February 4, 2010
Alan G. Robinson M.D.
Associate Vice Chancellor, Medical
Sciences
Executive Associate Dean,
David Geffen School of Medicine at UCLA

• Clance , a barrier to empowerment and achievement in women
• High achieving women who nonetheless believe themselves to be less intelligent and less competent than others perceive them to be
• Believe they have achieved success by
“fooling the others”

Percent impostors
Men Women P value
24% 41%
Mean impostor score 54.3
58.5
Depressed 26% 37%
.02
.03
.07
State anxiety score 38
Trait anxiety score 38
40
42
.18
.01

Henning – Perfectionism and the imposter phenomenon in medical, dental, nursing and pharmacy students
• 30% of students were clinically positive on
Clance Impostor Phenomenon scale (CIP)
• 27% were experiencing psychological distress of clinical significance
• Perfectionism was scored by: “I expect it of me”,
“I expect it of others”, “Others expect it of me”
• The strongest predictors of psychological distress were CIP and perfectionism “Others expect it of me”

Shih
• African students stereotyped as poor students underperform when they believe they are being compared to white students
• Elderly people perform poorly on a memory task when primed with a negative stereotype of the elderly
• Most research has focused on one dimension of identity and on negative stereotyping

• Women have inferior math skills compared to men
• Asians have superior math skills compared to other ethnic groups
• An experiment was done with Asian-
American women, all with excellent math skills, mean SAT 751 (max 800)

Harvard Asian-American women were divided into three groups and given a questionnaire about residential life prior to a math test
• Female identity questionnaire - single-sex floors, coed dorms, had a roommate, etc.
• Asian identity questionnaire - language known, spoken at home, generations in America, etc.
• Control identity questionnaire – satisfaction with phone service, subscribe to cable television, etc.

• The Asian community is recently immigrated
• The stereotype is that Asians are less capable

Asian identity
No identity
Female identity
P value
43% .05
Harvard women
54% 49%
Vancouver women
44% 59% 28% .05

• Established program at the University of
Massachusetts medical school
• Students who participated in international programs had higher ratings on cultural competence
• However, possible major contributor may have been selection the bias for students who chose international experiences

st
rd
1 st year 3 rd year
Interest in underserved
Need to know patient living condition
Interest in rural medicine
Need collaboration with other professionals
Enthusiasm for being a physician
Interest in primary care
T>NT
NSD
T>NT
T>NT
NSD
NSD
T>NT
T>NT
NSD
NSD
T>NT
T>NT

Friedman
• Implications for decision support and error reduction
• Exponential growth of biomedical knowledge and shortened halflife of “correct” information suggest need for external support
• Will physicians seek external support?
• Participants were given a series of cases, ask the DX and whether they would seek help

Portion of cases correctly diagnosed at each confidence level –
Friedman JGIM, 2004

Confidence and DX not aligned
Correct DX but seek assistance
(underconfident)
Incorrect DX but not seek assistance
(overconfident)
Student 22% 75% 25%
Resident 36%
Faculty 37%
59%
64%
41%
36%

1) Have it in a relaxed location
2) Be monotonous in cheese and snacks, i.e. don’t let participants try to one up each other with contributions of food
3) Serve water, wine and soft drinks
4) Eliminate from participation those who do not attend regularly
5) A theme for the year encourages session to session continuity

6) Look outside the medical literature for ideas
7) Don’t allow handouts or long review articles as background
8) Discuss how the article relates to your present activities
9) Plan an annual social event for participants and guests, e.g. movie and supper
10) Don’t allow nudity at the sessions

•
Barlow A, et al. Home-visiting intervention to improve child care among American
Indian adolescent mothers. Archives of Pediatrics & Adolescent Medicine 2006;
160:1101-1107.
•
Beach MC, Rosner M, Cooper LA, Duggan PS, Shatzer J. Can Patient-centered attitudes reduce racial and ethnic disparities in care? Academic Medicine 2007; 82(2):
193-198.
• Berwick, Donald M. Disseminating Innovations in Health Care. JAMA 2003;289(15):
1969-1975.
• Chen, Pauline W. Final Exam: A Surgeon’s Reflections on Mortality
• Clance P, Imes S. The impostor phenomenon in high-achieving women: dynamics and therapeutic intervention. Psychotherapy: Theory, Research, and Practice
1978;15:241-247.
• Dornan T, Boshuizen H, King N, Scherpbjer A. Experience-based learning: A Model
Linking the Processes and Outcomes of Medical Students’ Workplace Learning.
Medical Education 2007; 41:84-91.
• Eva K, Cunnington J, reiter H, Keane D, Norman G. How can I know what I don’t
Know? Poor self assessment in a well-defined domain. Advances in Health Sciences
Education 2004;9: 221-224.
•
Friedman, Charles P., Guido G. Gatti, Timothy M. Franz, Gwedolyn C. Murphy et al.
Do Physicians Know When Their Diagnoses Are Correct?" . Journal of General
Internal Medicine 2005;20: 334-339.

•
Godkin, Michael, and Judith Savageau. The Effect of Medical Students' International
Experience on Attitudes Toward Serving Underserved Multicultural Populations.
Family Medicine 2003;35(4): 273-278.
•
Henning, Kris, Sydney Ey, and Darlene Shaw. Perfectionism, the imposter phenomenon and psychological adjustment in medical, dental, nursing and pharmacy students. Medical Education 1998;30:456-464.
• Ingram, M., et al. The Impact of Promotoras on Social Support and Glycemic Control
Among Members of a Farmworker Community on the UC-Mexico border. The
Diabetes Educator 2007; 33(6): 172S-178S.
• Klitzman, R . Improving Education on Doctor-patient Relationships and
Communication: lessons from doctors who become patients. Academic Medicine
2006; 81(5): 447-453.
• Koskinen L, Tossavainen K. Study Abroad as a Process of Learning Intercultural
Competence in Nursing. International Journal of Nursing Practice 2004;10:111-120
• Oriel, Kathy; Mary Beth Plane, and Marlon Mundt. Family Medicine residents and the
Impostor Phenomenon. Family Medicine 2004;36(4): 248-252.
• Shih, Margaret, Todd L. Pittinsky, and Nalini Ambady. STEREOTYPE
SUSCEPTIBILITY: Identity Salience and Shifts in Quantitative Performance.
Psychological Science 1999;10(1): 80-83.
• White C. Smoothing Out Transition: How Pedagogy Influences Medical Students’
Achievement of Self-Regulated Learning Goals. AHSE 2007; 12:279-297.

•
Connery, Sean, Laurence Mark, Rhonda Tollefson et al. (Producers), & Van Sant, G.
(Director). (2000). Finding Forester [Motion Picture]. United States: Columbia
Pictures.
• Sanders, Tim, John Barnett, Frank Hubner et al. (Producers), & Caro, N. (Director).
(2003). Whale Rider [Motion Picture]. New Zealand: Newmarket Films.
• Brown, Effie, George LaVoo et al. (Producers), & Cardoso, P. (Director). (2002). Real
Women Have Curves [Motion Picture]. United States: HBO Independent Productions.
•
Loader, Kevin, Nicholas Hytner, Damian Jones et al. (Producers), & Hytner, N.
(Director). (2006). The History Boys [Motion Picture]. United Kingdom: Fox
Searchlight.
•
Bosanquet, Simon. (Producer), & Nichols, M. (Director). (2001). Wit [Motion Picture].
United States: HBO Independent Productions.

•
Brockway, Jody, Howard Burkons, Tom Cox et al. (Producer), & Haines, R.
(Director). (2006). The Ron Clark Story [Motion Picture]. United States: Turner
Broadcasting Inc.
• DeVito, Danny, Michael Shamberg, Stacy Sher et al. (Producers), & LaGravenese, R.
(Director). (2007). Freedom Writers [Motion Picture]. United States: Paramount
Pictures.
• Franco, Larry J., Charles Gordon, Marc Sternberg et al. (Producers), & Johnston, J.
(Director). (1999). October Sky [Motion Picture]. United States: Universal Studios.
•
Grazer, Brian, Ron Howard. (Producers), & Howard, R. (Director). (2001). A Beautiful
Mind [Motion Picture]. United States: Imagine Entertainment.
•
Cort, Robert W. (Producer), & Sargent, J. (Director). (2004). Something the Lord
Made [Motion Picture]. United States: HBO Independent Productions.
• Gladstein, Richard N. (Producer), & Hallstrom, L. (Director). (2000). Cider House
Rules [Motion Picture]. Australia: Miramax Films.
•
Farrell, Mike, Barry Kemp, Marvin Minoff, Charles Newwirth et al. (Producers), &
Shadyac, T. (Director). (1998). Patch Adams [Motion Picture]. United States:
Universal Studios.