Tackling Impostor Syndrome Individually and Institutionally: A Longitudinal Impostor Syndrome Curriculum for Pediatric Residents.

Purpose: Medical professionals may be particularly susceptible to “impostor syndrome” (IS), the inability to internalize successes that leads individuals to believe they are less qualified and intelligent than others know them to be. 1–4 Although IS is associated with poor psychological (anxiety, depression, emotional exhaustion) and professional (job satisfaction, career advancement) outcomes, few interventions have been created for trainees, and none are longitudinal in design. 2,5 In a needs assessment sent to incoming interns in our large pediatric residency program from 2018 to 2020, greater than 88% endorsed feelings of IS. We aimed to create a longitudinal curriculum that would increase residents’ awareness and understanding of IS and decrease the distress and anxiety associated with these common thoughts. We also aimed to equip residents with actionable steps to combat IS individually and also consider how IS is more broadly generated and perpetuated institutionally. This included incorporating how IS may interact with structural and societal biases (e.g. racism, sexism), impact professional advancement, and lead to underrepresentation in leadership. Approach: As transitions are known to amplify IS, 4 3-hour-long sessions were designed to target the transition from medical student to physician (new interns), intern to supervisor (new juniors), and resident to fellow/attending (new seniors). Residents and program leaders outlined the curriculum’s specific objectives, which informed the educational strategies chosen. These were further informed by self-determination theory and therapeutic strategies recommended to address IS, including normalization of feelings and reframing of maladaptive thought processes. 5 Each session followed a similar format, including a presession survey, evidence-based didactic, and sharing of common experiences; later sessions also incorporated reflective writing exercises. Sessions concluded with the recitation of a verbal contract, first in the form of group affirmations followed by statements of self-actualization. Sessions were evaluated via an anonymous survey. Outcomes: The first session was piloted in 2018 and assessed for acceptability and value before curricular expansion. From 2018 to 2020, 113/150 interns (75%) completed a postsession survey and rated the first session as highly useful, with a mean of 9.3 (SD 1.3) on a scale of 1 (not useful) to 10 (invaluable); 95% (107/113) of respondents “definitely” (66%) or “most likely” (28%) wanted IS discussed in a longitudinal curriculum. In 2019 and 2020, objectives were assessed: a majority reported improvement in their understanding of (90% “much better” or “better) and feelings associated with IS (89% “better/relieved”). Junior and senior sessions were introduced in 2021; 23/40 (58%) and 31/40 (78%) residents completed surveys, respectively. Although sessions were rated less useful (means 7.9 ± 2.6 and 6.7 ± 1.4) and impactful on IS feelings (65% and 67% positive), the majority of juniors (79%) and seniors (80%) felt the longitudinal curriculum was “definitely” or “most likely” valuable to their training. Significance: A novel longitudinal curriculum introduced pediatric trainees to IS, highlighted its commonality, and provided action steps to mitigate its effects on individual and institutional levels. The first session was particularly valuable to participants, with a large majority reporting positive changes in their understanding of and feelings associated with IS. Subsequent sessions were perceived as slightly less valuable, though a majority still felt better/relieved about their IS feelings as a result of the sessions. This decline may be due to residents’ existing awareness of IS from the first session and also may be due to later sessions focusing more on broader (rather than individual) impacts of IS. However, this content is lacking from existing residency curricula and is important when considering the implications of IS on the diversity of our workforce. Explicitly addressing IS among trainees early in postgraduate education is needed and valuable, particularly during intern year. Longitudinal curricula that allow for ongoing exploration of this phenomenon, including discussions about its potential downstream effects, are also critical to efforts around workforce diversity and representation. Similar curricula can easily be adopted by other programs.