Prevalence of self-esteem and imposter syndrome and their associated factors among king saud university medical students

Lara Alsaleem; Nada Alyousef; Zaina Alkaff; Lujane Alzaid; Reema Alotaibi; Shaffi Ahamed Shaik

doi:10.4103/jnsm.jnsm_167_20

ORIGINAL ARTICLE

Year : 2021 | Volume : 4 | Issue : 3 | Page : 226-231

Prevalence of self-esteem and imposter syndrome and their associated factors among king saud university medical students

Lara Alsaleem, Nada Alyousef, Zaina Alkaff, Lujane Alzaid, Reema Alotaibi, Shaffi Ahamed Shaik
Department of Family and Community Medicine, King Saud University, Riyadh, Saudi Arabia

Date of Submission	13-Dec-2020
Date of Decision	21-Mar-2021
Date of Acceptance	16-Apr-2021
Date of Web Publication	26-Jul-2021

Correspondence Address:
Shaffi Ahamed Shaik
Professor of Biostatistics & Consultant Epidemiological Biostatistician, Department of Family & Community MedicineCollege of MedicineKing Saud University, P.O.Box: 7065, Riyadh 11461
Saudi Arabia

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jnsm.jnsm_167_20

Abstract

Objectives: Our objectives are to estimate the prevalence of self-esteem and imposter syndrome, to compare their prevalence between genders and different academic years, and to determine their associated factors among King Saud University (KSU) medical students. Methods: Our study is a quantitative analytical cross-sectional study. Data were collected on the KSU campus. Participants in this research are KSU medical students including males and females from 1^st to 5^th year, with a sample size of 502. A stratified random sampling design was used. Data were collected through a self-administered questionnaire that includes the Young imposter scale, Rosenberg self-esteem scale, and sociodemographic factors. Results: The prevalence of low self-esteem and positive imposter syndrome is 23.6% and 42.1% (n = 573), respectively. There is a positive correlation between low self-esteem and positive imposter syndrome. There is a significant association between self-esteem and gender, mother's education, and Grade Point Average (GPA). Imposter syndrome is significantly associated with gender. Conclusion: Low self-esteem and positive imposter syndrome are prevalent among medical students, especially in the first few years and particularly in female students. These issues affect the mental health of medical students and thus need to be addressed to possibly improve the educational system.

Keywords: Imposter syndrome, medical students, Saudi Arabia, self-esteem

How to cite this article:
Alsaleem L, Alyousef N, Alkaff Z, Alzaid L, Alotaibi R, Shaik SA. Prevalence of self-esteem and imposter syndrome and their associated factors among king saud university medical students. J Nat Sci Med 2021;4:226-31

How to cite this URL:
Alsaleem L, Alyousef N, Alkaff Z, Alzaid L, Alotaibi R, Shaik SA. Prevalence of self-esteem and imposter syndrome and their associated factors among king saud university medical students. J Nat Sci Med [serial online] 2021 [cited 2023 Mar 27];4:226-31. Available from: https://www.jnsmonline.org/text.asp?2021/4/3/226/322324

Introduction

The Cambridge dictionary defines self-esteem as belief and confidence in your own ability and value. High self-esteem has been proven to have an effect on humans. These effects include better performance in certain jobs, being able to pick one's strategy, and doing better when working with a group. Self-esteem is vitally important in medical school. Medical students face many stressors including the pressure to meet the expectations of their families or themselves. As medical students are high achievers who have succeeded academically, medical school can be a huge shock that results in low self-esteem. This can manifest itself as imposter syndrome, which, according to the Harvard Business Review, can be defined as “the feeling of inadequacy that persists despite evident success.” In our research, we chose medical students because, as medical students, we know that the medical school is demanding, and having low self-esteem and imposter syndrome would affect the students negatively.^[1]

A study conducted in Riyadh, Saudi Arabia, found that 17% of Saudi women have low self-esteem.^[2] For medical and dental students in Saudi Arabia, the rate of low self-esteem is even higher at 23.4%. Low self-esteem among medical and dental students has an association with an increase in stress, depression, and anxiety.^[3] Self-esteem does not differ between male and female medical and dental students. Various studies have found a positive correlation between self-esteem and academic performance. In Pakistan, a study was conducted on eighty university students with an equal number of males and females to determine the association between self-esteem and academic performance using the Rosenberg self-esteem scale and Academic Performance Rating Scale. The results indicate a strong positive correlation between self-esteem and academic achievement (r = 0.879, P < 0.01).^[4] Furthermore, it is indicated that high levels of self-esteem lead to satisfactory academic performance.

A cross-sectional study using the Clance Imposter Phenomenon Scale conducted in Malaysia on 256 medical students found that 45.7% (117) of the participants who completed the questionnaire scored as having imposter syndrome. Of those 117, 48% are males and 44% are females, which indicate that there is no significant difference between the genders in having imposter syndrome. It is also evident that imposter syndrome is positively correlated with self-esteem, by which those who scored as having imposter syndrome had low self-esteem.^[5] This topic is not well researched within our region, especially not at our university (King Saud University [KSU]). Our study aimed to measure the prevalence of self-esteem and imposter syndrome, compare their prevalence between genders and different academic years, and determine the factors associated with self-esteem and imposter syndrome. The participants completed an online questionnaire containing both the Rosenberg self-esteem scale and Young impostor scale to fulfill our objectives.

Methods

This study is a quantitative analytical cross-sectional study, and it was conducted among medical students at the KSU campus between September 2018 and March 2019. We included both male and female KSU medical students during their 1^st, 2^nd, 3^rd, 4^th, and 5^th years of medical school, and we had no exclusion criteria.

A previous study, “Imposter syndrome and burnout among American medical students: a pilot study,”^[6] revealed that 49.4% of female medical students and 23.7% of male medical students have imposter syndrome. Using the single proportion sample size calculation formula, a sample size of 385 or 278, respectively, was required, with a confidence level of 95% and a precision of 5%. From these numbers, we chose to collect information from 385 students, as a higher sample size provides more reliable and precise results. Considering the 30% nonresponse rate, which is 116 samples, our sample size was calculated as 116 + 385 = 501. To compare males to females, we distributed the sample size equally between them: 251 male KSU medical students and 251 female KSU medical students. In doing so, we reached a total sample size of 502; the extra participant is to obtain an equal representation of the strata.

A stratified random sampling design was used. The students were divided into five groups for each academic year and then grouped as females and males. E-mails with the questionnaire were sent to all groups including a consent form. Identities of the students were kept anonymous to eliminate response bias. IRB approval number CMED 305-F3-2018-19 was obtained on November 29, 2018 due to compliance to the ethical standards of the IRB Committee for CMED 305 Research Projects. The research adhered to the ethical guidelines of the Declaration of Helsinki.

Data on imposter syndrome were collected by a self-administered questionnaire using the Young imposter scale, in which a score above 40 is an indication of intense imposter syndrome. In addition, data on self-esteem were collected using the Rosenberg self-esteem scale, which is a ten-item scale. Each statement on the scale is answered with strongly agree, agree, disagree, or strongly disagree. The scale ranges from 0 to 30, in which scores between 15 and 25 are considered normal, and scores below 15 indicate low self-esteem. Additional sociodemographic factors were included in the questionnaire: academic performance (GPA), socioeconomic status (monthly income), and family influence (family members who are doctors). Both the Young imposter scale and the Rosenberg self-esteem scale are reliable, as they are adapted without alteration from previously published research studies, “Imposter Syndrome among Pakistani Medical Students” and “Society and the Adolescent Self-Image.”^[4],[7]

In this research, no pilot study was needed, since all the instruments used are validated scales. They have been used in many other cross-sectional studies regarding self-esteem and imposter syndrome with similar populations.

Data were analyzed using SPSS version 24.0 statistical software, (IBM Corp., Armonk, New York, United States).Descriptive statistics (mean, standard deviation, frequencies, and percentages) were used to describe the quantitative and categorical variables. Bivariate statistical analysis was carried out using appropriate (Chi-square) statistical tests, based on the type of study and outcome variables. A P <0.05 and 95% confidence interval were used to report the statistical significance and precision of the results.

This study did not expose any of the participants to physical or psychological harm. Respondents' dignity was our priority, and all responses were respected. Participation in this study was voluntary, and respondents had the right to withdraw at any time. Before completing the questionnaire, written informed consent was obtained, revealing the purpose of the study and ensuring the privacy and confidentiality of all entered information will be protected, kept safely, and only used to fulfill the study's purposes.

Results

In this study, 573 students with a mean age of 21.27 (1.558 standard deviations) participated. Several sociodemographic characteristics were measured among the KSU medical students: Gender, monthly family income, the father's educational level, the mother's educational level, and GPA [Table 1]. In our study, 23.4% (134) of the participants were 1^st-year medical students; 53.2% (305) of the participants were males, while 46.8% (268) were females. Regarding monthly family income, 65.1% (373) have a monthly family income of >20,000 Saudi Riyal ($5332.68). For both the father's and mother's educational levels, a bachelor's degree was the most common with 41.5% (238) and 42.1% (241), respectively. Students with a GPA of >4.5 responded the most with a percentage of 46.9% (269 students).

Table 1: Sociodemographic characteristics of King Saud University medical students (n=573)

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The prevalence of self-esteem and imposter syndrome was measured among KSU medical students as well as their association [Table 2]. Results reveal that the prevalence of low, normal, and high self-esteem is 23.6%, 64.9%, and 11.5% (135, 372, and 66 students). As for the presence of imposter syndrome, our results report that 42% (241) of medical students experience imposter syndrome. A significant association was found between imposter syndrome and self-esteem (P < 0.0001). Whereas only 2.1% (5) of students with high self-esteem are positive for imposter syndrome, 42.3% (102) of students with low self-esteem are positive for imposter syndrome.

Table 2: Prevalence of self-esteem and imposter syndrome among King Saud University students and its association (n=573)

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The association of sociodemographic characteristics with levels of self-esteem was measured [Table 3] and reveal that the variables of gender, mother's educational level, and GPA are associated with self-esteem; the association is statistically significant (P < 0.0001, P = 0.032, and P = 0.021, respectively). Out of the six measured variables, three have a direct association with the level of self-esteem among medical students at KSU.

Table 3: Association of categorical study variables with levels of self-esteem (n=573)

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The association of sociodemographic characteristics with imposter syndrome was measured [Table 4]. The only association found was with the gender of the student, which was statistically significant (P < 0.0001). The remaining variables were found statistically insignificant; therefore, no other association with positive imposter syndrome among students was indicated.

Table 4: Association of categorical study variables with imposter syndrome (n=573)

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Discussion

Our study aimed to measure the prevalence of low self-esteem and imposter syndrome among male and female medical students at KSU. We also wanted to determine whether sociodemographic factors, such as gender and socioeconomic status, had any correlation with the outcome of the study. In addition, we were interested to learn if low self-esteem correlated directly with the prevalence of imposter syndrome among students.

Our study revealed that the prevalence of low self-esteem among medical students is 23.6%. As for imposter syndrome, 42% of the medical students were found positive.

Regarding sociodemographic characteristics, three of the six measured variables had an association with the outcome of the study and were statistically significant. These factors were the mother's educational level, gender, and GPA.

Students with a lower mother's level of education had lower self-esteem, as 34% of students whose mothers had an educational level of a diploma or below had low self-esteem. This aligns with the findings of a study conducted in Turkey, in which a mother's educational level had a significant association with the level of the student's self-esteem.^[8]

Gender also had a significant association with the prevalence of low self-esteem, as female students had a higher prevalence of low self-esteem than did their male counterparts. In females, 32.2% had low self-esteem. This does not correlate with a study that was performed in Saudi Arabia that found no association with gender, as male and female dental students had similar outcomes.^[3] However, a 2016 article supports our findings that gender plays a role in the level of self-esteem.^[9] The same results were also obtained in a study that aimed to translate into Spanish and validate the Rosenberg self-esteem scale.^[10]

Our study also correlated with a study performed in Pakistan and other studies that aimed to understand the effect of self-esteem on academic performance, in which academic performance had a significant positive association with the level of self-esteem among university students.^{[4],[11],[12],[13]} This was also true in our study, as the GPA has an association with the level of self-esteem.

Regarding imposter syndrome, our study measured a prevalence of 42.1% and a positive association with gender. Female students are more likely to experience imposter syndrome than their male colleagues are. This was also found in a study conducted in the USA, in which 49.4% of female students had imposter syndrome compared to 23.7% of male students. Another study conducted in the US found more than double the number of females displayed imposter syndrome than their male counterparts.^[6]

Finally, our study indicates a significant association between low self-esteem and imposter syndrome (P < 0.0001). Students with low self-esteem are more likely to experience imposter syndrome, as 42.3% of students with low self-esteem had imposter syndrome. This correlates with a study conducted in Malaysia that found a positive association between low self-esteem and imposter syndrome.^[5] A negative correlation between low self-esteem and imposter syndrome was found by a study conducted in Iran.^[14]

As for limitations, the first was the initial lack of response because the surveys were sent through E-mail; a solution for this would be interviews with the participants or paper-based surveys. Another limitation was that our study lacked a psychological aspect. Psychological illness may be of significance to the outcome, and previous studies have included mental illness and its effect on self-esteem and imposter syndrome.^[15] Future studies may address psychological disorders in the surveys to solve this issue. Furthermore, a 2007 study indicated that a person's body mass index (BMI) can affect his or her level of self-esteem.^[16] We did not include BMI as a parameter in our study, and we recommend future studies include it.

Conclusion

Self-esteem plays an important role in shaping human personality and self-image and can affect people's behaviors and contributions to the society. We recommend raising awareness of the importance of self-esteem and its impact on an individual's level of productivity in the community, by conducting friendly motivational talks targeted toward students to help them identify low self-esteem and boost their self-confidence before it interferes with their career goals. We believe that the results of our research can help students from a variety of majors with identifying the factors that contribute to self-esteem and imposter syndrome.

Acknowledgments

We would like to thank the Community and Family Medicine Department; the completion of this research would not have been accomplished without their cooperation; we are very grateful for their help and teaching.

Glossary Terms

Imposter syndrome: Defined by the Harvard Business Review as “the feeling of inadequacy that persists despite evident success”(Corkindale 2008).

Financial support and sponsorship

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Deanship of Scientific Research at KSU through the Undergraduate Student's Research Support Program, Project number (URSP-4-19-67).

Conflicts of interest

There are no conflicts of interest.

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