Welcome back to my series on imposter syndrome as it affects our students in PA education. Today’s newsletter will look at the people who are most likely to fall into this cognitive trap, and why.

Ironically, imposter syndrome tends to affect high-achievers and perfectionists with far greater intensity. It’s one of life’s little jokes that true imposters – people who have attained positions or success dishonestly or unfairly – aren’t nearly as likely to worry about it! 

But why does this happen? High-achievers, perfectionists, those people with incredible drive to succeed, also tend to do these things:

• They forget about their hard work: the sheer amount of study, time, thought, and sweat put into accomplishments. 

• They don’t celebrate their successes. Give a high achiever an award, a perfect test score, or a medical degree and they’ll fail to acknowledge their achievement as anything particularly special. It wasn’t an accomplishment but a necessity. They’re already thinking about their next goal.

• They may extrapolate that their success, position, or award means that someone else was denied that success, position or award. This can lead to feelings of guilt, a belief that they have something that was more justly deserved by someone else.  

Who is more susceptible?

Within the general population, imposter syndrome tends to occur in people with the following traits:

• They had overly critical, controlling, or protective parents 

• They are perfectionists, who set impossible standards for themselves.

• They may be neurotic or depressed, already experiencing a wider spectrum of negative emotions.

• They are in a life transition (i.e., starting graduate school) and surrounded by new challenges.

• There are numerous stressors on them: heavy class loads or major tests coming up. People under stress are already likely to suffer lowered resistance and fear, which can manifest as imposter syndrome.

• They are in a minority group. DEI studies further our awareness of just how much disconnection (and thus, imposter syndrome) can occur for people who feel underrepresented and excluded. Disconnection is one of the first triggers of imposter syndrome.

The Anxious Student

About 70% of Americans report feeling imposter syndrome at some time, and our graduate students and even our faculty (all the way up to senior leadership roles) are in a prime position to be affected. 

A cohort of PA students is full of high achievers and perfectionists so it is ripe ground for imposter syndrome to bloom. Those suffering from imposter syndrome show the following symptoms:

1. They compare themselves negatively to other students (other students are so much smarter, more experienced, more accomplished);

2. They don’t believe they have what it takes to succeed in graduate school;

3. They perceive that they undeservedly got a seat in the cohort thanks to luck, or a mistake, or because the school had to meet a quota;

4. They believe that they are the only one who feels this way, and they fear telling anyone about their feelings, furthering their isolation.

Why do medical students suffer from it especially?

Students accepted into graduate-level medical programs are special. They competed against hundreds of applicants for limited seats, beating out an overabundance of people who would cherish the same opportunities. It is natural to question how one managed to deserve this coveted position. Hopefully the answer is, “Through my hard work, study, motivation and capabilities.” Imposterism forgets those things, or discounts them. When that student asks, “Why do I deserve this?” their inner negative voice says, “I don’t deserve it, or someone else deserves it more. What am I doing here?”

Additionally, healthcare is a noble and highly respected profession, and a serious calling. The field requires dedication, strict standards, and a strong work ethic. Our patients’ lives may be on the line. Certainly their well-being and quality of life are in our hands. That responsibility can be overwhelming. It’s no wonder that medical professionals frequently question their skills or capabilities. Still, the questioning itself is not the problem, because mindful self-assessment keeps us on the path to improvement. Imposter syndrome, however, is not mindful self-assessment, but undeserved negativity that ignores all evidence to the contrary.

Conclusion

Graduate students and medical professionals have a high vulnerability to imposter syndrome. Our PA students are an intersection of both categories. If they are in a minority group, that vulnerability multiplies. We can anticipate that the incidence of imposter syndrome will be quite high among the members of a cohort. With that in mind, in my next newsletter, I’ll discuss the ways in which we might accidentally make things worse, and how we can prevent doing so!