Abstract
Objective. To evaluate the prevalence of impostor phenomenon in student pharmacists and faculty members at two educational institutions in the United States.
Methods. Participants anonymously completed an electronic self-report survey instrument that included the validated Clance Impostor Phenomenon Scale (CIPS) from April 2020 to May 2020. Demographic data including age range, gender, and other characteristics were collected. The Clance Impostor Phenomenon Scale scores were reported as means (SDs), and data were compared between institutions and demographic groups using t tests.
Results. The overall mean CIPS survey score (N=209, 35.5% response rate) was 63.8 (SD=15.1). The mean student pharmacist CIPS score for Northeast Ohio Medical University (NEOMED) was 64.7 (SD=14.4) vs 63.8 (SD=16.1) for Sullivan University College of Pharmacy and Health Sciences (SUCOPHS), which was statistically similar. Mean faculty CIPS score for NEOMED was 59.2 (SD=14.0) vs 64.7 (SD=16.8) for SUCOPHS, which was statistically similar. Mean CIPS score for the combined student pharmacist group (NEOMED and SUCOPHS) was 64.3 (SD=15.1) vs 61.2 (SD=15.1) for the combined group of faculty members, which was statistically similar. Overall, most respondents fell in the “moderate” to “frequent” CIPS score classification range (36.4% and 44%, respectively).
Conclusion. Impostor phenomenon feelings were common among responding student pharmacists and faculty members at the institutions surveyed; however, little is known about the implications of these findings. Future research should seek to elucidate factors predictive of or associated with impostor phenomenon as well as assess the impact of strategies to prevent or manage impostor phenomenon.
INTRODUCTION
Impostor phenomenon describes an internal experience of intellectual fraudulence, which is often experienced by high-achieving individuals.1 “Impostors” can suffer from chronic self-doubt that overrides feelings of success or external proof of their competence.2 Pharmacists are a crucial part of the health care team and are considered medication experts. Work responsibilities for pharmacists include activities that often require intense critical thinking and high-stakes decisions in fast-paced environments. Accordingly, pharmacists understandably place much importance and value in their work contributions and feelings of self-worth. Multiple contributing factors to impostor phenomenon in health professionals have been suggested, including gender, religion, demographic factors, cultural factors, familial factors, and training environment.3,4 While a paucity of literature exists in pharmacy to date, studies point to a high prevalence of impostor phenomenon in other health professions, (primarily medicine), though not associated with years of training, age, and most other demographics.3,5⇓-7 Furthermore, many pharmacists may have difficulty formulating their professional identity (ie, a sense of how a person views themself combined with how others see them). Difficulty in accepting their professional identity may further contribute to fraudulent feelings.8,9
The impostor phenomenon also involves a constant fear of exposure, isolation, and rejection.10 While internal factors such as anxiety and depression can negatively affect those who experience impostor phenomenon, these feelings can cause external consequences.3,5⇓-7 For example, impostor phenomenon may have an impact on a person’s career trajectory, as it often manifests in indecisiveness, avoiding responsibilities, self-sabotage, inability to delegate, postponing deadlines, and many more self-limiting issues. Left unchecked and allowed to fester and propagate, these feelings can further stymie career growth, impede innovation, and limit progression up the corporate ladder.3,11
Given the potential effect that impostor phenomenon can have on personal and professional growth across disciplines and demographic groups, an appropriate first step to addressing impostor phenomenon is to examine the prevalence of impostor phenomenon in student pharmacists and faculty members. To date, limited data has been published related to student pharmacists and no studies have been published describing impostor phenomenon in pharmacy faculty. The objective of this pilot study was to describe the prevalence of IP in pharmacy faculty and student pharmacists at two Doctor of Pharmacy (PharmD) programs in the Midwestern and East South Central United States.
METHODS
A 49-question self-report survey instrument was delivered anonymously using Qualtrics software (Provo, UT) from April 2020 to May 2020. Subjects in this cross-sectional study included student pharmacists and faculty members at Sullivan University College of Pharmacy and Health Sciences (SUCOPHS) in Louisville, Kentucky (a three-year accelerated PharmD program), and Northeast Ohio Medical University College of Pharmacy (NEOMED) in Rootstown, Ohio (a traditional four-year PharmD program). Branching logic was employed to funnel faculty members and student pharmacists to receive the appropriate demographic questions (eg, faculty members were asked about their academic rank while student pharmacists were asked about their professional year in the program). Survey completion time was approximately eight to 10 minutes (as estimated by the survey software). Upon survey completion, participants were able to enter a raffle to win one of five $100 Amazon.com gift cards. This study was deemed exempt by the institutional review boards of both institutions.
The Clance Impostor Phenomenon Scale (CIPS) is a 20-item self-report instrument which asks respondents to rate each statement on a Likert-type scale on which 1=not at all true to 5=very true.12,13 Example statements include, “I can give the impression that I’m more competent than I really am” and “I tend to remember the incidents in which I have not done my best more than those times I have done my best.” All items are identically scored, and the score is reported as the sum of all ratings (minimum=20, maximum=100). Scores of 40 or less are considered indicative of few impostor phenomenon experiences; scores of 41-60, moderate experiences; 61-80, frequent experiences, and scores over 80 representative of intense experiences of impostor phenomenon. This scale was chosen over others because it had been used extensively over nearly 40 years to conduct research in a variety of populations and was free to use for research purposes. The full text of the CIPS is available online at https://paulineroseclance.com/impostor_phenomenon.html. Other than the name of the survey instrument to be used, limited background information about impostor phenomenon was provided to potential study subjects prior to inviting them to participate in the survey. This approach was taken to prevent selection bias if individuals had learned about impostor phenomenon from our survey invitation and elected to participate because they believed they were experiencing impostor phenomenon.
The 49-question instrument included relevant demographic items, including the participant’s age range and gender as well as two additional self-report scales not directly related to the topic of this study. An additional item on the instrument was included to assess professional identity formation prior to either professional training (for student pharmacists) or becoming a faculty member (as a type of professional) to determine if the feeling of alignment between the participants’ view of themselves and others’ view of them was associated with CIPS scores.8 Due to the lack of a widely accepted means of evaluating professional identity development in student pharmacists or faculty members, a simple yes/no question was included (“In your experience prior to pursuing pharmacy, have you developed an alternative professional identity?”). Respondents were not instructed or guided on how to interpret this item.
Survey responses were downloaded from Qualtrics into a spreadsheet for further analysis. Statistics were performed using Excel and SPSS, version 23 (Armonk, NY). Demographics were reported as means (SD) or raw numbers with percentages as appropriate for type of data. The CIPS results were reported as sum of the numerical rating of all responses (with mean and SD for the different cohorts). Results from the demographic groups were compared using t tests. The CIPS scores were sorted into the respective classifications noted previously (ie, few and moderate).
RESULTS
The overall survey response rate, including participants at both institutions and counting student pharmacists and faculty members together, was 35.5% (209/589). The overall response rate at SUCOPHS was slightly higher at 40.5% (85/210) vs 32.7% (124/379) at NEOMED. The overall response rate for student pharmacists at SUCOPHS was 33.9% (174/514). The response rate at SUCOPHS was higher at 39.6% (72/182) vs NEOMED at 30.7% (102/332). For faculty, the overall response rate was 46.7% (35/75). The response rate at each institution was similar, with 46.8% (22/47) at NEOMED and 46.4% (13/28) at SUCOPHS. Demographic characteristics for student pharmacist respondents are listed in Table 1. Most student pharmacists were 25 years of age and under or 26-30 years (55.7% and 31%, respectively), with similar ratios of students in each age group at each program. Most student pharmacists who responded to the survey identified as female (70.7%), with similar percentages at each program. Overall, student pharmacist respondents were evenly distributed among years of their respective programs, though the differing nature of the programs (ie, three-year PharmD program vs four-year PharmD program) prevented significant interpretation of year in program as a delineating demographic characteristic. Most student pharmacist respondents (68.4%) reported having no alternative professional identity prior to pharmacy school.
Student Pharmacists Who Participated in a Survey to Determine the Prevalence of Impostor Phenomenon (N=174)a
Demographic characteristics for faculty respondents are listed in Table 2. Most faculty members who responded to the survey were 31-35 years of age, with that proportion of that demographic slightly higher at NEOMED than at SUCOPHS (31.8% and 23.1%, respectively). The next largest age group among faculty respondents was 41-45 years, in which 20% of the overall faculty respondents fell. Most faculty respondents (57.1%) identified as female, though the percentage of female participants was different between institutions (p=0.03). The overwhelming majority (84.6%) of faculty respondents from SUCOPHS identified as female, whereas less than half (40.9%) of the faculty respondents from NEOMED identified as female. Overall, the ranks of faculty respondents were evenly split between assistant and associate professor (42.9% for each), with only a minority (11.4%) being full professors. The majority of faculty respondents overall (62.9%) reported no administrative rank, and 60% reported practicing pharmacy in their current position. The majority of faculty respondents (77.1%) reported having no alternative professional identity prior to becoming a faculty member.
Pharmacy Faculty Members Who Participated in a Survey to Determine the Prevalence of Impostor Phenomenon (N=35)a
The mean CIPS score for all survey respondents (N=209) was 63.8 (SD=15.1). Overall, there was no significant difference in the mean CIPS score for NEOMED respondents (63.7, SD=14.4) vs SUCOPHS respondents (63.9, SD=16.1). Also, there was no significant difference in mean CIPS score for student pharmacists at NEOMED (64.7, SD=14.4) compared to the CIPS score for student pharmacists at SUCOPHS (63.8, SD=16.1). There was no significant difference between the mean CIPS score for faculty at NEOMED (59.2, SD=14.0) vs the mean CIPS score for faculty at SUCOPHS (64.7, SD=16.8). Finally, there was no significant difference between the mean CIPS score for the combined (NEOMED and SUCOPHS) group of student pharmacists (64.3, SD=15.1) vs the mean CIPS score for the combined group of faculty members (61.2, SD=15.1).
Results indicated that the highest percentage of respondents were classified as having moderate to frequent IP experiences based on the CIPS score classifications, as shown in Table 3. The largest proportion of respondents overall (44%, including both student pharmacists and faculty) were classified as having frequent feelings of impostor phenomenon (defined as a CIPS score of 61-80). Only 6.2% (13/209) of all respondents were classified as having “few” feelings of impostor phenomenon (defined as a CIPS score ≤40). Only 13.4% (28/209) of all respondents were classified as having intense feelings of impostor phenomenon (defined as a score >80 on the CIPS), with the proportion of student pharmacists and faculty reporting this level of impostor phenomenon ranging from 12.1%-15.4%.
Clance Impostor Phenomenon Scale (CIPS)a Results of Student Pharmacists and Faculty Members by Institution and Score Classification (N=209)
DISCUSSION
To our knowledge, this is the first study evaluating the prevalence and severity of impostor phenomenon in pharmacy faculty. Our findings also expand on preliminary data demonstrating the prevalence and severity of impostor phenomenon in student pharmacists. Henning and colleagues conducted a study of medicine, dental, nursing, and pharmacy students (n=477) and demonstrated that the overall impostor phenomenon prevalence was 30.2%.7 The mean CIPS score for student pharmacists in this study indicated that respondents had “moderate” impostor phenomenon experiences.7 While the study by Henning and colleagues was notable for its large sample population and inclusion of multiple health professions students, a significant limitation was that the study was conducted at a time when the entry level degree to practice pharmacy was a bachelor’s of science degree. Pharmacist training has significantly changed since the time this data was published with the PharmD degree becoming the required entry level degree to practice in 2000.14 The transition to an all PharmD curriculum significantly changed the landscape of pharmacy education and continued efforts already underway to transition the pharmacy profession from a focus on products to one on patient care. It would be difficult to ascertain whether the curricular and practice transformations that have taken place since 2004 have affected the prevalence or severity of IP in student pharmacists.
Legassie and colleagues also demonstrated that health care professionals experience impostor phenomenon during postgraduate training.6 Their study, which evaluated impostor phenomenon feelings during medical residency (n=48), determined that 43.8% of respondents experienced impostor phenomenon feelings, with higher scores in residents who were foreign-trained or at later stages of their training.6 Accordingly, Oriel and colleagues conducted a survey of family medicine residents (n=185) which concluded that 41% of women and 24% of men scored as “imposters” on the CIPS and that impostor experiences were highly correlated with depression (r2=.45, p<.001) and anxiety (r2=.65, p<.001).5 The researchers also concluded that about one third of family medicine residents believe they are less intelligent and less competent than others perceive them to be.5 Sullivan and colleagues focused on describing IP in pharmacy residents (n=720) and found that 57.5% experienced IP feelings with positive correlations to receiving prior treatment for a mental health condition and longer work hours.15 These authors also described that CIPS score and the Mayo Clinic Residency Well-Being Index were weakly but significantly correlated (ϱ=.357; p<.001).15 The Mayo Clinic Well-Being Index for residents is a seven-item validated tool that is used to assess distress in medical residents, alluding to the possibility that impostor phenomenon feelings could be associated with feelings of burnout.15 While this evidence provides support for IP feelings emerging during postgraduate training, literature is lacking regarding impostor phenomenon that occurs during a student pharmacist’s academic career or at later stages in a pharmacist’s career.
Strengths of this study include the cross-institutional collaboration, two unique study populations (student pharmacists and pharmacy faculty), and the use of a validated survey tool to determine the prevalence of impostor phenomenon. To our knowledge, this study represents the first published study on impostor phenomenon to include pharmacy faculty members. While preliminary in nature, this information could also potentially be helpful in the professional development of student pharmacists and pharmacy faculty members. Larger, more comprehensive studies of impostor phenomenon in pharmacy faculty members are needed to fully understand this issue and its scope.
There are several important limitations to this study. First, like all survey research, nonresponse bias could have occurred based on nonresponders lacking interest in the subject or having not experienced feelings of impostor phenomenon.16 Additionally, our study had a relatively small sample size because of the limited response rate (35.5% overall). However, our response rate and overall number of respondents were similar to those in several previously published studies in the area (response rates of 18.7% to 48%) and reflected a diversity of demographic groups.7,15 Another important limitation is related to how potential survey respondents perceived the survey and their baseline knowledge of impostor phenomenon. As noted earlier, limited information was provided to potential survey respondents about impostor phenomenon to mitigate or minimize selection bias. Thus, individual survey respondents may have had entirely disparate internal conceptions of impostor phenomenon and therefore approached the survey from different baseline levels of knowledge and understanding. The net impact or effect of this decision on our study is impossible to determine but worth noting in interpreting the results. Finally, while the CIPS instrument has been used for decades across multiple demographic groups, respondents may have interpreted the wording of various items differently than what was intended (a type of framing bias). This challenge is not unique to our study or its design, however, and it is impossible to know how or if such differences in interpretation would impact the results.17,18 One unique confounder to our study that could have affected both the response rate and potential interpretation of the results was the timing of survey administration. This survey was completed during the early stages of the COVID-19 pandemic in April 2020 to May 2020, just as national and local lockdowns were in effect and many educational institutions switched to virtual learning. It is unclear, however, what (if any) effect this had on the results. It is certainly possible that specific circumstances during that period could have affected how respondents perceived their abilities.
These findings may have implications on how schools and colleges of pharmacy approach professional development for student pharmacists and pharmacy faculty. We hypothesize that implications of these findings could impact academic or professional success, job satisfaction, self-efficacy, work engagement, and/or propensity for burnout as individuals may work harder to “prove themselves” because of the fraudulent feelings they are having.19,20 However, evidence of such associations would need to be investigated and documented to draw definitive conclusions. It would also be interesting to explore how impostor phenomenon feelings change throughout a pharmacist’s academic or professional career as well as what demographic or environmental factors correlate with impostor phenomenon results. Additionally, surveying a larger and more diverse population may bring to light consistent or new findings regarding impostor phenomenon prevalence and severity within the profession and in pharmacy education.
CONCLUSION
Our study found that impostor phenomenon feelings may be common among pharmacy faculty members and student pharmacists. In our study, most student pharmacists and faculty were found to have impostor phenomenon scores that fell into the “moderate” or “frequent” classification. However, little is known currently about the implication of those classifications. Future research should seek to elucidate factors predictive of impostor phenomenon in student pharmacists and faculty members as well as evaluate potential mitigation strategies that could be employed by programs or individuals to prevent or manage feelings of impostor phenomenon.
- Received November 13, 2020.
- Accepted May 11, 2021.
- © 2022 American Association of Colleges of Pharmacy
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