Imposter Syndrome

“I always knew I wanted to be a doctor.”

It’s a common sentiment heard among medical students. Many of my classmates had grown up in families of doctors, and it was just expected that medical school was the next step. Unlike many of my classmates, I don’t have anyone in the medical field in my family. Researching how to get into medical school seemed like a daunting task, and I knew if I was going to be successful I’d have to work for it.

When I was 15, I reached out to the surgery department at my community hospital and asked if I could shadow an anesthesiologist for a day. To my surprise, they said yes! I spent the day learning how to scrub like a surgeon and sat in on knee arthroscopes, tonsillectomies, and laparoscopic gallbladder removal. I patiently waited until I turned 16 and I applied to be an emergency room volunteer. Although I spent my 4 hours per week cleaning rooms and organizing drawers I felt like it was a step closer to my end goal. Gradually I started volunteering in the home health office and the hospital’s human resources office in addition to my emergency room commitments. During my senior year I begged my high school advisor to allow me to use my study hall to go watch surgeries at the hospital, and after piles of paperwork he finally agreed. By the time I graduated from high school I had logged over 200 hours in the OR.

Once I moved to college, I applied to be an emergency room volunteer at the largest trauma center in the Twin Cities. I was accepted and again I found myself spending 4 hours per week cleaning rooms and escorting patients. After a couple months of volunteering, a nurse nominated me for a position on the research associate program in the Emergency Department.  As a research associate, I felt like I had found my calling. Volunteering 16 hours per week, I had a front row seat to all the trauma cases and I had hands-on experience. I interviewed patients on my own, and I had to present my findings  to the attending physicians. For the first time ever I felt like my role mattered in patient care.

After my sophomore year of college, I spent my summer earning my Certified Nursing Assistant (CNA) and my Emergency Medical Technician (EMT-Basic) licenses. With my certifications I was quickly hired as a surgical assistant, a position I held until I moved out of state for medical school. I spent my weekends volunteering for the University of Minnesota’s EMS team at sporting events.  When I began the medical school process, my first interview offer came just weeks after I sent in my application. Just a few days after my interview, I received my first medical school acceptance, a week before I started my senior year of college. My university recognized this accomplishment and asked me to sit as a student advisor for our pre-med students. I was present for mock interviews and people sought me out for feedback on their applications and CVs.

I was prepared, I had this whole medical school thing figured out!

Or so I thought.

Once I got to medical school, I felt as if my school had made a mistake. Why did they select me? I knew plenty of my undergraduate classmates who had much more impressive resumes than me that weren’t accepted, so why was I let in? My medical school classmates had accomplished so much more than I had. Many of them had published research and a large majority of them already had a post-grad education and years of work experience under their belt. What did I have to show? A Bachelor of Science degree, some volunteer experience and a couple years experience working as a nurse assistant.

I began to feel like my acceptance was a fluke. I doubted my ability to be able to pass classes, and I dreaded the idea of taking my boards. I walked out of every test sure I had failed, and then when my results came out and I had passed I wrote it off to lucky guesses or a grading curve. For the first two years of medical school, I was just stumbling through every day. It felt like I was drowning, just kicking with all my might to stay afloat. Despite passing every quiz, test, and class I approached boards absolutely sure I was going to fail. I made myself physically ill preparing for my this test. I couldn’t sleep, I gained weight, I was always battling a cold. I was absolutely sure that this was going to the time I was found out as a fraud. I feared I would fail boards so miserably and everyone would know that I didn’t belong here in medicine and the gig would be up. In turn I found it hard to justify why I should “waste” my day studying. I became easily distracted and my hours spent studying slowly dwindled as my fears of failure grew.

But something remarkable happened. I didn’t fail boards. I passed and moved on to clinical rotations. Slowly but surely I’ve thrived on rotations. My hard work has been acknowledged and my confidence has grown.  I’ve been encouraged to pursue the career of my dreams and I’ve had the opportunity to mentor other students. My achievements are being recognized and for the first time in this 8 year journey I’m beginning to feel like a doctor.

I’m not alone in feeling painfully inadequate, in fact I’m in good company (Tina Fey, Emma Watson, Maya Angelou just to name a few). This phenomenon has a name, imposter syndrome, which is defined as “an inability to internalize one’s accomplishments”. Under this premise someone feels like a fraud because they think that they have duped the people around them into believing that their accomplishments are of a high caliber and have a fear of being found out.

“I have written eleven books, but each time I think, ‘uh oh, they’re going to find out now. I’ve run a game on everybody, and they’re going to find me out.’ “

– Maya Angelou

When imposter syndrome was first identified by two psychologists in 1978 they believe it only affected professional women. Subsequent research has since shown that this feeling of inadequacy and fear of failure affects many professions, from housewives to CEOs.

According to The International Journal of Behavioral Sciencethere is an “imposter cycle” which begins with an achievement related task whether it be a job opportunity or an upcoming exam. Those with imposter syndrome begin to experience anxiety or self-doubt over the task  and either over-prepare for the task or procrastinate. If they pass the test or get the job, those that over-prepare attribute the success to hard work and those that procrastinate attribute their success to luck, but neither will attribute the success to their own ability. As this cycle continues on with each new achievement related task those suffering from imposter syndrome overwork to make up for perceived self deficits which leads to self-doubt and anxiety. Surprisingly the repetition of success actually reinforces the feeling of being a fraud because it creates a bigger discrepancy between one’s perceived abilities and one’s accomplishments.

“There are an awful lot of people out there who think I’m an expert.  How do these people believe all this about me?  I’m so much aware of all the things I don’t know.”

-Dr. Chan, Chief of the World Health Organization

So why does having imposter syndrome matter? Feelings of inadequacy and failure can lead to frustration, unhappiness and even depression. Depression causes decreased workplace efficiency and an increase in number of absences which costs the nation billions of dollars each year due to lost productivity.  Those that aren’t depressed may be burnt out by constantly overcompensating for their perceived failures. Constantly doubting yourself can lead to self-sabotage of career opportunities which means qualified applicants may not apply for jobs or promotions and when they do they will understate their experiences which may cause a less qualified candidate to be selected for the same position.

Fortunately imposter syndrome is reversible. Here are 5 tips for combating imposter syndrome:

  1. You don’t need to be “the best”. An old adage in medical school is “what do you call the student who graduates last in medical school? Doctor”. I used to think what a scary thought that was, that someone you entrust your life and medical care in may have been the lowest ranked person in their medical class, but if you take a step back and realize what an accomplishment it is to not only be accepted to medical school, but to pass all the required tests, courses and boards then heck yeah they’re qualified to be a doctor! Grades and test scores can measure knowledge but they aren’t the be all end all to measuring intelligence and success.
  2. Accept praise. If someone compliments you, they’re probably doing so because you deserve it. Something I started doing when I started this blog was collecting the compliments I have received in a file on my computer. On days when I question whether anyone would want to read anything I write, I look back at these compliments and it motivates me to continue my work. It’s not conceited to be proud of the praise you have received
  3. Stop comparing yourself to classmates and coworkers. Someone else’s success does not detract from your own accomplishments.
  4. Don’t fear failure. Failure is a fact of life and it is unreasonable to think that you’ll be a rockstar in everything you do.
  5. Realize that nobody knows what they’re doing. When I was younger, I used to think physicians were god-like. I was intimidated to talk to them and I thought that there was no way they’d want to “waste their time” talking to a volunteer/a nurse assistant/a medical student like me. As a 4th year medical student I had the opportunity to socialize with physicians outside of the hospital as part of my interview trail. I was actually shocked that we could laugh and chat just as easily as I could with any of my friends. Earning a certain title doesn’t induce some magical coming of age epiphany. No matter where you are in your education or career you have something special that only you can contribute.

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