HealthApril 29, 2020

Overcoming imposter syndrome in medicine

By: Ajibike Lapite

I moved to Philadelphia five days before residency orientation. On moving day, I noticed flyers promising popcorn and an assortment of beverages in the apartment lobby later that evening. Having no groceries — cut me some slack, I had just moved in — I made my way to the lobby and soon found myself in a conversation about an unexpected topic: imposter syndrome.

One of my new neighbors asked me if I was ready to enter the work world, and I answered honestly. "No, but I don't think there's any point where I could feel entirely 'ready,'" I said.

"Are you prepared for the racial microaggressions that come with being a minority in your field of work? I imagine you'll constantly have to prove and reassert why you deserve to train at such a strong institution."

We had only just met, but she was touching a nerve. I had become familiar with the concept of imposter syndrome at the tail end of my medical school career. I learned about it following a prolonged period of discomfort and inadequacy that I struggled to understand, and I spent the majority of my first year of residency unaware of my strengths.

What is imposter syndrome?

When a person experiences imposter syndrome, they doubt their accomplishments and are plagued by a fear of being exposed as inadequate. One paper published in Academic Medicine explains that it's typically associated with perfectionism, excessive anxiety and self-doubt. These triggers make it common in the high-stakes and evaluative culture of medicine.

The phenomenon has consequences for doctors and those they treat. Negative experiences at work contribute to burnout, and constant self-doubt is hardly positive. The New York Times reports that these feelings of inadequacy disproportionately impact those in racial, gender or sexual orientation minorities, who lack the privilege of some of their co-workers.

Academic Medicine also notes that the problem of feeling like an imposter can affect medical professionals at any level of their career development, and even high-performing students, residents and physicians are not immune.

3 Ways to overcome imposter syndrome

My gratitude at having matched at such an esteemed program became a major source of my self-doubt. I questioned everything. Did I deserve to train at the Children's Hospital of Philadelphia? Why had they chosen me? When would they realize they'd made a mistake?

The fear of being exposed as the fraud I felt I was did not make me a better physician or resident. My faculty mentor said it best: "When you believe that everything is a weakness, you cannot make steps to improve your actual deficits."

During vacation before the start of my second year of residency, I took the time to reflect. I tried to identify the source of my self-doubt and define strategies that could improve my confidence at work.

Here are three that worked for me, and maybe they will work for you, too.

1. Identify a goal

I noticed that on the days I felt the most defeated at work, I focused on one failure in particular. Perhaps the attending hadn't agreed with my plan for one patient or I found myself unable to answer a "pimp" question on rounds.

Our negative experiences stick with us in a way that positive experiences do not, yet there is almost always a moment during a day that can be classified as a win. I established the practice of making a goal each day that I felt I'd be able to achieve no matter what happened. Some examples include do right by my patients or make sure my patients feel heard. A goal that is rooted in the heart of your purpose is restorative.

2. Make a routine of daily affirmations

Our mental state is affected by our circumstances and our practices. I set time aside each morning to think of three of my strengths, ones that were unrelated to my role as a physician.

Soon after I began this practice, I noticed that it got easier to think of my strengths and positive attributes. When I doubted myself at work, I replayed my affirmations in my head. It momentarily dispelled my self-doubt and helped me zero in on the short-lived nature of any hardship.

3. Seek legitimate feedback

Ultimately, our insecurity stems from our wish to be good physicians. When we haven't gotten to where we want to be at work, imposter syndrome can creep in.

We are often our own worst critics — both in terms of our harshness toward ourselves and the inaccuracy of our self-analyses. Seek out mentors who can give you honest feedback about where you excel and how you can improve.

Medical professionals are plagued by perfectionism for good reason. We navigate a high-stakes career where mistakes can result in serious consequences. But there needs to be a balance between identifying room for growth and being paralyzed by perceived inadequacies. You made it to this point of medical training because you are talented and hard-working. Remind yourself of that — and when you can't, surround yourself by people who will.

Ajibike Lapite
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