Context Impostor syndrome (IS) is increasingly recognised as a condition among physicians and physicians in training. Impostor syndrome is especially problematic because of its association with increased rates of burnout and suicide. In order to address this issue, we need to fully understand its prevalence, scope, and factors associated with IS. The purpose of this scoping review is to analyse the existing literature on IS among practising physicians and physicians in training in order to identify current trends and directions for future research. Methods The authors conducted a literature search of nine databases for any articles on IS among practising physicians or physicians in training published prior to January 2019. Two reviewers independently screened articles and identified 18 papers meeting the study inclusion criteria. Two authors independently extracted data and performed quantitative and qualitative syntheses consistent with best practice recommendations for scoping reviews. Results Most studies utilised the Clance Impostor Phenomenon Scale and cited rates of IS ranging from 22% to 60%. Studies found that gender, low self‐esteem and institutional culture were associated with higher rates of IS, whereas social support, validation of success, positive affirmation, and both personal and shared reflections were protective. Overall, IS was also associated with higher rates of burnout. Conclusions This review summarises the existing literature on IS among practising physicians and physicians in training, providing valuable insights and areas for future research.

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BACKGROUND Burnout syndrome was defined in the 1970s as a triad of emotional exhaustion (EE), depersonalization (DP), and a low sense of personal accomplishment (PA). 1 Almost half of physicians report burnout, and emergency physicians (EP) are near the top of the list. 2 In 2018, 48% of EPs reported burnout. 3 Physician burnout has been shown to negatively correlate with patient safety, quality of care, physician professionalism, and patient satisfaction. 4,5 In EPs, burnout was associated with increased frequency of self-reported, suboptimal patient care, including admitting or discharging patients early, not communicating effectively with patients, ordering more tests, not treating patients' pain, and not communicating important handoffs. 6 Additionally, burnout has been associated with substance use, relationship issues, depression, and suicide. 5,7,8 Originally, burnout was believed to manifest in those who practiced medicine for a prolonged amount of time. However, recent evidence has shown that burnout may begin as early as medical school and residency. 9-10 In fact, recent studies on emergency medicine (EM) residents reported burnout rates ranging from 65-76%. 9,11 Across all fields of medicine, residents have shown higher rates of burnout when compared to medical students and early-career physicians. 9,10 In response to this data indicating early onset of burnout,

IntroductionBurnout, depression, and suicidality among residents of all specialties have become a critical focus of attention for the medical education community.MethodsAs part of the 2017 Resident Wellness Consensus Summit in Las Vegas, Nevada, resident participants from 31 programs collaborated in the Educator Toolkit workgroup. Over a seven-month period leading up to the summit, this workgroup convened virtually in the Wellness Think Tank, an online resident community, to perform a literature review and draft curricular plans on three core wellness topics. These topics were second victim syndrome, mindfulness and meditation, and positive psychology. At the live summit event, the workgroup expanded to include residents outside the Wellness Think Tank to obtain a broader consensus of the evidence-based toolkits for these three topics.ResultsThree educator toolkits were developed. The second victim syndrome toolkit has four modules, each with a pre-reading material and a leader (educator) guide. In the mindfulness and meditation toolkit, there are three modules with a leader guide in addition to a longitudinal, guided meditation plan. The positive psychology toolkit has two modules, each with a leader guide and a PowerPoint slide set. These toolkits provide educators the necessary resources, reading materials, and lesson plans to implement didactic sessions in their residency curriculum.ConclusionResidents from across the world collaborated and convened to reach a consensus on high-yield—and potentially high-impact—lesson plans that programs can use to promote and improve resident wellness. These lesson plans may stand alone or be incorporated into a larger wellness curriculum.

Part One of this two-article series reviews assessment tools to measure burnout and other negative states. Physician well-being goes beyond merely the absence of burnout. Transient episodes of burnout are to be expected. Measuring burnout alone is shortsighted. Well-being includes being challenged, thriving, and achieving success in various aspects of personal and professional life. In this second part of the series, we identify and describe assessment tools related to wellness, quality of life, resilience, coping skills, and other positive states.

Physician well-being is a complex and multifactorial issue. A large number of tools have been developed in an attempt to measure the nature, severity, and impact of both burnout and well-being in a range of clinical populations. This two-article series provides a review of relevant tools and offers guidance to clinical mentors and researchers in choosing the appropriate instrument to suit their needs, whether assessing mentees or testing interventions in the research setting. Part One begins with a discussion of burnout and focuses on assessment tools to measure burnout and other negative states. Part Two of the series examines the assessment of well-being, coping skills, and other positive states.

IntroductionDespite high rates of burnout in senior medical students, many schools provide the majority of their wellness training during the first and second preclinical years. Students planning a career in emergency medicine (EM) may be at particularly high risk of burnout, given that EM has one of the highest burnout rates of all the specialties in the United States We developed an innovative, mindfulness-based curriculum designed to be integrated into a standard EM clerkship for senior medical students to help students manage stress and reduce their risk of burnout.MethodsThe curriculum included these components: (1) four, once-weekly, 60-minute classroom sessions; (2) prerequisite reading assignments; (3) individual daily meditation practice and journaling; and (4) the development of a personalized wellness plan with the help of a mentor. The design was based on self-directed learning theory and focused on building relatedness, competence, and autonomy to help cultivate mindfulness.ResultsThirty students participated in the curriculum; 20 were included in the final analysis. Each student completed surveys prior to, immediately after, and six months after participation in the curriculum. We found significant changes in the self-reported behaviors and attitudes of the students immediately following participation in the curriculum, which were sustained up to six months later.ConclusionAlthough this was a pilot study, our pilot curriculum had a significantly sustained self-reported behavioral impact on our students. In the future, this intervention could easily be adapted for any four-week rotation during medical school to reduce burnout and increase physician wellness.

Background Emergency medicine (EM) applicants consider many factors when selecting residency programs. Prior studies have demonstrated that applicants consider geography as well as modifiable/nonmodifiable program factors. Less attention, however, has been paid to underrepresented groups. Additionally, the prevalence and characteristics of “red flags,” or factors that may lead an applicant to lower a program's rank or not rank it at all, remain unknown in EM. Our objective was to describe the factors that influence current EM‐bound medical students’ residency selection focusing on underrepresented applicants and red flags encountered during the recruitment process. Methods We conducted a mixed‐methods survey study of EM‐bound graduates from U.S. medical schools in the 2020 application cycle. Quantitative analysis included descriptive statistics, measures of central tendency, 95% confidence intervals (CIs), nonparametric tests for ordinal data, and logistic regression. For the qualitative portion of the study, two independent reviewers performed a thematic analysis of the red flag free‐text responses. Discrepancies were addressed via consensus with third‐party oversight. Results Our survey response rate was 49%, and most applicants considered both geographic and program factors. Underrepresented applicants prioritized program diversity, program commitment to the underserved, neighborhood/community, and patient population. Of all respondents, 71% reported red flags. Women had a significantly higher odds of encountering red flags (odds ratio = 1.64, 95% CI = 1.25 to 2.18). Red flags included seven key themes: violations of regulatory standards, program characteristics, interview day experience, program culture, interpersonal interactions, lack of fit, and quality of life; subthemes included lack of diversity and racism. Conclusions Modifiable/nonmodifiable program factors and geography continue to influence EM‐bound applicants’ residency choices. Underrepresented applicants place a higher value on diversity, community, and patients served. Residency programs should consider modifiable factors and self‐assess for red flags to successfully recruit the next generation of EM physicians.