Background and Objectives: Medical student distress and mental health needs are critical issues in undergraduate medical education. The imposter phenomenon (IP), defined as inappropriate feelings of inadequacy among high achievers is linked to psychological distress. We investigated the prevalence of IP among first-year medical school students and its association with personality measures that affect interpersonal relationships and well-being. Methods: Two hundred fifty-seven students at a large, urban, northeastern medical school completed the Clance Impostor Phenomenon Scale (CIPS), Jefferson Scale of Empathy, Self-Compassion Scale, and Zuckerman-Kuhlman Personality Questionnaire immediately before beginning their first year of medical school. At the end of their first year, 182 of these students again completed the CIPS. Results: Eighty-seven percent of the entering students reported high or very high degrees of IP. Students with higher IP scores had significantly lower mean scores on self-compassion, sociability self-esteem (P<.0001 for all), and getting along with peers (P=.03). Lower IP scores were related to lower mean scores on neuroticism/anxiety and loneliness (P<.001 for both). Women obtained a higher mean IP score than men. IP scores at the end of the school year increased significantly compared with the beginning of the year (P<.001), both in frequency and intensity of IP. Conclusions: IP was common in matriculating first-year medical students and significantly increased at year’s end. Higher IP scores were significantly associated with lower scores for self-compassion, sociability, self-esteem, and higher scores on neuroticism/anxiety.

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Objectives: This study aimed to determine whether words used in medical school admissions essays can predict physician empathy. Methods: A computational form of linguistic analysis was used for the content analysis of medical school admissions essays. Words in medical school admissions essays were computationally grouped into 20 'topics' which were then correlated with scores on the Jefferson Scale of Empathy. The study sample included 1,805 matriculants (between 2008-2015) at a single medical college in the North East of the United States who wrote an admissions essay and completed the Jefferson Scale of Empathy at matriculation. Results: After correcting for multiple comparisons and controlling for gender, the Jefferson Scale of Empathy scores significantly correlated with a linguistic topic (r = .074, p< .05). This topic was comprised of specific words used in essays such as "understanding," "compassion," "empathy," "feeling," and "trust." These words are related to themes emphasized in both theoretical writing and empirical studies on physician empathy. Conclusions: This study demonstrates that physician empathy can be predicted from medical school admission essays. The implications of this methodological capability, i.e. to quantitatively associate linguistic features or words with psychometric outcomes, bears on the future of medical education research and admissions. In particular, these findings suggest that those responsible for medical school admissions could identify more empathetic applicants based on the language of their application essays.

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While a system-level approach is necessary to achieve a significant positive impact on the well-being of medical students and graduate medical education (GME) trainees, individuals share a concurrent responsibility to commit to intentional and strategic self-care that promotes their own well-being. The goals of this chapter are to emphasize the importance of a shared responsibility framework using organizational and individual strategies to promote well-being, introduce an expanded framework for strategic self-care, review the data for many individual-focused strategies that can be utilized by learners when practicing strategic self-care, and provide guidance for the creative integration of individual-focused practices and wellness strategies into programmatic structures and longitudinal curricula. When training programs and schools support well-being by both improving system-level drivers of burnout and facilitating opportunities for strategic self-care, medical students and GME trainees feel valued and encouraged to better care for themselves and the populations they serve.