Impostorism in first year medical students: An art-based analysis of masks

Context The Impostor Phenomenon (IP) has been described as the feeling of inadequacy despite intelligence, education, hard work, and experience1,2,3. This can lead to stress, anxiety and hinder performance4. Feelings of impostorism have been reported among medical students5.

Objective This study examined IP in medical students at Penn State College of Medicine using visual and narrative arts to describe their experiences in Professional Identity Formation (PIF) and IP as both product (mask) and process (experiences).

Study Design This is an exploratory study using descriptive and qualitative techniques.

Setting and Population Studied First year medical students of the Penn State College of Medicine (n=131) were surveyed using the Clance IP Scale and asked to complete an arts-based mask during medical school orientation.

Intervention/Instrument Students were given blank masks and painting supplies to explore their sense of identity as they entered medical school. Students were prompted to paint the outside of the mask to depict how they portray themselves to others (projected self) and the inside of the mask to depict how they see themselves (true self). After completing their masks, students were given a set of narrative prompts to then explain the meaning of the masks using their own words.

Outcome Measures An arts-based qualitative thematic analysis was performed on a subset of these masks, examining the top 10% and bottom 10% of Clance IP Scale scores.

Results Similarities between the two groups (high impostorism and low impostorism scores) included the use of imagery and narrative descriptions that were superficial in nature (e.g., themes of nature, sports teams, interests). However, participants with high impostorism scores featured darker and more complex art and colors, whereas individuals with low impostorism scores created masks that were simpler, more brightly colored and seemingly happier.

Conclusions Students in first-year may have chosen superficial imagery during their orientation because they did not want to expose their “true selves” too quickly. However, the darker art and colors on those with high IP scores and the brighter colors for those with low IP scores should be longitudinally explored for impacts across time. This research provides unique insight into IP using visual and narrative techniques which could have implications for both IP and PIF throughout their medical school career and beyond.