What is imposter syndrome? it is the notion that high-achieving individuals, despite objective successes, fail to internalize accomplishments, and instead experience self-doubt and fear of being exposed as a fraud or imposter (1). Psychologists Clane and Imes first described the imposter phenomenon in 1978, referring to a condition where persons feel out of place or a lack of belonging (2). The imposter syndrome is linked with perfectionism, triggered by anxiety and self-doubt, and is highly prevalent in the culture of medicine (3). In other words, no matter how much a person has accomplished (degrees, accolades, positive peer feedback), the sensation of being an imposter prevails. Positive feedback is quickly dismissed, and negative feedback may be agonized over. You’d think imposter feelings fade over time, but self-doubt affects clinicians at all career stages (3). People with imposter syndrome experience doubt about their career as they wonder whether they are truly equipped, trained, smart enough, or competent enough for the job.

If you have ever had thoughts like, “everyone else is smarter than me,” “I’m not good enough,” “I don’t belong here,” “my peers are better than me,” or “am I actually qualified for this job?” you’re probably experiencing imposter syndrome. Can you relate? I know I can.

BOTTOM LINE: Recognize common imposter syndrome feelings and thoughts - such as feeling unworthy, feeling out of place, feeling as though others are more competent, underestimating your own accomplishments and emphasizing failures.

Why is Imposter Syndrome an Issue?

There is robust literature describing the harmful association between imposter feelings and job performance, job satisfaction, and burnout across many careers, including healthcare professionals (4). A recent systematic review revealed depression and anxiety are frequently co-morbid with imposter feelings (4). Imposter syndrome can lead to low confidence, stress, fear of failure, feelings of insecurity and unworthiness (5). Many people do not openly discuss imposter feelings because doing so could be construed as a sign of weakness (5). Imposter syndrome can cause us to deny ourselves job opportunities and life experiences, if we feel we aren’t good enough for them (6).

Clinicians who experience imposter syndrome may not be able to appropriately manage the emotional turmoil that can accompany medical errors. As clinicians, we know that mistakes are common in medicine and we are all bound to make them during our careers. If we underestimate our competence, it’s difficult to objectively reflect on the mistakes we make. To put it into context, a person experiencing imposter feelings who makes a mistake may think the error occurred because of their own lack of competence, poor skill set, lack of intelligence, etc. A person experiencing imposter feelings might think “someone smarter wouldn’t have made that mistake.” As you can imagine, these types of thoughts following a medical error can lead to guilt, stress, anxiety, and self-doubt (3).

How can we Manage the Imposter Syndrome?

1. Recognize the imposter: When I first learned about imposter syndrome, I was elated. At last, I had a way to conceptualize my imposter feelings and no longer felt alone. I read about it, listened to podcasts, watched videos of professionals who have had similar experiences. Recognizing imposter feelings can lead to acceptance, and a solution-focused mindset to start to manage them.

2. Share experiences: Discussing our experiences with others (especially those in our profession), can help contextualize feelings and eliminate the feeling of being alone (5). Regular debriefing with trusted colleagues can help offset the negative feelings associated with imposter syndrome.

3. Stop comparing yourself to others: We tend to over-emphasize the achievements of others while underestimating their struggles and failures. Read a biography of any famous person or talk with someone you look up to – was success the only part of their journey? This notion applies to all of us. We will always meet someone with more experience and more expertise (6). Try not to see this as a negative thing. We can learn from their expertise and embrace the fact that medical knowledge and skills take years to develop and are passed down from person to person.

4. Introduce the concept of imposter syndrome during medical training: I had no idea what I was experiencing until I read an article on imposter syndrome, and finally everything clicked. I felt ill-prepared for the self-doubt that accompanied the transition from student to nurse practitioner. Medical educators should develop an awareness that insecurities and self-doubt are common and recurrent among students (3). If this awareness exists, solutions can be implemented during the training process. Medical programs need to foster a culture where students can safely share feelings of self-doubt and fear of failure (3). Encouraging students to debrief when medical errors occur can transform failure into a teaching tool (3). In a safe learning culture, people feel free to speak up, and dialogues can take place about fears, errors, and uncertainties.

Thankfully, there are a lot of resources available to learn more about imposter syndrome, and I encourage you to explore them.

BOTTOM LINE: Recognize the imposter syndrome, share and debrief your experiences and feelings with trusted colleagues, and limit comparing yourself to others.

 Readings/References:

1. Kolligian Jr J, Sternberg RJ. Perceived fraudulence in young adults: Is there an'imposter syndrome'?. Journal of personality assessment. 1991 Apr 1;56(2):308-26.

2. Clance PR. The Impostor Phenomenon: When Success Makes You Feel Like a Fake. Atlanta: Peachtree Publishers; 1985.

3. LaDonna KA, Ginsburg S, Watling C. "Rising to the Level of Your Incompetence": What Physicians' Self-Assessment of Their Performance Reveals About the Imposter Syndrome in Medicine. Acad Med. 2018 May;93(5):763-768. doi: 10.1097/ACM.0000000000002046. PMID: 29116983.

4. Bravata DM, Watts SA, Keefer AL, Madhusudhan DK, Taylor KT, Clark DM, Nelson RS, Cokley KO, Hagg HK. Prevalence, predictors, and treatment of impostor syndrome: a systematic review. Journal of general internal medicine. 2020 Apr;35:1252-75.

5. Gill P. Imposter syndrome–why is it so common among nurse researchers and is it really a problem?. Nurse Researcher. 2020 Sep 16;28(3).

6. Abdelaal G. Coping with imposter syndrome in academia and research. The Biochemist. 2020 Jun 23;42(3):62-4.

Videos:

The Surprising Solution to the Imposter Syndrome by Lou Solomon