Defeating Imposter Syndrome in Medicine. The 3 things you need to know.

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Defeating Imposter Syndrome in Medicine. The 3 things you need to know.

Do you feel like you don’t belong in medicine? Like there are so many people doing amazing things, and you think, I could never do that? If you have ever found yourself holding back because you think you don’t bring anything unique to the table, if you have ever felt intimidated by all the amazing people around you and decided not to push on and put yourself out there, know that you are not alone.

So Many Applications!

Did you know that for the 2020 academic year, there were 53,000 applicants to U.S. medical schools? AAMC data Together, they submitted over 900,000 applications, and yet despite submitting an average of 17 applications each, less than half of those applicants, 42% were accepted and matriculated. Wow! That’s a lot of applications. It has gotten even more competitive than when I was applying for medical school, so there must be even more qualified candidates out there every day.

Med School Gets Intimidating

With that background, we’ll pick up my story as I left college, graduating summa cum laude of a small liberal arts college with a bachelor’s of science in physics. From being the top part of my class in a school of about 3000 undergraduates. To a medical school with a first year class of nearly 200. I never had a lecture class that large ever in college. Maybe freshman biology had 75 or so students, maybe a little more. But that was it. In college, I was a big fish in a small pond. I benefited from small classes, more opportunities to ask questions, get mentoring, I was unique. Yes, being a physics major and Pre-Med was out of the ordinary too, but that story will just have to wait for another time. I show up in medical school and find out, wow, I thought I was pretty smart, but these classmates of mine, they are super smart. Some had prior graduate degrees in chemistry, work experience outside of medicine, prior research or plans for research on their way to whatever specialty they had their mind set on. It was a bit intimidating.

So I’m not the top of my class anymore, but I’m still pretty good, right. And then, the classes come, anatomy, biochemistry, physiology, histology. Some of these things were covered extensively for my classmates in undergrad and others were just smarter than me. I get a failing grade on my first exam for histology. Do I really belong here? I was used to working hard, I was a learner, and yet, wow, am I really cut out for this?

Imposter Syndrome…How To Fight It

Let’s stop for a moment and identify what’s going on here. This comparison game that had me stuck, questioning myself, my journey in medicine before it had barely begun, I felt like an imposter. Feeling that I don’t measure up, that I’m not good enough, letting that hold me back. These are all components of how imposter syndrome showed up in my life.

Today I’m going to show you the three things you need to do to fight imposter syndrome. It will likely pop up in your life as a physician if it hasn’t already. And then before we end here, I will leave you with a vision of what your next step forward could look like in your life.

Identify Imposter Syndrome

First, you need to identify that you might be facing imposter syndrome. Those feelings of paralysis, I can’t do this, I can’t apply for this. I wondered after I failed that first histology exam. Am I really cut out for this? Was it a mistake to do physics in undergrad which I enjoyed? Should I have done biology like I was quote supposed to? You need to know that this is a common experience in medicine. I faced some of those thoughts again as my USMLE step 1 score was average or slightly above it, but not much. Will I be able to get into a good residency program? I already was leaning towards pediatrics, combined internal medicine/pediatrics or med/peds, or family medicine. I knew that I didn’t need scores as high as I would to apply for ophthalmology or some other competitive specialty, but even though I knew I had done my best, it was still intimidating to hear my classmates say, oh yeah, I got this score on Step 1, and now I want to apply for this prestigious residency or this higher paying, cool specialty.

It doesn’t just stop there. It also cropped up in residency when I applied for one of three chief resident positions during the middle of my second year. While not the most gifted teacher, I am good with details, spreadsheets, and logistics. I saw this as an opportunity to grow in leadership, and I thought I brought sufficiently different skills, particularly on the administrative side when I saw the things that at the time didn’t make sense, particularly about scheduling. And yet, I didn’t get one of those three positions. I was definitely bummed at first, like I had missed out, I wasn’t what the program leadership was looking for.

I know it’s not just me. Whether it is saying, “Oh I’m just specializing in pediatrics not med/peds or something else”, whether “I’m just the medical student” or “just the intern”. It could be, well I’m not going to be as good of a doctor because my clinical experiences were more virtual than in person because of COVID. Whether you have considered applying for a leadership position, considered starting a new clinical program, writing a particular paper, or something else, there is always someone out there that you could compare yourself to. Just realize that, when these thoughts come up and you start to feel like, I can’t do what so and so person does, you could be experiencing imposter syndrome.

Rehearse and Remind

Great, so I am now an imposter. I feel like I can’t do this.

It can show up differently for different people, so naturally, what you will need to rehearse in your mind, what you will need to keep telling yourself over and over again, this too, will be different. So what am I going to keep on my mind?

Two things. Number one thing to rehearse, keep telling yourself positive, meaningful things. This could be starting a gratitude journal and adding a few things every day. This could be prior positive feedback from attendings, from patient families, or from loved ones or friends that have encouraged you in the past. This could be about things inside or outside medicine, opportunities you have taken to care for others and be involved in their lives. Even writing those things down or keeping a few cards or notes that people have written you. These can be helpful things in reminding you of your impact on other people and how they care about you.

It could also be a positive thought or favorite quote from a particular author, a song, a mantra, or a religious text that is meaningful to you. For me, the wisdom sayings of King Solomon of Israel in the 10th century BC are valuable to me. As I went into my USMLE board exams, I kept holding on to one of these sayings, “The horse is made ready for the day of battle, but victory rests with the Lord.” In other words, I can do all I need to prepare, and yet I can’t control the outcome. I have to trust in something outside myself that things will work out one way or another. It’s that illusion of control again, I can’t control everything.

In addition to what you tell yourself and keep on the forefront of your mind, the second thing to rehearse is the positive or helpful input you get from friends, family, or colleagues in your life who encourage and support you. You may need to let them in on some of the struggles you have, some of which may be universal and some of which are unique to medicine. Medicine is a beautiful privilege and a calling for many, but it is a hard road at many points along the way. People who know you and can help keep you grounded, encouraged, and supported are so important, since we were not meant to do this life all on our own. That community is so important.

Ongoing Growth Opportunities

So, imposter syndrome is super common, especially as we come up on new challenges, new chapters in our medical careers. Whether from medical school to residency, being an attending vs trying to add a particular other clinical opportunity. Those seemingly insurmountable obstacles, the thing you didn’t think you could do. Was that simply because you were intimidated, or is there actually something to learn from it? It may be a gap between where you are and where you need to be either in skills or knowledge, where you could actually get equipped, whether an additional training, coaching, or something else to close the actual gap in your ability to accomplish that other goal. Imposter syndrome shows up a lot of time when the only gap is in your mindset, that feeling that I feel like I can’t do it, when in reality, you probably could.

I have heard this from medical students who are dealing with imposter syndrome, being third and fourth year medical students in the midst of a pandemic with many experiences truncated or shifted all virtual. Yes, there are gaps in your clinical skills, and yes, you will need to seek out feedback and opportunities to address some of those things you missed, but this doesn’t mean that you will not be a good doctor. On the contrary, if you take that gap and then rehearse those positive thoughts from before, you can encourage yourself that you are a learner, you are a hard worker, you never give up, and you are committed to getting what you need to progress.

Take Action

So take a moment and reflect on how you need to put these things into practice, to step forward, to take that next step, to go do that hard thing, try something new, apply for that leadership position, take confidence in who you are as a great physician, or soon to be physician for all you medical students out there.

What could it look like for you?

Now imagine how your life will look in 6 months if you put some of these things into practice. You won’t say, I’m “JUST pediatrics”, no I am categorical peds or specializing in general pediatrics, full stop. I am not “just Ryan”, or I am “just the medical student”. Hi my name is Ryan, and I am the fourth year medical student on the team. I’m Dr. Stegink, the first year resident or intern. However you want to say these things, owning these things can make a big difference in your own mindset, how you see yourself, but also how you communicate that confidence, not in a brash, demeaning way, but in a way that draws the patient or family in, helping them feel “this is my doctor”, “this medical student is really part of my medical team and I can trust them”.

You won’t think that just because you haven’t done it and someone else has means you can’t. Each of those individuals were once there as well, not yet having done whatever amazing thing they now do. You could be the next physician coaching other doctors on how to start and grow profitable businesses. You could be a physician coaching your patients on weight loss and wellness with amazing results. You could be branching out with your own private allergy practice and having a full schedule quickly so you can serve your patients. This is not to tempt you to play the comparison game again but to imagine what is possible.

To recap, first you need to identify that you are facing imposter syndrome, rehearse those encouraging thoughts and words from important people in your life, and evaluate where you still may need to grow, but then go do whatever that thing is. That thing you have been waiting for, dreaming of, that thing that can help you make a difference for your patients, your career. Your community.

Take that next step in your wellness journey, even when imposter syndrome lurks around the corner. Go for it, and then share your wins with someone else to spur them on in their journey.