Feeling Like an Imposter as a Med Student? You’re Not Alone

Have you been feeling like you’ve fooled the admissions committee and faculty into believing that you are more competent, intelligent, qualified, and/or talented than you actually are? Do you believe that you’ve only gotten a slot in the medical school of your choice because of luck or legacy? More importantly, do you have a persistent, deep-rooted fear that you might be “found out?”

These feelings, fears, and beliefs are collectively known as imposter syndrome (IS, also known as the imposter phenomenon). IS affects more than 75% of high-achieving individuals, especially those in health and Science, Technology, Engineering, and Mathematics fields.

“It’s broadly pervasive and can impact the way that students see themselves as part of the healthcare team, where they see themselves within the institution, and how they perform,” said Ted O’Connell, MD, director of Medical Education at Kaiser Permanente of Northern California.

“The impact of imposter syndrome tends to repeat itself,” he added, noting that it commonly rears its ugly head during major transition periods along the pathway to a medical career.

It can feel lonely. But it’s likely that many of your peers or even faculty are intimately familiar with what you’re feeling, or like you, are silently suffering through a culture where knowledge and intellect are tested and critiqued on a daily basis. Fortunately, there are strategies to unlearn IS and create a healthier, more fulfilling experience in medical school and beyond.

Recognizing IS

Before you can unlearn IS, it’s essential to understand what it is (and what it is not). To establish a baseline, it’s important to acknowledge that it is not the same as low self-esteem — a global sense that we have about ourselves, and many people with IS don’t have low self-esteem. The same is true for twinges of anxiety or self-doubt, for example, feeling nervous before going on stage or going on a date.

Instead, IS is specific to situations where knowledge and intellect are being tested, that is, arenas of achievement, like medical school and becoming a doctor. It especially affects students from backgrounds and of genders that are historically underrepresented in medicine and in society, for example, Black, Native, and female people.

“When you’re in incredibly stressful, competitive environments like med school, you perceive everyone as being so much smarter than you, so much more accomplished than you, and so you don’t want to give people any sense that you don’t belong there or that they are much further ahead than you,” said Kevin Cokley, PhD, University Diversity and Social Transformation Professor of psychology at the University of Michigan, Ann Arbor, and editor of The Impostor Phenomenon: Psychological Research, Theory, and Interventions.

“Part of my lived experience was starting medical school and suddenly being surrounded by other students who were the best of the best and trying to figure out a very steep learning curve around the quantity of materials that needed to be learned and understanding the culture of medicine — the hidden curriculum of many things that are expected but aren’t readily explained or written in any type of policies,” said O’Connell.

Cokley also pointed out that for people from minority groups, there’s also a racialized component, that is, racial cues from the environment help shape the way that they experience IS.

Still, there is a unifying factor in IS.

“The singular thing that connects people with imposter syndrome, regardless of race, gender, situation, occupation, or the organization’s culture, is unrealistic, unsustainable self-expectations around competence,” said Valerie Young, PhD, an international expert on IS and co-founder of the Imposter Syndrome Institute.

“We can hit these markers sometimes, but we can’t consistently hit them; no one can. And when we fall short, we judge ourselves as ‘less than’ and as imposters,” she said.

Young’s decades of experience in IS have reinforced that key factors like failure and shame are not experienced the same way. There are five patterns of what she referred to as competence distortions:

• The perfectionist focuses on how something is done and how it turns out, the need to be the best. These unattainable standards are often associated with a sense of failure even when they are successful in the eyes of others (eg, getting a 99 out of 100 on an exam).
• The expert is the knowledge version of the perfectionist and is characterized by the eternal search for knowledge, the “hat” or “how much” one knows, which inevitably leads to feelings of shame because they never feel that they know enough.
• The natural genius judges their confidence on the speed and ease with which they are able to achieve a goal. Any struggle or extra effort around mastering a skill or subject leads to feelings of shame and failure.
• The soloist feels the need to do something on their own. Asking for help is a sign of “less than,” and like the natural genius, can result in shame and failure.
• The superhuman needs to excel in multiple roles simultaneously, easily, and with perfect execution. Falling short in any of these roles means failure.

Overcoming IS

Though evidence-based interventions are currently lacking, there are steps that you can take.

“People need to normalize imposter syndrome by doing less psychologizing and more contextualizing to understand it,” said Young, referring to a concept she called the “humble realist.” This means:

• Being realistic and having a healthy respect for your limitations.
• Acknowledging that you are better at some things than at others, that setbacks happen, and learning a healthy response to failure, mistakes, and constructive feedback.
• Understanding that a certain amount of fear and self-doubt is part of the achievement journey.

In other words, it’s not about fixing oneself, but rather flipping the question from “Why do I feel like an imposter?” to “I’m in medical school. I am here to learn. I am in a rapidly changing, information-dense area and a culture of shaming. How could I not be okay?”

“With more recent generations of medical students, there is more of a willingness to talk about imposter syndrome and acknowledge it,” said O’Connell.

In addition to whatever support the medical school may provide, he said it can be helpful to find peers and even faculty with similar life experiences or racial/ethnic backgrounds to develop community or study groups. It’s equally important to proactively seek out mentors and/or tutors who can help in areas where a person might be coming up short or is not as competent in as they’d like to be.

O’Connell said that being aware of how one contextualizes feedback is also important. Constructive criticism, even if it sounds very critical and harsh, can still have an impact in terms of how one approaches good patient care, he said.

“You might not have realized that this is the culture that you were going into, but it is the culture that you are in,” added Young. “You have to change your thoughts first, then act like you believe the new thoughts (eg, how would you act if you really thought that you were entitled to make a mistake or not understand something). Over time, the feelings will catch up.