Educational interventions for imposter phenomenon in healthcare: a scoping review

Abstract

Background
Imposter Phenomenon (IP) is a subjective feeling of intellectual fraudulence and self-doubt experienced by individuals in goal-orientated high-achieving professions. The impact of IP within healthcare has been associated with individual physical and mental health and concerns around training, career progression and DEI at an institutional level. To effectively address IP in healthcare, this scoping review aims to explore educational interventions designed to empower high-achieving individuals with the tools needed to confront and overcome IP.

Methods
The scoping review adhered to a predetermined protocol informed by the JBI methodology and PRISMA-ScR guidelines in order to identify educational interventions addressing IP in high-achieving industries. Articles were searched across multiple databases, including MEDLINE (Ovid), PsychINFO, SCOPUS, and Web of Science, alongside grey literature, without imposing any time constraints. A systematic approach including a thematic analysis allowed for a nuanced exploration and interpretation of the identified educational interventions and their impact on addressing IP.

Results
Seventeen articles were incorporated into the review, with the majority originating from the USA and majority being published since 2020. Ten studies targeted healthcare professionals, undergraduate and postgraduate healthcare students. Majority of studies aimed at addressing IP, featured a larger number of female participants than males. Workshops with self-reflection and group-guided exercises to overcome IP were the most popular educational interventions. Coaching and structured supervision were also suggested. Across all papers, three themes emerged for coping strategies: individual, peer-to-peer, and institutional.

Conclusions
This scoping review suggests how group and individual interventions such as workshops, small group discussions and coaching can be used to overcome IP in healthcare. Institutional changes like diversity promotion, supervisor education, and support networks are crucial in addressing IP. Further long term and speciality specific assessments are needed to measure impact. Overall, the review highlights how educational awareness and a variety of strategies can be implemented to create a supportive environment for professionals dealing with IP, promoting their well-being and success.

Full text

Siddiquietal. BMC Medical Education (2024) 24:43
https://doi.org/10.1186/s12909-023-04984-w
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BMC Medical Education
Educational interventions forimposter
phenomenon inhealthcare: ascoping review
Z Kamran Siddiqui1,5, H. R Church2,6*, R. Jayasuriya3,5, T. Boddice4 and J. Tomlinson1,3,5
Abstract
Background Imposter Phenomenon (IP) is a subjective feeling of intellectual fraudulence and self-doubt expe-
rienced by individuals in goal-orientated high-achieving professions. The impact of IP within healthcare has been
associated with individual physical and mental health and concerns around training, career progression and DEI
at an institutional level. To effectively address IP in healthcare, this scoping review aims to explore educational inter-
ventions designed to empower high-achieving individuals with the tools needed to confront and overcome IP.
Methods The scoping review adhered to a predetermined protocol informed by the JBI methodology and PRISMA-
ScR guidelines in order to identify educational interventions addressing IP in high-achieving industries. Articles were
searched across multiple databases, including MEDLINE (Ovid), PsychINFO, SCOPUS, and Web of Science, along-
side grey literature, without imposing any time constraints. A systematic approach including a thematic analysis
allowed for a nuanced exploration and interpretation of the identified educational interventions and their impact
on addressing IP.
Results Seventeen articles were incorporated into the review, with the majority originating from the USA and major-
ity being published since 2020. Ten studies targeted healthcare professionals, undergraduate and postgraduate
healthcare students. Majority of studies aimed at addressing IP, featured a larger number of female participants
than males. Workshops with self-reflection and group-guided exercises to overcome IP were the most popular
educational interventions. Coaching and structured supervision were also suggested. Across all papers, three themes
emerged for coping strategies: individual, peer-to-peer, and institutional.
Conclusions This scoping review suggests how group and individual interventions such as workshops, small group
discussions and coaching can be used to overcome IP in healthcare. Institutional changes like diversity promotion,
supervisor education, and support networks are crucial in addressing IP. Further long term and speciality specific
assessments are needed to measure impact. Overall, the review highlights how educational awareness and a variety
of strategies can be implemented to create a supportive environment for professionals dealing with IP, promoting
their well-being and success.
Keywords Imposter phenomenon, Impostor syndrome, Intervention, Workshop, Coaching
Background
Imposter Phenomenon (IP), a psychological experience
characterised by feelings of intellectual fraudulence
despite evident accomplishments, was first described
in 1978 by Clance who recognised the phenomena in
high-achieving women [1]. IP is experienced as debili-
tating self-doubt often leading high-achieving individu-
als to ascribe their success to luck or external factors
*Correspondence:
H. R Church
helen.Church@nottingham.ac.uk
Full list of author information is available at the end of the article
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

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Siddiquietal. BMC Medical Education (2024) 24:43
[2]. High-achieving industries are defined as those
that demand exceptional performance, innovation,
and competitiveness, fostering a constant pursuit of
excellence. IP can be prevalent in such goal-oriented
environments, driven by the pressure to meet high
standards. Examples of such industries include, but are
not limited to, healthcare, technology, business, law,
arts, academia, and research. Studies have shown that
at least 70% of high-achievers report experiencing the
collective symptoms of imposterism: self-doubt, intel-
lectual fraudulence and feelings of fear and failure, at
some point during their careers [3, 4]. Furthermore,
interpersonal traits, such as maladaptive perfectionism
and neuroticism, can contribute to the persistence of
IP. Additionally, environmental factors like experiences
of discrimination, external negative stereotypes, fam-
ily dynamics, and social experiences further shape and
amplify the impact of this phenomenon on individuals
[3]. Recognizing and addressing both these personal
and environmental aspects is essential for developing
effective strategies to mitigate the effects of IP.
The prevalence of IP has been established across var-
ious high-achieving professions including nursing [5,
6], psychology [1, 7], law [8], engineering [9], business
[10], academia [11], and medicine [12, 13], each pro-
posing unique approaches to tackle it. Several studies
have associated IP with depression, anxiety, burnout,
and perfectionism [11, 14–16]. These lead to emo-
tional exhaustion, work-life conflict, and, in severe
cases, even the risk of self-harm and suicide [17–20].
The potential impact of IP within the healthcare sector
is concerning. IP is a threat to diversity [21, 22], may
negatively affect patient care [23], obstruct individuals
from pursuing leadership roles and further challenge
their career progression [24] and professional identity
within local and national organizations [25]. Hence,
there is a growing need to address IP to limit its impact
within healthcare.
Despite its widespread acknowledgment, there exists
limited research that offers specific tactics for effi-
ciently handling and mitigating IP. Early research sug-
gests individual and group psychotherapy principles
such as validating doubts and addressing individual
fears of failure as potential methods to alleviate feelings
of imposterism [1, 26, 27]. A recent systematic review
found no evaluated treatment for IP [4]. However, a
preliminary search indicated a recent surge of inter-
est in addressing IP through educational interventions
such as group discussions and workshops in the past
five years. erefore, this scoping review aims to pro-
vide a comprehensive summary of these interventions
aimed at addressing IP across various high-achieving
professional settings. e review also summarises the
strategies that can help overcome IP and foster a sup-
portive environment for healthcare professionals.
Methods
A scoping review approach was used to achieve several
objectives including examining the extent of research
activity, determining the value of a full systematic review,
summarising, and disseminating research findings, and
identifying gaps in existing literature [28]. e review
adopted the Joanna Briggs Institute (JBI) methodology
[29], and used the Preferred Reporting Items for System-
atic Reviews and Meta-Analyses extension for Scoping
Reviews (PRISMA-ScR) guidelines [30] to report find-
ings. e a priori protocol is registered with the Open
Science Framework (OSF) [31].
Research question
What educational interventions have been developed to
address IP in high-achieving professionals, and how have
they been designed and evaluated? We aimed to explore
the following themes:
1. What is currently being done to address IP?
2. What is successful?
3. What is the gap for future work?
Identifying relevant studies
An initial limited search of MEDLINE (Ovid) was per-
formed to identify articles on the topic. e text words
contained in the titles and abstracts of the relevant arti-
cles and the index terms used to describe the articles
were used to develop a full search strategy (Additional
file1). e search strategy was reviewed and agreed upon
by an independent librarian at the University of Sheffield.
Searches were completed across MEDLINE (Ovid), SCO-
PUS, Web of Science, and PsycINFO databases between
10th August 2022 and 15th September 2022. Sources of
unpublished studies and grey literature, including con-
ference proceedings and research dissertations/theses
were searched using Google Scholar. e reference lists
of articles selected for full-text review and those finally
included in the review, were also screened for additional
papers. e search was not limited by a time period.
Given the scarcity of literature on interventions for
IP within healthcare education research, the review
extended its scope to include interventions developed in
non-healthcare settings. Consequently, exploring edu-
cational interventions designed to address IP beyond
healthcare systems becomes a logical progression and
with a previously adopted strategy for addressing other
inquiries in healthcare education [32].
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e review excluded syndromes that mimic IP such as
Capgras syndrome, along with studies solely focusing on
the prevalence or recommending theoretical strategies
to overcome IP without any description of interventions.
Additionally, interventions addressing associated effects
of IP, such as burnout and suicide, but without explicit
mention of IP, were also excluded. Type and quality of
article was not a basis for exclusion in this review.
Study selection
A total of 427 papers were identified from databases, and
168 duplicates were eliminated using Covidence [33]. An
independent reviewer (ZKS) screened titles and abstracts
against the inclusion criteria. Potentially relevant papers
were retrieved for full-text evaluation, and reasons for
exclusion were documented. To minimise author bias and
error, ZKS randomly distributed 20% of the studies at the
abstract and full text review stages to be independently
screened by authors HRC, RJ, and TB. A high agreement
rate of 96% was achieved, and any disagreements among
the reviewers were resolved through team discussion.
e PRISMA flow diagram illustrates the study selec-
tion process (Fig.1). No additional articles were found in
the grey literature search; 49 articles underwent full-text
review, and 17 manuscripts met the inclusion criteria for
the study.
Collating, summarising, andreporting results
Data was extracted from included papers using a custom
standardised form, on Covidence 2.0. e extracted data
was analysed using MS Excel for quantitative data and
NVivo for qualitative data. e finalised compiled raw
Fig. 1 PRISMA flow chart demonstrating outcomes of search process
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Siddiquietal. BMC Medical Education (2024) 24:43
data is available in Additional file2. Collaborative analy-
sis (ZKS and HRC) allowed comprehensive exploration
into the structure and content of educational workshops
(Additional file3).
Strategies suggested and those used for addressing
Imposter Phenomenon were systematically compiled
from each of the included papers. e collated strategies
were subsequently imported into NVIVO 12 for a more
intricate thematic analysis. Following Braun & Clarke’s
six-step thematic analysis approach, ZKS amalgamated
related codes to give rise to prospective themes (Table2).
e generated themes were subjected to scrutiny by HRC
and further reviewed by the rest of the team, resulting in
a unanimous agreement on their formulation.
Results
e study characteristics are summarised in Table 1.
e review revealed a notable temporal trend, with the
majority of the articles published in the last three years
since 2020. Majority of the studies were original research
papers originating in the USA. Of the 17 papers, only 10
studies centred exclusively on healthcare. Among these,
5 studies encompassed diverse medical disciplines such
as internal medicine, clinical radiology, primary care pro-
viders, psychiatry, surgery, obstetrics, and gynaecology.
Two articles included undergraduate medical and dental
cohorts; among the postgraduate student studies, three
out of the four were related to nursing and family therapy.
e professional setting in the remaining was technology,
business, and STEM/academia. Two reports featured a
varied professional cohort spanning the aforementioned
fields as well as law and teaching. Specifically, four papers
exclusively focused on females, while three others had a
greater female participation than males. No interventions
solely involved males, and none of the studies explored
gender beyond the male/female binary.
What educational interventions have been developed
toaddress IP?
A review of 17 papers revealed a classification into two
main intervention types: individual and group-based
approaches (Table1).
Individual approach
Only 4 papers advocated for one-to-one intervention
(Table 1). Studies recommending coaching were from
fields of business, executive roles, and technology, while
one-on-one structured supervision using therapy mod-
els like narrative therapy and Bowen’s Family erapy
(BFST) were utilised in training programs for healthcare
trainees delivering therapy to others. An additional quali-
tative reflective study advocated for the effects of reflec-
tive journaling [35].
Group based approach
Among the 13 papers that employed a group-based
approach, 10 studies were workshops, forming the
majority of all identified educational interventions.
Two reports proposed group psychotherapy, inspired
by Gestalt psychology, outlining an intervention aimed
at augmenting clients’ awareness of their thoughts,
Table 1 Summary of characteristics studies (n = 17)
Year of publication Frequency (%
of all studies) Reference
1978 1 (5.9) [27]
1995 1 (5.9) [34]
2017 1 (5.9) [35]
2018 2 (11.8) [36, 37]
2020 4 (23.5) [38–41]
2021 4 (23.5) [42–45]
2022 4 (23.5) [46–49]
Country
USA 13 (76.5) [27, 34, 37, 39–48]
UK 2 (11.8) [35, 49]
Canada 1 (5.9) [36]
Austria 1 (5.9) [38]
Type of article
Research papers 13 (76.5) [35–41, 43, 44, 46–48]
Reports 3 (17.6) [27, 34, 42]
Dissertation 1 (5.9) [45]
Professional eld
Healthcare 5 (29) [39, 42, 43, 47, 48]
Postgraduate students 4 (23) [35–37, 45]
Undergraduate healthcare 2 (11.8) [41, 46]
Business and Management 2 (11.8) [44, 49]
STEM & Academia 2 (11.8) [40, 44]
Mixed high achieving
industries 2 (11.8) [27, 34]
Technology 1 (5.9) [38]
Gender
Males > females 3 (17.6) [38, 41, 47]
Females > males 3 (17.6) [44, 45, 48]
Only females 6 (35.3) [27, 34, 35, 40, 42, 49]
Only males 0
Other gender reported 0
Gender not reported 5 (29) [36, 37, 39, 43, 46]
Intervention type
Group:
Interactive workshop 10 (58.8) [36, 37, 39, 40, 43–48]
Group psychotherapy 2 (11.8) [27, 34]
Online training module 1 (5.9) [41]
Individual:
Coaching / Supervision 3 (17.6) [38, 42, 49]
Reflective journaling 1 (5.9) [35]
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emotions, and behaviours. One study assessed the
effectiveness of an independent online training mod-
ule designed to raise awareness of IP and provide cop-
ing strategies to address IP in dental students [41].
e studies exhibited variation in the total number of
participants. Group interventions conducted multiple
times encompassed a range of 65 to 396 total partici-
pants, while non-repeated interventions had a compar-
atively smaller sample size.
A sub-analysis was conducted to gain a deeper under-
standing of the educational program of the workshops,
including their context and learning activities (Additional
file3).
Workshops aimed at addressing IP were conducted in
diverse settings, with participant numbers ranging from
small groups of 5 to larger gatherings of 100. Four papers
did not specify the number of participants per workshop;
however, among these, three papers provided an aggre-
gate count of participants across multiple workshops.
Some workshops were designed for multi-professional
participation, while others specifically targeted individual
professionals.
e duration of the group sessions ranged from approx-
imately 30 to 120min. Most workshops were designed to
last around 60 to 90min; however, the longest workshop
occurred annually over 5 years. e duration of these
workshops was adapted to accommodate different learn-
ing objectives and participant engagement strategies.
All the studies aimed to empower participants by
equipping them with strategies, tools, and skills to com-
bat IP and its negative effects. e educational objectives
across the ten papers were grouped under prevalence
exploration (PU), understanding and awareness of IP
(U/A), intervention development (ID) and evaluation
(E). All workshops use a variety of creative approaches
to address IP, combining didactic presentations, interac-
tive activities, personal reflection, and group discussions
to empower participants and equip them with strategies.
e learning activity for each workshop is also high-
lighted in Additional file3.
What strategies were employed andrecommended?
e strategies employed in educational programs
and those suggested by authors in the 17 studies were
Table 2 Thematic analysis results of strategies used to address IP in identified studies
Theme Code Major outcome References
Individual strategies Record Keeping Journaling and reflecting (positive feedback, achievements,
imposter thoughts) [27, 35, 41, 46]
Recognising strengths [37, 39]
Cognitive reframing Developing growth mindset, positive thinking, and engage-
ment, challenging negative thinking patterns, story telling [48, 37, 38, 44, 49]
Self-awareness, mindfulness, self-compassion [48, 39, 45, 35, 44, 43, 49]
Improvisation techniques, visualising success, rewarding self-
accomplishments, embracing confidence [27, 47–49]
Support communities Building a community for safe spaces for expression, group
therapy, experiential workshops [34, 36, 44]
Seeking peer and mentor / supervisory support, building small
networks [37, 39, 35, 41, 43, 40, 47]
Seeking structured supervision Coaching for personal growth managing fear of failure [41, 38, 49, 40]
Exploring family of origin patterns in supervision [27, 34, 45]
Building personal skills Strategic communication practices, time management, procras-
tination prevention, recognising stuck points [39–41, 44]
Peer strategies Acknowledgement Understanding of IP in others with emphasis on empathy, com-
munity, and connection; allowing vulnerability [36, 40, 41, 43]
Breaking the silence Challenging perfectionism and implicit bias; Celebrating peers’
success, cultivating positive culture [43, 47, 48]
Institutional Strategies Creating awareness Normalising IP feelings, exploring negative/ positive effects of IP [44, 45, 49]
Acknowledging the role of IP in institutional processes [40, 45]
Using CIPS – as a tool to guide conversation [37, 49]
Education on IP Training supervisors, collaborative supervision, mentorship [35, 42, 45, 47]
Organisational support for coaching [38, 49]
Delivery of workshops, provide terminology and tools in existing
curriculum [36, 37, 39, 40, 43–48]
Addressing systemic biases, gender equality, diversity & inclusion [40, 47]
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analysed thematically and categorised into individual,
peer-to-peer, and institutional levels (Table2).
How have these interventions been evaluated?
A brief overview of interventions targeting IP and the
methodologies used for evaluation can be found in
Table3. Only eleven studies assessed whether the inter-
vention had a positive effect on IP. Eight studies exclu-
sively measured post-intervention outcomes, and three
of them did not explicitly define the time frame for the
evaluation after the intervention. Notably, three stud-
ies included multiple evaluation points during their
described intervention [38, 41, 44]. Among these, two
studies focused on measuring the distal impact of the
intervention, with one assessing impact at 5 weeks
using a questionnaire [38] and the other at 3 months
using a questionnaire and focus group [44]. e third
study assessed the impact at the "end of the semes-
ter" by administering the Clance Imposter Scale (CIPS)
to measure any changes in imposter-related thoughts
throughout the semester along with evaluating how stu-
dents applied the six coping strategies introduced during
the intervention through self-reported outcomes [41].
Eight of the eleven interventional studies evaluated, used
self-reported data measurements, using validated and
some self-developed questionnaires using Likert scales
to measure outcomes such as imposter scores, career
management, goal attainment, core self-evaluation, self-
efficacy, satisfaction, and perceived knowledge acquisi-
tion. Only three studies measured the distal impact of
the intervention [38, 44, 45].Furthermore, only four used
qualitative methodology to evaluate the intervention
(Table3).
Although the studies did not undergo a qualita-
tive assessment of methodology of all the studies there
was only one randomised control trial which demon-
strated the effectiveness of coaching over group training
in consistently reducing IP scores and fear of negative
evaluation in technology trainees, along with sustained
effectiveness after 5 weeks post-coaching [38]. Addi-
tionally, a qualitative study concluded a positive impact
of coaching in business executives, however highlighted
that the positive effects of coaching decline post-inter-
vention [49].
Discussion
is scoping review outlines 17 published studies con-
cerning educational interventions aimed at addressing
IP within high-achieving professions, further providing
insights into strategies that can be adopted by healthcare
professionals.
What iscurrently being done toaddress IP?
e proposition of employing a combination of vari-
ous therapeutic approaches, both individual and group-
based, to address IP in high-achieving women, was put
forth by Clance, the pioneer behind the concept of IP
in 1978 [27]. Langford and Clance discuss how self-psy-
chological theory interprets the imposter phenomenon
as arising from a desire to boost self-esteem by attempt-
ing to match an idealised self-image. is behaviour is
viewed as a way to cope with underlying feelings of inse-
curity and self-doubt. e study recommends therapeutic
strategies that incorporate principles from self-psychol-
ogy and cognitive therapy to address and mitigate the
imposter phenomenon [7].
A review of the current literature indicates workshops
are a popular means of addressing IP in high-achieving
individuals particularly since 2020 (Table 1), possibly
driven by the increasing focus on physician well-being
[25]. Group workshops offer a platform for enhancing
Table 3 Evaluation approaches and methodologies in the
reviewed studies
Evaluation of intervention Frequency (% of
all studies)
Post-intervention only
- Immediately 4 (24)
- 3 weeks post intervention 1(5)
- Duration not clearly defined 3 (18)
Multiple points of evaluation 3(18)
No evaluation 6 (35)
Measure of evaluation References
Self-reported outcomes (Likert scale survey ± open
response questions) [36, 38, 39, 41, 43,
44, 47, 48]
Standardised Measurement Tools
CIPS survey
- Pre intervention only [37, 40]
- Pre and post intervention [38, 41, 44]
YIS survey
- Pre intervention only [43, 48]
Evaluation of outcome measures other than imposter scores
- Goal attainment, career management, self-effi-
cacy, tendency to cover up errors, fears of negative
evaluation
[38]
- Burnout (single question) [47]
- Core self-evaluation [44]
- Knowledge based assessment [38, 48]
Qualitative feedback
- Focus groups [44]
- Written reflections [46]
- Semi-structured interviews [45, 49]
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awareness, acknowledgment, and maintaining consistent
validation [27].rough group engagement, individuals
come to recognize the prevalence of imposter feelings
which alleviate symptoms of self-doubt and isolation,
further are empowering individuals to challenge cogni-
tive thinking and negative patterns [26].Coaching and
structured one-to-one supervision are other alternatives
suggested by limited literature, both honing a cognitive
reframing approach towards addressing IP. While coach-
ing interventions were prominent in non-healthcare set-
tings, healthcare professionals have specific challenges
and considerations that may necessitate customising or
adapting such interventions to make them suitable and
effective within the healthcare context. Could such an
individualistic approach place the burden of tackling a
phenomenon felt by many in the hands of a few? More-
over, could it further perpetuate feelings of isolation?
Individual psychotherapy on its own may imply that IP
is a medical dysfunction viewing those experiencing it
as patients, whereas IP is not even indexed in DSM-5 or
ICD-10. Given the evidence that IP is a universal phe-
nomenon prevalent across high-achieving professions,
[1, 5–13, 15] groupwork places responsibility not only
on the individual but also challenges peers and creates
awareness on an institutional level. is is in line with
the notion that IP is rooted not only within the family of
origin but also within social context [34]. Group sessions
and coaching for employees can be a strategic investment
for institutions like the NHS, promoting mental health,
well-being, and a positive workplace culture.
Strategies totackle IP
While formal recognition of IP as a medical diagnosis
may enhance interventions, caution is warranted due to
the potential stigma attached. Integrating IP interven-
tions into broader practitioner health initiatives is tempt-
ing for a supportive environment, yet a tailored approach
is crucial. Cumulatively, the 17 studies advocate for a col-
laborative approach to tackle IP using individual, peer
and institutional strategies. Individual strategies can
be applied within group or coaching settings, focusing
on sub-themes of cognitive reframing, record keeping,
building interpersonal skills, seeking structured supervi-
sion and a community for support (Table2). e role of
gender in IP remains inconclusive due to mixed evidence.
While some studies suggest a potential link between
higher IP scores and female gender, [41, 48]other studies
[47]including a systematic review, [3] found no signifi-
cant gender-related correlation with IP. Despite evidence
indicating that IP can affect both men and women,
the majority of interventions primarily or exclusively
enrolled female participants. is pattern may not solely
be attributed to gender differences but rather suggests
the influence of unconscious bias and institutional chal-
lenges that women encounter in the workplace, which
may perpetuate the phenomenon in women [22]. ere-
fore, some workshops [40, 47] advocate for a systemic
cultural change. A small proportion of the selected stud-
ies call for institutional awareness of IP on a wider scale
further advocating for an educational platform deliver-
ing workshops to address IP, systemic bias, and diver-
sity and inclusion (Table 2). Additionally, four papers
underscore the pivotal role of supervisors in addressing
IP [35, 42, 45, 47]. Supervisors and training programme
directors within the NHS play a multifaceted role in
guiding, mentoring, and assessing trainees to ensure
their development into competent and compassionate
healthcare professionals. eir support and mentorship
are vital for the success of trainees and the delivery of
high-quality patient care. erefore, educating supervi-
sors about IP is essential for the well-being and success
of trainees in healthcare training programs. Institutions
should empower supervisors to recognize and address IP
through collaborative supervisory relationships to sup-
port trainees going through this experience. is will
ultimately contribute to the development of confident
and competent healthcare professionals.
e feasibility of delivering interventions for IP within
healthcare presents challenges stemming from limited
resource allocation, including qualified facilitators, mate-
rials, dedicated time, and space. Nonetheless, securing
support and endorsement from governing bodies, such
as Health Education England, can empower program
directors to establish clear policies and secure funding,
thereby reinforcing the credibility and legitimacy of these
interventions.
What issuccessful?
Determining whether a group setting is more effective
than an individual approach poses a challenging ques-
tion. All 17 interventions reported positive outcomes,
whether they entailed changes in CIPS scores, increased
awareness and confidence in recognizing IP, or an intent
to utilise discussed strategies. However, the evaluation
measures employed were primarily subjective, relying
on self-reported Likert scales accompanied by open-text
questions. is reliance on self-reported Likert scales
raises concerns about the validity of the assessment
method in capturing the full scope of outcomes. Fur-
ther majority of studies assessing the intervention did
so immediately after its implementation. is approach
captures only short-term impacts and may inadvertently
introduce test–retest bias. Participants might be inclined
to provide more favourable feedback immediately post-
intervention due to social desirability [50]. While seven
studies utilised validated CIPS scores for evaluation, it’s
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Siddiquietal. BMC Medical Education (2024) 24:43
important to note that the CIPS, despite relying on self-
reported responses, is designed to serve as an objective
tool for assessing the presence and severity of imposter
syndrome in individuals. Researchers employ it in a sys-
tematic and standardised manner to gather data that
can be analysed objectively, thereby providing valuable
insights into the phenomenon of imposter syndrome
within both research and clinical setting [51]. Not all the
studies that incorporated CIPS consistently employ the
survey before and after the intervention. is practice
poses a challenge as it hinders the ability to establish a
clear baseline and measure the intervention’s true impact
over time [52].
Only four studies tried to capture the long-term impact
of the intervention, which aligns with Kirkpatrick’s Level
3 evaluation, [53] assessing changes in behaviour result-
ing from the training. For example, an RCT evaluated
the effects of coaching five weeks post-intervention, uti-
lising validated questionnaires that assessed various fac-
ets, including IP scores, goal attainment, the inclination
to conceal errors, the fear of negative evaluation, and
career management [38].Another study explored the use
of BFST as a supervision tool in group therapy through
semi-structured interviews conducted three weeks
after the intervention [45]. Another study examined the
effects of employing cognitive processing therapy tools to
address IP through a follow-up validated questionnaire
that assessed imposter tendencies and core self-evalu-
ation outcomes, complemented by a one-hour follow-
up focus group to delve into the transfer of learning
[44].Lastly, Metz etal. evaluated the strategies students
had adopted and used over the course of the semester
after the intervention [41].
Despite the well-established associations of imposter
syndrome with burnout, depression, anxiety, leadership
challenges, career advancement, self-efficacy, and perfor-
mance, only four studies assessed the broader impact and
outcomes beyond imposter scores achieved as a result of
the intervention (Table3). Among these, only two stud-
ies, namely Zanchetta etal. [38]and Hutchins and Flo-
res, [44] employed validated questionnaires to assess
these secondary outcomes.
e strategies recommended in the selected papers
for addressing IP are based on the work done by Clance
and her research team [7, 26, 27, 34]. However, these
strategies are often not evaluated systematically within
specific professional settings to determine their effec-
tiveness for participants. Some studies gather informa-
tion about the strategies participants use in their daily
lives but fail to consistently report these findings in their
results. ere is a lack of reporting regarding strategies
suggested by participants during small group discussions
[39]. When evaluations do occur, they often take place
after a few weeks, with limited consideration for real-life
applicability or behaviour changes [41]. Instead, partici-
pants are typically asked about their intentions to apply
specific strategies rather than observing actual behav-
ioural changes [36, 43].
What isthegap forfuture work?
Strengths
e scoping review covers a wide range of studies related
to educational interventions for addressing imposter
phenomenon in high-achieving professionals, provid-
ing a comprehensive overview of the existing literature.
e review employs a well-defined methodology, includ-
ing the use of JBI guidelines, [29]to ensure rigour and
consistency in the data collection and analysis process.
e inclusion of studies from various high-achieving pro-
fessions and settings, not limited to healthcare, allows
for a broader perspective on the strategies employed to
address IP. e thematic analysis of strategies used to
address IP at individual, peer, and institutional levels
provides valuable insights into the various approaches
to tackle this phenomenon. e review highlights prac-
tical strategies and interventions that can be employed
by healthcare professionals and institutions to address IP
effectively, which is particularly relevant given its impact
on the healthcare sector.
Limitations
e review may be subject to publication bias. Studies
with negative or null results may not have been pub-
lished, leading to an overrepresentation of positive find-
ings. is could potentially skew the conclusions about
the effectiveness of interventions. Despite efforts to con-
duct a comprehensive search, it is possible that some
relevant studies were overlooked. Studies published in
languages other than those searched may also have been
missed. e scoping review focused on interventions
explicitly designed to address IP. However, interventions
solely targeting burnout, depression, and related psycho-
logical issues could indirectly impact IP. Excluding such
interventions might have overlooked valuable insights
into addressing IP within broader mental health and well-
being contexts. e included studies may have employed
different methodologies and evaluation techniques. Vari-
ability in study designs, outcome measures, and data col-
lection methods can make it challenging to draw direct
comparisons and generalise findings. e review encom-
passes non-healthcare sectors, primarily business and
technology, where individual coaching has demonstrated
positive effects in addressing IP. However, the applicabil-
ity of these encouraging outcomes from non-healthcare
to healthcare settings presents a challenge due to the
substantial disparities between the two environments.
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Siddiquietal. BMC Medical Education (2024) 24:43
Healthcare professionals navigate distinctive challenges,
including high-pressure scenarios, critical life-or-death
decision-making, ethical responsibilities in patient care,
and the intricacies of multidisciplinary teamwork. ese
unique aspects differentiate their work environment sig-
nificantly from the corporate world, potentially influenc-
ing the manifestation and impact of IP in distinct ways.
Direction forfuture research
Future research should aim for gender-inclusive stud-
ies to better understand how IP manifests in individu-
als of all genders and whether interventions need to be
tailored differently. Many of the included studies rely
on self-reported Likert scales for short-term evaluation,
with limited analysis of comparing interventions or eval-
uating change in behaviour. erefore, future research
could benefit from more objective measures, longitudinal
assessments, and high-quality methodology using control
groups to allow for a more robust assessment of the effec-
tiveness of interventions. Furthermore, conducting more
in-depth qualitative research to explore participants’
experiences, coping strategies that are effective and those
that are not, and the nuances of IP in different profes-
sional settings would provide richer insights. Future
research could also investigate the impact of institutional
strategies, such as diversity and inclusion initiatives, in
mitigating IP and creating supportive environments for
professionals. Lastly, research on sustainable interven-
tions that maintain their effectiveness over an extended
period would be valuable, especially in high-stress pro-
fessions like healthcare.
While this scoping review provides valuable insights
into current educational interventions that predomi-
nantly address the negative aspects of IP, such as the fear
of failure, perfectionism, and undermined self-esteem,
it is crucial to acknowledge that certain adaptive traits
contributing to feelings of IP can, at times, lead to posi-
tive outcomes. ese include a strong drive for excellence
and high achievement motivation [54]. is raises crucial
questions about the multifaceted nature of IP. e vary-
ing ways individuals perceive and utilize their impostor
feelings highlight the need for a more nuanced and com-
prehensive exploration of this phenomenon, aiming to
inform the development of well-rounded strategies.
Conclusion
is scoping review has summarised and synthesised
existing literature on educational interventions designed
to address Imposter Phenomenon in high-achieving
professionals, with a particular focus on healthcare.
e review examined a diverse array of interventions,
including individual and group-based approaches, across
various professional settings. Further recommending
a hybrid approach to address IP, such as incorporating
small group discussions and individual exercises as part
of the intervention.
While the positive outcomes reported in the reviewed
interventions are promising, the study revealed limi-
tations in evaluation methods, often relying on self-
reported data and assessing only short-term impacts.
Healthcare professionals face unique challenges related
to IP within their sub-speciality, necessitating the adap-
tation of interventions developed in other industries.
Future work in this area should prioritise the develop-
ment and rigorous evaluation of interventions tailored
specifically to the respective professional setting. ere
is a need for comprehensive, long-term assessments of
the interventions’ effectiveness, considering their impact
on behavioural changes. Systemic changes within insti-
tutions, such as promoting diversity and inclusion, edu-
cating supervisors, and establishing support networks,
may play a crucial role in addressing IP effectively among
high-achieving professionals in healthcare and other
industries.
e review underscores the potential for a combina-
tion of individual and group-based interventions utilising
individual, peer, and institutional strategies to create a
supportive environment and promote the well-being and
success of professionals experiencing IP.
Abbreviations
BFST Bowen family systems theory
CIPS Clance imposter phenomenon scale
CSE Core self-evaluation
E Evaluation
IP Imposter phenomenon
ID Intervention development
JBI Joanna Briggs Institute
OSF Open science framework
PRISMA-ScR Preferred reporting items for systematic reviews and meta-
analyses extension for scoping reviews
PU Prevalence exploration
U/A Understanding and awareness of IP
YIS Young’s imposter scale
Supplementary Information
The online version contains supplementary material available at https:// doi.
org/ 10. 1186/ s12909- 023- 04984-w.
Additional le1. Phase 1 Search in Ovid MEDLINE (conducted on August
10, 2022) and number of articles yielded.
Additional le2. Raw Data Set from the Scoping Review.
Additional le3. Sub analysis of workshops (n = 10) developed to
address IP. Abbreviations: Prevalence exploration (PE), Understanding &
awareness (U/A), Intervention development (ID), Evaluation (E), Young’s
Imposter Scale (YIS), Clance Imposter Phenomenon Scale (CIPS).
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

Page 10 of 11
Siddiquietal. BMC Medical Education (2024) 24:43
Acknowledgements
We would like to thank Anthea Tucker, Faculty Liaison Librarian for Medicine,
Dentistry and Health, University of Sheffield, for peer reviewing the search
strategy and literature search.
Authors’ contributions
The whole team was involved in the protocol development of this scoping
review. ZKS completed the literature search, reviewed abstracts, and full texts,
20% of which were independently screened by authors HRC, RJ, and TB. ZKS
and HRC collaboratively analysed the data which was reviewed by RJ and
JT. ZKS wrote the main manuscript text. ZKS and HRC prepared figures and
tables. All authors reviewed the manuscript..
Funding
No funding was received to undertake this scoping review.
Availability of data and materials
All data generated or analysed during this study are included in this published
article and its supplementary information files.
Declarations
Ethics approval and consent to participate
Not applicable.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Author details
1 Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK. 2 Faculty
of Medicine and Health Sciences, University of Nottingham, Nottingham, UK.
3 NHS England Workforce, Training and Education North East and Yorkshire,
Sheffield, Yorkshire and Humber, UK. 4 Mid Yorkshire Teaching NHS Trust,
Wakefield, UK. 5 Faculty of Health, The University of Sheffield, Sheffield, UK.
6 Nottingham University Hospitals NHS Trust, Nottingham, UK.
Received: 13 October 2023 Accepted: 17 December 2023
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