Breaking out of imposter syndrome during medical school

Imposter Syndrome is a term that was coined in the late 70s. And while it originally focused on dysphoria among successful and high-achieving women, “Imposter Syndrome” today is the feeling that one’s own success or achievements are a result of luck or tricking others into thinking that they’re smarter or more capable than one really is, despite having external evidence saying otherwise.

An early socio-psychological focus on women seems natural for the time when the concept was introduced; with all the systemic barriers and biases, especially at every level of academia, the promotion of “Imposter Syndrome” was all too familiar for minorities in general and specifically for women of color. The intersection of these two clearly distinguishable identities have long suffered discrimination, and even today there are all too many barriers for women of color pursuing an education in the sciences, especially.

Feeding into the unsettling experience of “Imposter Syndrome,” equally important are the cultural barriers in place for Asian and Latina women. Generally speaking, the American history of correcting racial intolerance has appeared to focus less on people of Asian descent. For some Asian Americans, this spurs an internal reluctance to seek help when encountering racial barriers—resulting in a sort of internalized and self-perpetuated downplay of their struggles.

For Latina women, a culture of staying at home to care for the family have continually torn at the motivation to seek an education or a successful life outside of the house—even today, it can be seen as abandoning or caring less about one’s family.

Clearly, there are reasons to believe that women—and specifically women of color—in positions of high achievement may be faced with believing that they aren’t meant to be where they are, or that their success is unwarranted. This is the core of the Imposter Syndrome experience.

Imposter Syndrome does not only affect women, however. Later focuses over the last 20 years have found that this experience affects men as well, making it clear now that this isn’t only a product of systemic bias.

Although the symptoms of Imposter Syndrome are similar to those of depression, it is not officially recognized as a mental condition. Nevertheless, it can absolutely impact your health negatively and, if left “untreated,” can put you at risk for other health problems and even depression itself.

Beginning to believe that you’re an “imposter” can lead to a diminishing drive or motivation to keep working and chasing your dreams and a decline in performance—professionally and academically as well as physically, ultimately causing increased anxiety and increased stress. One demographic that is affected by Imposter Syndrome all too often is that of medical students.

Science career students and Imposter Syndrome

We’ve mentioned before that medical school is no easy thing, and that there are many, many struggles to overcome along the way. Many of those struggles link intimately to motivation and drive, and so it’s not surprising to learn that Imposter Syndrome is often a consequence. Studies have shown that approximately one third of medical students believe that they are imposters, which, of course can be attributed in large part to struggles meeting the amount of work, studying, and practice that goes into every stage of getting your degree.

Between all the knowledge and skills that medical students are expected to pick up and handle well, it’s common to feel flustered and overwhelmed, perhaps subsequently thinking that the white lab coat you wear is the only thing making you fit in with classmates and colleagues—while the person underneath is somehow “less-than-worthy.” Maybe it feels less like a doctor’s coat you wear, and more like a Halloween lab coat.

In the context of med school, Imposter Syndrome can lead to a lowered motivation to finish school, more clouded goals both during your academic career and afterword, and a declined performance on exams and other assignments. In this video, Marilyn Merola talks about how Imposter Syndrome has played a role in her med school career.

In medicine, Imposter Syndrome is also linked closely to burnout, which is often described as a feeling of both emotional and physical exhaustion as well as depersonalization and decreased feelings of personal achievement. This manifests in feeling like you’re just “going through the motions,” which can lead to a disassociation between yourself and your successes. Going through the motions can potentially be a danger, too, not only your health and performance but to the health of your patients.

Clearly, Imposter Syndrome isn’t healthy, and its persistence can only get worse. Breaking out of it isn’t always easy, but knowing how to move towards feeling better is critical. Let’s look at some recommended actions you can take to break out of Imposter Syndrome.

Reach out

While it’s easier said than done, realizing that you might be suffering from Imposter Syndrome is the most important first step you can take. It isn’t enough, however.

Once you’ve realized the problem, a helpful next step is to talk about it. Find somebody that you trust—it can be a parent, a sibling, any other family member, or a close friend—and talk about it. Simply verbalizing the problem and receiving feedback can help you find the steps necessary for you to overcome the struggle and to recognize your own hard work and achievements.

We’ve mentioned already that Imposter System is not uncommon in the medical community. Talking to your classmates, colleagues, mentors, and professors can lead you to have conversations with people who are facing the same thing and maybe even with people who felt the same thing and have overcome it. In either case, reaching out can help you find solutions or ways to improve the situation.

Especially as Imposter Syndrome has very real effects on your health and is even linked to depression, it is also totally valid to seek professional help in therapy. Medical training doesn’t necessarily make you immune to thinking or pretending that your mental and emotional health are just as important as your physical health, even if only subconsciously. In fact, anything that can affect your wellbeing in this way merits professional intervention.

Take the good with the bad

This is also something that is easier said than done, on multiple levels. For one, we all have to deal with negative bias. Psychologically speaking, negative bias (or positive-negative asymmetry) is our tendency to register negative experiences more readily and to more quickly recall and dwell on them.

For example, you could be having a very good day before someone makes a nasty comment about you. Not only can this immediately put a dampener on your mood, chances are you’ll spend a good amount of time later dwelling on the comment and trying to understand from where it came.

On the other hand, if you’re having bad day, a compliment probably won’t be enough to turn your day around—and later on you’ll probably be too busy sulking to be dwelling on the nice thing someone said earlier.

The “this always happens to me” feeling might illustrate the power of this bias a little better. Maybe you know someone that is afraid of dogs and claims that dogs always attack her whenever they get near. This fear didn’t come out of nowhere, but it probably isn’t true that all the dogs she encounters attack her 100% of the time—or even a majority of the time. What probably is true is that on multiple occasions dogs have gotten aggressive with her, and now every time she sees a dog she automatically thinks of the times that she was attacked rather than the many times that she didn’t even notice the dog walking by. We’re quicker to recall negative experiences than good ones, and especially more than neutral ones.

This is something that everyone has to deal with and is manageable, but becomes quite problematic when we start to dwell on every negative experience and ignore the positive ones. Reaching out is the most important thing you can do conquer this or avoid it altogether, but once you’ve recognized and worked through the negativity bias, it’s incredibly important to take the good with the bad. Dwelling on mistakes will move neither your career nor your education forward, but learning to take them in stride and learn from them can help you become a better student, a better doctor, and down the line can even save lives.

Visualize

Visualization is a common tool used for motivation no matter the field you’re in. Runners picture the finish line to push themselves to keep going; tournament players picture themselves holding the championship trophy; and, of course, medical students picture that white coat ceremony and holding their degree.

The effectiveness of visualization is a matter of persistence. In a long distance race, for example, the end is literally nowhere in sight. Based on time, landmarks, and maybe even distance markers, you might have an idea how close you are to finishing, but without being able to actually see the finish line, every step you take is taken towards an end that you are simply picturing in your head. Without that visualization, there’s no clear motivation for maintaining a good pace—or continuing at all.

Likewise for med school, the end is nowhere in sight until that last semester. Sure, you know more or less how much you have to do before finishing. You know how many classes you’ve taken and how many are left to take, you know how many years, months and days are left, you know more or less where you are in the race, but you can’t actually see the finish line. Until you’re right up next to it, graduation is more of an abstract concept than a tangible point in your future—you know you’re heading in the right direction, but it might not be exactly obvious how every step takes you there, or whether getting there should really be your goal at all.

And though you can’t see the finish line, you can picture it. You can picture yourself with your classmates in your doctor lab coats at your white coat ceremony; you can picture yourself holding your degree; you can picture yourself deciding between your custom lab coats and wondering whether or not your fashionable lab coat will make a difference to your patients. You can visualize the end and everything you’ll do afterwards—even if the goals and aspirations get fuzzy at times, focusing on them can help you find the motivation to keep moving forwards.

Of course, visualization can be double-edged. Picturing “being the best” as your end goal, for example, might not be the healthiest visualization. Any visualization that is too ambitious might ultimately set you up to never be satisfied with where you are. While it’s great to always strive to be better and make improvements any way you can, it’s also healthy to stop, recognize, and admire your own achievements and hard work up to the point you’re at now. It’s better, in general, to keep your eyes on more tangible and plausible goals such as graduation, your degree, or seeing your first patients after your white coat ceremony.

Getting through medical is no easy feat, and working in medicine in general can certainly be a challenge at any level. Chances are that, at some point, you might feel like your success and achievements aren’t merited or that you didn’t earn them. When this happens, it’s important to realize that all the work that’s making you feel that way is precisely the work that got you where you are. It’s important to be able to recognize that you’re feeling off and to know how you can go about feeling better.

Hopefully, these tips will help in breaking out of Imposter Syndrome, or at the very least guide you towards other solutions.