Exploring the relationships between emotional intelligence, mindfulness, and impostor syndrome among medical and nursing students: a multi-institutional cross-sectional study in Palestine

Abstract

Background

Impostor syndrome (IS) is a prevalent psychological challenge among healthcare students, characterized by persistent self-doubt and fear of being exposed as a fraud despite objective evidence of competence. Although emotional intelligence (EI) and mindfulness have been proposed as protective psychological resources, their combined relationship with IS remains underexplored, particularly in conflict-affected settings. This study examined the associations between trait EI, mindfulness, and IS among medical and nursing students in Palestine.

Methods

A multi-institutional cross-sectional study was conducted between October 2025 and February 2026 across five universities in the West Bank, Palestine. A total of 1,065 students (654 medical, 411 nursing) completed an online questionnaire comprising the Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF), the Mindful Attention Awareness Scale (MAAS), and the Clance Impostor Phenomenon Scale (CIPS). Data were analyzed using independent-samples t-tests, one-way ANOVA, Pearson correlation, and logistic regression. IS was defined as a CIPS score of 62 or higher.

Results

Nearly half of participants (45.45%) reported frequent or intense impostor experiences; a similar percentage (45.82%) reported moderate IS experiences, and only 8.73% had few impostor feelings. Medical students scored significantly higher on the CIPS than nursing students (62.63 vs. 58.75, P < 0.001). EI and mindfulness were each negatively correlated with IS (r = − 0.470 and r = − 0.333, respectively; both P < 0.001) and positively correlated with each other (r = 0.458, P < 0.001). In logistic regression, EI was the strongest independent protective factor (adjusted OR = 0.424, 95% CI: 0.347–0.517, P < 0.001), followed by mindfulness (adjusted OR = 0.774, 95% CI: 0.651–0.921, P = 0.004). Preclinical academic stage (adjusted OR = 1.491, P = 0.026) was independently associated with higher odds of IS. The model explained 18.8% of the variance.

Conclusions

IS is highly prevalent among Palestinian medical and nursing students, with medical students being more affected. Our findings suggest that EI and mindfulness may serve as protective factors against IS and that EI- and mindfulness-focused curricular content may be a worthwhile area for future interventional study, particularly during preclinical years in conflict-affected educational settings.

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1186/s40359-026-05358-9.

Introduction

Healthcare education is widely recognized as one of the most psychologically demanding academic pathways, exposing students to persistent stressors that can adversely affect their academic performance, professional development, and overall well-being [1, 2]. Medical and nursing students, who constitute the future backbone of healthcare systems, are frequently subjected to intense workloads, high-stakes examinations, clinical responsibilities, and the emotional burden of patient care [3, 4]. These cumulative pressures may create fertile ground for psychological vulnerabilities, including self-doubt, emotional dysregulation, and diminished resilience. Consequently, understanding the psychological factors influencing healthcare students’ experiences has become a priority for educators and researchers globally.

Among the psychological challenges frequently encountered by healthcare students is impostor syndrome (IS), also known as the impostor phenomenon (IP), which refers to a pattern in which high-achieving individuals struggle to fully accept or internalize their accomplishments [5]. Despite clear evidence of their success, they often experience persistent self-doubt and a continuing fear that others will eventually expose them as a fraud [5]. Psychologists Clance and Imes first described the impostor phenomenon in 1978, and it gained widespread public attention following Clance’s 1985 book [5].

Although IS is not classified as a formal psychiatric disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or the International Classification of Diseases (ICD-11), its psychological sequelae are well documented and include anxiety, depression, burnout, perfectionism, and reduced self-efficacy [6–8].

The scope of IS in healthcare education is striking. A systematic review and meta-analysis encompassing 30 studies and 11,483 health service providers estimated a pooled global prevalence of 62% (95% CI: 52.6–70.6%) [6]. Among medical students specifically, rates of frequent or intense impostor experiences have been reported in the range of 20–60%, depending on the population studied and the instruments employed [9]. Nursing students are also affected. A multi-center cross-sectional study by El-Ashry et al. found that 46.3% reported moderate IS, 33% had frequent impostor feelings, and 6.2% faced intense experiences [10].

Two psychological constructs that have been identified as potentially protective against IS are emotional intelligence (EI) and mindfulness [11, 12]. Emotional intelligence, defined as the ability to perceive, understand, regulate, and utilize emotions effectively in oneself and others, has become an important predictor of well-being and stress management in healthcare settings [13, 14]. Petrides and colleagues conceptualized trait EI as a constellation of emotion-related self-perceptions and dispositions, encompassing four factors: well-being, self-control, emotionality, and sociability [15]. Research among health professions students has demonstrated that higher EI is associated with lower stress, reduced burnout, and greater academic performance [16, 17]. Interestingly, Dogham et al. found that 57% of nursing students demonstrated high levels of EI, with the well-being domain receiving the highest scores [18], while Aithal et al. reported that 65% of medical students possessed high EI [19].

Mindfulness, defined as the quality of maintaining present-moment awareness with a non-judgmental and accepting attitude [20, 21], has also emerged as a valuable resource in healthcare education. With the practice of mindfulness, individuals can become more attentive and sensitive to their thoughts and bodily signals, which can help bring a wandering mind back to the present moment [22]. Moreover, mindfulness-based interventions have been shown to reduce stress, enhance emotional regulation, and promote self-awareness [23–26].

Theoretical and empirical considerations suggest that EI, mindfulness, and IS are interrelated. Students with higher EI may be better equipped to recognize and regulate the emotional disturbances associated with IS, while greater mindfulness may reduce the ruminative and self-critical thought patterns that sustain impostor feelings [27, 28]. The hypothesized protective roles of EI and mindfulness against IS are supported by the Job Demands-Resources (JD-R) model, which posits that when job demands (or, in an educational context, academic and environmental pressures) exceed available personal resources, individuals become vulnerable to negative psychological outcomes; EI and mindfulness can be conceptualized as personal resources that buffer against such demands.

Medical and nursing students represent the two largest healthcare training pathways, yet they differ substantially in program duration, curricular structure, timing of clinical exposure, and professional socialization processes. These structural differences may create discipline-specific vulnerabilities to IS, making their comparison valuable for identifying targeted intervention strategies. Despite the growing body of literature examining each construct individually, few studies have simultaneously explored the triadic relationship among EI, mindfulness, and IS.

The Palestinian context presents a uniquely important yet underexplored setting for this investigation. Palestinian healthcare students face compounding challenges beyond the typical academic pressures, including political instability, restricted mobility, socioeconomic hardships, and limited access to mental health resources [29–31]. For instance, frequent disruptions to clinical rotations and restricted campus access due to military checkpoints may prevent students from accumulating the hands-on competency milestones that typically build professional confidence, thereby reinforcing feelings of intellectual fraudulence characteristic of IS, a mechanism distinct from generalized psychological distress. Recent regional data further highlight that Palestinian undergraduates are exposed to substantial psychological stress due to recent conflict, further exacerbating the need for protective psychological resources [32–34].

This study addresses this critical gap by examining the relationships between EI, mindfulness, and IS among medical and nursing students across five Palestinian universities. Specifically, we aimed to: (a) assess the prevalence and intensity of IS among medical and nursing students; (b) evaluate the levels of EI and mindfulness in this population; (c) examine the bivariate correlations between EI, mindfulness, and IS; and (d) identify independent predictors of IS. We hypothesized that higher EI and mindfulness would be associated with lower IS, and that they would serve as independent protective factors against the impostor phenomenon.

Methods

Study design and setting

This study employed a quantitative, descriptive, cross-sectional correlational design. It was conducted between October 2, 2025, and February 16, 2026, among medical and nursing students at five major universities offering medical and nursing education in the West Bank, Palestine: Al-Quds University (Jerusalem), An-Najah National University (Nablus), Palestine Polytechnic University (Hebron), Hebron University (Hebron), and the Arab American University (Ramallah/Jenin).

The West Bank is a landlocked territory in the southern Levant, home to approximately 3 million Palestinians, characterized by a complex geopolitical landscape shaped by decades of military occupation. The territory is divided into multiple governorates, with major urban centers including Jerusalem, Nablus, Hebron, Ramallah, and Jenin. Movement between cities is frequently restricted by military checkpoints, the separation barrier, and permit requirements, all of which affect students’ access to universities and clinical training sites. The five participating universities collectively represent major institutions offering medical education in Palestine [35]. Together, they provide broad geographic representation of the West Bank by encompassing its northern, central, and southern academic regions [36].

Population, sampling, and sample size

The target population comprised all undergraduate medical and nursing students aged 18 years or older who were currently enrolled at the participating universities. Students from all academic years were eligible for inclusion, specifically medical students from the first through sixth year and nursing students from the first through fourth year. A convenience sampling approach was employed owing to practical and accessibility constraints. The minimum required sample size was calculated using StatsDirect software (power = 0.95, α = 0.05, expected correlation coefficient r = 0.3), yielding a minimum of 140 participants. Recruitment remained open to maximize participation and representation across universities, programs, and academic levels. Ultimately, 1065 students completed the questionnaire, substantially exceeding the minimum requirement.

The adequacy of the sample size for the multivariate model was evaluated post hoc using the Events-per-variable (EPV) heuristic [37]. Out of 1065 participants, 484 met the IS threshold (CIPS ≥ 62). With 9 degrees of freedom in the final model, the EPV was approximately 53.8, significantly above the minimum recommended threshold of 10, indicating that the sample size was sufficient for conducting a reliable logistic regression analysis.

Inclusion and exclusion criteria

Inclusion criteria: (a) undergraduate medical or nursing students aged 18 years or older; (b) currently enrolled at one of the five participating universities during the study period; and (c) provision of informed consent. Exclusion criteria: (a) postgraduate or graduate-level students; and (b) incomplete questionnaire submissions.

Data collection procedure

Data were collected through an anonymous, self-administered online questionnaire distributed via Google Forms on various social media platforms. The questionnaire was administered in Arabic, the native language of Palestinian students. No personally identifiable information was collected, and participation was entirely voluntary with the option to withdraw at any time. Upon completion, participants received a brief supportive message encouraging them to attend to their mental health and well-being.

Study instruments

Sociodemographic questionnaire

A structured researcher-developed questionnaire collected information on participants’ age, gender, marital status, university affiliation, program of study (medicine or nursing), academic year, place of residence, current living situation, if diagnosed with chronic health conditions (physical or mental), and if engaged in regular physical activity.

Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF)

The TEIQue-SF is a 30-item self-report measure designed to assess global trait emotional intelligence. It was developed by K. V. Petrides as a short version of the Trait Emotional Intelligence Questionnaire [15]. The scale evaluates trait EI across four factors: well-being (6 items), self-control (6 items), emotionality (8 items), and sociability (6 items), with an additional 4 auxiliary items (items 3, 14, 18, and 29) that do not load onto any specific factor. Responses are rated on a 7-point Likert scale from 1 (completely disagree) to 7 (completely agree), with 15 items reverse-coded (items 2, 4, 5, 7, 8, 10, 12, 13, 14, 16, 18, 22, 25, 26, and 28). Global Scores are computed as the mean of all 30 items, ranging from 1.00 to 7.00, with higher scores indicating greater EI. The global scores are further categorized into low, average, and high based on the 30th and 70th percentiles of the sample’s observed score distribution (low tier ≤ 30th percentile, average tier between 30th and 70th percentiles, and high tier > 70th percentile), consistent with the percentile-banding convention used in TEIQue-SF standard reports. The Arabic version of the TEIQue-SF has shown good psychometric properties and has been validated for use among Arabic-speaking and Middle Eastern populations [38–40]. In the current study, the TEIQue-SF demonstrated good internal consistency (Cronbach’s α = 0.877).

Mindful Attention Awareness Scale (MAAS)

The MAAS, originally developed by Brown and Ryan [41], is a 15-item self-report instrument designed to assess dispositional mindfulness, specifically the frequency of open and receptive attention to and awareness of present-moment experiences. Items are rated on a 6-point Likert scale from 1 (almost always) to 6 (almost never), with higher mean scores indicating greater mindfulness. Mean scores are categorized as: very poor (1.00 to 1.99), poor (2.00 to 2.99), fair (3.00 to 3.99), good (4.00 to 4.99), very good (5.00 to 5.99), and excellent (6.00). The Arabic version (A-MAAS) was used. It was validated among Lebanese adults with strong internal consistency (Cronbach’s α = 0.932) and strong test-retest reliability (ICC = 0.983) [42]. In the current study, the A-MAAS demonstrated good internal consistency (Cronbach’s α = 0.839).

Clance Impostor Phenomenon Scale (CIPS)

The CIPS, developed by Clance [43], is a widely validated 20-item self-report instrument that assesses the subjective experience of intellectual fraudulence, including fear of evaluation, inability to internalize success, and attribution of achievements to external factors. Items are rated on a 5-point Likert scale from 1 (“not at all true”) to 5 (“very true”), yielding total scores from 20 to 100. Scores are categorized as: ≤40 (few impostor characteristics), 41–61 (moderate IS experiences), 62–80 (frequent IS experiences), and ≥ 81 (intense IS experiences). The Arabic version was validated among Saudi university students with strong internal consistency (Cronbach’s α = 0.90) [44]. In the current study, it demonstrated good internal consistency (Cronbach’s α = 0.896).

Statistical analysis

All data were analyzed using IBM SPSS Statistics version 25. A two-sided P value < 0.05 was considered statistically significant.

The distribution of continuous variables was assessed using the Shapiro-Wilk test and visual inspection of histograms and Q-Q plots, while considering the large sample size (n = 1,065). Continuous variables were summarized as means and standard deviations (SD), and categorical variables as frequencies and percentages.

Between-group comparisons were performed using the independent-samples t-test for two-group comparisons. Pearson correlation analysis assessed the bivariate linear associations among CIPS, MAAS, and TEIQue-SF global scores.

Binary logistic regression analysis was employed to identify factors independently associated with impostor syndrome, defined using a cutoff of ≥ 62 based on previous literature [9, 12]. Initially, associations between each potential predictor and IS were examined. Variables demonstrating statistically significant associations in bivariate analyses were subsequently entered into a multivariate logistic regression model. For categorical variables with more than two levels, the entire variable (including all dummy-coded categories) was retained in the multivariate model if at least one level showed statistical significance in the bivariate model. Results are reported as crude and adjusted odds ratios (OR/aOR) with 95% confidence intervals (CI). Model assumptions (Multicollinearity, linearity of the logit for continuous predictors, and influential observations) were assessed as detailed in Supplementary File 1.

Model fit was evaluated using the Omnibus test of model coefficients and the Hosmer-Lemeshow goodness-of-fit test, with results reported as chi-square (χ²), degrees of freedom (df), and corresponding p-values. Additionally, Nagelkerke’s R² was calculated to estimate the proportion of variance explained by the model, and discriminative ability was assessed using the area under the receiver operating characteristic curve (AUC) based on predicted probabilities from the fitted model.

Ethical considerations

The study protocol was reviewed and approved by the Ethics Committee of Al-Quds University (Ref No: 593/REC/2025). All procedures adhered to the principles outlined in the Declaration of Helsinki. Informed consent was obtained electronically from all participants prior to questionnaire completion. Participation was voluntary, anonymous, and confidential, with no personal identifiers collected. Data were securely stored and accessible only to the research team.

Results

Participant characteristics

A total of 1,065 students completed the questionnaire, comprising 654 (61.4%) medical students and 411 (38.6%) nursing students. The mean age was 20.87 years (SD = 2.0), and 644 (60.5%) participants were female. The vast majority of participants (96.3%) were single, and 81.3% reported living with their families. Regarding university distribution, the largest proportion of the total sample was from Al-Quds University (29.4%), followed by An-Najah National University (22.8%). In terms of academic levels, the majority of nursing students were in their third (37.5%) and fourth year (38.4%). Among medical students, 307 (46.9%) were in the preclinical stages (years 1–3) and 347 (53.1%) were in the clinical stages (years 4–6). Approximately half of all participants resided in urban areas, with 44.1% in rural areas and 5.2% in refugee camps. Full details are presented in Table 1.

Table 1.

Sociodemographic characteristics of participants (N = 1,065)

Variables		Medical Students (n = 654)	Nursing Students (n = 411)	Total (n = 1065)
Age: Mean (SD)		21.01 (2)	20.65 (2.1)	20.87 (2)
Gender: N %	Female	360 (55)	284 (69.1)	644 (60.5)
	Male	294 (45)	127 (30.9)	421 (39.5)
Marital Status: N %	Single	637 (97.4)	389 (94.6)	1026 (96.3)
	Married	17 (2.6)	20 (4.9)	37 (3.5)
	Divorced	0 (0)	2 (0.5)	2 (0.2)
Place of Residence: N %	Camp	25 (3.8)	30 (7.3)	55 (5.2)
	Rural	262 (40.1)	208 (50.6)	470 (44.1)
	Urban	367 (56.1)	173 (42.1)	540 (50.7)
Current Living Situation: N %	I live with my family	491 (75.1)	375 (91.2)	866 (81.3)
	I live in the university dormitory	133 (20.3)	28 (6.8)	161 (15.1)
	I live with my friends	16 (2.5)	1 (0.2)	17 (1.6)
	I live alone	14 (2.1)	7 (1.7)	21 (2)
University: N %	An-Najah National University	165 (25.2)	78 (19)	243 (22.8)
	Al-Quds University	152 (23.2)	161 (39.1)	313 (29.4)
	Palestine Polytechnic University	122 (18.7)	67 (16.3)	189 (17.8)
	Hebron University	81 (12.4)	66 (16.1)	147 (13.8)
	Arab American University	134 (20.5)	39 (9.5)	173 (16.2)
Academic Year: N %	First Year	82 (12.5)	47 (11.4)	129 (12.1)
	Second Year	133 (20.3)	52 (12.7)	185 (17.4)
	Third Year	92 (14.1)	154 (37.5)	246 (23.1)
	Fourth Year	54 (8.3)	158 (38.4)	212 (19.9)
	Fifth Year	122 (18.7)	----	122 (11.5)
	Sixth Year	171 (26.1)	----	171 (16)
Have you been diagnosed with a chronic health condition? (YES) N %		72 (11)	44 (10.7)	116 (10.9)
Do you exercise regularly? (YES) N %		167 (25.5)	96 (23.4)	263 (24.7)

Continuous variables are reported as mean and standard deviation (SD), while categorical variables are reported as frequencies and percentages (N/%)

Impostor syndrome prevalence and distribution

The overall mean CIPS score was 61.13 (SD = 15.08). Medical students reported significantly higher CIPS scores than nursing students (62.63 vs. 58.75, Cohen’s d = 0.274, P < 0.001). Regarding the distribution of impostor severity categories, the largest proportion of the total sample (45.82%) reported moderate IS experiences, followed by 34.46% with frequent experiences, 10.99% with intense experiences, and 8.73% with few impostor characteristics.

The distribution of impostor syndrome categories by gender showed a comparable pattern between males and females, with no statistically significant association (P = 0.069) (Fig. 1).

Fig. 1.

Distribution of impostor syndrome by gender

Mindfulness levels

The overall mean MAAS score was 3.68 (SD = 0.85). Nursing students had a slightly higher mean MAAS score than medical students (3.72 vs. 3.66); however, this difference was not statistically significant (P = 0.314). The distribution of mindfulness categories revealed that the majority of participants demonstrated fair (45.5%) or good (29.7%) levels of mindfulness. Smaller proportions were classified as poor (15.6%) or very poor (2.3%), while only 6.5% and 0.4% achieved very good and excellent levels, respectively.

Emotional intelligence levels

The overall mean TEIQue-SF global score was 4.68 (SD = 0.79). Nursing students had slightly higher mean global EI scores and subscale scores compared to medical students; however, none of these differences reached statistical significance (all P > 0.05). The largest segment of the overall sample fell within the average emotional intelligence tier (n = 426, 40%); the remaining participants were distributed almost equally across the low tier (n = 322, 30.2%) and the high tier (n = 317, 29.8%).

Among the subscales, sociability had the highest mean score (5.38, SD = 1.22), followed by well-being (4.97, SD = 1.12), emotionality (4.70, SD = 0.90), and self-control (4.48, SD = 0.94). Detailed comparisons of all psychological measures are presented in Table 2.

Table 2.

Comparison of impostor syndrome, trait emotional intelligence, and mindfulness scores between medical and nursing students

Variables		Medical Students (n = 654)	Nursing Students (n = 411)	Mean Difference [95% CI]	Cohen’s d	P- value	Total (n = 1065)
TEIQue-SF   Mean (SD)	Well-Being	4.95 (1.10)	5.00 (1.15)	-0.04 [-0.18–0.09]	-0.039	0.529	4.97 (1.12)
	Self-Control	4.44 (0.93)	4.53 (0.94)	-0.09 [ -0.21–0.02]	-0.096	0.116	4.48 (0.94)
	Emotionality	4.70 (0.91)	4.70 (0.89)	0.01 [ -0.10–0.12]	0.010	0.874	4.70 (0.90)
	Sociability	5.32 (1.24)	5.46 (1.17)	-0.14 [ -0.29–0.01]	-0.103	0.062	5.38 (1.22)
	Global	4.65 (0.78)	4.71 (0.81)	-0.06 [ -0.16–0.04]	-0.074	0.227	4.68 (0.79)
MAAS: Mean (SD)		3.66 (0.84)	3.72 (0.87)	-0.05 [ -0.16–0.05]	-0.062	0.314	3.68 (0.85)
CIPS: Mean (SD)		62.63 (15.68)	58.75 (13.75)	3.88 [ 2.08–5.67]	0.274	< 0.001 *	61.13 (15.08)

The independent t-Test was used to compare continuous variables. Effect estimates are reported as Cohen’s d

TEIQue-SF Trait Emotional Intelligence Questionnaire- Short Form, MAAS Mindful Attention Awareness Scale, CIPS Clance Impostor Phenomenon Scale

^*Indicates statistical significance

Correlations among study variables

Pearson correlation analysis revealed significant associations among all three primary study variables. The TEIQue-SF global score was positively correlated with MAAS scores (r = 0.458, P < 0.001), indicating that students with higher EI also reported greater mindfulness. Conversely, the TEIQue-SF global score was negatively correlated with CIPS scores (r = − 0.470, P < 0.001), and MAAS scores were also negatively correlated with CIPS scores (r = − 0.333, P < 0.001). These findings indicate that higher levels of EI and mindfulness are each associated with lower levels of impostor syndrome. Correlation coefficients are presented in Table 3.

Table 3.

Pearson correlations between impostor syndrome (CIPS), mindfulness (MAAS), and emotional intelligence (TEIQue-SF)

Variable	Mean	Standard Deviation	1.	2.	3.
1. TEIQue-SF Global Scale	4.68	0.79	----	0.458**	-0.470**
2. MAAS Scale	3.68	0.85	0.458**	----	-0.333**
3. CIPS Scale	61.13	15.08	-0.470**	-0.333**	----

TEIQue-SF Trait Emotional Intelligence Questionnaire- Short Form, MAAS Mindful Attention Awareness Scale, CIPS Clance Impostor Phenomenon Scale

^**P value < 0.001

Predictors of impostor syndrome

Logistic regression analysis

Logistic regression was conducted to identify factors independently associated with IS (CIPS ≥ 62). In bivariate analyses, significant predictors included medical program enrollment (crude OR = 1.645, P < 0.001), nursing academic stages compared to clinical medical stages (crude OR = 0.675, P = 0.008), enrollment at An-Najah National University (crude OR = 1.486, P = 0.048), presence of a diagnosed chronic health condition (crude OR = 1.491, P = 0.043), MAAS scores (crude OR = 0.572, P < 0.001), and TEIQue-SF global scores (crude OR = 0.385, P < 0.001). Age, gender, and regular exercise were not significantly associated with IS in bivariate analyses (all P > 0.05) and were therefore excluded from the multivariate model.

Assumption checks for multicollinearity violations found that all variables had VIF values ranging from 1.005 to 4.861 and tolerance values from 0.206 to 0.995. The university program and academic stage variables showed potential collinearity, over the “Nursing” category, reflecting partial overlap. Therefore, we retained only the academic stage variable in the multivariate model, given its more granular distinction (preclinical vs. clinical medical training vs. Nursing). The linearity assumption of the logit was also met (Box-Tidwell test for interaction terms for continuous predictors indicated no significance (MAAS score, p = 0.997; TEIQue-SF Global score, p = 0.054). Additionally, no influential outliers were identified in the model (max Cook’s D = 0.0996, max leverage = 0.0278). Full diagnostic results are available in Supplementary File 1.

In the multivariate logistic regression model, EI emerged as the strongest independent predictor, with an adjusted OR of 0.424 (95% CI: [0.347–0.517], P < 0.001), indicating that each one-unit increase in TEIQue-SF global score was associated with an approximately 57.6% reduction in the odds of experiencing IS. Mindfulness remained independently associated with IS (adjusted OR = 0.774, 95% CI: [0.651–0.921], P = 0.004), corresponding to an approximately 22.6% reduction in the odds of IS per one-unit increase in MAAS.

Regarding academic stages, preclinical medical students showed significantly elevated odds of experiencing impostor feelings after adjustment for other variables (adjusted OR = 1.491, 95% CI: [1.050–2.118], P = 0.026), and nursing academic stages had significantly lower odds compared to clinical medical stages (adjusted OR = 0.706, 95% CI: [0.512–0.972], P = 0.033).

The association between An-Najah National University and IS lost statistical significance in the multivariate model (P = 0.057), as did the association between chronic health condition status and IS (P = 0.140).

The overall multivariate model was statistically significant (χ² = 161.651, df = 9, P < 0.001) and explained approximately 18.8% of the variance in IS (Nagelkerke R² = 0.188). Additionally, the Hosmer-Lemeshow test indicated adequate model fit (χ² = 4.493, df = 8, P = 0.810) and the model demonstrated acceptable discrimination (AUC = 0.714, 95% CI: 0.684–0.745, P < 0.001) Fig. 2. Full regression results are presented in Table 4.

Fig. 2.

Receiver Operating Characteristic (ROC) curve of the multivariable predictive model. The curve was generated using the model’s predicted probabilities of clinical impostor syndrome (CIPS ≥ 62). AUC = 0.714, 95% CI: 0.684–0.745, P < 0.001)

Table 4.

Bivariate and multivariate logistic regression analysis of factors associated with impostor syndrome (CIPS ≥ 62)

Variables		OR [95% CI]	P-Value	Multivariate aOR [95% CI]	P-Value
Age		0.961 [ 0.905–1.021]	0.198	------
Gender	Female	Ref		------
	Male	0.995 [ 0.777–1.273]	0.967
University Program	Nursing	Ref		------
	Medicine	1.645 [ 1.279–2.115]	< 0.001 *
Academic stages	Clinical (Medicine)	Ref
	Preclinical (Medicine)	1.249 [0.918–1.698]	0.157	1.491 [ 1.050–2.118]	0.026 *
	Nursing (Years 1–4)	0.675 [ 0.505–0.902]	0.008 *	0.706 [ 0.512–0.972]	0.033 *
University	Arab American University	Ref
	An-Najah National University	1.486 [ 1.003–2.202]	0.048 *	1.542 [ 0.988–2.409]	0.057
	Al-Quds University	1.180 [ 0.811–1.717]	0.387	1.457 [ 0.959–2.213]	0.078
	Palestine Polytechnic University	1.098 [ 0.724–1.667]	0.659	1.218 [ 0.761–1.949]	0.411
	Hebron University	0.995 [ 0.637–1.554]	0.982	1.000 [ 0.613–1.632]	0.999
Have you been diagnosed with a chronic health condition?	No	Ref
	Yes	1.491 [ 1.012–2.196]	0.043 *	1.375 [ 0.901–2.097]	0.140
Do you exercise regularly?	No	Ref		------
	Yes	0.893 [ 0.675–1.183]	0.431
MAAS Score		0.572 [ 0.491–0.667]	< 0.001 *	0.774 [ 0.651–0.921]	0.004 *
TEIQue-SF (Global Score)		0.385 [ 0.322–0.462]	< 0.001 *	0.424 [ 0.347–0.517]	< 0.001

References: Gender (Female), University Program (Nursing), Academic Stage (Clinical Medicine), University (Arab American University), Have you been diagnosed with a chronic health condition (No), Do you exercise regularly (No). Overall Multivariate Model Fit: Nagelkerke R2 = 0.188, χ2 = 161.651, df = 9 P  < 0.001). Hosmer-Lemeshow test indicated adequate model fit (χ² = 4.493, df = 8, P = 0.810)

TEIQue-SF Trait Emotional Intelligence Questionnaire- Short Form, MAAS Mindful Attention Awareness Scale, OR/aOR Odds Ratio/Adjusted Odds Ratio

^*indicates significance

Discussion

This multi-institutional cross-sectional study, to our knowledge, is the first to simultaneously examine the relationships among emotional intelligence, mindfulness, and impostor syndrome among medical and nursing students in Palestine. Our findings reveal a high prevalence of impostor experiences in this population, with nearly half (45.45%) meeting the threshold for clinically relevant impostor syndrome (IS). Emotional intelligence and mindfulness were identified as significant protective factors against IS, with EI emerging as the strongest independent predictor.

Prevalence and distribution of impostor syndrome

The overall mean CIPS score of 61.13, along with the finding that nearly half of participants reported frequent or intense impostor experiences are consistent with the existing global literature on IS prevalence among healthcare students. Alammar et al. reported a high prevalence of IS among medical students in Saudi Arabia, with nearly half of the participants (49.2%) demonstrating frequent imposter characteristics, and a considerable proportion (27.1%) experiencing intense levels of these characteristics [45]. Likewise, a study conducted among Malaysian medical students reported a high prevalence of the impostor phenomenon (IP), with nearly half of the participants (48% of males and 44% of females) meeting the criteria for impostorism, which was also associated with greater psychological distress, including low self-esteem, depression, and anxiety, as well as stronger intentions to leave medical school [46]. However, others reported markedly higher rates of students experiencing imposter feelings. For example, a study among Saudi undergraduate dental students found that 84.1% of participants reported moderate to severe impostor experiences, while 7.05% reported intense experiences [47]. Our findings are also in line with those of Franchi and Russell-Sewell, who reported that medical students frequently experience IS precipitated and perpetuated by their educational environment [9], and with the multi-center study by El-Ashry et al. among nursing students [10].

Notably, medical students in our study reported significantly higher CIPS scores than nursing students (62.63 vs. 58.75, P < 0.001), and the multivariate analysis confirmed that enrollment in a medical program was independently associated with approximately 70% higher odds of experiencing IS. This finding may be attributable to several factors specific to medical education, including the longer duration of training, the transition from preclinical to clinical settings with its attendant steep learning curve, the hierarchical nature of medical teams, the phenomenon of “pimping” (in which senior clinicians challenge junior students publicly), and the intense competition for residency positions. The finding that preclinical medical students had significantly higher adjusted odds of IS compared to clinical medical students (adjusted OR = 1.491, P = 0.026) is noteworthy and may reflect the heightened uncertainty and identity formation challenges that characterize the early years of medical training, before students have had the opportunity to consolidate clinical competencies.

In contrast, nursing students had significantly lower odds of IS than clinical medical students (adjusted OR = 0.706, P = 0.033). This may be related to differences in program structure, with nursing curricula often integrating clinical practice earlier and providing more structured mentorship and collaborative learning environments, which could buffer against impostor feelings. Alternatively, the generally shorter program duration and perhaps different cultural perceptions of nursing as a profession in Palestine may play a role.

Gender was not significantly associated with IS in our study (P = 0.069), which contrasts with the original characterization of IS as primarily affecting women [6]. Recent evidence has shown mixed results concerning gender differences in impostor syndrome rates [5].

Emotional intelligence as a protective factor

Our study identified EI as the strongest independent predictor of IS, with each one-unit increase in the TEIQue-SF global score corresponding to a reduction of approximately 57.6% in the odds of experiencing impostor syndrome. This finding adds to the growing evidence that EI may serve as a crucial psychological resource in healthcare education [16, 48–50].

It is important to note, however, that the overall model explained only 18.8% of the variance in IS (Nagelkerke R² = 0.188), indicating that a substantial proportion (81.2%) of the variability in impostor experiences remains unaccounted for by the variables examined in this study. This suggests that other psychological constructs not measured here, including perfectionism, self-esteem, resilience, academic self-efficacy, coping strategies, social support, personality characteristics (e.g., neuroticism), and perceived psychological safety within the learning environment, likely contribute meaningfully to impostor experiences. Future research should adopt more comprehensive models that incorporate these additional variables to provide a fuller understanding of the factors driving IS in healthcare students.

The mean global TEIQue-SF score of 4.68 in our sample suggests moderate levels of EI among Palestinian healthcare students, broadly comparable to findings from other populations. Dogham et al. found that 57% of Egyptian nursing students demonstrated high EI [18], and Aithal et al. reported that 65% of medical students in their sample had high EI [19]. Notably, EI levels did not differ significantly between medical and nursing students in our study, despite the significant differences in CIPS scores. This suggests that while EI is protective against IS, other program-specific and contextual factors may contribute independently to impostor experiences.

Mindfulness as a protective factor

Mindfulness was independently associated with lower IS in both univariate (r = − 0.333) and multivariate analyses (adjusted OR = 0.774, P = 0.004). Each one-unit increase in MAAS scores was associated with an approximately 22.6% reduction in the odds of IS. This finding is consistent with the cross-sectional study by Tanrıöver et al. in Türkiye, which similarly reported a significant negative association between mindfulness and IS among medical students [12]. It also aligns with broader theoretical and empirical evidence suggesting that mindfulness reduces psychological distress by disrupting ruminative and self-critical cognitive patterns [51–53].

While EI had a stronger independent association with IS than mindfulness in our multivariate model, the positive correlation between EI and mindfulness (r = 0.458) suggests that these constructs are synergistic. Students who are both emotionally intelligent and mindful may benefit from a compounding protective effect, wherein emotional self-awareness facilitates mindful attention and vice versa. This aligns with research demonstrating that mindfulness-based interventions can enhance EI [27, 28, 54].

The moderate positive correlation between EI and mindfulness raises the possibility that these constructs may not operate entirely independently in relation to IS. Specifically, mindfulness may partially mediate the relationship between EI and IS, such that emotionally intelligent students are more likely to engage in mindful attention, which in turn is associated with lower impostor feelings. Alternatively, EI may moderate the effect of mindfulness on IS, such that the protective value of mindfulness is amplified in students with higher emotional awareness. However, because the current cross-sectional design precludes testing directional or mediational hypotheses, future research employing structural equation modeling or formal mediation analysis should examine these pathways.

The Palestinian context

The Palestinian context adds important background to our findings. Healthcare students in Palestine face challenges beyond typical academic stressors, including political instability, restricted movement, socioeconomic hardships, and limited mental health access. These factors may increase psychological burden and explain the high prevalence of IS in our sample. The lack of difference in EI or mindfulness between medical and nursing students, despite varying IS, suggests program-specific stressors, not psychological resources, influence IS. The multi-university design across five West Bank universities, the balanced participant distribution, and the large sample size (n = 1,065) provide solid estimates of IS prevalence and strengthen the generalizability of our results.

Practical implications

Our findings have practical implications that can be organized across four levels: At the practice level, routine screening for impostor feelings using the CIPS should be considered during preclinical years, when students appear most vulnerable. Individual EI coaching sessions and reflective journaling exercises could help students develop greater emotional self-awareness and challenge impostor-related cognitions. At the organizational level, universities should consider establishing peer mentorship programs that pair senior students with juniors to normalize self-doubt and provide role modeling. Dedicated psychological support units within health professions faculties could offer confidential counseling and workshops focused on IS awareness. At the educational level, structured mindfulness-based stress reduction (MBSR) programs, adapted for the academic calendar, could be integrated into curricula. EI training modules based on validated frameworks (e.g., the TEIQue model) could be incorporated into professional development courses, alongside faculty development initiatives training educators to adopt supportive, non-shaming pedagogical approaches. At the policy level, Palestinian health professions education authorities should consider developing national curricular standards that incorporate psychological well-being competencies alongside clinical skills. Advocacy for dedicated funding to support mental health infrastructure in conflict-affected universities is essential, as is cross-institutional collaboration to share best practices and resources.

Strengths and limitations

This study has several strengths. It is the first to examine the triadic relationship among EI, mindfulness, and IS in Palestinian healthcare students, addressing a significant gap in the regional literature. The multi-institutional design spanning five universities enhances generalizability within the West Bank. The large sample size (n = 1,065) provides adequate statistical power for the analyses performed. Additionally, all instruments used have been validated in Arabic-speaking populations, supporting their cultural appropriateness.

However, some limitations must also be acknowledged. First, the cross-sectional design precludes causal inferences; the observed associations may be bidirectional, and longitudinal studies are needed to establish temporal relationships. Second, convenience sampling may introduce selection bias [55], and the recruitment through social media platforms introduces a digital access and engagement bias. Students with greater social media activity, digital literacy, or smartphone access may be overrepresented, potentially limiting the representativeness of the sample and the generalizability of the findings. Third, the reliance on self-reported measures may be subject to social desirability. Fourth, although the model explained 18.8% of the variance in IS, a substantial proportion of variance remains unexplained, suggesting that other factors, such as perfectionism, self-esteem, social support, and resilience, should be explored in future studies. Fifth, all three primary constructs (EI, mindfulness, and IS) were assessed through self-reported measures administered in a single online session, introducing the possibility of common-method variance, which may artificially inflate the observed correlations among these variables. Future studies should consider multi-method assessments (e.g., combining self-report with peer ratings or behavioral measures) or temporal separation of measurements to mitigate this concern.

Conclusions

This multi-institutional cross-sectional study demonstrates that impostor syndrome is highly prevalent among Palestinian medical and nursing students, with medical students being more affected. Emotional intelligence and mindfulness were identified as significant protective factors against IS, with EI emerging as the strongest independent predictor. These findings suggest that EI development programs and mindfulness-based interventions may be worthwhile areas for future interventional research. Future longitudinal and interventional studies are warranted to establish causal pathways and evaluate the effectiveness of targeted psychological support programs in reducing impostor experiences and promoting the well-being of healthcare students in conflict-affected settings.

Abbreviations

IS

Impostor Syndrome

IP

Impostor Phenomenon

EI

Emotional Intelligence

CIPS

Clance Impostor Phenomenon Scale

TEIQue-SF

Trait Emotional Intelligence Questionnaire-Short Form

MAAS

Mindful Attention Awareness Scale

A-MAAS

Arabic Mindful Attention Awareness Scale

SD

Standard Deviation

OR

Odds Ratio

aOR

Adjusted Odds Ratio

CI

Confidence Interval

DSM-5

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

ICD-11

International Classification of Diseases, Eleventh Revision

Authors’ contributions

Conceptualization, A.Z.; Methodology, A.Z. and R.D.; Formal analysis, A.Z. and R.A.; Investigation, R.D., M.A.A., T.B.S., A.E.A., M.N., T.R.A., T.A.M., M.H.S. and B.A.; Resources, T.A.M., M.N., M.H.S., B.A. and A.A.; Data curation, T.A.M., M.H.S. and B.A.; Writing—original draft, A.Z., R.D., R.A., M.A.A., T.B.S., A.E.A., M.N. and T.R.A.; Writing—review and editing, A.Z., R.D., R.A., T.A.M., M.H.S., B.A. and A.A.; Supervision, A.A.; Project administration, A.Z. All authors have read and agreed to the published version of the manuscript.

Funding

This research did not receive any funding.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

Ethical approval for this study was obtained from Al-Quds University research committee (Ref No: 593/REC/2025). Participation was voluntary and anonymous, and electronic informed consent was obtained from all participants. This study followed the ethical principles of the Declaration of Helsinki.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.