Objectives: The aims of this review, focused on medical students, residents, and physicians, were a) to determine the levels of perfectionism and prevalence of impostor phenomenon, b) to assess the relationship between perfectionism, impostor phenomenon, and mental health, and c) explore how medical culture may influence these personality characteristics.
Methods: A narrative literature review was conducted. Search terms were entered into PubMed, PsychINFO, Web of Science, EMBASE, and Google Scholar without date or geographic restrictions. The McMaster Critical Review Forms for Quantitative and Qualitative Studies were used for article appraisal. Final decisions on inclusion and exclusion were reached through discussion. Sixteen articles were included in this review and summarized in a data extraction table.
Results: Medical students had similar perfectionism scores to other student groups but scored lower in maladaptive perfectionism. The overall prevalence of the impostor phenomenon ranged from 22.5% to 46.6%. More females (41% - 52%) experienced clinical levels of impostor phenomenon compared to males (23.7% - 48%). Most studies did not find an association between the impostor phenomenon and academic year of training. Both personality characteristics were associated with negative mental health effects. Medical culture can train for and/or exacerbate these characteristics, affecting professional identity formation. Both characteristics contribute to distress for learners during commonly-used teaching methods in medical education.
Conclusions: Comprehensive changes in medical education that consider the relationship between medical culture, professional identity formation, impostor phenomenon, and perfectionism are needed. Longitudinal studies will help identify the implications of these findings for professional identity formation and medical education.
Extensive research has found the psychology of perfectionism to be rather complex. Yes, perfectionists strive to produce flawless work, and they also have higher levels of motivation and conscientiousness than non-perfectionists. However, they are also more likely to set inflexible and excessively high standards, to evaluate their behavior overly critically, to hold an all-or-nothing mindset about their performance. So while certain aspects of perfectionism might be beneficial in the workplace, perfectionistic tendencies can also clearly impair employees at work. Researchers combed through four decades of study on perfectionism to answer: Are perfectionists better performers at work? Taken as a whole, their results indicate that perfectionism is a much bigger weakness than many job applicants and interviewers probably assume.
Most of the studies we reviewed used one of three established scales of perfectionism. But there were some studies that used others. That said, virtually every study measured perfectionism by having individuals report their own perfectionistic tendencies.
Given there are a few different scales for perfectionism, there is not one definition of what it is. But there are characteristics of perfectionism that are mostly agreed upon, such as inflexibly high standards and an all-or-nothing mind set.
While these effects were consistently evident for perfectionists in general, closer examination yielded important distinctions about when these effects were more or less extreme. Research has identified two distinct but related sub-dimensions of perfectionism. The first, which we call excellence-seeking perfectionism, involves tendencies to fixate on and demand excessively high standards. Excellence-seeking perfectionists not only stringently evaluate their own performance but also hold high performance expectations for other people in their lives. The second, which we call failure-avoiding perfectionism, involves an obsessive concern with and aversion to failing to reach high performance standards. Failure-avoiding perfectionists are constantly worried their work is not quite right or good enough and believe that they will lose respect from others if they do not achieve perfection.
Taken as a whole, our results indicate that perfectionism is likely not constructive at work. We did find consistent, modestly-sized relationships between perfectionism and variables widely considered to be beneficial for employees and organizations (i.e., motivation and conscientiousness). Yet critically, we found no link between perfectionism and performance. This, coupled with the strong effects of perfectionism on burnout and mental well-being, suggests perfectionism has an overarching detrimental effect for employees and organizations. In other words, if perfectionism is expected to impact employee performance by increased engagement and motivation, then that impact is being offset by opposing forces, like higher depression and anxiety, which have serious consequences beyond just the workplace.
Perfectionism is one of the hot topics in counselling psychology and clinical psychology since the 1990s; from the beginning of theoretical analysis to empirical studies, more and more researchers focus on perfectionism. However, there is still much controversy on the definition of its conceptual extension and core characteristics. As a personality trait that is closely related to mental health, more and more researchers believe that perfectionism may have not only negative influence on mental health, but also positive influence (Ganske, Gnilka, Ashby, & Rice, 2015). Therefore, this study is a systematic review of the literature, starting with the definition of the concept, in order to clarify some of the fundamental issues, so that the follow-up research can be better carried out.
From the multidimensional perspective, Frost et al. (1990) divided perfectionism into six dimensions: Concern over Mistake (CM), Personal Standards (PS), Doubts about Actions (DA), Parental Expectations (PE), Parental Criticism (PC), and Organization (O). Frost argues that the CM represents the core trait of pathological perfectionism, while PS and Organization represent the positive characteristics of perfectionism in pursuit of high achievement. Frost and his colleagues also developed the Frost Multidimensional Perfectionism Scale (FMPS) to verify the validity of these dimensions.
It is also a controversial issue to divide the population on the scale of perfectionism, and whether to cluster into several categories is more in line with the actual situation and can highlight the differences in different indicators between the groups. The most popular models on this topic are the tripartite model of perfectionism (e.g. Parker, 1997; Rice & Ashby, 2007; Rice & Slaney, 2002) and the 2 2 model (Gaudreau & Thompson, 2010).
Gaudreau and Thompson (2010) believe that the perfectionism subtypes defined by within-person combinations of various perfectionism dimensions, rather than the dimensions themselves, therefore, the 2 2 model of perfectionism has been proposed. It is challenging the tripartite model of perfectionism by suggesting that it is important to differentiate not three, but four subtypes of perfectionism: 1) pure PSP, 2) mixed perfectionism, 3) pure ECP, and 4) non-perfectionism.
The negative effects of perfectionism on mental health are mainly manifested in psychological disorders and psychosomatic diseases. In previous studies, perfectionism has been found to be associated with a variety of psychopathological phenomena, such as depression, anxiety, obsessions, eating disorders, and psychosomatic disorders (Kearns et al., 2007; Egan et al., 2011).
Depression is the most common manifestation of perfectionist individuals. Enns et al. (2002) concluded that individuals with perfectionism traits are prone to feelings of stress and depression. Huprich (2010) studied clinical patients with depression and found that the CM of FMPS was significantly associated with depression. Bell (2010) argued that perfectionism is prone to failure, anger, anxiety, helplessness, and disappointment. These feelings are closely related to depression and suicidal concepts. Self-oriented and socially prescribed perfectionism are associated with depression (Flett, Panico, & Hewitt, 2011). Chang and his colleagues (Chang et al., 2011) studied in 121 college students and found that parental expectations (PE) and doubts about actions (DA) in FMPS significantly positively predicted depression levels. Noble, Ashby, and Gnilka (2014) found that different types of perfectionists have significant differences in depression levels. Specifically, the depression levels from high, medium to low are: maladaptive perfectionists, non-perfectionists and adaptive perfectionists. Compared with maladaptive perfectionists and non-perfectionists, adaptive perfectionists are less likely to use avoidance coping strategies, which also explain the lower level of depression of adaptive perfectionists.
In addition, self-oriented and socially prescribed perfectionism has been associated with the development of multiple types of eating disorders. Specifically, self-oriented and socially prescribed perfectionism has been associated with bulimic automatic thoughts and binge eating (Flett et al., 2011; Mackinnon et al., 2011). Self-oriented and socially prescribed perfectionism is also associated with the display of anorexia nervosa symptoms (Cockell et al., 2002). Soares (2015) found that socially prescribed perfectionism and self-oriented perfectionism were significantly associated with eating disorders. In addition, socially prescribed perfectionism was a predictor of eating disorder and eating concern. Wang and Li (2017) found that positive perfectionism was negatively associated with emotional eating and negative perfectionism was positively associated with emotional eating.