in which more than two-thirds of students from the IP group are above 2.5, the cut-point grade in the college curriculum system. As in our curriculum system, students are classified into 3 phases. As explained earlier, almost 47% of the IP group is from phase three/clinical years, followed by phase two/transitional preclinical years with 35%. This factor is statically not significant. Corresponding with the study in Bahrain that shows more than half of the students are from clinical years, and found no significant differences in CIPS between the years of study, including the critical transitional year.12
It is essential to highlight that major transitions are crucial periods when IP is likely to occur. Particularly in the phase two (classroom to the clinic) transition, the present study finds higher IP in Phase two compared to phase one. Nonetheless, clinical years are higher due to graduation stress and increased responsibilities.
The perceived fraudulence, fraud syndrome, imposter experience, or imposter phenomenon are all synonyms of imposter syndrome, which was described at first in high-achieving women in 1978 by Clance and Imes.1 It is generally known as a behavioral health phenomenon when individuals experience extreme self-doubt and fail to acknowledge their success. It usually attributes it to external factors like good timing or luck. Subsequently, individuals experience anxiety, depression, and fears of being exposed to fraudulence despite their success.19 Since Clance and Imes's original identification of the imposter syndrome, its criteria have expanded significantly. Nevertheless, it is still most commonly linked to typically high-achieving individuals and was found to be disproportionately prevalent among academics, particularly healthcare workers. There is an enticing part to studying this syndrome in medicine. There is a known relationship between imposter syndrome and other behavioral health disorders, including anxiety, burnout, depression, and exacerbation of other behavioral health issues.20
In a highly competitive and challenging environment like medical school, several mental and behavioral issues find a well-nourished ground to develop and grow. Evidence suggests that medicine carries a certain risk to the mental health of medical physicians and students.21 One of the global meta-analysis studies shows an overall prevalence of depressive symptoms and suicidal ideation in medical students to be 27.2% and 11.1%, respectively.20 On the other hand, a recent global meta-analysis suggests that anxiety is most prevalent among middle eastern and Asian medical students.22 In 2017, a cross-sectional study was conducted among 662 medical students at Sultan Qaboos University; the results show a 7.4% prevalence of burnout syndrome and 24.5% depressive symptoms.23 Along with the anxiety and depression medical students are at risk of, their perception of the medical college as a place where they are continuously scrutinized can build up the feeling of intellectual fraudulence and phoniness.12
After the first identification of imposter syndrome in high-achieving women by Clance, and with the increased interest in the phenomena, arguments emerged on the reliability of the IP measurement by Clance, as it initially measured the presence of IP on females. As a result, further measurement instruments are established as several research studies show that men and women experience IP at similar rates.14 Among the scales used to assess IP is Harvey's scale, a list of 14 statements scored 1 to 7. The total scores range from 0 to 84, where higher scores indicate a higher degree of impostorism.24 As for the one used in this study, it is a new Clance IP scale developed in 1985 from the original one established in 1978 after the criticism of IP measurement raised by the researchers.14 This scale is a 20-item instrument that assesses some clinical attributes and feelings not addressed by Harvey's imposter scale. It is as well positively worded to minimize social desirability effects.25 According to studies, the Clance IP scale is more sensitive and has reduced the incidence of false positives and false negatives.14 With all these contributing factors, it was a better option for our study.