Exploring reasons for MD-PhD trainees' experiences of impostor phenomenon.

BACKGROUND: Acceptance into U.S. MD-PhD dual-degree programs is highly competitive, and the lengthy training program requires transitioning between multiple phases (pre-clinical-, PhD-research-, and clinical-training phases), which can be stressful. Challenges faced during MD-PhD training could exacerbate self-doubt and anxiety. Impostor phenomenon is the experience of feeling like a fraud, with some high-achieving, competent individuals attributing their successes to luck or other factors rather than their own ability and hard work. To our knowledge, impostor phenomenon among MD-PhD trainees has not been described. This study examined impostor phenomenon experiences during MD-PhD training and reasons trainees attributed to these feelings. METHODS: Individuals in science and medicine fields participated in an online survey that included the 20-item Clance Impostor Phenomenon Scale (CIPS); higher scores (range 20-100) indicate more frequent impostor phenomenon. Some respondents who reported experiencing impostor phenomenon also voluntarily completed a semi-structured interview, sharing experiences during training that contributed to feelings of impostor phenomenon. Interview transcripts were coded and analysed using the constant comparative method and analytic induction to identify themes. RESULTS: Of 959 survey respondents (students and professionals in science and medicine), 13 MD-PhD students and residents completed the survey, nine of whom (five male, four female; four white, five other race-ethnicity) also completed an interview. These participants experienced moderate-to-intense scores on the CIPS (range: 46-96). Four themes emerged from the interview narratives that described participants' experiences of IP: professional identity formation, fear of evaluation, minority status, and, program-transition experiences. All reported struggling to develop a physician-scientist identity and lacking a sense of belonging in medicine or research. CONCLUSIONS: Impostor experiences that MD-PhD participants attributed to bias and micro-aggressions in social interactions with peers, faculty, and patients challenged their professional identity formation as physician-scientists. It is important to further examine how MD-PhD-program structures, cultures, and social interactions can lead to feelings of alienation and experiences of impostor phenomenon, particularly for students from diverse and underrepresented populations in medicine.

Intervening on impostor phenomenon: prospective evaluation of a workshop for health science students using a mixed-method design.

BACKGROUND: Unaddressed impostor feelings that impede developing interest in science and self-efficacy in conducting research have a dispiriting effect that perpetuates unsatisfactory diversity in the health science workforce when such feelings are experienced more by those historically underrepresented in the workforce. This warrants effective interventions to reduce the impact of impostor feelings and related factors that diminish career resilience. We examined the effects of a 90-minute workshop on impostor perceptions and growth mindset to raise awareness of impostor phenomenon (IP) and develop skills to manage IP successfully for students attending a 10-week summer research experience program. METHODS: Using a convergent mixed-methods design, data were analyzed from 51 racially and ethnically diverse students who participated in an interactive IP workshop. Using students' half-way and final progress reports about their summer experiences and pre- and post-summer online surveys, we identified how the workshop changed awareness of IP and helped students develop coping strategies. RESULTS: Students strongly endorsed the workshop, remarking that its content and personal stories from peers validated their own IP experiences and relieved anxiety by revealing how common the experience was. Many reported applying mindset-changing solutions, including positive self-talk, focusing their thinking on facts about themselves and situation, and grounding themselves firmly against potentially persuasive and confidence-eroding impostor feelings. While students reported end-of-summer impostor feelings at levels similar to before the program, they described being able to manage their feelings better and persist towards goals and challenging tasks. One measure of IP appeared to be addressed through students' activation of a growth mindset, potentially explaining a specific mechanism for intervention. Discrepancies between qualitative responses and quantitative IP measures demand additional work on IP instruments. CONCLUSIONS: A brief, theory-based IP workshop administered by research training programs, including those as short as 10-weeks, can have positive impact on subsequent IP experience and its successful management, with potential long-term impact on retention of a diverse biomedical research workforce.

A Cultural Impostor? Native American Experiences of Impostor Phenomenon in STEM.

Using a framework of colonization in science, technology, engineering, and mathematics (STEM), this U.S.-based study examined how seven Native American PhD students/postdoctoral scholars experienced impostor phenomenon. Participants were identified/contacted at a national conference on minorities in STEM through purposeful sampling. Surveys computed impostor phenomenon scores on a validated scale, while interviews documented how identity and culture contributed to impostor phenomenon in academia. Using a phenomenological approach, interviews were analyzed inductively using a constant comparative method. Surveys scores indicated high to intense impostor phenomenon. Interviews with the same participants further identified the following aspects of impostor phenomenon in relation to their minoritized identity: cultural differences and lack of understanding of Indigenous culture, lack of critical mass and fear of standing out, academic environment, family background and upbringing, and looks and diversity status. Developing a diverse and culturally competent STEM workforce requires a deeper understanding of what deters Native American individuals from pursuing a STEM career. They have the lowest college enrollment and retention rates compared with any race in the United States and could be vulnerable to racial bias and discrimination. Understanding impostor phenomenon through culturally relevant experiences would be crucial to broaden participation in STEM careers.

Faculty Experiences of the Impostor Phenomenon in STEM Fields.

Successful people experiencing impostor phenomenon consider themselves less competent and less worthy of their positions or achievements. They attribute their success to luck, deceit, fraudulence, and others being kind to them instead of their own competence. Prior research has focused primarily on students in higher education; faculty experiences of impostor phenomenon in science, technology, engineering, and mathematics (STEM) fields are not well understood. The research question guiding this inquiry was: "What kind of academic events or activities could contribute to faculty experiences of impostor phenomenon in STEM?" Using a qualitative analysis of 56 interviews, this U.S.-based study examined occurrences and experiences among faculty who self-identified as experiencing impostor phenomenon. A prior survey from the same participants revealed that they were predominantly White and female, experiencing moderate, high, or intense impostor phenomenon. Thematic interview analysis revealed that impostor phenomenon could be related to the following: 1) peer comparison, 2) faculty evaluation, 3) public recognition, 4) the anticipatory fear of not knowing, and 5) a perceived lack of competency. A comparison with findings from the larger study revealed that there are commonalities among faculty, PhD student, and postdoctorate experiences of impostor phenomenon in STEM. This necessitates professional development opportunities that could address self-limiting beliefs across the academic pipeline.

First-generation and continuing-generation college graduates' application, acceptance, and matriculation to U.S. medical schools: a national cohort study.

Many U.S. medical schools conduct holistic review of applicants to enhance the socioeconomic and experiential diversity of the physician workforce. The authors examined the role of first-generation college-graduate status on U.S. medical school application, acceptance, and matriculation, hypothesizing that first-generation (vs. continuing-generation) college graduates would be less likely to apply and gain acceptance to medical school.Secondary analysis of de-identified data from a retrospective national-cohort study was conducted for individuals who completed the 2001-2006 Association of American Medical Colleges (AAMC) Pre-Medical College Admission Test Questionnaire (PMQ) and the Medical College Admissions Test (MCAT). AAMC provided medical school application, acceptance, and matriculation data through 06/09/2013. Multivariable logistic regression models identified demographic, academic, and experiential variables independently associated with each outcome and differences between first-generation and continuing-generation students. Of 262,813 PMQ respondents, 211,216 (80.4%) MCAT examinees had complete data for analysis and 24.8% self-identified as first-generation college graduates. Of these, 142,847 (67.6%) applied to U.S. MD-degree-granting medical schools, of whom 86,486 (60.5%) were accepted, including 14,708 (17.0%) first-generation graduates; 84,844 (98.1%) acceptees matriculated. Adjusting for all variables, first-generation (vs. continuing-generation) college graduates were less likely to apply (odds ratio [aOR] 0.84; 95% confidence interval [CI], 0.82-0.86) and be accepted (aOR 0.86; 95% CI, 0.83-0.88) to medical school; accepted first-generation college graduates were as likely as their continuing-generation peers to matriculate. Students with (vs. without) paid work experience outside hospitals/labs/clinics were less likely to apply, be accepted, and matriculate into medical school. Increased efforts to mitigate structural socioeconomic vulnerabilities that may prevent first-generation college students from applying to medical school are needed. Expanded use of holistic review admissions practices may help decision makers value the strengths first-generation college graduates and other underrepresented applicants bring to medical educationand the physician workforce.

EXPLORING REASONS THAT U.S. MD-PHD STUDENTS ENTER AND LEAVE THEIR DUAL-DEGREE PROGRAMS.

AIM/PURPOSE: In response to widespread efforts to increase the size and diversity of the biomedical-research workforce in the U.S., a large-scale qualitative study was conducted to examine current and former students' training experiences in MD (Doctor of Medicine), PhD (Doctor of Philosophy), and MD-PhD dual-degree programs. In this paper, we aimed to describe the experiences of a subset of study participants who had dropped out their MD-PhD dual-degree training program, the reasons they entered the MD-PhD program, as well as their reasons for discontinuing their training for the MD-PhD. BACKGROUND: The U.S. has the longest history of MD-PhD dual-degree training programs and produces the largest number of MD-PhD graduates in the world. In the U.S., dual-degree MD-PhD programs are offered at many medical schools and historically have included three phases-preclinical, PhD-research, and clinical training, all during medical-school training. On average, it takes eight years of training to complete requirements for the MD-PhD dual-degree. MD-PhD students have unique training experiences, different from MD-only or PhD-only students. Not all MD-PhD students complete their training, at a cost to funding agencies, schools, and students themselves. METHODOLOGY: We purposefully sampled from 97 U.S. schools with doctoral programs, posting advertisements for recruitment of participants who were engaged in or had completed PhD, MD, and MD-PhD training. Between 2011-2013, semi-structured, one-on-one phone interviews were conducted with 217 participants. Using a phenomenological approach and inductive, thematic analysis, we examined students' reasons for entering the MD-PhD dual-degree program, when they decided to leave, and their reasons for leaving MD-PhD training. CONTRIBUTION: Study findings offer new insights into MD-PhD students' reasons for leaving the program, beyond what is known about program attrition based on retrospective analysis of existing national data, as little is known about students' actual reasons for attrition. By more deeply exploring students' reasons for attrition, programs can find ways to improve MD-PhD students' training experiences and boost their retention in these dual-degree programs to completion, which will, in turn, foster expansion of the biomedical-research-workforce capacity. FINDINGS: Seven participants in the larger study reported during their interview that they left their MD-PhD programs before finishing, and these were the only participants who reported leaving their doctoral training. At the time of interview, two participants had completed the MD and were academic-medicine faculty, four were completing medical school, and one dropped out of medicine to complete a PhD in Education. Participants reported enrolling in MD-PhD programs to work in both clinical practice and research. Very positive college research experiences, mentorship, and personal reasons also played important roles in participants' decisions to pursue the dual MD-PhD degree. However, once in the program, positive mentorship and other opportunities that they experienced during or after college, which initially drew candidates to the program was found lacking. Four themes emerged as reasons for leaving the MD-PhD program: 1) declining interest in research, 2) isolation and lack of social integration during the different training phases, 3) suboptimal PhD-advising experiences, and 4) unforeseen obstacles to completing PhD research requirements, such as loss of funding. RECOMMENDATIONS FOR PRACTITIONERS: Though limited by a small sample size, findings highlight the need for better integrated institutional and programmatic supports for MD-PhD students, especially during PhD training. RECOMMENDATIONS FOR RESEARCHERS: Researchers should continue to explore if other programmatic aspects of MD-PhD training (other than challenges experienced during PhD training, as discussed in this paper) are particularly problematic and pose challenges to the successful completion of the program. IMPACT ON SOCIETY: The MD-PhD workforce comprises a small, but highly -trained cadre of physician-scientists with the expertise to conduct clinical and/or basic science research aimed at improving patient care and developing new diagnostic tools and therapies. Although MD-PhD graduates comprise a small proportion of all MD graduates in the U.S. and globally, about half of all MD-trained physician-scientists in the U.S. federally funded biomedical-research workforce are MD-PhD-trained physicians. Training is extensive and rigorous. Improving experiences during the PhD-training phase could help reduce MD-PhD program attrition, as attrition results in substantial financial cost to federal and private funding agencies and to medical schools that fund MD-PhD programs in the U.S. and other countries. FUTURE RESEARCH: Future research could examine, in greater depth, how communications among students, faculty and administrators in various settings, such as classrooms, research labs, and clinics, might help MD-PhD students become more fully integrated into each new program phase and continue in the program to completion. Future research could also examine experiences of MD-PhD students from groups underrepresented in medicine and the biomedical-research workforce (e.g., first-generation college graduates, women, and racial/ethnic minorities), which might serve to inform interventions to increase the numbers of applicants to MD-PhD programs and help reverse the steady decline in the physician-scientist workforce over the past several decades.

Transition Experiences in MD-PhD Programs.

MD-PhD training takes, on average, 8 years to complete and involves two transitions, an MD-preclinical to PhD-research phase and a PhD-research to MD-clinical phase. There is a paucity of research about MD-PhD students' experiences during each transition. This study examined transition experiences reported by 48 MD-PhD students who had experienced at least one of these transitions during their training. We purposefully sampled medical schools across the United States to recruit participants. Semistructured interviews were audio-recorded and transcribed for analysis; items focused on academic and social experiences within and outside their programs. Using a phenomenological approach and analytic induction, we examined students' transition experiences during their MD-PhD programs. Five broad themes emerged centering on multiple needs: mentoring, facilitating integration with students in each phase, integrating the curriculum to foster mastery of skills needed for each phase, awareness of cultural differences between MD and PhD training, and support. None of the respondents attributed their transition experiences to gender or race/ethnicity. Students emphasized the need for mentoring by MD-PhD faculty and better institutional and program supports to mitigate feelings of isolation and help students relearn knowledge for clinical clerkships and ease re-entry into the hospital culture, which differs substantially from the research culture.

The best of both worlds: Building on the COPUS and RTOP observation protocols to easily and reliably measure various levels of reformed instructional practice.

Researchers, university administrators, and faculty members are increasingly interested in measuring and describing instructional practices provided in science, technology, engineering, and mathematics (STEM) courses at the college level. Specifically, there is keen interest in comparing instructional practices between courses, monitoring changes over time, and mapping observed practices to research-based teaching. While increasingly common observation protocols (Reformed Teaching Observation Protocol [RTOP] and Classroom Observation Protocol in Undergraduate STEM [COPUS]) at the postsecondary level help achieve some of these goals, they also suffer from weaknesses that limit their applicability. In this study, we leverage the strengths of these protocols to provide an easy method that enables the reliable and valid characterization of instructional practices. This method was developed empirically via a cluster analysis using observations of 269 individual class periods, corresponding to 73 different faculty members, 28 different research-intensive institutions, and various STEM disciplines. Ten clusters, called COPUS profiles, emerged from this analysis; they represent the most common types of instructional practices enacted in the classrooms observed for this study. RTOP scores were used to validate the alignment of the 10 COPUS profiles with reformed teaching. Herein, we present a detailed description of the cluster analysis method, the COPUS profiles, and the distribution of the COPUS profiles across various STEM courses at research-intensive universities.

How Do Interaction Experiences Influence Doctoral Students' Academic Pursuits in Biomedical Research?

This exploratory qualitative study investigated how doctoral students reported their personal and professional interaction experiences that they believed might facilitate or impede their academic pursuits in biomedical research. We collected 19 in-depth interviews with doctoral students in biomedical research from eight universities, and we based our qualitative analytic approach on the work of Miles and Huberman. The results indicated that among different sources and types of interaction, academic and emotional interactions from family and teachers in various stages essentially affected students' persistence in the biomedical science field. In addition, co-mentorship among peers, departmental environment, and volunteer experiences were other essential factors. This study also found related experiences among women and underrepresented minority students that were important to their academic pursuit.