Studies suggest that at least a third of doctors-in-training feel like a fraud at some point in their careers. Dr Caitlin Weston shares her advice for managing imposter syndrome.
Many of us know the feeling – that nagging suspicion that despite all the things you have “achieved” in your lifetime, it’s really just been a combination of good timing, help from other people, a lowering of standards, people liking or taking pity on you, and/or your painstakingly maintained façade of competence.
Imposter phenomenon (IP; also called imposter syndrome) was first described in 1978 by psychologists studying a group of high-achieving women apparently incapable of internalising their achievements despite considerable success and accolades. Those suffering from IP also have remarkable capacity to internalise and ruminate upon failures, and believe that only through good luck and smooth talking have managed to create a very positive but very inaccurate impression of themselves.
Others may see the imposter as a highly capable achiever, and ask more and more of them, hoping to encourage growth and knowing they will do a great job on any task set for them. The imposter, trying desperately to maintain the façade of easy perfection, may take on more and more responsibility, downplaying the time and effort required to maintain their incredibly high standards. Alternatively, imposters may hesitate to apply for new opportunities or to evaluate themselves positively for fear that they will be exposed as failures, neither of which is helpful to career advancement or development.
Beyond merely being an unpleasant experience, these patterns increase the imposter’s risk of burnout, dissatisfaction, distress, anxiety and depression, and can lead to an intense desire to escape their responsibilities, self-sabotaging behaviours like procrastination, and withdrawal from those around them.
Of course, the self-doubt that leads to imposter syndrome isn’t all bad. Second-guessing our decisions, particularly as training clinicians, makes us safer and can provide us with increased opportunities for learning. People who never experience feelings of self-doubt exist in a much more sinister state known as sociopathy.
Imposter phenomenon is common. It’s not a permanent state, but it visits most of us from time to time throughout our careers and beyond. An awareness of when these thoughts are likely to strike can help us recognise them as just thoughts when they do.
A recent review of imposter phenomenon in academia states: “IP is more often seen in those with advanced degrees, those who have the traits of conscientiousness, achievement orientation, perfectionistic expectations, and people who work in highly competitive and stressful occupations.”
It probably won’t escape your notice that that description fits just about everyone in medicine. Many (but not all) studies suggest a preponderance for IP among women (who are often taught that modesty is a virtue), but men experience it at high rates too (despite cultural norms teaching them to suppress feelings suggestive of vulnerability). Meanwhile individuals who are in a minority group in their discipline are at higher risk regardless of whether the divide is based on race or gender (this may well stretch to other demographic divides too).
In terms of timing, we are likely to have more IP-like thoughts as we face new roles or challenges, and especially in our first jobs. If you are reading this on the eve of your internship, fear not! Although this year is probably your peak risk time for experiencing frequent imposter syndrome, you will not be alone. The vast majority of your peers will feel the same way at some point.
You’ve handled it before: the thoughts are probably familiar from your first weeks of medical school, or your first few clinical placements. They will likely return as you rotate between terms, and each time you’re called to take a step up in responsibility: supervising your first medical students, awaiting your first night shift, if you pursue a specialty and have to step up to the role of registrar, fellow, junior consultant, winding down to retirement, even outside of medicine: for example, as a parent.
The years ahead will provide you with plenty of opportunities to learn how to recognise your brain’s script for imposter syndrome, understand what is likely to trigger it for you, and figure out how you can best keep it in check at a healthy level rather than letting it dominate you.
Nurturing and maintaining trusting relationships with colleagues and friends is one of the best things you can do to combat imposter syndrome. You will realise that everyone feels like a fraud sometimes, even those who look as though they have breezed through their entire life feeling confident.
Cultivating insight and self-compassion will serve you better in your career and life than almost any skill set.
Cultivating a “growth mindset”– a fundamental belief that your abilities can be improved with effort and persistence – will enhance your capacity for learning and increase your ability to bounce back from adversity and failure. Many people suffering from imposter syndrome experience evaluation anxiety, but feedback, appraisal, assessments and applications are an inherent part of our training system.
If you are a medical student or junior doctor, you form a part of a new generation in medicine, one that is more open than ever to showing vulnerability and emotional intelligence. This is something that should be celebrated, nurtured and encouraged.
So let me tell you now that you are enough, that you are welcome here in the big wide world of medicine, that you have strengths that contribute to your patients and your team, and that you are not supposed to know everything. You are here to learn and will continue to do so for the rest of your life.
In turn, I hope that you will pass these concepts on to those who follow you as you make your way in the world.
Key references and resources:
Dr Caitlin Weston, CF
Non-Executive Director, Doctors Health Services Pty Ltd Wellbeing Project Lead at MedApps Pty Ltd AMA (NSW) Doctors-in-Training Committee