Impostor Syndrome in Occupational Therapy – 2020 Pilot Study and Insights

Imposter Syndrome Featured

What is Impostor Syndrome?

Feeling like a fraud while in occupational therapy school, at fieldwork, and as a practicing occupational therapist? OTS/OTs may experience internal “phoniness” in regards to their profession and career. Those experiencing impostor syndrome may attribute their success to luck rather than personal achievements based on merit. Some may have a temporary or constant fear of being exposed as incompetent.

How Does it Feel Like?

Impostor syndrome may be benign, but may also be linked to:

  • Anxiety
  • Depression
  • Isolation
  • Low self-esteem

Negative Self-talk:

  • “I am not competent.”
  • “I am not successful.”
  • “I’m not smart.”
  • “I just got lucky.”
  • “I’m a fraud.”
  • “I’m not good enough.”
  • “It was only because I have a good team.”

Prevalence

Some studies reveal that impostor syndrome may be experienced by 70% of individuals at least once while working.

38.5% of Australian student nurses experienced impostor syndrome symptoms.

1 in 3 family medicine residents reported correlated symptoms of anxiety and depression.

43.8% of American internal medicine residents reported symptoms.

Women are more likely to experience impostor syndrome than men.

In a 2020 pilot study of allied health professionals (graduate occupational therapy and audiology), 37.5% reported symptoms of impostor syndrome on the Young Impostor Syndrome scale.

Screening

  • Clance IP Scale
  • Impostorism Scale
  • Young Impostor Scale

Behavior and Risks

  • Passing up opportunities due to feeling unqualified.
  • Downplaying achievements and taking credit.
  • Over-preparing and over-achieving.
  • Self-sabotage
  • Psychosocial symptoms
  • Dissatisfaction
  • Lack of growth
  • Compassion fatigue
  • Burnout

Potential Causes

  • Unrealistic standards, overachievers
  • Stressful work environment
  • Stressful patients and family members, co-workers
  • Perfectionism
  • The quick transition between school and working; careers
  • Pressure for productivity and to succeed
  • Criticism
  • Lack of mentorship

Overcoming Impostor Syndrome

  • Finding a support system, community group, peers.
  • Receiving feedback and criticism.
  • Minimizing negative self-talk.
  • Welcoming positive praise.
  • Reflection
  • Relaxation, meditation, de-stress techniques
  • Reframing success vs. failure
  • Seeing OT as a practice (continuing learning), similar to medicine.
  • Asking for help

My Opinion

Why do many occupational therapy students and practitioners feel like impostors? This is a complex phenomenon that requires further research. I personally have felt it during my career as a new grad, despite working the exact same position where I completed my level II fieldwork. Many studies suggest that impostor syndrome is especially high in the healthcare field. The stakes are high (possible fear of cause injury, death, getting sued, losing your license) and there is a lot of stress. If an occupational therapist messes up, there could be real consequences compared to another job where a loss may only be reprimand and company money.

The environment may be stressful as well — fast-paced, there are smarter people (e.g., doctors) who may question OTs, and often upset patients or family members. Then there’s the potential high productivity demands and pressure to keep up with your caseload. Documentation has largely moved to EMRs, but the time it takes to document seems to go up. OTs may not have a lot of time to document. Students and new grads lack the experience to write concisely and quickly.

There may be a lack of overall mentorship in the field (as fieldwork placements themselves can be difficult). As students, they have the safety net of their clinical instructor, but as a new grad, this safety net is removed. New grads may lack the support they need (and be afraid to ask for it).

Students may also lack the clinical experience that is needed and may need time to research or read up on unfamiliar conditions and interventions. They often do not have the time to do this at work. By the time students and new grads get off work, they are probably exhausted (both physically and mentally).

Occupational therapy is not well understood both by the general public and other allied health professionals. So the roles that OTs may have may feel minimized compared to other professions such as physical therapy or nursing.

Due to the lack of understanding of the scope of practice of occupational therapists, students and new grads may be asked difficult or inappropriate questions that would be better directed at a doctor, specialist, or even a physical therapist. Externally, there is added pressure that may contribute to impostor syndrome. The lack of understanding of the roles of OTs, other professionals such as doctors, case managers, social workers, nurses, etc. may undervalue the importance of occupational therapy. For example, they may put an emphasis on the clinical importance and judgment of physical therapists and potentially ignore that of occupational therapists’.

Occupational therapists may be outnumbered in a work setting. For example, the ratio of PTs to OTs may be 5:1, for example. This may make it hard to speak up and to have a voice. Research has shown that women are less likely to speak up. More women are in the occupational therapy field than men. Occupational therapists may lack the resources, equipment, or tools they need to do their job.

As you can see, this impostor syndrome in occupational therapy students and new grads is not simple black and white. In reflecting on my own experience and ongoing research, there are themes that may help to minimize this phenomenon: improving the healthcare system, education (school, workplace, general public), mentorship, advocacy for occupational therapy, and more research with quantitative/qualitative measures that demonstrate the value of occupational therapy in various settings.

Further Research

According to the Schmulian and Fleming pilot study, this was the first to explore the prevalence of impostor syndrome in university students in allied health.

Results suggest the importance of prioritizing impostor syndrome in future student mental health research.

References

Impostor syndrome and compassion fatigue among graduate allied health students: A pilot study

“Rising to the Level of Your Incompetence”: What Physicians’ Self-Assessment of Their Performance Reveals About the Imposter Syndrome in Medicine

How to Deal With Imposter Syndrome as a Healthcare Professional

 

Jeff is a licensed occupational therapist and lead content creator for OT Dude. He covers all things occupational therapy as well as other topics including healthcare, wellness, mental health, technology, science, culture, sociology, philosophy, and more.