Effectively managing imposter syndrome in medicine

Author

Beata Chami, ACC, MA, Organizational Psychology (biography and disclosures)

Disclosures: Private practice.

Frequently asked questions I have noticed

Have you ever felt like a fraud, like your peers would eventually uncover that you are misrepresenting the medical degree and certifications that you’ve acquired? If so, it’s a familiar feeling among the medical community — up to 60% of physicians experience imposter syndrome (IS). IS interferes with an individual’s belief and confidence in their own accomplishments, leaving them uncertain and feeling unworthy of their achievements, despite evidence to support the contrary.

Due to the highly competitive nature of medicine, from studying rigorously for the MCAT, competing for acceptance into medical school, surviving residency, and maintaining medical licensing requirements as a practicing physician; this industry is faced with a perpetual culture of unrealistic self-standards, significant pressure to succeed, and exposure to constant criticism. One can assume these conditions are why IS is most common in medicine than any other professional sector. Despite its prevalence in the medical community, there is little discussion of IS among physicians.

This piece will discuss IS and the way in which it manifests, while offering solutions to effectively manage its onset in medical staff environments.

Data that answer these questions

As graduate students, in 1978, Suzanne Imes and Pauline Rose Clance both felt unworthy of their hard-earned positions in their academic programs. They then started to notice that their students, mainly female, were having the same experience. As a result, both Imes and Clance started researching the feeling and coined the term imposter phenomenon, otherwise known as ‘imposter syndrome’ or ‘imposterism’.

IS is not a medical disorder that is diagnosable, otherwise listed in the Diagnostic and Statistical Manual of Mental Disorders. Instead, it is a notable feeling that mostly high-achieving individuals face where they feel a fraudulent sense of self-worth, in constant fear that others will “find out” that they are not as capable, intelligent, and creative as others think they are. Although the preliminary findings were largely done with female academicians and suggested a predominant impact on the one gender, as the phenomenon evolved and accrued more literature, it was found that both females and males are equally susceptible to the experience.

It is important to note that imposterism is distinct from self-esteem and perfectionism but is certainly linked with both personality traits.¹ Unsurprisingly, research shows that the imposter phenomenon is associated with negative mental health outcomes² such as anxiety and depression.³ It is for this reason it is important to understand and pinpoint IS within ourselves, as it has the potential to take away from our well-being and overall quality of life.

According to IS researcher Dr. Valerie Young, there are five types of ‘imposterism’ we should look out for. The following categories of imposterism have evolved as individuals with IS do not all experience failure-related shame in the same way as they all have different criteria for what competence looks like.

Categories:

The Perfectionist’s focus is based on how something is done and how it turns out. Perfectionists tend to set abnormally high objectives, which need to be fulfilled seamlessly. When these goals are unfulfilled or mostly complete but not fully, this is when the perfectionist’s imposterism is activated. Success is rarely satisfying for this group as they hold a deep and constant belief that no matter the outcome, they can always do better. Often, there is a lack of acknowledgement of progress or celebration of achievements.

The Expert’s competence is contingent on the amount of information they’ve grasped. This group has a hard time ever believing that they have sufficient information to act successfully as they constantly fear being perceived as inexperienced or unknowledgeable. These individuals are likely to have an abundance of qualifications to support their promotion in a role or involvement in a project but adopt the belief that they have obtained them through fluke or trickery of the system. The expert does not believe in experiential learning and instead, obsesses over acquiring more training. Some may refuse to use their skills until they’re ‘qualified enough’, where the time to pursue a goal likely will never come as there is consistent participation in the cycle of needing to know more before feeling ready to complete a task.

The Soloist believes that success is attained individually and that receiving help from others signifies the inability to perform entirely. Therefore, they have a difficult time asking for help, believing it will reveal their fraudulence. Successfully completing a task on their own positively contributes to the soloist’s self-esteem. Receiving help would therefore lead a soloist to believe that they are being perceived by others as an imposter: someone who could not possibly manage on their own and does not possess the knowledge, skills, and abilities to succeed.

The Natural Genius firmly believes that their competence is based on their rapid and effortless ability to grasp new concepts. This individual assumes that success comes naturally and that when a task requires hard work, this signifies their imposterism. In fact, the more effort or struggle is put towards completing a task, the more this yields a natural genius’ fraudulent feelings. There is no opportunity to learn or develop additional skills for this individual. Therefore, they may be hesitant to take on new challenges unless their skillfulness shows at the very beginning of their pursuit.

The Superhuman is the high achiever who over-excels in not only work, but all other aspects of their life. This type of imposter is constantly in search of external validation from others to feel worthy (many people comment on their rare ability to successfully juggle multiple hats), instead of recognizing internal feelings of success. They perceive success in how much they do, believing that their competence lies in their ability to manage and brilliantly upkeep the multiple roles they represent such as employee, leader, friend, child, and parent. When the ‘superhuman’ becomes challenged at upholding all of these identities at once, this is when their imposterism is triggered.

What I recommend (practice tips)

The purpose of this piece is to address the experience of imposter feelings among the medical community. It is important to discuss and understand the genesis of this phenomenon as it’s not only linked to poor mental health outcomes such as anxiety, depression, and burnout but has also resulted in lower professional fulfillment.⁴ Physicians who experience IS are typically overlooked for promotions, less likely to pursue challenging assignments, held back from speaking up or sharing ideas in group settings, procrastinate on projects, overwork and over-prepare, and more frequently switch jobs.

There may not be a “cure” for IS, but there are strategies available to minimize the onset of it. The first step is to start with you and identify the symptoms. Mental health stigma is prevalent among physicians,⁵ which in turn deters them from accessing help. Support can be sought in various ways, depending on comfort level. You can begin with self-help by reading books and reviewing wellness websites, connecting with colleagues for peer support, or reaching out to a care provider. Whichever option you start with is the first step towards addressing symptoms that can have a significant impact on your well-being and those that you care for. Here are a few approaches for your consideration:

IS-specific resources and approaches:

• If this piece resonates, complete this free imposter-syndrome assessment by Dr. Pauline Rose Clance and further learn about the specific ways in which this phenomenon shows up in you.
• Pay attention to your inner critic — use positive affirmations to offset this chatter.⁶ The language you use to describe yourself and your needs impacts how you feel about your abilities and ultimately, cope with the imposterism. This technique can help with overcoming negative thinking patterns and cognitive biases that all individuals experience from time to time. For specific tips and strategies, review the following resource by Mind Tools.
• Make a list of your strengths and ask trusted peers around you for feedback. Revisit them during moments when you question the value that you bring to the work that you do/team that you contribute to.
• Consider shifting your perspective from a performance to a learning mindset. Sometimes, our concentration can be whisked away by striving to perform, and we ignore the process required to effectively intake new information. Medicine is a large, ever-evolving field that involves constant learning and application of new concepts and research, where often physicians are tasked with balancing it with clinical practice. Reasonably, adopting a growth mindset allows room for practitioners to learn, fail, and continuously strengthen their skillset. As demonstrated in Mangels et al. (2006) research conducted with students, those under the impression that their intelligence was a fixed entity became negatively impacted by feedback, avoiding the pursuit of challenging learning opportunities.⁷ Whereas, those who perceived intelligence as malleable rebounded more optimally from failure.
• Seek out a trusted mentor — consider enrolling in a department-wide mentorship or leadership programs. If you serve as a mentor, consider reflecting on your possible relationship with imposter syndrome and whether you find it appropriate to share your experience with your mentees. This effort has the potential to demonstrate the phenomenon’s common presence in medicine and destigmatize sharing and seeking support.
• Recognize the advantages of being a novice: feeling like an imposter is often triggered in midst of developing a new skill. Having a beginner’s mindset allows you to learn with little bias and an abundance of creativity of how you can resolve certain challenges.

Medicine-specific resources:

• The Physician Health Program of British Columbia (PHP BC) provides support for physicians in BC seeking to pursue counselling, coaching, addressing career and life transitions, strengthening professional relationships, experiencing substance use, finding a family physician, and addressing concern for a colleague’s well-being. In addition, PHP allows users to directly connect with a fellow physician colleague, providing peer-to-peer support. Access PHP’s 24-hour helpline at 1.800.663.6729.*PHP services are available to all BC physicians, medical students, residents, and retired physicians.
• The Canadian Medical Association (CMA) Wellness Connection is a virtual, safe space for physicians, residents, and retired physicians to gather collectively to discuss, receive support, and build community around well-being. There are a number of different sessions to choose from, such as peer support, compassion rounds, mindful parenting, and psychological first aid to name a few. Weekly sessions are available, led by trained facilitators. This resource can be accessed by all Canadian physicians and medical learners (both non-CMA and CMA members).
• CMA Physician Wellness Hub is a repository of well-being resources that promotes health and wellness in the medical profession by curating CMA content and information from trusted sources to support physicians, residents, and medical students. This is an excellent tool for physicians to lean on for wellness self-help, particularly if one prefers to begin their journey by independently addressing their well-being. Consider the following featured article: Healthcare leadership in action: Overcoming imposter syndrome.
• Access Health Authority Resources
  • Fraser Health Medical Staff Website
  • Northern Health Physician Health & Wellness Resources
  • Providence Healthcare Medical Staff Website
  • Vancouver Coastal Health (VCH) Medical Staff Website
    • Medical Staff Intranet
  • Interior Health Physician Wellness Resources
• Check in with your facility’s Medical Staff Association (MSA) or community’s Division of Family Practice (DoFP) as many of these groups are addressing and providing well-being supports and resources for physicians. This is a great opportunity to join the conversation about and address site/community-specific challenges with like-minded peers who share similar experiences in your community.

References

1. Cokley K, Stone S, Krueger N, Bailey M, Garba R, Hurst A. Self-esteem as a mediator of the link between perfectionism and the impostor phenomenon. Pers Individ Dif. 2018;135:292-297. doi:10.1016/j.paid.2018.07.032 (View with CPSBC or UBC)
2. Cokley K. McClain S. Enciso A. Martinez M. An examination of the impact of minority status stress and impostor feelings on the mental health of diverse ethnic minority college students. J Multicult Couns Devel. 2013;41(2), 82–95. doi:10.1002/j.2161-1912.2013.00029.x (Request with CPSBC or view with UBC)
3. Clance PR, Imes SA. The imposter phenomenon in high achieving women: dynamics and therapeutic intervention. Psychotherapy. 1978;15(3):241-247. (View)
4. Albert Henry T. Survey: 1 in 4 doctors struggles with “imposter phenomenon”. American Medical Association. February 13, 2023. Accessed November 8, 2023. (View)
5. Galbraith N, Boyda D, McFeeters D, Hassan T. The mental health of doctors during the COVID-19 pandemic. BJPsych Bull. 2021;45(2):93-97. doi:10.1192/bjb.2020.44 (View)
6. Gottlieb M, Chung A, Battaglioli N, Sebok-Syer SS, Kalantari A. Impostor syndrome among physicians and physicians in training: A scoping review. Med Educ. 2020;54(2):116-124. doi:10.1111/medu.13956 (View with CPSBC or UBC)
7. Mangels JA, Butterfield B, Lamb J, Good C, Dweck CS. Why do beliefs about intelligence influence learning success? A social cognitive neuroscience model. Soc Cogn Affect Neurosci. 2006;1(2):75-86. doi:10.1093/scan/nsl013 (View)
8. Beckman TJ. The Imposter Syndrome in Physicians. Mayo Clin Proc. 2022;97(11):1964-1965. doi:10.1016/j.mayocp.2022.09.014 (View with CPSBC or UBC)
9. Chen C. Doctor who? Reflecting on impostor syndrome in medical learners. Can Fam Physician. 2020;66(10):e268-e269. (View)
10. Shanafelt TD, Schein E, Minor LB, Trockel M, Schein P, Kirch D. Healing the professional culture of medicine. Mayo Clin Proc. 2019;94(8):1556-1566. doi:10.1016/j.mayocp.2019.03.026 (View with CPSBC or UBC)

Vote

Please indicate how this article will change your practice:

Effectively managing imposter syndrome in medicine

• I disagree with this approach
• I will consider changing my practice, but need more information/time
• I will likely change my practice
• I will definitely change my practice
• I already do this

View Results

 Loading ...