Global prevalence of impostor phenomenon in medical students: A systematic review and meta-analysis

Introduction: Impostor phenomenon (IP) is a psychological phenomenon in which successful individuals fail to internalize their achievements and fear being exposed as “incompetent.” Medical students may be particularly vulnerable to IP because medical training combines repeated high-stakes assessment, competitive peer comparison, hierarchical clinical supervision, and rapid professional identity transition, potentially affecting psychological well-being and academic performance. Objective: To estimate the global prevalence of IP in pre-licensure medical students and analyze differences by sex, academic stage, and geographic region. Methods: A systematic search was conducted in MEDLINE/PubMed, Scopus, Web of Science, and EMBASE, including studies published between January 1, 2000, and June 30, 2025. Observational studies reporting IP prevalence in pre-licensure medical students using validated instruments were selected. Pooled prevalences were calculated using random-effects meta-analysis, with subgroup analyses and meta-regression by publication year. Results: Thirty-five studies were included for qualitative synthesis, with 26 studies (n = 9,110 students) employing the Clance Impostor Phenomenon Scale (CIPS) included in the primary meta-analysis. The global CIPS-based prevalence was 54.2% (95% CI: 47.0%−61.3%) with high heterogeneity (I² = 98%). Studies using probabilistic sampling (n = 4) reported 36.5% prevalence, while non-probabilistic sampling (n = 22) yielded 57.5%. Prevalence was similar between women (50.5%) and men (47.1%), and between preclinical (48.9%) and clinical (46.8%) students. The highest rates were observed in the United Arab Emirates (89.5%), Canada (75.8%), and the United Kingdom (66.0%), while Peru presented the lowest estimate among CIPS studies (30.6%). Meta-regression showed no significant temporal trend from 2018–2024 (β = 0.0221, p = 0.1747). Conclusions: IP was frequent among pre-licensure medical students, although pooled estimates should be interpreted cautiously because heterogeneity was substantial and prevalence varied by sampling method and geographic context. These findings support the need for standardized measurement, probabilistic sampling when feasible, longitudinal research, and rigorously evaluated interventions addressing both individual coping and institutional educational practices.