IMPROV-ing The Impostor Phenomenon

Overview

The impostor phenomenon refers to feelings of self-doubt and fraudulence in one's own abilities, despite the presence of external evidence to suggest otherwise. Symptoms of the impostor phenomenon can impede achievement of career-related goals in medical trainees and impact resilience, stress levels, and burnout. If these symptoms go unnoticed, they could progress to a severity that threatens sustained wellness among medical trainees. Our research questions are: 1) Is the time of the academic year (e.g., beginning, middle, end) associated with severity in impostor phenomenon as measured by the Clance Impostor Phenomenon Scale (CIPS) in medical trainees at the University of Toronto? 2) Is participation in improvisation workshops over the course of an academic year a feasible intervention to mitigate symptoms of impostor phenomenon in medical trainees at the University of Toronto? Combined, our two-part study will explore peak risk periods of impostor phenomenon and whether improvisation workshops are a feasible intervention to address this.

Part 1 of the study: This will be a prospective cohort study investigating the longitudinal prevalence and levels of impostor phenomenon among medical trainees over the course of one calendar year. Outcomes of interest will be measured in each participant every 3 months with rolling recruitment into the study until the end of the study. Recruitment will last for 2 years. Study investigators will offer and administer an electronic survey to measure impostor phenomenon and symptoms using validated scales. The surveys will be administered to all consenting medical trainees participating in University of Toronto-affiliated hospital rotations on the first day of the rotation. Participant recruitment will occur at University of Toronto-affiliated medical school and hospitals. Part 2 of the study: Among participants invited for research question 1 of our study, 10-20 participants will be recruited to further explore the feasibility of an improvisation curriculum during medical training. If volunteer numbers exceed 20, participants will be randomly chosen from the group of interested participants. This curriculum will be a uniquely designed series of flexibly-timed improvisation workshops administered during the study period. Based on within-study participant feedback, sessions will be organized to develop optimal timing and duration of improvisation sessions. Previous studies on improvisation in medical education have varied in terms of timing, frequency, and exercises. Accordingly, each improvisation workshop will involve a series of exercises derived from an improvisation game book previously developed by study investigators, followed by a reflective debrief of the experience. Although improvisation workshops can vary as described, a recently published scoping review revealed three consistent structural elements that will serve as a framework for the improvisation intervention in this study: orientation and setup, culture of safety, and debriefing. Pre-session readings will orient participants to key principles and skills in improvisation. During the exercises, facilitators foster a culture of safety by normalizing uncertainty, creating a low-stakes environment, and providing freedom for time-outs. Improvisation exercises will be followed by debrief to reflect on the session, exchange feedback, and draw connections between improvisation and the impostor phenomenon. The workshops for this study are designed based on the recommendations established by previous studies with improvisation in medical education. Using published guidelines, workshops will have groups of approximately 10 study participants and last on average 2 hours under the instruction of an expert medical improvisation facilitator. Improvisation sessions will be initially planned to be delivered once per month for 2 hours for four consecutive months with built-in flexibility with respect to session duration and frequency based on participant feedback. Additional sessions can be subsequently offered biweekly and/or for longer than 4 months (up to 10 months) as needed.