Impostor syndrome in medicine: what it is and what helps

On the ward round, the attending asks the intern what her hypothesis is for the fever of the patient in bed 12. She answers correctly, justifies it well and proposes the management the team ends up following. On the way home, instead of remembering the correct answer, she goes over the question, asked ten minutes later, that she could not answer, about the dose of an antibiotic. "One day they will realize I don't know as much as it seems." She has the best grades in the class. No objective data supports the fear, but the fear is real and comes back every week.

This feeling of being a fraud about to be found out has a name: impostor syndrome, or impostor phenomenon. It is common in medicine, appears in students, residents and practicing physicians and is linked to burnout. This guide explains what it is, shows how common it is according to the most recent reviews, discusses where it comes from and what the evidence, still limited, suggests for dealing with it, both for those who feel it and for those who teach.

Key points

• Impostor syndrome is the persistent feeling of not deserving one's own achievements and that, at any moment, others will find out you are not as competent as you seem.
• It is not in the psychiatric diagnostic manuals: it is a thought pattern studied with scales, such as the Clance scale.
• Recent meta-analyses estimate that about half of medical students report impostor feelings at a relevant level, with wide variation between studies.
• It is linked to stress, anxiety, depression and burnout, and seems more frequent at transitions, such as entering the clinical years and residency.
• Structured interventions, with coaching and thought restructuring, reduced symptoms in some trials. The teaching environment also matters.

What impostor syndrome is

A definition

Impostor syndrome describes people with objectively good performance who attribute success to luck, excessive effort or a misjudgment by others, and who live in fear of being unmasked. The term was created in psychology in the 1970s, and the most used measure today is the Clance scale, which produces a score of impostor feelings.

A systematic review of 62 studies with 14,161 participants found the phenomenon in men and women and in various age groups, from adolescents to professionals late in their careers (Bravata et al., 2020). The same review noted that it usually comes together with depression and anxiety (Bravata et al., 2020).

Not a diagnosis, but real

Impostor syndrome is not in the psychiatric diagnostic manuals. It is a thought pattern, not a disease. That does not make it less important: it changes how a person studies, asks questions, accepts feedback and chooses opportunities. When it comes with persistent sadness, intense anxiety or thoughts of giving up on everything, it may be a sign of something that needs professional care. In that case, seek the help you need.

The typical thoughts

Those who feel the syndrome usually recognize some of these thoughts:

• "I passed because the test was easy", or "because I got lucky with the questions".
• "If I don't study everything, they will realize I know nothing."
• "The praise was politeness; the attending didn't see what I got wrong."
• "Everyone here is smarter than me."
• "I can't ask, because they will think I should already know."

Different from humility and ordinary insecurity

Recognizing what you do not know is a clinical virtue. Insecurity in a new situation is also normal. Impostor syndrome is different because it persists even in the face of evidence of competence and because it turns every correct answer into luck and every mistake into proof of fraud. The guide on calibration of confidence in diagnosis deals with the adjustment between confidence and correctness; in impostor syndrome, confidence stays systematically below performance.

How common it is

In medical students

A meta-analysis published in 2026, with 26 studies and 9,110 medical students assessed by the Clance scale, estimated a global prevalence of 54.2% (Vera-Ponce et al., 2026). Heterogeneity between studies was very high, and studies with probability sampling found 36.5%, against 57.5% in the others (Vera-Ponce et al., 2026).

Another meta-analysis, with 34 studies and 9,550 students, reached a prevalence of 49%, also with extreme heterogeneity (Omar et al., 2026). The authors questioned the conceptual basis and the measures used, which vary greatly from one study to another (Omar et al., 2026). The exact number, therefore, depends heavily on how it is measured. What is consistent is that the phenomenon is frequent.

In residents and physicians

In a survey of 736 pediatric residents from 25 programs, 31.4% reported frequent impostor feelings and 15.4% intense ones (Zwemer et al., 2026). In a scoping review with 54 studies, prevalence ranged from 33.0% to 75.0% among residents and from 23.5% to 50.0% among practicing physicians and professors (Chua et al., 2025).

Among general surgeons and surgical residents, the mean impostor score was higher in residents than in practicing surgeons (Leach et al., 2019). A systematic review of 12 studies with surgeons found high prevalence and suggested that the feeling may decrease with age (El Boghdady and Ewalds-Kvist, 2025).

And gender?

The results on gender are not uniform. In a pilot study with 138 medical students, 49.4% of women and 23.7% of men presented the syndrome (Villwock et al., 2016). In another study, the mean score was 9% higher among female students (Levant et al., 2020). The 2026 meta-analysis, in turn, found similar prevalence among women, 50.5%, and men, 47.1% (Vera-Ponce et al., 2026), and the study with pediatric residents found no relationship with female gender (Zwemer et al., 2026).

A summary of the numbers

Source	Who	What it found
Vera-Ponce et al., 2026	9,110 students, 26 studies	Prevalence of 54.2%, with great heterogeneity (Vera-Ponce)
Omar et al., 2026	9,550 students, 34 studies	Prevalence of 49%; highly varied measures (Omar)
Chua et al., 2025	54 studies, undergraduate and graduate	Residents from 33.0% to 75.0%; physicians from 23.5% to 50.0% (Chua)
Zwemer et al., 2026	736 pediatric residents	31.4% frequent and 15.4% intense (Zwemer)
Bravata et al., 2020	62 studies, various professions	Prevalence from 9% to 82%, depending on the scale and the cutoff point (Bravata)

Each row includes the link to the study the numbers come from.

What the syndrome causes

Stress and burnout

The link with exhaustion appears in almost all studies. In students, the syndrome was associated with exhaustion, cynicism and depersonalization (Villwock et al., 2016). Impostor and perceived stress scores moved together in men and women (Levant et al., 2020).

Among surgeons and surgical residents, burnout was the only factor significantly associated with clinical impostor symptoms, with an odds ratio of 3.95 (Leach et al., 2019). The guide on burnout in medical school describes the warning signs.

Performance and behavior

A broad systematic review associated the syndrome with worse work performance and lower professional satisfaction in several populations, including clinicians (Bravata et al., 2020). But a study with pediatric residents found no relationship between impostorism and clinical performance assessment in the adjusted models (Zwemer et al., 2026). The authors suggested that educators reassure residents that these feelings do not reflect competence (Zwemer et al., 2026).

In the clerkship and residency

The clerkship and the first year of residency concentrate the triggers of the syndrome. The student leaves an environment where performance was measured by exams and enters one where it is measured by decisions about people, under the gaze of those with far more experience. Questions no longer have one right alternative and come to have several reasonable answers. Feedback, when it comes, is usually quick and informal.

In this scenario, it is common for the person to compare their own backstage, full of doubts, with the showcase of colleagues, who always seem confident. The comparison is unfair by definition: no one shows the doubt they felt before answering. A scoping review associated the syndrome, among professionals in training, with the more junior position and the self-perception of weak clinical skills (Chua et al., 2025). Knowing that this phase usually comes with this feeling does not eliminate it, but it helps not to treat it as proof.

Another common effect is the difficulty of delegating and asking for help. Those who feel they need to prove all the time that they deserve the place tend to solve everything alone, to stay beyond the schedule and to hide doubts. This increases fatigue and, in some cases, the risk to the patient, because the unshared doubt is the one that cannot be corrected in time. Asking for a second opinion on a difficult case is part of patient safety, not a sign of weakness.

In the daily life of study

In practice, the impostor changes habits silently:

• Studying too much what one already knows, for fear of forgetting, and too little what is difficult.
• Avoiding questions on rounds so as not to seem unprepared.
• Refusing opportunities, such as presenting a case or joining a research project.
• Reading negative feedback as proof and positive feedback as kindness.
• Hiding mistakes instead of learning from them.

Where it comes from

Perfectionism

A review on perfectionism and impostorism in medicine showed that the two traits are linked to negative effects on mental health and that medical culture can train or worsen both (Thomas and Bigatti, 2020). Common teaching methods, such as the question in public during rounds, can cause distress in those who already have this profile (Thomas and Bigatti, 2020).

Transitions and belonging

In undergraduate studies, the syndrome was associated with breaks in the course, transition periods and poor academic performance; in graduate studies, with younger age, more junior position, fewer years of work and little support from professors (Chua et al., 2025). The same review pointed to conflicts and a low sense of belonging among the factors linked to the phenomenon (Chua et al., 2025).

Minorities and professional identity

In a study with interviews of students and residents from programs that combine medicine and a doctorate, participants related impostor experiences to biases and microaggressions from colleagues, professors and patients (Chakraverty et al., 2022). All reported difficulty in building the identity of a physician-researcher and a lack of belonging (Chakraverty et al., 2022). In these cases, the problem is not only in the mind of the person who feels it; it is also in the environment.

Constant comparison

Medicine is a training of permanent comparison: grades, ranking for residency, number of publications, who was called to present the case. Social networks add another layer, with colleagues who show approvals, heroic shifts and accepted articles. None of this shows the failures, the doubts and the nights of study that did not work out. For those who already tend to doubt themselves, this constant showcase reinforces the idea that everyone else is one step ahead.

The teaching environment

The pilot study with medical students ended with a message for schools: reconsider teaching based on embarrassment and the general teaching style (Villwock et al., 2016). The guide on hidden curriculum in medicine shows how implicit messages about perfection and error pass from one generation to the next.

Impostor or real gap

The two things can exist together

Insecurity and impostor syndrome are different things. Sometimes, the feeling of not knowing reflects a real gap in knowledge or reasoning, and ignoring that would be a mistake. The point is to separate the two with data, not with the mood of the day. The guide on knowledge or clinical reasoning gap helps identify which is which.

A table to tell them apart

Sign	More suggestive of impostor	More suggestive of a real gap
Objective performance	Good in exams, assessments and feedback	Repeated errors in the same type of case
Reaction to getting it right	Attributes it to luck	Can explain why they got it right
Reaction to error	Sees it as proof of fraud	Sees it as a study point
Feedback from others	Positive and consistent	Points to the same difficulty several times
What solves it	Review the evidence of competence	Study and practice the specific topic

The table is an editorial proposal, based on the descriptions in the cited reviews, and not a validated instrument.

A record of evidence

A simple exercise is to keep a short record of evidence for a few weeks: cases where you got it right and why, feedback received, errors and what you learned from each one. The review on surgeons summarized the key to reducing the impostor feeling as learning to separate fact from fiction, undermining the distorted thoughts that feed the feeling (El Boghdady and Ewalds-Kvist, 2025). A written record is a concrete way of doing this.

What helps those who feel it and those who teach

What the evidence says

The first systematic review on the topic found no study that assessed treatments for the syndrome (Bravata et al., 2020). Since then, some trials have appeared. A systematic review of online interventions with professionals in training included six studies, and two randomized trials showed a significant reduction in impostor symptoms compared with control groups (Hsu et al., 2024). Interventions with coaching and thought restructuring seemed the most promising, but the effect on burnout was inconclusive (Hsu et al., 2024).

Practical strategies

1. Name the thought when it appears: "this is the impostor talking".
2. Confront it with data: what do grades, feedback and cases actually say?
3. Talk to colleagues: finding out that others feel the same reduces the weight.
4. Look for a mentor who speaks openly about their own mistakes and insecurities.
5. Accept the compliment without explaining it: a "thank you" is enough.
6. Treat the error as information, not as a verdict on who you are.
7. Seek professional help if the distress is intense or persistent.

About asking

Asking is part of the work, not a confession of incompetence. Experienced doctors ask all the time, of colleagues, specialists and references. A good criterion is to ask about what changes the patient's management, even if it seems basic, and to study later what does not change it.

For those who teach: the climate in the room

Teachers and preceptors strongly influence students' experience of impostor feelings. Questions in public used to embarrass, comparisons between students and the idea that a good doctor never errs feed the phenomenon (Thomas and Bigatti, 2020). The text on morbidity and mortality sessions discusses how the climate in the room changes what is learned from error.

For those who teach: practices that help

Some simple practices change the climate. Talking about your own mistakes and doubts in front of students shows that erring is part of the work, not a lack of talent. Giving specific feedback, tied to observed behaviors, helps the student trust the praise, because it comes with a reason. Separating the question that teaches from the question that exposes prevents the ward round from becoming a public test. Recognizing what was done right explicitly, and not only correcting the error, balances the scale. And following transitions closely, such as the start of the clerkship and of residency, catches the problem at the moment it usually appears.

For those who teach: the role of the institution

Mentoring programs, peer conversation groups and easy access to support services are institutional responses. The 2025 scoping review recommended practical measures for both students and qualified professionals (Chua et al., 2025).

How NEXO helps you read right and wrong answers with data

Hits and misses recorded

On NEXO, each case arrives with up to six progressive clues, and each hypothesis gets feedback by proximity in ICD-10 across five levels, from the exact code to a different chapter. These are fictional cases with a real clinical presentation. A miss in the same diagnostic group is very different from a miss in another chapter, and the game shows that difference. NEXO treats the miss as information, and that is a way to read your own stumbles without turning them into a verdict.

Distribution by clue

On the home screen, the distribution of hits by clue shows how many clues you usually need to reach the diagnosis. For anyone who feels like an impostor, this is an objective record that does not depend on the impression of the day. It can serve as one of the pieces of evidence in the record described above. The streak calendar shows the consistency of your practice. To get to know the game, read what NEXO is. Usage limits are in NEXO economy.

Training in a group

Comparing results with colleagues in a light way helps you see that everyone misses cases and that missing close is part of learning. If you teach and want to use cases with your class, see the Curator page. If you research well-being or medical education, see the Researcher page.

Frequently asked questions

What is impostor syndrome?

It is the persistent feeling of not deserving your own achievements and the fear of being found out as less competent than you seem. It appears in men and women and at various ages and in various professions (Bravata et al., 2020).

Is it common among medical students?

Yes. Recent meta-analyses estimated prevalences of 49% and 54.2%, with wide variation between studies (Omar et al., 2026; Vera-Ponce et al., 2026).

Does impostor syndrome cause burnout?

Studies show an association, but they do not prove cause. Impostorism and burnout go together in students, residents and surgeons (Villwock et al., 2016; Leach et al., 2019).

Are people who feel the syndrome less competent?

The data do not support that. In a study with pediatric residents, impostorism had no relationship with the assessment of clinical performance in the adjusted models (Zwemer et al., 2026).

Is there a treatment?

A standard treatment is still missing. Some trials with online interventions, with coaching and restructuring of thoughts, reduced the symptoms (Hsu et al., 2024). If the distress is intense, seek the help you need from a professional.

How can I tell if it is impostor or if I really do not know?

Look at the data: grades, feedback and repeated misses in the same type of case. If performance is good and consistent, the feeling is probably impostor; if there are repeated misses on the same topic, there is a real gap to study.

How does NEXO relate to impostor syndrome?

NEXO records hits and misses with feedback by proximity in ICD-10 and shows the distribution of hits by clue, which offers objective data for looking at your own reasoning. None of the studies cited here measures NEXO.

Checklist against the impostor

1. Name the thought when it appears.
2. Keep a record of evidence for a few weeks.
3. Separate impostor from a real gap with data, not with the mood of the day.
4. Study what is hard, not only what you already know.
5. Ask what changes management, even if it seems basic.
6. Accept the compliment without explaining it.
7. Treat the miss as information and record what you learned.
8. Talk with colleagues and mentors about what you feel.
9. Watch the transitions, such as the start of the clerkship and of residency.
10. Seek the help you need if the distress is intense or persistent.

Want to train with an objective record of hits and misses? Play the case of the day on NEXO.

References

1. Bravata DM, Watts SA, Keefer AL, Madhusudhan DK, Taylor KT, Clark DM, et al. Prevalence, Predictors, and Treatment of Impostor Syndrome: a Systematic Review. J Gen Intern Med. 2020. https://pubmed.ncbi.nlm.nih.gov/31848865/
2. Vera-Ponce VJ, Huaman-Vega CH, Zuzunaga-Montoya FE, Guerrero Uceda CI, León-Figueroa DA, Rivera-Lozada O, et al. Global prevalence of impostor phenomenon in medical students: A systematic review and meta-analysis. PLoS One. 2026. https://pubmed.ncbi.nlm.nih.gov/42647456/
3. Omar YM, Khattab YA, Abdelmageed A, Messak M, Mandour Y, Shabeeb AE, et al. The impostor phenomenon construct in medical education: a meta-analysis of its prevalence and a critical appraisal of its measurement. Adv Health Sci Educ Theory Pract. 2026. https://pubmed.ncbi.nlm.nih.gov/41801596/
4. Chua SM, Tan IYK, Thummachai ME, Chew QH, Sim K. Impostor syndrome, associated factors and impact on well-being across medical undergraduates and postgraduate medical professionals: a scoping review. BMJ Open. 2025. https://pubmed.ncbi.nlm.nih.gov/40669926/
5. Zwemer E, Nassetta LB, Schwartz A, Batra M. Impostor Phenomenon in Pediatric Residents: Prevalence and Association With Clinical Performance. Acad Pediatr. 2026. https://pubmed.ncbi.nlm.nih.gov/41791646/
6. Villwock JA, Sobin LB, Koester LA, Harris TM. Impostor syndrome and burnout among American medical students: a pilot study. Int J Med Educ. 2016. https://pubmed.ncbi.nlm.nih.gov/27802178/
7. Levant B, Villwock JA, Manzardo AM. Impostorism in American medical students during early clinical training: gender differences and intercorrelating factors. Int J Med Educ. 2020. https://pubmed.ncbi.nlm.nih.gov/32356519/
8. Leach PK, Nygaard RM, Chipman JG, Brunsvold ME, Marek AP. Impostor Phenomenon and Burnout in General Surgeons and General Surgery Residents. J Surg Educ. 2019. https://pubmed.ncbi.nlm.nih.gov/30122638/
9. El Boghdady M, Ewalds-Kvist B. Surgeon's imposter syndrome: a systematic review. Langenbecks Arch Surg. 2025. https://pubmed.ncbi.nlm.nih.gov/39825919/
10. Thomas M, Bigatti S. Perfectionism, impostor phenomenon, and mental health in medicine: a literature review. Int J Med Educ. 2020. https://pubmed.ncbi.nlm.nih.gov/32996466/
11. Chakraverty D, Cavazos JE, Jeffe DB. Exploring reasons for MD-PhD trainees' experiences of impostor phenomenon. BMC Med Educ. 2022. https://pubmed.ncbi.nlm.nih.gov/35490228/
12. Hsu CL, Liu CH, Huang CC, Chen HL, Chiu YL, Yang CW. The effectiveness of online educational interventions on impostor syndrome and burnout among medical trainees: a systematic review. BMC Med Educ. 2024. https://pubmed.ncbi.nlm.nih.gov/39578759/