From ‘imposter’ to insight: Reframing imposter phenomenon in health professions education

Imposter phenomenon (IP) describes persistent feelings of self-doubt and difficulty accepting one's accomplishments despite objective evidence of competence.1 Interest in IP has grown substantially within health professions education.2, 3 Despite decades of scholarship, IP remains particularly resistant to resolution in settings characterised by high performance expectations and entrenched hierarchies.2 In their umbrella review, Gisselbaek and colleagues synthesise existing systematic and scoping reviews to examine how IP has been defined, the contexts in which it arises, and the efficacy of interventions designed to address it.4 Rather than identifying a straightforward evidence gap, their findings suggest that many challenges may stem from how IP itself has been conceptualised and operationalised. Building on this insight, we argue that meaningful progress may depend less on generating additional data and more on critically reexamining the assumptions that continue to shape research and educational responses to imposter experiences. A central challenge in the IP literature is the wide variability in conceptualization and measurement. As highlighted in the umbrella review, this heterogeneity is often treated as a methodological limitation; however, it may instead signal deeper conceptual problems. IP is frequently approached as a largely static phenomenon, assessed through cross-sectional surveys that attempt to quantify its presence at a single point in time.4 Such approaches overlook the dynamic and context-dependent nature of imposter experiences, which fluctuate in response to personal, relational and systemic factors.5 Moreover, reliance on dichotomous thresholds risks oversimplifying a complex construct and obscuring important nuances. In response, some scholars proposed conceptualising imposterism along a continuum rather than as a binary state.3, 4, 6 While this shift may better reflect lived experience, it does not fully address the underlying issue of what precisely is being measured. Equally problematic is the persistent framing of IP as an individual-level deficit. Most interventions focus on modifying learners' cognitions or behaviours, despite evidence that contextual and systemic factors play a substantial role.7, 8 This mirrors early approaches to burnout within the health professions, which initially emphasised individual resilience before evolving to prioritise organisational and system-level interventions.9-11 Imposter experiences may reflect misaligned performance expectations, poor-quality or inconsistent feedback and cultures that undermine confidence-competence calibration.6, 12 They may also arise from discordance between an individual's professional identity and institutional norms shaped by hidden curricula, resulting in the marginalisation of certain groups, including women, racially and ethnically minoritised trainees and first-generation learners. In such contexts, feelings of imposterism may actually reflect an accurate appraisal of exclusionary environments rather than distorted self-perception.13 IP may thus be an expected response to biased assessments, microaggressions and inequitable systems.13 When framed solely as an individual problem, responsibility for remediation is implicitly shifted away from the learning environment and onto the learner. Notably, even interventions described as ‘system-level’ often remained centred on changing trainees rather than structures.14-16 Reframing IP through a more holistic lens is therefore essential to redistribute responsibility and focus attention on the broader educational ecosystem. Intervention studies often implicitly treat lower IP scores as success, a premise that deserves far more scrutiny. One must consider whether lower scores represent a meaningful outcome, or whether alternative goals (e.g., creating learning environments that are less ‘fraud-inducing’) may be more appropriate. In some circumstances, imposter experiences may even catalyse positive behaviours, including self-reflection, feedback-seeking and growth-oriented learning. Yet, there is little empirical work examining IP as a potential signal for system dysfunction or as a starting point for improvement.14-16 Without such inquiry, reductions in measured IP may offer reassurance while leaving underlying problems unaddressed. At the conceptual level, IP often functions as a container construct encompassing multiple overlapping phenomena, including self-doubt, belonging uncertainty, stereotype threat, perfectionism, and fixed versus growth mindset. Each of these has distinct and unique elements requiring different interventions. Treating IP as a broad or undifferentiated construct risks obscuring these distinctions and limits the ability to tailor responses effectively. As a result, interventions may successfully reduce IP scores without addressing root causes such as burnout, institutional biases and exclusionary environments.13, 15 This raises a more fundamental question: Rather than refining how IP is measured, should educators and researchers reconsider whether IP is the most useful construct in the first place? This is not a call to abandon IP entirely, but rather to reposition it as a starting point instead of an endpoint. Future work should focus on identifying the specific underlying factors contributing to imposter experiences and aligning interventions accordingly, with explicit attention to system-level contributors. Practical steps may include examining institutional feedback cultures, assessing the balance between formative and summative assessment, and identifying biases in evaluation and feedback delivery.12, 17-19 Recognising that threats to belonging and inclusion can produce experiences labelled as IP,13 institutions must also commit to identifying and addressing inequities embedded throughout our educational systems.20, 21 Ultimately, moving beyond IP as a label applied to individuals allows educators to interrogate the conditions that give rise to these experiences and to enact changes at both the individual and institutional level. The literature on IP continues to expand, yet conceptual and practical progress remains limited. The field now faces a choice: Continue refining a construct that resists coherence or use this moment to redirect attention towards the underlying factors that imposter experiences illuminate. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.