Intended for healthcare professionals

Opinion

Imposter syndrome—a particular problem for medical students

BMJ 2021; 375 doi: https://doi.org/10.1136/bmj.n3048 (Published 09 December 2021) Cite this as: BMJ 2021;375:n3048
  1. Malaikah Khan, fourth year student
  1. University of Manchester
  1. malaikahkhan1999{at}gmail.com

“Everyone loses when bright people play small,” according to Valerie Young, an internationally renowned expert on imposter syndrome and co-founder of the Imposter Syndrome Institute.

Valerie joined the Sharp Scratch podcast panel to discuss imposter syndrome or, as it should more appropriately be called, the imposter phenomenon, due to the fact it is not a medical illness. Imposter syndrome is when capable and intelligent people externalise their accomplishments and feel like they have fooled others into believing in them. These individuals chalk up their achievements to error, timing, or luck and often find themselves feeling like imposters walking among those who deserve to be where they are. Issy Walker, a fourth year medical student at the University of Nottingham, shared how the concept resonated with her, as she often catches herself wondering how she has “got this far” or “surely I’m going to trip up.”

A breeding ground for imposter syndrome

The panel also discussed why imposter syndrome is so common among medical students. Valerie explained that medicine is an achievement arena. The breadth and depth of medical knowledge is ever growing and there is a pressure for students and doctors to keep up, while medical school itself is a hive of testing knowledge, day in, day out.

At its crux, imposter syndrome is the result of “unrealistic, unsustainable expectations of what it means to be competent,” Valerie says. In reality, competence is being able to identify the resources we need to get the job done. When we use illogical definitions of competence, we lose our confidence for fear of making mistakes. Yet as medical students, for example, we need to take a step back and look at the bigger picture in which it should be expected for us to make mistakes. After all, why wouldn’t we? We lack experience and mistakes are a reliable way of learning. As someone who has been through the experience and is now a general surgical trainee, Clara Munro shares her insight, emphasising that “acceptance of failure is the most important step to training as a doctor.”

Organisational culture also plays a role in the development of imposter syndrome and it’s safe to say that the culture in medicine surrounding the fear of failure is harmful. Whether it’s getting professional feedback that focuses solely on negatives, or the shame of making mistakes stemming from inherent perfectionism, medicine is a breeding ground for imposter syndrome. Declan Murphy, an academic FY2 doctor in north east England, pointed out that the maximum praise that can be achieved in formal feedback in certain areas is “no concerns,” which shows how positive feedback is not prioritised in the same way negative feedback is. While it is hugely important for us to know where we can improve, not getting those positive affirmations formally means we are forced to seek them out elsewhere, whether that’s from our patients or peers.

Lack of representation exacerbates feelings of doubt

Imposter syndrome is made more acute by the people around us. When there are individuals of the same age or background, or with the same prior experiences and interests as us, we are less likely to feel like an imposter. Valerie pointed out that this is all to do with representation. When there are less people like us, we feel a pressure to represent our entire group. This logic explains why Valerie is approached most often by international students seeking advice when she speaks at universities.

This means that feelings of imposter syndrome intersect with under-representation, bias, and exclusion, which must be tackled alongside imposter syndrome itself. Until systemic changes in diversity and inclusion are put into place, imposter syndrome is perhaps almost a direct consequence of the current system, not to mention the toll it takes on someone’s confidence and belief in oneself, which can take a long time to rebuild.

Overcoming imposter syndrome

It’s not all bad news, however. Valerie suggested a lot of things that can help to stop imposter syndrome, both on a personal level and at an institutional level. Normalising it is the first step. Hearing those who are successful in their careers acknowledging imposter syndrome offers a level of reassurance that it can be overcome. On a more personal level, it’s important to reframe your own thoughts and the constructive criticism you receive, says Valerie. Going from feeling out of your depth when surrounded by intelligent people, thinking “everyone here is brilliant and I’m not,” to thinking “everyone here is brilliant, I’m going to learn so much” turns you into someone with a healthy drive to excel.

The last tip Valerie offered to address imposter syndrome is to carry on despite how you feel. It’s unrealistic to wait until you feel 100% confident in something before you attempt it, especially because a huge part of confidence is gaining experience. Projecting confidence when you have appropriate training will carry you through even the most difficult tasks.

So next time you are questioning your capability, thinking that you got to where you are by mistake, remember that this is the ammunition of the loaded gun that is imposter syndrome. Remind yourself that you are there for a reason and that you deserve to be there as much as anyone else.

Footnotes

  • Competing interests: none declared.

  • This article was based on a discussion on our Sharp Scratch podcast. Listen to the episode on Spotify or Apple pods

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