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American Journal of Pharmaceutical Education 87 (2023) 100074
Contents lists available at ScienceDirect
American Journal of Pharmaceutical Education
journal homepage: www.elsevier.com/locate/ajpe
Qualitative Research
Student Pharmacist Engagement in Infographic Creation to Increase
Awareness of Impostor Phenomenon
Viveca Vélez Negrón
a
, Laurie L. Briceland
a,⁎
, Paul M. Denvir
b
a
Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, NY, USA
b
Department of Population Health Sciences, Albany College of Pharmacy and Health Sciences, Albany, NY, USA
ARTICLE INFO
Keywords:
Impostor phenomenon
Infographics
Peer-to-peer engagement
Professional identity formation
Student pharmacist well-being
ABSTRACT
Objective: To assess first professional year (P1) students learning about impostor phenomenon (IP) through
participation in learning activities featuring the creation of an educational IP infographic.
Methods: A total of 167 P1 students were invited to complete a validated survey to determine baseline IP ten-
dencies and attended a near-peer-delivered course lecture on IP. Student groups of 4 created an infographic
containing IP lecture information and survey results, aimed at increasing IP awareness in a target audience.
Mixed methods were integrated to assess learning outcomes. Qualitatively, infographics were evaluated by
rubric for completeness, accuracy, and visual literacy, and student reflections were thematically evaluated on the
impact of IP activities; quantitatively, 19 student learning objectives were anonymously self-assessed by Likert
Scale survey. Students viewed all 42 created infographics, applied criteria, and voted for the 3 best.
Results: Survey results indicated 58% of P1 students exhibited IP tendencies above the scale’s defined threshold
for significant impostorism. Student groups demonstrated IP learning through developing creative, accurate, and
concise infographics, with a mean score of 85% (4.27/5). Assessment survey respondents agreed they can
confidently describe IP (92%) and design an infographic for a target audience using acquired knowledge (99%).
Through critical reflections on the impact of IP exercises, students expressed improvement in self-awareness and
communication skills; described the benefits of engagement in random peer groups; and voiced appreciation for
a novel method of learning material (infographic creation).
Conclusion: Students demonstrated learning about IP by incorporating lecture and survey results into engaging
infographics and expressed benefits from learning about this important topic that is prevalent in P1 students.
1. Introduction
First coined in 1978 by Clance and Imes,
1
the term impostor phe-
nomenon (IP) is attributed to individuals who doubt their well-founded
abilities and experience persistent fear of exposure as a fraud.
1,2
Initially,
IP was thought to occur primarily in high-achieving women with ad-
vanced degrees and subsequently has been shown to be prevalent among
individuals of any demographic or professional background, including
pharmacy and other health profession students, residents, practitioners,
and faculty.
3–9
If not addressed, IP can lead to mental health concerns such
as burnout, anxiety, and low self-esteem, as well as the inability to re-
cognize well-deserved accomplishments; potential repercussions include
hindering one’s professional identity formation, and ultimately career
advancement.
9–12
A first step to minimize IP tendencies in pharmacy
professionals is to educate practicing and student pharmacists on mani-
festations and strategies to address IP.
13,14
We reasoned that it is important
to introduce IP to student pharmacists early, during the first professional
year (P1). Early exposure can inform students that their detrimental mis-
conceptions have a name (known as IP) and occur frequently in student
pharmacists. Additionally, strategies to reduce the negative impact of IP on
personal and professional growth can be provided to students. Although
recent studies from Boyle and colleagues
3
and McWilliams and colleagues
4
have identified frequent IP tendencies in student pharmacists, neither
describe interventions to educate students and reduce the impact of IP,
and the authors of those studies have advocated such interventions as next
steps. We aimed to address this gap by introducing IP in a required P1
pharmacy course and creating an innovative educational module in-
corporating traditional didactic instruction based on published literature,
https://doi.org/10.1016/j.ajpe.2023.100074
Received 4 October 2022; Received in revised form 30 December 2022; Accepted 16 February 2023
Available online 9 May 2023
0002-9459/© 2023 American Association of Colleges of Pharmacy. Published by Elsevier Inc. All rights reserved.
]]]]
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⁎
Corresponding author.
E-mail address: laurie.briceland@acphs.edu (L.L. Briceland).
Author's Personal Copy
along with peer-to-peer collaborative learning activities incorporating vi-
sual communication. Peer interactions play an invaluable role in in-
creasing student learning, engagement, and inclusivity within a didactic
course, especially in online environments that have become more com-
monplace due to the COVID-19 pandemic.
15
Visual communication, with its focus on accessible symbols, ima-
gery, and data presentation, is gaining in popularity in health science
education, often used to supplement formal didactic educational
methods.
16,17
Visual communication can prove highly effective, as hu-
mans can remember up to 6.5 times more information that is presented
visually rather than in textual format.
18
Through visual communica-
tion, educators employ diagrams, flow charts, graphs, or illustrations
instead of solely written text to explain complex concepts to learners.
One type of visual communication used in health science education is
the informational graphic or infographic.
17,18
Infographics are designed
to tell a story featuring visualizations with clear, concise, and com-
prehensive messaging aimed at attracting the reader’s attention and
prompting a change in behavior in a target audience.
18,19
The creator of
the infographic benefits by applying knowledge about the topic they
have researched, strengthening analytic and critical thinking skills,
promoting clear/concise communication in writing skills, enhancing
efficiency in literature retrieval, and gaining valuable experience in
creative graphic design, a transferable skill for our P1 students to learn
for future applicability in educating patients and the public.
17,20,21
The study objective was to assess P1 student learning about IP
through participation in varied learning activities, featuring a group
activity in which an educational IP infographic was created for a target
audience. More specifically, the study aim was to assess P1 student
pharmacists’ baseline levels of IP tendencies, knowledge about IP,
competence, and confidence in communicating about IP through info-
graphics, and perceptions of the educational and professional impact of
this learning experience.
2. Methods
A mixed methods design combining quantitative and qualitative
data was employed in the assessment of the IP learning activities, which
were mapped to 10 different Center for the Advancement of
Pharmaceutical Education (CAPE) educational outcomes (Table 1).
22,23
This evaluation assessed P1 student pharmacists’ baseline levels of IP
tendencies, knowledge about IP, competence, and confidence in com-
municating about IP through the visual medium of infographics, and
perceptions of the educational and professional impact of this learning
experience. The project was conducted at Albany College of Pharmacy
and Health Sciences, a private college in New York that offers a tradi-
tional 4-year Doctor of Pharmacy program. The project underwent In-
stitutional Review Board review and met the criteria for exemption
from the requirements of federal regulations.
During the fall semester of 2021, all P1 class members (n = 167)
enrolled in our required Foundations of Pharmacy course were invited
to voluntarily participate in an online IP survey. The survey was in-
tended to determine baseline IP tendencies and was anonymously ad-
ministered using Qualtrics software (Provo, UT). The survey included
the 20-item validated Clance Impostor Phenomenon Scale (CIPS), as
well as 4 demographic questions, gender identity; race/ethnicity; prior
years of college before P1; and first-generation family member to attend
college. Upon submission of the survey, students were immediately able
to view their own CIPS scores. The CIPS survey yielded scores between
20 and 100, with IP tendencies categorized as follows based on the
attained score: Few (40 or less); Moderate (41−60); Frequent (61−80);
and Intense (higher than 80). The lower the score, the lower the chance
that a person is experiencing imposterism; a score of at least 62 is
considered the threshold for IP, which could warrant strategies and
resources to address IP.
24–26
Two weeks after completion of the IP survey, students in the course
received a 30-minute synchronous online IP lecture delivered by a near-
peer P3 student (the first author who was completing an independent
study professional elective centered on IP) via the Zoom platform
(Santa Clara, CA). The lecture included an introduction to the topic of
IP; an overview of its prevalence and consequences in pharmacy; stra-
tegies to reduce IP tendencies; descriptive statistics generated by class
responses to the IP survey presented in visual data formats (tables, pie
charts, and bar graphs); and literature citations supporting the lecture.
Immediately after the didactic instruction, students were randomized to
42 online Zoom breakout groups of 4 to create an infographic designed
to educate a target audience about IP and provide strategies for redu-
cing its negative impacts. Each group was instructed to select 1 of 4
target audiences within the college community whom they wished to
educate: future P1 students during P1 orientation; upper-class members
of the student pharmacist body; faculty advisors or preceptors; or stu-
dent leaders planning co-curricular programming. Groups were in-
structed that their infographics must include 4 elements: (1) 3 pieces of
background information from the P3 student’s lecture, such as IP de-
finition, manifestations, prevalence in student pharmacists, or re-
percussions if left unchecked; (2) 2 data visuals from the students’ ag-
gregated IP survey results, such as IP tendency data in P1 cohort, or
demographic comparisons of IP; (3) 2 strategies to reduce IP tendencies,
such as employing self-reflection/self-care, seeking assistance from fa-
culty or peers, or seeking professional mental health counseling
14
; and
(4) at least 2 citations from the literature. Students were provided with
2 sample infographics (created by first author) as well as links to in-
structional resources on infographic design in multiple software for-
mats, including Microsoft PowerPoint and Canva (Sydney, Australia).
Students worked collaboratively in their groups during the remainder of
the class period, and the authors (instructors for this exercise) fielded
questions as needed; students completed the assignment asynchro-
nously during the week, with the assignment upload due at week's end.
A 5-point grading rubric (out of 100 points in the course) was cre-
ated by the authors and used to grade the infographics; it contained 2
main components: educational value (presenting required information
accurately and concisely), and creativity (layout and visual appeal).
Students were informed that their infographics would be displayed in
an assignment-specific Padlet (San Franciso, CA), a software platform
Table 1
Ten Educational CAPE Outcomes Addressed Through IP Exercises.
Prompt: After completing IP exercises, I can
confidently:
CAPE Outcome
Define IP 1.1
Distinguish IP from self-doubt and perfectionism 4.1
Describe IP prevalence in students and
pharmacists
1.1
Identify causal factors of IP 1.1, 3.2, 4.1
Reflect on individual IP score 4.1
Explain strategies to address IP 2.4, 3.6, 4.4
Motivate self to address tendencies 4.1
Analyze IP data from peers 1.1, 4.2
Apply data to promote IP awareness 3.2, 3.3, 3.6, 4.3
Design an infographic for target audience using
acquired knowledge
1.1, 2.4, 3.2, 3.3, 3.6,
4.2, 4.3
Prompt Based on my participation in IP
exercises, I have:
Gained verbal communication skills from peer
interactions
3.4, 3.6, 4.4
Gained non-verbal communication skills from
peer interactions
3.6, 4.4
Worked for a shared goal 3.4
Engaged in innovative activities 4.3
Exhibited professional behavior 4.4
1.1 = Learner; 2.4 = Provider; 3.2 = Educator; 3.3 = Advocate;
3.4 = Collaborator; 3.6 = Communicator; 4.1 = Self-aware; 4.2 = Leader;
4.3 = Innovator; 4.4 = Professional.
Abbreviations: CAPE, Center for the Advancement of Pharmacy Education;
22
IP,
impostor phenomenon.
V.V. Negrón, L.L. Briceland and P.M. Denvir American Journal of Pharmaceutical Education 87 (2023) 100074
2
Author's Personal Copy
that can emulate social media interfaces, and were invited to anon-
ymously cast 3 votes that would be used to award the ‘Top 10
Infographics’ for the assignment. Our rationale for including the voting
activity was that students would need to apply what they would learned
about both IP and infographic design in analyzing the strengths of their
peers’ work. Criteria that students were to consider in voting for a top
infographic included: visual appeal (creative and eye-catching); ease of
reading and understanding; meeting the purpose of educating the target
audience about IP; and including accurate data and references for
support. The class was informed that they would be notified of the Top
10 Infographic awardees and that 3 of the Top 10 infographics of the
instructors’ (authors’) choosing would be de-identified and shared with
the Director of Pharmacy Professional Affairs for use in “real world”
outreach in the college community.
After completing all learning activities, students were invited to
complete a voluntary, anonymous 19-item electronic learning assess-
ment survey using Likert-type scalar responses through the platform
Poll Everywhere (San Franciso, CA), 1 = Strongly Disagree;
2 = Disagree; 3 = Agree; 4 = Strongly Agree; 5 = Not applicable.
Respondents self-reported their knowledge and confidence with respect
to explaining IP, reflecting on their own IP scores, analyzing IP survey
data for the class, and designing infographics. Additional items focused
on relevant CAPE educational outcomes that were covered by these IP
exercises, including verbal/non-verbal communication, teamwork, re-
sponsibility, professionalism, and creativity.
22
Respondents also rated
the educational impact of each of the 4 components of the experience:
IP survey; near-peer lecture; peer-to-peer collaboration on infographic
creation; and Padlet voting exercise.
To gain a more nuanced first-hand perspective on this learning ex-
perience, a subset of students’ final reflection papers was thematically
analyzed. The reflection paper was a required assignment, and students
were free to select a course component from a list of several options
upon which they would reflect. Of the 167 students who submitted
reflections, 16 elected to reflect on the IP experience, all of which were
included in the thematic analysis. The reflection prompt asked students
to critically reflect in 500–600 words on 1 learning experience in the
course and consider its contributions to transforming their future in
pharmacy.
2.1. Data Analysis
To assess overall IP tendencies from the IP survey cohort, basic
descriptive statistics (range, mean, frequencies) were generated for
future inclusion in the student-created infographics. To assess student
learning, evaluation procedures included: grading rubric for student-
created infographic (required assignment and thus data expected for all
students); learning assessment survey (optional activity); and analysis
of final reflection papers (available for self-selected subset of students
who opted to address IP for reflection assignment).
The infographic grading rubric was completed independently by all
3 members of the instruction team (authors), who then compared and
adjusted their scoring to enhance reliability of final scores. For the
learning assessment survey, basic descriptive statistics (mean, fre-
quencies) were generated for each item. The analysis of final reflection
papers employed inductive thematic analysis, a qualitative method
well-suited to the analysis of textual data.
27
Induction is a “bottom-up”
process in which relevant themes emerge out of repeated exposure to
data, rather than through the application of pre-existing theoretical
concepts or categories. Analysis proceeded in 3 waves. In wave 1, the
second and third authors read each reflection and entered free-text
comments to identify recurring topics and themes of interest. Using
insights from wave 1, the qualitative analysis software Atlas.ti (Cor-
vallis, OR)was used to develop an 18-item coding framework, essen-
tially a list of topics/themes that could be applied to the full data set. In
wave 2, the third author created relevant text extracts from each re-
flection and applied the coding framework to them. Selecting the
boundaries of a text extract requires some judgment, but the goal is to
capture a complete thought and its surrounding context; in this ana-
lysis, text extracts were generally 3–6 sentences long. The total number
of extracts was 54 and the average number of extracts per reflection was
3.4. Wave 2 resulted in a refined coding framework as it became clear
that some of the 18 initial codes, while potentially insightful, did not
apply to enough extracts to warrant further analysis. The revised coding
framework included 9 coding categories, with an average of 11 extracts
in each category. In wave 3, the first and third authors closely analyzed
and discussed interpretations of the 9 coded collections that were most
relevant to the current analysis. This process yielded 4 main themes.
3. Results
Of 167 students, 163 (97.6%) completed the voluntary IP survey to
determine baseline IP tendencies in the cohort. Table 2 provides the
distribution of IP tendencies for respondents based on the score attained
on the CIPS and demographics surveyed. A total of 89% (n = 145) of
respondents presented with at least moderate IP tendencies. The
median CIPS score for all respondents was 62.5, indicative of the pre-
sence of frequent and intense IP tendencies in 58% of the cohort. A
larger percentage of females than males, students with < 2 years of
pre-pharmacy studies, Asian students, and students who were not the
first in the family to attend college were at or above the IP threshold.
Of the 42 infographics submitted by the groups, all but 2 featured
future P1 students as the target audience. The average score on the 5-
point grading rubric was 4.27 (85%). Fig. 1 shows the Top 3 Info-
graphics, as determined by student voting on the Padlet poll, and af-
firmed by instructors/authors. All 42 infographics are displayed on the
Padlet and are available to readers upon request to the authors.
For the voluntary learning assessment survey, 139/167 (83.2%) of
students responded. Table 3 provides the results of the student’s level of
agreement with their attainment of the learning objectives of the IP
exercises. More than 80% of respondents agreed or strongly agreed with
the statements, lending evidence toward the achievement of the
Table 2
Demographic Distribution of IP Tendencies on CIPS for 163 Respondents.
CIPS Score
40 or
less
n (%)
41–60
n (%)
61–80
n (%)
Higher
than 80
n (%)
Gender
Male 8 (15) 23 (44) 18 (35) 3 (6)
Female 8 (7) 30 (28) 59 (54) 12 (11)
No Response = 2
Prior college experience before beginning P1 year
2 years 5 (5) 29 (28) 57 (55) 12 (12)
3 years 1 (8) 5 (38) 7 (54) 0 (0)
4 + years 10
(21)
19 (40) 14 (30) 4 (9)
No Response = 0
Race-ethnicity
Asian 3 (6) 15 (29) 27 (52) 7 (13)
Black or African
American
2 (13) 5 (31) 9 (56) 0 (0)
Hispanic or Latino 4 (29) 4 (29) 4 (29) 2 (13)
White 7 (9) 27 (34) 37 (47) 8 (10)
No response = 2
Member of the family to attend college
First 5 (15) 13 (38) 14 (41) 2 (6)
Not First 11 (9) 40 (31) 64 (49) 14 (11)
No response = 0
Score 40 or less = few IP tendencies; score 41–60 = moderate IP tendencies;
score 61–80 = frequent IP tendencies; score higher than 80 = intense IP
tendencies.
Abbreviations: CIPS, Clance Impostor Phenomenon Scale; IP, impostor phe-
nomenon; P1, first professional year.
V.V. Negrón, L.L. Briceland and P.M. Denvir American Journal of Pharmaceutical Education 87 (2023) 100074
3
Author's Personal Copy
learning objectives. Students were also surveyed as to the impact of
participation in 4 components of the IP exercises and stated at least
moderate or significant impact in participation in the following ex-
ercises: peer group exercise to create an infographic (79% of re-
spondents); polling Padlet for ‘Top 10 infographic’ (67%); IP lecture
with question/answer period (88%); and completion of IP validated
survey (93%).
For the thematic analysis of student reflections, Table 4 summarizes
the 4 main themes and the number of extracts that support them, in-
cluding a representative quotation for each. The themes identified in
this sub-sample of students reinforce quantitative evidence that stu-
dents perceived value in the core elements of this learning experience:
peer-to-peer engagement, reflecting on IP as a matter of professional
identity formation and development, and developing novel visual
communication skills in an emerging, creative medium of health com-
munication. Although peer-to-peer engagement is typically framed as a
method of developing interpersonal communication skills, students also
described it as an opportunity to cultivate intrapersonal (cognitive or
socio-emotional) qualities such as confidence and trust. One sub-theme
specifically addressed the value of random group assignments, which
required students to develop rapport quickly with strangers, a skill
many perceived as highly relevant to their future as pharmacists
working with both patients and other health professionals. Another key
insight from this analysis is the power of naming and normalizing IP.
Many extracts in this theme indicated that naming IP for the first time,
providing a concrete term for this nagging and isolating emotional
experience, was a comforting revelation. The ability to see the ag-
gregated class results on the IP survey served as a further normalizing
influence, surfacing a largely unspoken but widely shared psychological
experience in their cohort. Several students described having con-
versations about this while working in their groups. Finally, students
spoke of the value of applying IP knowledge in at least 2 ways. First,
they indicated that applying new knowledge to inform others was more
engaging than traditional knowledge assessment techniques (ie,
quizzes) and instilled a sense of responsibility to be factually accurate.
Second, several students indicated that they had personally begun to
use IP coping strategies they had learned in their own lives. Although
the idea of applied learning is often associated with academic output,
these data provide evidence that this assignment also prompted a self-
directed application of learning.
Fig. 1. Top 3 student-created IP infographics per peer polling. ACPHS, Albany College of Pharmacy and Health Sciences; IP, impostor phenomenon; P1, first
professional year.
V.V. Negrón, L.L. Briceland and P.M. Denvir American Journal of Pharmaceutical Education 87 (2023) 100074
4
Author's Personal Copy
4. Discussion
Recent studies from Boyle and colleagues
3
and McWilliams and
colleagues
4
have identified that IP is prevalent among student phar-
macists and have noted a gap in addressing this important topic in
pharmacy curricula. Our initiative narrows that gap by providing an
educational module on IP to P1 students within the first semester of the
degree program. Our module contained a series of 4 IP learning activ-
ities in which students found merit and demonstrated learning, begin-
ning with the CIPS survey. Our IP survey data predictably identified
over one-half of our P1 cohort exhibiting IP tendencies above the IP
threshold, corroborating previous studies reporting similar IP pre-
valence in student pharmacists.
3,4,6
Our reasoning for employing the
CIPS survey was not to further study the prevalence of IP in P1 student
pharmacists per se, but rather to use the survey to set the stage and serve
as a foundation for the remainder of our planned IP learning activities.
Our premise was that through participation in the survey, students
would become aware of the attributes of IP and would be primed to
learn more about what their individual scores signified. Students would
then progress to the second learning activity, the near-peer-delivered IP
lecture, and would formally learn about IP and methods to address it.
Armed with their own IP survey score and new knowledge on this topic,
students could then self-reflect upon the meaning of that score, and as
needed develop a personal plan of help-seeking action to address IP
tendencies. The IP survey data would also be included in the third
learning activity, the creation of the educational infographic for a target
audience.
These 3 learning activities (ie, CIPS survey, IP lecture, infographic
creation) positively impacted students’ learning of IP as more than 75%
of respondents indicated on the learning assessment survey at least
moderate impact for each activity. Upon qualitative analysis of the
critical reflection comments, we learned that the IP survey coupled with
the IP lecture proved to be quite eye-opening for P1 students (Table 4).
Specifically, these learning activities provided opportunities for stu-
dents to develop self-awareness, overcome doubts about belonging in
pharmacy, and prioritize their mental health and well-being, which is
critical in pharmacy curricula.
28
The IP lecture and survey results in-
creased confidence by normalizing IP. Realizing there is a name for
these tendencies and seeing cohort data that confirmed they are not
alone was a comforting validation. These IP learning activities and their
beneficial learning outcomes are well-aligned with the self-awareness
domain “engaging in help-seeking behaviors when appropriate” within
the CAPE Outcomes for pharmacy programs.
22
Indeed, many of these
attributes that students valued from the IP exercises were noted by
authors of previous studies as often lacking or limited in pharmacy
curricula, such as the early introduction of IP to increase awareness and
begin to address IP in student pharmacists; the opportunity to reflect
upon a learning experience and receive instructor feedback; and crea-
tion of infographics in pharmacy education as an active learning
strategy.
3,4,17,29
When considering the infographic learning activity, the sample of 3
infographics in Fig. 1 (as well as the remaining 39 infographics, not
shown), demonstrates how students incorporated the IP lecture and
survey data using creative visual communication approaches. Upon
evaluating the learning outcomes of the infographics using our as-
signment rubric, 85% of student groups earned perfect scores, demon-
strating their understanding and effective utilization of visual com-
munication for providing education to a target audience. Interestingly,
each group creatively highlighted differing pieces of IP survey or
background information that resonated with them; no 2 were alike. The
students revealed in critical reflections that the creation of an info-
graphic was an engaging way to learn new material and stimulated
creativity in unexpected ways, underscoring the value of conciseness
and clarity in infographic-based health communication. The CAPE
Outcomes include an innovation domain in which pharmacy curricula
should engage students in creative thinking to envision better ways to
meet the intended purpose;
22
the IP infographic creation proved to be
an excellent opportunity for students to creatively interpret and com-
municate data in developing educational materials for a target audience
and will provide a framework for students to extend their infographic
design skills to future patient care applications.
17,21
The peer-to-peer engagement aspect of the infographic exercise also
made an impact on students, as expressed in critical reflections. Group
work provided a context for developing intrapersonal qualities (con-
fidence, trust) and interpersonal skills (mutual compromise, rapport)
needed for professional identity formation.
29
Specifically, it served as
an icebreaker for some students who knew no one else in the class, and
allowed students to develop verbal communication and collaborative
Table 3
Learning Assessment Survey of Learning Outcomes from IP Exercise from 2021 Foundations of Pharmacy Class.
Prompt: After completing IP exercises, I can
confidently:
Strongly agree
(%)
Agree
(%)
Disagree
(%)
Strongly disagree
(%)
Not applicable
(%)
Likert score
median
Define IP 79 (57) 49 (35) 5 (4) 6 (4) 0 (0) 4
Distinguish IP from self-doubt and perfectionism 37 (27) 93 (67) 7 (5) 2 (1) 0 (0) 3
Describe IP prevalence in students and
pharmacists
71 (51) 62 (45) 3 (2) 3 (2) 0 (0) 4
Identify causal factors of IP 45 (32) 79 (57) 14 (10) 1 (1) 0 (0) 3
Reflect on individual IP score 67 (48) 67 (48) 4 (3) 1 (1) 0 (0) 3
Explain strategies to address IP 52 (37) 75 (54) 10 (7) 2 (1) 0 (0) 3
Motivate self to address tendencies 44 (32) 81 (58) 10 (7) 4 (3) 0 (0) 3
Analyze IP data from peers 54 (39) 75 (54) 7 (5) 1 (1) 2 (1) 3
Apply data to promote IP awareness 45 (32) 87 (63) 5 (4) 1 (1) 1 (1) 3
Design an infographic for target audience using
acquired knowledge
67 (48) 70 (50) 0 (0) 1 (1) 1 (1) 3
Prompt Based on my participation in IP exercises,
I have:
Gained verbal communication skills from peer
interactions
59 (43) 69 (50) 9 (6) 2 (1) 0 (0) 3
Gained non-verbal communication skills from
peer interactions
54 (39) 63 (45) 18 (13) 3 (2) 1 (1) 3
Worked for a shared goal 66 (47) 69 (50) 2 (1) 1 (1) 1 (1) 3
Engaged in innovative activities 52 (37) 70 (50) 14 (10) 1 (1) 2 (1) 3
Exhibited professional behavior 77 (55) 59 (43) 2 (1) 1 (1) 0 (0) 3
Likert Scale: 1 = Strongly Disagree; 2 = Disagree; 3 = Agree; 4 = Strongly Agree; 5 = Not applicable.
Abbreviations: CAPE, Center for the Advancement of Pharmacy Education;
22
IP, impostor phenomenon.
V.V. Negrón, L.L. Briceland and P.M. Denvir American Journal of Pharmaceutical Education 87 (2023) 100074
5
Author's Personal Copy
teamwork skills of building rapport without passing judgment and
treating respectfully members with diverse viewpoints; students noted
that working as a team provides practice for upcoming collaborative
practice pharmacy settings and interacting with people of differing
personalities.
A final noteworthy observation requires us to step back from the
details of evaluation and adopt a broader perspective on peer engage-
ment in pharmacy programs. Building on Seymour’s
30
notion of vir-
tuous cycles or “winning streaks” in higher education, we believe this
project illustrates the power of creating positive peer-to-peer feedback
loops in our curricula. As Seymour argues, “Instead of losing streaks
that feed on negativity, the virtuous cycle is an engine of investment,
learning, and growth. Winning streaks are upward spirals of positivity
in which each success becomes the platform for future successes”.
30
This aptly describes how student pharmacists connected through this
experience. It began with the first author, a P3 student at the time,
being impacted by exposure to IP in another course and seeking out
pharmacy faculty to initiate research on the topic. This became a
“platform” that led to the IP survey and the near-peer lecture described
herein. The lecture and survey then became a platform from which P1
students could apply their newly acquired IP knowledge and visual
communication skills, all of which were undergirded by aggregated
data provided by fellow P1 students. Although groups could select from
a range of different audiences, the overwhelming majority chose to
create their infographics for an audience of future P1 students, in es-
sence choosing to “pay it forward” to the next cohort who they knew
would be likely to experience IP tendencies themselves. Becoming
aware that the top infographics would be shared with the Director of
Pharmacy Professional Affairs for use in P1 orientation made this P1-
future P1 connection that much stronger. Sharing the 42 class info-
graphics on Padlet continued the virtuous cycle. Although we did not
treat their voting as a formal assessment method, many students com-
mented in their reflections that this created a safe and anonymous
context for healthy peer comparison, noticing the strengths and weak-
nesses of their own group work and appreciating the skills that their
peers were bringing to the pharmacy program and future profession.
Completing this positive peer-to-peer feedback loop is the fact that this
learning experience has led to multiple research products for the first
author, now a P4 student, providing yet another platform for future
success. Although it may not be possible for every student pharmacist to
have this experience, the broader lesson we draw is that pharmacy
curricula can benefit by looking for novel ways to create virtuous cycles
among our students, not just within cohorts, but across cohorts.
There are limitations to our work, which was derived from 1 cohort
at 1 college of pharmacy. We did not administer a pre-assessment
survey to determine the students’ IP knowledge at baseline and serve as
a comparator for the post-activity assessment questions, which may
have demonstrated growth in learning. Further, because students
worked in groups to design their infographics, it was not possible to
assess individual knowledge or competence in infographic creation; it is
possible that highly knowledgeable students or those with strong visual
communication skills masked deficiencies in other group members.
Thematic analysis of student reflections was limited to a sub-sample of
students who self-selected to write about the IP exercises and, as such,
we cannot be sure how representative their views are in the full class
sample. Although we included these data to provide a richer first-hand
perspective on the educational potential of this experience, readers
should be cautious in overgeneralizing these results. Future scholarship
exploring this approach to IP education could be strengthened by
conducting student focus groups to gain richer insights into the team-
work dynamics involved in creating innovative educational materials.
Additional instructional resources on visual communication/info-
graphic creation could raise performance standards and provide for a
more nuanced grading rubric to better assess multiple dimensions of
infographic design.
Table 4
Themes Highlighted in Student’s Course Reflections.
Theme Sub-themes (codes) n (%) Explanation Sample quote
Value of peer interaction Develop confidence 26 (48) Group work provided a context for developing intrapersonal qualities
(confidence, trust) and interpersonal skills (mutual compromise, rapport)
needed for professional identity formation.
I found this to be positively impactful because later down the line when
I’m working as a pharmacist I will have to work with physicians and
patients that I have never even met before. I felt this exercise to be a
good way to recreate that feeling to some extent.
Engage in healthy
peer comparison
Practice group
decision making
Working with
strangers
Value of IP survey reflection Naming it normalizes
it
17 (31) IP lecture and survey results gave a name to a distressing internal feeling,
thereby externalizing it as an obstacle to overcome; access to aggregate
peer data further normalized the feeling.
Learning about the symptoms and reviewing the data from the class
made me realize that I am not an imposter and I am not alone in those
feelings,I am not alone
Value of developing visual
communication skills
9 (16) Designing infographics was an engaging way to learn new material; it
stimulated creativity in unexpected ways and highlighted the value of
conciseness and clarity in health communication.
Because I think I better understood the material when we used different
media in this course, I think I will be able to better apply that material.
Applying IP training in one’s life 8 (15) After learning and applying strategies to address IP in their infographics,
students were able to apply them when their own feelings of impostorism
surfaced.
This interaction made me realize that this type of trustworthy
interaction needs to happen in healthcare more. My group and I had a
true and honest conversation without judging one another while
working to complete a goal of an IP infographic.
Abbreviation: IP, impostor phenomenon.
V.V. Negrón, L.L. Briceland and P.M. Denvir American Journal of Pharmaceutical Education 87 (2023) 100074
6
Author's Personal Copy
5. Conclusion
First-year pharmacy students reported learning about IP through the
IP learning activities, including the CIPS survey, IP lecture, and info-
graphic creation, and demonstrated the ability to create innovative
educational materials through the emerging medium of infographics.
Students found participation in IP exercises and peer-peer engagement
to be impactful in various ways, as described in critical reflections and
learning assessment surveys.Acknowledgments
Cecily Corbett and Paula Zeszotarski from Institutional Effectiveness
for assistance with Qualtrics survey; Lily Shafer-Lahnum for assistance
with Padlet and Poll Everywhere course tools; Angela Palmer for as-
sistance with Figure graphics.
Declaration of Competing Interest
None declared.
Funding/Support
None declared.
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