Welcome to another Dr. Scott Massey newsletter. Today I’m starting a new series about a topic that affects a high percentage of graduate school students, faculty, and medical professionals. It is imposter syndrome. 

We’ve all heard of it – and chances are good that we’ve all suffered it at some point. Who hasn’t had a moment when they thought, “Oh boy, I do not belong here. Everyone is smarter, more qualified, or better trained than me. Any minute now, someone will figure out that I’m a fraud.”

I was the first one in my family to go to college. There was a certain pressure on me to succeed, to make my family proud. At school, I was positive that I was surrounded by erudite people from sophisticated, educated families. I imagined that they knew something I didn’t – if not literal, factual knowledge, then something about behavior or culture or belonging. Sometimes the idea floated through my mind: I don’t belong here, and soon, I’ll either fail, or someone will discover that I’m a fraud.

What is imposter syndrome?

Imposter syndrome is a normal cognitive distortion – a negative thinking pattern that has no basis. Other cognitive distortions include overgeneralization or catastrophizing. This condition’s name is admittedly a bit alarming, with “imposter” sounding sneaky, and “syndrome” sounding like a disease. This makes a common distortion seem a lot more insidious than it really is. Imposter syndrome (also sometimes called imposter phenomenon) is usually just the tendency for us to experience self-doubt.

Self-doubt is good in small doses. Think of it as mindful self-awareness, serving as a sort of checks-and-balances system in our head. We think, “Wait a minute. Let me double-check my work, a make certain I’m delivering what I promised.” This feeling can motivate us to improve ourselves, to keep learning and trying. Plus, it helps us avoid the mistakes of overconfidence that occur when we question nothing and believe we are infallible. 

 Obviously there is a healthy balance. A bit of self-doubt is useful to us. But  constant feelings of imposter syndrome may lead to anxiety, depression, and worst of all, decreased quality in performance, which then feeds into increased feelings of imposterism. 

Symptoms 

Imposter syndrome, common as it is, manifests in a few different ways that may look like modesty, humility or self-deprecation on the surface. But those pleasant traits don’t result in the same anxiety and negativity for the sufferer. See if any of these statements sound familiar:

1. I can’t internalize my success. Even as I accomplish things, they don’t feel like something that I actually did.

2. I credit luck, or good timing, for much of my success.

3. I don’t know how to accept compliments.

4. I fear being discovered as a fraud.

5. I focus on my mistakes and failures far more than my successes.

6. I always seem to feel disappointed with myself and my position.

7. I fear failure, to the extent that I won’t try new things.

8. I constantly, negatively compare myself to other people.

9. I don’t like to talk about my possible accomplishments until they have already happened.

Coming Up…

Imposter syndrome is a hot topic these days because it figures into Diversity/Equity/Inclusion efforts, making it a most relevant issue to those of us running PA programs. Also, graduate medical students and faculty are disproportionately likely to suffer the syndrome, so it is certainly something for we should increase awareness. Over the next few issues of the newsletter, I will discuss the following aspects of imposter syndrome in graduate-level medical education:

• Who is most likely to suffer imposter syndrome, and why imposter syndrome disproportionately affects people studying for and working in medical careers.

• Environmental and social aspects that increase feelings of imposter syndrome (sometimes called imposterization) and how we might inadvertently exacerbate the condition in students; and

• What we can do to help our students (and ourselves) keep imposter syndrome from damaging performance and well-being.

I look forward to continuing this series with you.