Imposter Syndrome

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“Am I really meant to be here,” you wonder. “How quickly will the school find out I am a fraud and they made a mistake admitting me?”

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The views and opinions expressed in this collection are those of the author and do not necessarily reflect the positions of the Association of American Medical Colleges.

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Roshini Pinto-Powell, MD, is an internist and the associate dean of students and admissions at the Geisel School of Medicine at Dartmouth. She is also a Public Voices Fellow in the Op-Ed Project at Dartmouth.

You are finally in medical school. Years of hard work and preparation have finally paid off. Why then do you feel as if you do not belong? You look around at the smart people that surround you — professors, peers, the portraits of wise looking people hanging on the walls of the school you longed to join. “Am I really meant to be here?" you wonder. “How quickly will the school find out I am a fraud and they made a mistake admitting me?”

You are not alone. Once a smart, accomplished student in your premed class, you are now surrounded by seemingly perfect people. It is easy to start questioning your ability.

Suzanne Imes and Pauline Rose Clance first described this “syndrome” in 1978 as occurring in high achieving women, but shortly after clarified that Imposter Syndrome was not specific to women. While there still seems to be a preponderance of women who identify with these feelings, studies show that under pressure, men may be more affected by imposter syndrome than women.

Feeling like an imposter can be detrimental to good mental and physical health. Medical school, while never easy, has become particularly stressful in the past decade. The exhausting pace of medical school, the inherent competition for research and leadership experiences, and the ever looming specter of the licensing exams (USMLE) saps the enthusiasm and empathy with which students arrive at school. Feeling like they are “not good enough” on top of these stressors makes students question their abilities and, in many cases, can lead to social isolation, academic difficulties, and misaligned career paths. Even if career choices are not directly affected, feeling like an imposter causes individuals to have difficulty enjoying or taking credit for their successes. This trend is concerning to the AAMC and to medical schools, as the consequences are significant and can lead to burnout. A 2016 article Imposter syndrome and burnout among American medical students: a pilot study concluded that a quarter of male medical students and nearly half of female students experience imposter syndrome and report burnout components of exhaustion, cynicism, emotional exhaustion, and depersonalization.

There is also some evidence that society’s engagement and reliance on social media in the modern era contributes to our feeling of being imposters. Premed and medical school blogs and social media sites tend to portray the need to be ‘perfect’ or to hide one’s flaws. This is exactly the opposite of a growth mindset that is key to learning and success in medicine.

Can these feeling be mitigated? Yes they can!

As students and physicians, we need to acknowledge that we are mere mortals, subject to the same faults and human failings as the rest of the population. Yes, we must try hard to be the “ideal” student and physician, but trying our best does not mean we will always be perfect. The weight of living up to an ideal can be exhausting. We need to break the silence and isolation that surrounds imposter syndrome by sharing our stories. Hearing that mentors and advisors struggled with and survived these feeling provides guidance to recognize and address the symptoms of imposter syndrome and burnout and seek help early.

An article in the Journal of Physician Assistant Education in 2007 recommends a three-point exercise to recognize imposter traits:

  1. Acknowledge both positive feedback you have received and your doubts about its authenticity. This will demonstrate how you discount the opinion of other people.
  2. Examine the messages you receive about yourself from others. Understanding the source of your negative self-image can empower you to break free.
  3. Visualize telling your mentors and peers how you have “fooled” them. This will help you realize how absurd your words might sound to them.

Once you recognize that you might have imposter syndrome, seek out an advisor or mentor. It is important to gain perspective as you will realize that you are not alone. Almost everyone at some point in their lives or in certain situations feel like imposters. Another tip is to recognize that a student is NOT expected to know as much. Embrace being a novice and focus on developing a growth mindset. Each student enters medical school with different strengths. Comparing yourself to your peers is unhelpful, but sharing expertise among colleagues lifts everyone’s performance.

Your school did not make a mistake. You do not need to be someone perfect. You are enough.

Roshini Pinto-Powell, MD, FACP
Associate Professor of Medicine and Medical Education; Associate Dean of Students and Admissions; Dartmouth Public Voices Fellow; Co-director of On Doctoring; Co-director of Geriatrics and Ambulatory Medicine
Dartmouth Geisel School of Medicine

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