Impostor syndrome in medicine

The student passed one of the most competitive residency exams in the country. In the first week, while colleagues discuss management, he thinks the pass was luck, that the examiners made a mistake and that soon someone will notice. Every correct answer feels like an accident; every doubt feels like proof that he should not be there.

NEXO is a daily medical diagnosis game: one clinical case a day, six progressive clues, and ICD-10 proximity feedback across five levels.

This feeling has a name: impostor syndrome, or impostor phenomenon. It is the persistent sense of being a fraud, even in the face of evidence of competence. This guide explains what the syndrome is, how common it is among students and doctors, how it relates to burnout and stress, and what studies show about strategies for dealing with it.

Key points

• Impostor syndrome is the feeling that your own success comes from luck or deception, not from competence.
• Prevalences vary widely between studies, depending on the instrument and the cutoff point used.
• In medical students, the syndrome was associated with burnout and perceived stress.
• Experiences of bias and of not belonging appear in the accounts of students from underrepresented groups.
• Online interventions with coaching and cognitive restructuring reduced symptoms in two randomized trials.

What impostor syndrome is

A feeling, not a diagnosis

The term describes competent people who attribute their own results to luck, outside help or a mistake by whoever assessed them. It was proposed in psychology studies in the 1970s and is not listed as a disorder in the diagnostic manuals. That is why many authors prefer to speak of impostor phenomenon.

The most common traits

• Discounting success: the correct answer was luck, the test was easy, the grade was generous.
• Fear of being found out: the sense that, at any moment, someone will notice that you do not know.
• Constant comparison with colleagues who seem more confident.
• Perfectionism: any mistake confirms the fraud, and any correct answer seems insufficient.
• Overpreparation or procrastination, two opposite ways of dealing with the same fear.

Different from calibrated insecurity

Every student should have doubts, because they are learning. The problem appears when the doubt does not match the evidence: even after many correct answers, the person still feels incapable. The relationship between confidence and correct answers, called calibration, has its own guide on the blog, about calibrating confidence in diagnosis. Here the focus is the persistent feeling of fraud.

How common it is

What the systematic review says

A systematic review of 62 studies and 14,161 participants found prevalences of impostor syndrome between 9% and 82%, depending on the instrument and the cutoff point used (Bravata et al., 2020). The syndrome was common in men and women and across several age ranges, and more frequent in ethnic minority groups (Bravata et al., 2020).

The range of the numbers shows that the measure varies widely between studies. The message is that the syndrome is frequent in demanding professions, including medicine.

Among medical students

In a pilot study of 138 American students, the syndrome appeared in 49.4% of women and 23.7% of men (Villwock et al., 2016). The final year of the course was also significantly associated with the syndrome (Villwock et al., 2016).

In another study, with third-year students transitioning to the clinical phase, the mean score indicated moderate to frequent impostor feelings, and was 9% higher among women (Levant et al., 2020).

Among practicing doctors

A systematic review of 12 studies on surgeons found a high prevalence of impostor syndrome, more frequent among female surgeons (El Boghdady and Ewalds-Kvist, 2025). The feelings tended to decrease with age (El Boghdady and Ewalds-Kvist, 2025). In other words, the syndrome follows the career, but it can lose strength over time and with the right care.

What the syndrome causes

Burnout and stress

In the pilot study with American students, impostor syndrome was significantly associated with exhaustion, cynicism and depersonalization, components of burnout (Villwock et al., 2016). In the study with third-year students, impostor and perceived stress scores correlated in both men and women (Levant et al., 2020).

The systematic review found the syndrome associated with depression, anxiety, worse performance and lower job satisfaction, as well as burnout (Bravata et al., 2020). These are associations, not proof of cause, but they indicate that the feeling weighs heavily. Burnout in medical school has its own guide in this series.

In the day to day of study and clinical rotations

People who feel like impostors tend to avoid asking questions so as not to expose doubts, to not apply for opportunities, and to read any correction as a threat. This reduces precisely the experiences that would help build confidence. In case discussions, the fear of making a mistake in public can lead someone to keep a reasonable hypothesis to themselves.

Where it comes from

Transitions

Phases of change concentrate impostor feelings: entering medical school, moving into the clinical phase, the internship, the start of residency. In a study with students and residents in programs that combine medicine and a doctorate, transitions between phases appeared as one of the themes linked to the syndrome (Chakraverty et al., 2022).

Constant assessment

The same study identified fear of assessment and the formation of professional identity as central themes (Chakraverty et al., 2022). Exams, oral questioning and discussion rounds with back-to-back questions keep the student under almost permanent observation.

Belonging

Participants attributed part of their impostor experiences to biases and microaggressions in interactions with colleagues, professors and patients, and all reported difficulty feeling that they belonged in medicine or in research (Chakraverty et al., 2022). The sample was small, and the finding is consistent with the higher frequency of the syndrome in minority groups described in the 2020 review (Bravata et al., 2020).

This changes the framing: part of the syndrome comes from the environment, not only from the mind of the person who feels it.

What helps

What intervention studies say

In the 2020 review, no published study had evaluated treatments for impostor syndrome (Bravata et al., 2020). A 2024 review of online interventions for students, residents and preceptors included six studies, four of them randomized (Hsu et al., 2024). Two randomized trials showed a significant reduction in impostor symptoms compared with control groups, and interventions with coaching and cognitive restructuring seemed the most effective (Hsu et al., 2024).

The evidence is still limited, but it points to a path: talking about the topic in a group, with method, and training a more realistic reading of one's own achievements.

Strategies for the student

• Name the feeling: recognizing "this is the impostor talking" already creates distance.
• Separate fact from interpretation: the review on surgeons highlights the importance of telling fact from fiction to undo distorted thoughts (El Boghdady and Ewalds-Kvist, 2025).
• Keep a record of evidence: a file with praise, well-handled cases and grades helps on bad days.
• Talk to colleagues: finding out that others feel the same reduces isolation.
• Treat mistakes as data: the guide on metacognition in medicine shows how to turn mistakes into useful information.
• Seek professional help if the feeling comes with persistent sadness, intense anxiety or exhaustion.

The role of preceptors and medical schools

Preceptors who share their own doubts, praise reasoning and not only the right answer, and correct without humiliating help disarm the syndrome. Medical schools can include the topic in orientation for first-year students and in the transition to the internship, moments of higher risk. A good format for correction is in the guide on feedback in clinical cases.

Right answers, wrong answers and NEXO

NEXO can help build an honest record of your own reasoning. In the case of the day, fictional with a real clinical presentation, the diagnosis arrives within up to six clues, and the ICD-10 proximity across five levels shows whether the guess stayed in the same chapter, the same group or the same category. A near miss becomes concrete evidence that the reasoning was on the right track.

Over time, the match history shows correct answers that the impostor tries to erase. The guide what NEXO is explains the whole match, and the unlocking of modes is on the NEXO economy page.

If you coordinate a medical school, a league or a residency and want to use cases in group activities without individual exposure, meet NEXO Closer. Researchers in medical education can propose studies through NEXO Researcher. Doctors who review cases take part through NEXO Curator, and those who create health content on social media can take part through NEXO Creators.

Frequently asked questions

What is impostor syndrome?

It is the persistent feeling of being a fraud, attributing your own success to luck or deception, even with evidence of competence.

Is impostor syndrome common in medicine?

Yes. In a pilot study, it appeared in 49.4% of female students and 23.7% of male students (Villwock et al., 2016).

Is impostor syndrome a disease?

It is not listed as a disorder in the diagnostic manuals, but it often comes with depression, anxiety and burnout (Bravata et al., 2020).

What is the relationship with burnout?

In medical students, the syndrome was associated with exhaustion, cynicism and depersonalization (Villwock et al., 2016).

Is there treatment?

Online interventions with coaching and cognitive restructuring reduced symptoms in two randomized trials (Hsu et al., 2024).

Does the syndrome go away with time?

Among surgeons, the feelings tended to decrease with age (El Boghdady and Ewalds-Kvist, 2025).

Checklist against the impostor

1. Name the feeling when it appears.
2. Separate fact from interpretation.
3. Keep evidence of good results.
4. Talk to colleagues about the topic.
5. Ask questions even when afraid.
6. Treat mistakes as information.
7. Ask for help if the distress persists.

Want an honest record of your reasoning? 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. 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/
3. 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/
4. El Boghdady M, Ewalds-Kvist B. Surgeon's imposter syndrome: a systematic review. Langenbecks Arch Surg. 2025. https://pubmed.ncbi.nlm.nih.gov/39825919/
5. 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/
6. 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/