Imposter Syndrome among Pharm D Students: Investigating the Roles of Age, Gender, and Academic Progression

Abstract

Background: Imposter Syndrome (IS) is a psychological pattern characterized by persistent self-doubt, fear of failure, and the belief that one’s success is undeserved despite clear evidence of competence [1–3]. Students in health-professional programs, particularly Pharm D students, face rigorous academic expectations, continuous evaluation, and early clinical exposure, making them especially vulnerable to IS. Its impact on academic performance, clinical confidence, mental well-being, and professional identity formation highlights the need for focused research in this population. Objectives: To determine the prevalence and severity of IS among Pharm D students and examine the influence of age, gender, and academic progression. Methods: A cross-sectional survey study was conducted among 101 Pharm D students across different academic years. Data were collected using a validated demographic questionnaire and the Clance Imposter Phenomenon Scale (CIPS). Descriptive statistics and subgroup analyses were performed to assess IS differences across age groups, gender, academic years, and recent academic stress. Results: A majority of participants (79.2%) experienced Frequent or Intense Imposter Syndrome. The highest IS mean scores were observed among students aged 24–26 years, suggesting increased self-doubt during advanced stages of training. Female students reported higher IS levels than males. IS severity peaked during Years 2–4, where academic complexity and initial clinical exposure coincide. Students who reported significant academic stress in the past six months demonstrated notably higher IS severity. Conclusion: Imposter Syndrome is highly prevalent among Pharm D students and is strongly shaped by demographic and academic factors. The findings identify critical vulnerability periods—particularly the 24–26 age group and the middle academic years—where targeted support, mentorship, and mental-health interventions are essential. Early identification and structured guidance can help reduce impostor feelings, strengthen professional identity, and improve students’ readiness for real-world pharmacy practice.

Keywords

Introduction

4.2 Imposter Syndrome Intensity by program phase:

DISCUSSION

The findings of this study demonstrate that Imposter Syndrome is highly prevalent among Pharm D students, with nearly 80% experiencing Frequent or Intense levels of self-doubt. This aligns with existing literature indicating that students in healthcare programs commonly experience heightened impostor feelings due to the demanding nature of professional training [8,15]. The Pharm D curriculum requires students to transition rapidly from theoretical knowledge to clinical application, which may contribute to increased psychological vulnerability during their academic progression [12–14]. Such transitions involve exposure to real patient scenarios, interdisciplinary interactions, and high academic expectations, all of which can magnify feelings of incompetence despite demonstrated capability [41].

The present study found that students aged 24–26 years exhibited the highest IS scores. This age group corresponds with advanced academic years, during which students face substantial academic and clinical responsibilities, including research work, case presentations, professional examinations, and internship preparation. Similar findings have been reported in medical and pharmacy students internationally, where older learners approaching graduation experience increased pressure to perform independently, leading to intensified impostor feelings [22,28,42]. This period is also characterized by the consolidation of professional identity, a stage that naturally evokes uncertainty and heightened performance anxiety [37,43].

Gender differences were also evident, with female students reporting higher IS levels than males. This is consistent with prior research indicating that women are more likely to internalize academic expectations, engage in self-criticism, and experience fear of negative evaluation [23–26]. Sociocultural norms often place greater pressure on women to excel academically while simultaneously discouraging assertiveness, potentially reinforcing impostor experiences [44]. Studies in pharmacy and medical education have consistently shown higher IS among female students, citing factors such as perfectionism, stereotype expectations, and lower self-perceived competence even when performance is equivalent to that of male peers [45,46].

Academic progression played a significant role, with IS severity peaking in Years 2–4. These years are academically dense and often represent a transition point from foundational knowledge to advanced therapeutic concepts and clinical exposure. Students frequently report heightened anxiety during this period due to increased workload, complex subject matter, and frequent assessments [20–23]. Additionally, early clinical responsibilities—such as case discussions, patient counseling, and documentation—may contribute to feelings of unpreparedness, further amplifying impostor experiences [27–29,47]. By Year 6, IS scores declined, which may reflect increased maturity, clinical confidence, and familiarity with professional expectations. Similar trends have been reported among final-year medical and nursing students who develop stronger coping mechanisms and confidence through repeated clinical exposure [48].

Academic stress was a significant contributor to IS in this population. Students who reported high stress levels in the preceding six months also showed higher IS severity. This finding aligns with several studies indicating that stress from examinations, viva voce, time

constraints, and clinical responsibilities increases susceptibility to impostor feelings [33–36]. Stress may also interact with perfectionistic tendencies and fear of failure, forming a cycle that reinforces impostor experiences over time [49].

Overall, the findings highlight the multifactorial nature of Imposter Syndrome, influenced by personal, academic, and contextual variables. Pharm D students operate in environments where mistakes feel costly, expectations are high, and comparison with peers is common—all factors known to fuel impostor thinking [50]. Understanding these influences is essential for designing targeted interventions that can reduce psychological distress and promote confidence in future clinical pharmacists.

LIMITATIONS

1. The study was conducted in a single institution, which may limit generalizability.
2. Self-reported responses may be affected by personal bias.
3. The cross-sectional design captures only one timeframe and cannot establish causation.
4. Online data collection may have influenced participation rates.

CONCLUSION

The present study demonstrates a significant burden of Imposter Syndrome among Pharm D students, with a large majority experiencing frequent or intense levels of self-doubt despite their academic abilities. The findings clearly indicate that Imposter Syndrome is not uniformly distributed across the student population but is strongly influenced by age, gender, and academic progression. Students aged 24–26 years, female students, and those in the middle academic years (Years 2–4) were identified as the most vulnerable groups. These stages correspond with increased academic demands, early exposure to clinical responsibilities, and the formative stages of professional identity development, all of which may heighten perceptions of inadequacy.

The strong association between recent academic stress and Imposter Syndrome severity further underscores the emotional pressures faced by Pharm D students. High expectations, examinations, case presentations, and clinical evaluations contribute to a stressful academic environment that may intensify impostor feelings and reduce confidence in clinical performance. Without timely intervention, these psychological experiences may hinder academic success, limit engagement in clinical activities, and negatively affect preparedness for professional practice.

Addressing Imposter Syndrome within pharmacy education is therefore essential. Institutions should implement structured support strategies, including mentorship programs, mental-health counseling, stress-management training, and peer-support groups. Faculty awareness and supportive teaching approaches can also help reduce self-doubt and create an environment where students feel safe to learn, ask questions, and make mistakes. Encouraging reflective practice and promoting recognition of personal achievements can further strengthen students’ confidence and professional growth.

In conclusion, Imposter Syndrome represents a significant psychological challenge within Pharm D education. Proactive institutional efforts aimed at early identification, targeted support, and ongoing guidance are crucial for developing competent, confident, and resilient future pharmacists. Future research involving multiple institutions and longitudinal follow-up may provide deeper insights into the progression of impostor feelings and the effectiveness of intervention strategies.

REFERENCES

1. Clance PR, Imes SA. The impostor phenomenon in high achieving women: Dynamics and therapeutic intervention. Psychother Theory Res Pract. 1978;15(3):241–247.
2. Clance PR. The Impostor Phenomenon: Overcoming the Fear that Haunts Your Success. Atlanta: Peachtree Publishers; 1985.
3. Parkman A. The imposter phenomenon in higher education: Incidence and impact. J Higher Educ Theory Pract. 2016;16(1):51–60.
4. Hutchins HM. Outing the imposter: A study exploring imposter phenomenon among higher education faculty. New Horizons Adult Educ Hum Resource Dev. 2015;27(2):3–12.
5. Bravata DM, Watts SA, Keefer AL, et al. Prevalence, predictors, and treatment of impostor syndrome: A systematic review. J Gen Intern Med. 2020;35(4):1252–1275.
6. Villwock JA, Sobin LB, Koester LA, Harris TM. Impostor syndrome and burnout among American medical students: A pilot study. Int J Med Educ. 2016;7:364–369.
7. Henning K, Ey S, Shaw D. Perfectionism, the impostor phenomenon and psychological adjustment in medical, dental, nursing and pharmacy students. Med Educ. 1998;32(5):456–464.
8. Easton S, et al. Imposter phenomenon among healthcare students. J Allied Health. 2021;50(2):137–144.
9. Cain J. It’s time to confront impostor syndrome in pharmacy education. Am J Pharm Educ. 2019;83(6):Article 7764.
10. Vaughn AR, Taasoobshirazi G, Johnson ML. Impostor phenomenon and student achievement. Int J Educ Psychol. 2020;9(2):132–152.
11. Cokley K, McClain S, Enciso A, Martinez M. An examination of the impact of minority status stress and impostor feelings on the mental health of diverse ethnic minority college students. J Multicult Couns Dev. 2013;41(2):82–95.
12. Neureiter M, Traut-Mattausch E. Inspecting the “imposter phenomenon”: How fear of failure and rejection sensitivity predict impostor feelings. Pers Individ Dif. 2016;80:125–130.
13. Chrisman SM, Pieper WA, Clance PR, Holland CL, Glickauf-Hughes C. Validation of the Clance Imposter Phenomenon Scale. J Pers Assess. 1995;65(3):456–467.
14. Rohrmann S, Bechtoldt MN, Breslow L. Impostor feelings and task performance. Pers Individ Dif. 2016;103:127–132.
15. Rivkin A, Calmes C. Impostor phenomenon in pharmacy students. Curr Pharm Teach Learn. 2019;11(3):250–256.
16. Matthews G, et al. Imposter phenomenon and mental health among health professional students. Health Psychol Rev. 2020;14(2):157–175.
17. Kumar S, Jagacinski CM. Impostors have goals too: The impostor phenomenon and its relationship to achievement goal orientation. Pers Individ Dif. 2006;40(1):147–157.
18. Ferrari JR, Thompson T. Impostor fears: Links with self-presentational concerns and self-handicapping behaviours. Pers Individ Dif. 2006;40:341–352.
19. Leary MR, Patton KM, Orlando AE, et al. Self-esteem and impostorism. J Pers. 2000;68(4):725–756.
20. Holmes SW, et al. Imposter syndrome and medical student burnout. Med Educ Online. 2020;25(1):174–180.
21. Janka A, et al. Professional identity formation and impostor feelings among healthcare students. Adv Health Sci Educ Theory Pract. 2019;24(5):909–922.
22. Sondergaard H, et al. Imposters in training: Age-related impostor feelings in clinical trainees. Clin Teach. 2021;18(1):32–38.
23. Ewing KM, Richardson TQ, James-Myers L, Russell RK. The relationship between racial identity attitudes, world view, and African American graduate students’ experience of the imposter phenomenon. J Black Psychol. 1996;22(1):53–66.
24. Vergauwe J, et al. Fear of failure and perfectionism as predictors of impostor feelings. Pers Individ Dif. 2015;82:27–33.
25. Neff KD. Self-compassion and impostorism. Self-Identity. 2011;10(2):196–207.
26. Armstrong MJ, et al. Gender differences in impostorism among health students. Med Educ. 2018;52(3):296–304.
27. Gadsby R. Imposter phenomenon during transitional training years. Nurs Educ Today. 2020;89:104–108.
28. Frajerman A, Morvan Y, Krebs MO, Gorwood P, Chaumette B. Burnout in medical students before residency: A systematic review and meta-analysis. Eur Psychiatry. 2019;55:36–42.
29. Dyrbye LN, Thomas MR, Shanafelt TD. Medical student distress: Causes, consequences, and proposed solutions. Mayo Clin Proc. 2005;80(12):1613–1622.
30. Beiter R, et al. The prevalence and correlates of stress, anxiety, and depression in college students. J Affect Disord. 2015;173:90–96.
31. Zanchetta C, et al. Academic stress and impostor phenomenon among university students. J Educ Psychol. 2020;112:213–225.
32. Cope V, Ward P. Self-efficacy and impostor feelings in nursing students. J Clin Nurs. 2012;21(7–8):1102–1110.
33. Oriel K, Plane MB, Mundt M. Family medicine residents and impostor feelings. Fam Med. 2004;36(4):248–252.
34. Legassie J, Zibrowski EM, Goldszmidt MA. Residents’ Impostor Phenomenon and burnout. Med Educ. 2008;42(10):1037–1044.
35. McGregor L, Elliot AJ. Achievement goals and impostor phenomenon. J Res Pers. 2005;39:470–486.
36. Sakulku J, Alexander J. The impostor phenomenon. J Behav Sci. 2011;6(1):75–97.
37. Tigranyan G, et al. Identity formation and impostor feelings among healthcare trainees. Teach Learn Med. 2019;31(4):410–417.
38. Vaughn LM, et al. Stress and academic performance among healthcare students. Adv Med Educ Pract. 2020;11:657–666.
39. Hutchins HM, Rainbolt H. What triggers impostor phenomenon in women leaders? J Leadersh Stud. 2017;11(3):14–25.
40. Harvey V, Katz C. The impostor phenomenon in high-achieving women. Psychol Women Q. 1985;9(1):34–45.