At the heart of the debate lies a conceptual tension that will be familiar to anyone who studies mental health measurement. The Impostor Phenomenon, the persistent feeling that one’s accomplishments are undeserved and that one is a fraud despite evidence of competence, is not a diagnosis in the way that, say, major depressive disorder is. It is conceptually a continuous construct, distributed along a spectrum across the population. Critics argue that applying the epidemiological language of prevalence to such a construct is conceptually incorrect, because prevalence traditionally refers to the proportion of a population that has a categorical condition. You either have an infection or you do not; you cannot, in the same strict sense, have a fraction of impostorism.

Salari and colleagues do not dispute this premise. In their response, they explicitly agree that the Impostor Phenomenon is continuous and that referring to its prevalence in the strict epidemiological sense may be conceptually wrong. But they argue that this does not rule out threshold-based prevalence estimates, and they point to well-established precedents. Depression and anxiety are also conceptualized as continua, yet researchers routinely estimate their prevalence using instruments such as the PHQ-9 for depression and the GAD-7 for anxiety, which employ empirically derived thresholds to classify individuals above a cutoff. In those fields, decades of validation work have established which scores correspond to clinically meaningful impairment, giving the thresholds legitimacy. The question the exchange raises is whether the Impostor Phenomenon field has earned the same privilege.

The instrument in question is the Clance Impostor Phenomenon Scale, or CIPS, a questionnaire that yields a continuous score of impostor feelings. Primary studies included in the meta-analysis reported the percentage of health service providers scoring above various cutoffs on this scale, effectively equating the proportion of high scorers with prevalence. Salari’s team then pooled those reported proportions into a single estimate. Here the authors make a striking concession: they fully acknowledge that the current cutoffs for the CIPS are inconsistently applied across the existing literature and lack systematic validation. Different studies have used different thresholds, sometimes without empirical justification, meaning that two studies of identical populations could report wildly different prevalence figures depending solely on where they drew the line.

This is precisely the point Brauer and Proyer drove home with an empirical demonstration. By applying six different cutoffs to the same datasets, they showed that the resulting proportions of cases diverged dramatically. They also argued that the extremely high heterogeneity in the meta-analysis, quantified by an I-squared statistic of 98.6 percent, is evidence that pooling prevalence rates in the first place is invalid. In meta-analysis, I-squared describes the percentage of variation across studies that is due to real differences rather than chance; a value near 100 percent means the studies are barely measuring the same thing. To the critics, pooling estimates from studies that use incompatible thresholds produces a number that means little.

Salari and colleagues offer a different reading of that statistic. In their view, the high heterogeneity is itself an important empirical finding, a quantitative portrait of a literature that has operationalized its central construct inconsistently. Meta-analysis, they argue, is precisely the tool that allows researchers to measure and expose this problem, highlighting how different thresholds, samples, and instruments contribute to variance. Without such a synthesis, the field would lack any systematic appreciation of how widely prevalence estimates diverge. They also note that some of the cutoffs applied in the critics’ demonstration were arbitrary and drawn from two convenience datasets that are not population-representative, which they contend artificially inflates the apparent instability and should not be generalized to broader populations. Demonstrating variability across arbitrary thresholds, they write, does not invalidate prevalence research; it underscores the need for consensus and validation studies.

The exchange also touches on a provocative interpretive question. Brauer and Proyer suggested that if 62 to 70 percent of individuals report impostor feelings, as some estimates imply, then the experience should perhaps be regarded as normative rather than pathological. The Salari team counters that high prevalence does not imply triviality. They draw an analogy to physician burnout, which large systematic reviews have shown to be reported by a strikingly high proportion of doctors, yet which has clear and consequential implications for health care delivery. Similarly, they argue, impostor feelings, even if common, are associated with impaired well-being, reduced job satisfaction, and elevated burnout risk. Prevalence estimates, on this view, remain useful for scoping the potential consequences of a widespread experience, regardless of whether it is labeled a disorder.

Notably, the authors point out that their original review contained findings that survive the critique largely intact. Beyond the contested prevalence figures, the meta-analysis summarized correlations between impostor feelings and constructs such as self-esteem, anxiety, depression, stress, and burnout. Because those analyses used continuous scores rather than categorical cutoffs, they are conceptually reliable and less dependent on the threshold decisions that lie at the center of the dispute. This distinction matters for the field’s future direction: the relational findings, which describe how impostorism moves alongside other psychological variables, rest on firmer measurement ground than the headline prevalence numbers.

The response also ventures into a broader reflection on the nature of psychological measurement itself. The authors observe that screening tools for mental health conditions inevitably involve trade-offs, with all instruments producing false positives and false negatives, and that different thresholds can be deployed to compensate for these limitations and optimize screening performance. A screening tool, they emphasize, is not a diagnosis; it flags individuals for further clinical attention. Their stated goals in examining the Impostor Phenomenon were twofold: to draw attention to a condition that has received comparatively little scrutiny, and to provide clinicians with usable information. On that view, the very act of publishing a contested prevalence estimate, and engaging publicly with its critics, serves the scientific process by forcing the field to confront how much its conclusions depend on arbitrary measurement decisions.

Where does this leave the science of feeling like a fraud? The two sides converge more than the heated framing might suggest. Salari’s team agrees that any prevalence estimates should be presented with caution and explicit caveats until robust validation studies are conducted, and they endorse the critics’ implicit agenda: large-scale validation of CIPS thresholds against external criteria, studies using population-representative samples rather than convenience datasets, and community-wide consensus on cutoff standards, modeled on the practices that stabilized depression and anxiety research. The meta-analysis, they argue, does not endorse any single cutoff but documents the consequences of their inconsistency, functioning as a warning, while the commentary supplies the conceptual framework for understanding that warning. Both papers, read together, point toward the same next steps. For the millions of health care workers who quietly doubt their own competence, the practical takeaway is unchanged: the feelings are real, common, and linked to burnout. But for researchers hoping to put a single trustworthy number on how many people experience them, the message from this exchange is clear: the field first needs to agree on where the line should be drawn, and then prove that the line means something.

Subject of Research: Methodological debate over estimating prevalence rates of the Impostor Phenomenon using the Clance Impostor Phenomenon Scale

Article Title: Response to: Matters Arising from Salari et al. (2025): Why it is (currently) impossible to estimate accurate prevalence rates of the Impostor Phenomenon

Article References: Salari, N., Hashemian, S. H., Hosseinian-Far, A., Fallahi, A., Heidarian, P., Rasoulpoor, S., & Mohammadi, M. (2026). Response to: Matters Arising from Salari et al. (2025): Why it is (currently) impossible to estimate accurate prevalence rates of the Impostor Phenomenon. BMC Psychology, 14(1), Article 1400. https://doi.org/10.1186/s40359-026-05555-6

Image Credits: AI Generated

DOI: 10.1186/s40359-026-05555-6

Keywords: Impostor Phenomenon, prevalence, meta-analysis, Clance Impostor Phenomenon Scale, CIPS cutoffs, heterogeneity, psychological measurement, health service providers, burnout, screening thresholds, BMC Psychology, validation studies

The album, largely conceived by bassist and lyricist Roger Waters, follows Pink, a rock musician who erects an imaginary wall brick by brick, each brick a loss, a humiliation or a costly adaptation: a father killed in the Second World War, an overprotective mother, an authoritarian teacher, the loneliness of fame. The story is partly autobiographical — Waters modeled the protagonist on himself and the dead father on his own. When the wall is complete, Pink is protected from everything and incapable of genuine contact. The narrative arc is cumulative and non-linear, assembling apparently disconnected events that only in retrospect reveal a logic of construction, a structure the author compares directly to the trajectory of professional formation. Each brick, he writes, is a unit of undeclared learning.

The conceptual anchor of the essay is the scholarship on the hidden curriculum, formalized by Frederic Hafferty and Ronald Franks in the 1990s. They proposed that medical schools teach through three simultaneous registers: the formal curriculum that institutions declare, the informal curriculum learned in everyday interactions outside structured spaces such as corridors and rounds, and the hidden curriculum transmitted through institutional culture — unwritten policies, implicit assessment criteria, resource allocation and the rituals regulating professional belonging. The hidden register is the hardest to reform precisely because it operates without its agents recognizing it as teaching. Reforms confined to the formal curriculum are necessary but insufficient, the author notes, when they do not address what operates beneath the surface. One of the phenomenon’s most-cited formulations, from William Gofton and Glenn Regehr, holds that the hidden curriculum is what teachers teach without knowing they teach and what students learn without knowing they learn.

Among the best-documented effects of this silent pedagogy is the erosion of empathy. A longitudinal study by Mohammadreza Hojat and colleagues found that empathy scores decline from the third year of medical school onward — when clinical activity with real patients begins — and continue falling through residency. The finding is contested: other researchers argue the decline is largely an artifact of self-report measurement and is small or absent in many countries. The essay adopts the concept with caution, emphasizing that the training environment acts upon empathy regardless of its measured trajectory. What distinguishes psychiatric training, the author argues, is the nature of its clinical material — delusion, suicidality, abuse, psychotic disorganization — and a peculiar reflexive bind: psychiatrists are trained to recognize in others precisely what they learn not to recognize in themselves. The unsaid lesson is that this material must be borne without the personal cost being named, and that naming the cost may be read as fragility rather than reflective competence.

The essay then maps four moments of the album onto four bricks of psychiatric formation. The first, drawn from the tracks Mother and The Thin Ice, concerns what students carry before they arrive. The literature documents a recurrent profile among medical entrants: high perfectionism, identity organized around performance, and an early relation to caring for others that precedes the choice of profession. The parentified child — who learns early that their value lies in caring — enters a profession organized around care and rediscovers a familiar position. Medicine does not create the compulsive caregiver; it inherits them. In psychiatry, the dynamic deepens, because specialty choice is rarely random: trainees who excel intellectually while carrying significant psychic suffering are more common than institutions perceive, and what is rarely asked is whether the brilliance exists despite the pain or because of it.

The second brick comes from the album’s school tracks and describes teaching by humiliation. The cruel teacher in the album teaches no content; he teaches that humiliation can be constitutive of the pedagogical relation and that bearing it is the price of belonging. In medical education the mechanism has a name in the literature, but the author insists Waters captures what empirical accounts describe: the cumulative effect. No single episode of humiliation builds the wall; the repetition does, each apparently innocuous episode adding to the last. A specific variant appears in psychiatric training: the supervisor who interviews an emergency-room patient without privacy never explicitly teaches that privacy is dispensable, yet the observing student learns both the interview technique and the silent, durable norm that certain conditions are tolerable.

The third brick, from Comfortably Numb, offers a phenomenology of depersonalization. In the narrative, Pink stops feeling — not by decision but by exhaustion, arriving at something that looks like peace and is anesthesia. The educational correlate is burnout, and particularly the depersonalization central to Christina Maslach’s account: an emotional distancing that lets the professional keep functioning. Those who numb do not decide to stop feeling; they stop because the environment teaches, without saying so, that feeling is an obstacle to efficiency. The essay’s sharpest observation here is the contradiction the formation produces: a psychiatrist who identifies dissociation in a patient but does not perceive their own depersonalization as a response to the work — clinical competence and personal blindness in the same person.

The fourth brick, from the album’s closing sequence The Trial, resonates with disproportionate self-criticism and the impostor phenomenon, widely documented among students and residents: not merely the feeling of inadequacy but the conviction that others will eventually discover the fraud. The concept has been justly criticized for individualizing what is structural, locating in the trainee a fault that belongs to the culture producing it. That criticism, the author writes, is the essay’s point: the self-judgment is a brick laid by the environment, internalized until it feels like one’s own. He is careful to add that none of this is destiny — the same hidden curriculum transmits much that is good, and many learners emerge determined not to repeat it. The most personal section of the essay discloses that the author himself stopped teaching the class in 2020, during the pandemic, describing what clinical language calls experiential avoidance: unelaborated personal material was being repeatedly enacted in front of students, and at some point the cost of re-exposure exceeded what he could sustain. He draws on Ronaldo Cassorla’s concept of enactment — unsymbolized emotional material acted out rather than thought — and observes that an educator withdrawing from a subject without explanation teaches students, silently, that certain subjects disappear from the curriculum for invisible reasons. That, too, is a brick.

What can be done? The essay is deliberately modest about dismantling and emphasizes the patient work of opening breaches. Formal curricular reform is necessary but not sufficient; the next step is institutional conditions in which what is felt during training can be said — not as complaint but as formative data. Balint groups, reflective portfolios and formative supervision are not new; what determines whether they work is the culture that sustains them. A portfolio read with care and answered with feedback is a device of elaboration, while a portfolio filled in by obligation and ignored is another brick. Within such spaces, art can accomplish what no didactic lecture on professional distress can: it lets the subject recognize themselves without feeling diagnosed. Drawing on Parker Palmer’s idea of a third thing, introduced into medical education by Elaine Gaufberg and colleagues, the author describes The Wall as an oblique mirror that shows what is felt without demanding it be said. He also invokes institutional enactment — the collective acting-out of unthought material transmitted between generations of formators — to argue that reform demands educators recognize the wall built in themselves, and that institutions make such recognition possible. The album ends not with triumph but with the fragile voices outside the wall; in medical education, the author concludes, those voices are the students who write in portfolios what they actually felt, the faculty who admit that the material affects them, and those who ask how someone else is and wait for the real answer.

Subject of Research: The use of Pink Floyd's The Wall as a phenomenological model of the hidden curriculum in psychiatric and medical education

Article Title: Another Brick in the Wall: Pink Floyd’s The Wall as a Phenomenological Model of the Hidden Curriculum in Psychiatric Education

Article References: dos Santos Júnior, A. (2026). Another Brick in the Wall: Pink Floyd’s The Wall as a Phenomenological Model of the Hidden Curriculum in Psychiatric Education. Academic Psychiatry. https://doi.org/10.1007/s40596-026-02423-8

Image Credits: AI Generated

DOI: 10.1007/s40596-026-02423-8

Keywords: hidden curriculum, medical education, psychiatric training, Pink Floyd, The Wall, empathy decline, burnout, depersonalization, impostor phenomenon, teaching by humiliation, educator distress, medical humanities

Impostor phenomenon, first described by psychologists Pauline Rose Clance and Suzanne Imes in 1978, is not a formal psychiatric diagnosis but a well-documented psychological experience. People affected by it attribute their achievements to luck, timing, or deception rather than skill, and they live in fear that colleagues will eventually discover their supposed incompetence. In healthcare settings, the stakes of this pattern are considerable. Clinicians who doubt themselves may hesitate in decision-making, avoid seeking feedback, experience burnout, and disengage from professional growth. Early-career health professionals are considered especially vulnerable because they are navigating the demanding transition from supervised student to autonomous practitioner, a shift that confronts them with novel responsibilities, uncertain competence, and constant evaluation.

The research team, led by Fathimath Hisana and colleagues in the Department of Occupational Therapy at Yenepoya Faculty of Allied and Healthcare Professions, set out to measure how intensely impostor phenomenon affects occupational therapists in India with fewer than two years of clinical experience, and to identify the personal, occupational, and environmental factors that these professionals themselves believe drive the experience. The study recruited 100 participants through snowball sampling, a technique in which initial respondents refer additional eligible colleagues, a practical approach for reaching a dispersed professional population across the country.

Methodologically, the survey was built around the Leary Impostorism Scale, a widely used twenty-item instrument that asks respondents to rate statements about impostor-type feelings on a scale from ‘not at all true’ to ‘very true.’ Scores on this instrument place individuals along a continuum of impostor intensity, from low through moderate to high. To capture the contextual drivers of these feelings, the researchers supplemented the scale with constructs drawn from the Canadian Model of Occupational Performance and Engagement, a foundational framework in occupational therapy that conceptualizes how personal, occupational, and environmental dimensions interact to shape a person’s engagement in meaningful activity. The questionnaire was validated by experts before deployment, and the analysis combined descriptive statistics with Mann-Whitney U tests, a non-parametric statistical method suited to comparing scores between two independent groups when data are not normally distributed, to examine how impostor scores varied across demographic and professional characteristics.

The headline finding is stark in its simplicity: 25 percent of the surveyed early-career occupational therapists reported impostor phenomenon in the moderate-high to high intensity range. That figure aligns with a broader pattern documented across health professions, where studies of physicians, nurses, and allied health workers have repeatedly found that a substantial minority of trainees and new practitioners experience clinically meaningful impostor feelings. What distinguishes the new study is its focus on occupational therapy, a profession in which practitioners help patients regain the functional capacity for everyday life, and its grounding in the specific professional and cultural context of India, where workforce conditions, supervision structures, and recognition patterns may differ substantially from the Western settings where most impostor research has been conducted.

One demographic difference stood out with statistical significance. Female participants scored significantly higher than male participants on the impostorism measure, with a Mann-Whitney U statistic of 594 and a p-value of 0.046, a result that just crosses the conventional threshold of statistical significance at the 0.05 level. This finding echoes a large body of international literature suggesting that women in medicine and academia report impostor feelings more frequently and intensely than men, a disparity often attributed to gendered expectations, underrepresentation in leadership, and differential patterns of feedback and recognition. By contrast, the study found no significant differences in impostor scores based on age, educational qualification, or length of experience within the early-career window, suggesting that within this cohort, the experience of impostorism is not simply a function of being newest to the job but is distributed across the first two professional years.

Perhaps the most practically valuable contribution of the study lies in its catalog of perceived contributing factors, which the researchers organized around personal, occupational, and environmental dimensions. The most frequently endorsed factor, cited by 36 percent of participants, was fear of being perceived as inexperienced, a concern that speaks directly to the identity transition at the heart of early professional life. Close behind, at 35 percent, was physical exhaustion, linking impostor feelings to the tangible toll of demanding clinical work and long hours. People-pleasing tendencies, reported by 32 percent, reflect a personality-oriented contributor in which practitioners prioritize others’ approval over self-assessment, a pattern long associated with impostorism in the psychological literature. Transitional challenges, endorsed by 31 percent, capture the disorientation of moving from student roles to independent practice, while pressure to collaborate, cited by 30 percent, points to the interpersonal demands of multidisciplinary healthcare teams where new therapists must hold their own alongside senior colleagues from other professions.

Environmental factors also registered prominently. Limited professional opportunities were endorsed by 27 percent of respondents, and lack of recognition by 26 percent, findings that situate impostor feelings not merely as individual psychological quirks but as experiences shaped by the structural realities of the Indian allied health workforce. Where career ladders are short, roles are poorly defined, or achievements go unacknowledged, even competent practitioners may internalize the message that their work lacks value. The authors emphasize that these findings highlight the multifactorial nature of impostor phenomenon among early-career occupational therapists, with contributions from personal, occupational, and environmental sources, and they call for future research to examine the relative weight of each factor so that interventions can be targeted effectively.

The study’s implications extend beyond occupational therapy. If a quarter of new practitioners in one allied health profession report intense impostor feelings, the same dynamics are likely operating across the wider early-career health workforce in India and comparable settings. The identified contributors suggest concrete points of intervention. Mentorship programs and structured onboarding could directly address fear of inexperience and transitional challenges. Workload management and attention to fatigue could reduce the exhaustion component. Recognition systems, transparent career pathways, and team cultures that normalize questions from junior members could chip away at the environmental drivers. Because the study used a cross-sectional design, it captures a snapshot rather than a trajectory, and its sample of 100 participants recruited through snowball sampling, while adequate for exploratory analysis, limits generalizability and prevents causal inference. Self-reported perceived factors, moreover, reflect what practitioners believe drives their feelings rather than empirically verified causes.

Nevertheless, the research adds an important and underexplored population to the global map of impostor phenomenon, and it does so with a theoretically grounded instrument that bridges individual psychology and the occupational science framework central to the profession itself. For the occupational therapists who participated, and for the many colleagues they represent, the study offers a validating message: the sense of being a fraud is common, measurable, and shaped by identifiable forces, which means it can be named, studied, and ultimately addressed. As health systems worldwide confront burnout and attrition among young clinicians, understanding the psychological weight of the transition to practice, and the gendered and structural conditions that amplify it, may prove as important to workforce sustainability as any recruitment strategy. The Yenepoya team’s findings provide a data-driven starting point for that conversation in India, and a template for similar investigations in other allied health professions and regions where impostorism remains an unmeasured burden.

Subject of Research: Impostor phenomenon intensity and its perceived contributing factors among early-career occupational therapists in India

Article Title: Intensity of Impostor Phenomenon and Perceived Contributing Factors among Early-career Occupational Therapists in India

Article References: Hisana, F., KVP, H. H., Mufeeda, F., Afnan, F., & Pandey, L. (2026). Intensity of Impostor Phenomenon and Perceived Contributing Factors among Early-career Occupational Therapists in India. Discover Social Science and Health. https://doi.org/10.1007/s44155-026-00480-w

Image Credits: AI Generated

DOI: 10.1007/s44155-026-00480-w

Keywords: impostor phenomenon, occupational therapists, early-career professionals, India, mental health, occupational health, self-efficacy, burnout, healthcare workforce, occupational therapy, gender differences, Leary Impostorism Scale