Maladaptive Perfectionism, Impostorism, and Cognitive Distortions: Threats to the Mental Health of Pre-clinical Medical Students
While medical student wellness has been a subject of recent study and discussion, current efforts may fail to address possible underlying, harmful cognitive distortions regarding academic performance. The authors sought to examine dysfunctional thoughts (maladaptive perfectionism, impostor phenomenon) and negative feelings (shame, embarrassment, inadequacy) that may contribute to poor mental health in pre-clinical medical students.
A survey was administered to first-year medical students at Saint Louis University that included assessments for maladaptive perfectionism, impostor phenomenon, depression, and anxiety, as well as questions about feelings of shame, embarrassment, inadequacy, comparison, and self-worth.
A total of 169 students (93%) participated. Students who met criteria for maladaptive perfectionism were significantly more likely to report greater feelings of shame/embarrassment and inadequacy (P < 0.001) than their peers who did not; similar associations were observed in students who reported high/intense levels of impostor phenomenon (P < 0.001). Furthermore, students who reported feelings of shame/embarrassment or inadequacy were significantly more likely to report moderate/severe levels of depression symptoms (P < 0.001) and moderate/high levels of anxiety symptoms (P = 0.001) relative to students who did not report these negative feelings.
These preliminary data support a model for how negative thoughts may lead to negative emotions, and depression and anxiety in medical students. The authors propose strategies for preventive interventions in medical school beginning in orientation. Further research is needed to develop targeted interventions to promote student mental health through reduction of cognitive distortions and negative feelings of shame, embarrassment, and inadequacy.
KeywordsLearner well-being Medical education Shame Perfectionism
Compliance with Ethical Standards
On behalf of all authors, the corresponding author states that there is no conflict of interest.
The included study was approved by the Saint Louis University institutional review board. All study participants underwent an informed consent process to collect confidential responses.
- 3.Daye D. Association of American Medical Colleges. Student wellness initiatives compiled from the AAMC OSR 2013. https://www.aamc.org/download/351946/data/studentwellness.pdf. Accessed 24 June 2018.
- 4.Association of American Medical Colleges. Number of medical schools using selected grading systems in pre-clerkship courses. https://www.aamc.org/initiatives/cir/406418/11.html. 23 November 2017.
- 5.Association of American Medical Colleges. MCAT scores and GPAs for applicants and matriculants to U.S. medical schools, 2016–2017. https://www.aamc.org/download/321494/data/factstablea16.pdf. Published December 2016. Accessed 23 November 2017.
- 6.Bruni F. Where you go is not who you’ll be: an antidote to the college admissions mania. New York: Grand Central Publishing; 2015.Google Scholar
- 9.Spielberger CD, Gorsuch RL, Lushene R, Vagg PR, Jacobs GA. Manual for the State Trait Anxiety Inventory (Form Y). Palo Alto: Consulting Psychologists Press; 1983.Google Scholar
- 10.Enns MW, Cox B. The nature and assessment of perfectionism: a critical analysis. In: Flett GL, Hewitt PL, editors. Perfectionism: theory, research, and treatment. Washington, DC: American Psychological Association; 2002.Google Scholar
- 15.Chand SP, Chibnall JT, Slavin SJ. Cognitive behavioral therapy for maladaptive perfectionism in medical students: a preliminary investigation. Acad Psychiatry. 2017:1–4.Google Scholar