Imposter syndrome: Silencing the inner voice that whispers 'fraud'
Editor's Note: This story delves into the concept of "imposter syndrome" – defined by one source as "a psychological occurrence in which an individual doubts their skills, talents or accomplishment, and has persistent, internalized fears of being exposed as a fraud" – and how that condition impacts all of us as we progress through residency training, fellowship and beyond.
We bring insights from four exceptional individuals, all at different levels of training and practice – and all of whom I personally know to be outstanding clinically and technically. Based on their aptitude and propensity for excellence, one might assume they have a very low incidence of "imposter syndrome" – yet no matter how skilled, prepared and diligent we are, imposter syndrome and its manifestations are a universal experience for anyone within the realm of medicine and surgery. We've all felt and experienced it and, unfortunately, the implications of imposter syndrome don't magically disappear once we complete surgical training.
By examining imposter syndrome in more detail as it pertains to plastic surgery training and beyond, we hope our readers find solace and comfort in the connection to these shared experiences. I would like to thank each of our authors for their candid and thoughtful
responses on a topic that's inherently challenging and vulnerable to write about – but one that we all will find immensely relatable.
Russell E. Ettinger, MD
Chief Medical Editor, PSR
Alison Bae, MD
PGY-6, University of Washington, Seattle
How do you define imposter syndrome?
Imposter syndrome means feeling as though I'm not skilled, knowledgeable or good enough to be where I am. Specifically that I'm not accomplished or talented enough to be a plastic surgery resident, let alone one who's about to graduate. It comes with feeling less successful than my peers. It's thinking that luck – not my achievements – was responsible for me getting into medical school and residency, and hoping that people don't discover that I got in by mistake.
How has imposter syndrome manifested itself in you?
It's been an underlying theme during residency. It was a more constant feeling at the beginning of residency, but it's become less frequent as I've gained more experience and confidence in my skills and reframed my thinking. However, it still occasionally affects me whenever I come home from a rough day – wondering whether I made a mistake or feeling as though I wasn't perfect. Feelings of imposter syndrome are particularly strong when I compare myself to others.
How did you handle these feelings – and how did you move beyond them?
Several things helped me throughout residency. During my intern year, I went to a therapist who was made available through our residency program, because these feelings of imposter syndrome were weighing heavily and I felt like I was floundering. Something as simple as forgetting to look up a patient's drain output for rounds made me feel like I wasn't good enough. My therapist helped me realize that one mistake or one bad day does not make me a bad resident. It's normal to make mistakes, and the most important thing is to learn from them as opposed to letting them define you as a person. Talking to a therapist helped me realize that I had these negative thought patterns and taught me strategies to break these cycles.
Whenever I have feelings of imposter syndrome, I tell myself that I've already been vetted; I graduated from a top-tier medical school; and I've nearly completed residency at one of the best programs because I have what it takes. I don't have to prove that I belong because I already belong. I remind myself of the things that I'm good at instead of focusing on my weaknesses. I use the positive feedback that I've received from mentors to bolster these thoughts.
It helps that I talked to my peers and learned that imposter syndrome is not just from within – that systemic biases against women and people of color are contributing factors to feeling out of place. Sharing our experiences and knowing that other residents feel the same way normalizes things. Also, my confidence increased as I gained knowledge and improved technically, allowing me rise above imposter syndrome.
What advice do you have for residents who experience imposter syndrome?
Recognize that everyone experiences some varying degree of imposter syndrome and that it's not unique to you. Talk to your peers, seniors and mentors about it and learn the methods they used to move beyond it. Seeking expert advice from a therapist can give you outside perspective and help you learn new strategies. Residency is about becoming a plastic surgeon – so learn from your mistakes and learn from your peers, and imposter syndrome will get better over time.
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Calvin Young, MD
Private practice, Rochester, N.Y.
How do you define imposter syndrome?
Imposter syndrome is that quiet voice of frequent self-doubt. It rears its ugly head during times when I'm alone with my thoughts. It asks questions such as: "Are you sure this is the right plan?" or "When are they going to find out I don't belong here?" It makes statements such as "You're not good, just lucky" or "You're one slip-up away from the walls crashing down."
How has imposter syndrome manifested itself in you?
I trained in general surgery for seven years followed by three years of plastics residency. As a chief resident in general surgery, you're running traumas or codes, managing care of the critically ill and doing procedures you've done hundreds of times.
When I started training in plastic surgery, all that confidence went away and I was basically starting over. Coupled with that, I entered a class of some very smart people who had much more experience and knowledge than I. Sure, I could operate, but most of the procedures were new to me and my colleagues were speaking a different language of surgical terminology. It was a real "sink or swim in the deep end" moment.
Once training was over, I took a job as the only plastic surgeon in a dermatology group. I could no longer walk down the hall to the attendings' offices or into the resident room to bounce ideas or plans off anyone. Now I was the attending. "Who are you kidding?" I thought. Even as I answer this question, I'm waiting for my board-certification results. "Who am I to write something about helping overcome imposter syndrome? I might well actually be an imposter!"
How do you handle these feelings – and how do you move beyond them?
I don't know if you ever really move beyond it – maybe when you've seen it all, you can. Sometimes I wonder if this feeling is just part of me and how I prepare for each case. I still spend a lot of time thinking about consults, reviewing notes and exams and writing down my exact surgical plan for each case. With each great outcome or thankful patient, though, your confidence grows a little bit. Learning to say, "No, I'm not the surgeon for you" is also very powerful and helps reinforce your confidence in your surgical decision-making.
What advice do you have for residents who experience imposter syndrome?
During times of self-doubt, I find it helpful to talk to people who've been there. Sometimes it's people in medicine who've been there in surgery – or even perspectives from other specialties. I'm lucky enough to be married to a pediatric endocrinologist who's been practicing for years. She went through it; I think we all do. For what it's worth, I'll be happy to chat if you need someone to talk you down.
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Shanique Martin, MD
PGY-3, University of Washington, Seattle
How do you define imposter syndrome?
Imposter syndrome is this looming thought of inadequacy and self-doubt – ever present in the back of my mind – fearing that one day I will be unveiled for the world to see. As an immigrant, first-generation-to-college Black woman whose lifestyle, education and career aspirations led to me being a minority in many spaces, I was often told that to achieve the same level of success and respect as a non-minority peer, I had to be an overachiever. That everything that I do will be scrutinized, my work will always be double-checked for accuracy and people like me are rarely given second chances. This advice motivated me in my earlier years, but it has now become a major contributor to my imposter syndrome.
How has imposter syndrome manifested itself in you?
A large part of life is learning and growing from your mistakes, and it's in challenging times – such as residency – that imposter syndrome rears its ugly head. In some ways, imposter syndrome has acted as a source of motivation to do better and be better throughout residency, but many times it has made me feel as though I somehow made it to where I am because of a fluke in the system – and it's in moments of making a mistake or not knowing how to manage a complex patient that these feelings of inadequacy often take over.
How did you handle these feelings – and how did you move beyond them?
It can be particularly challenging, but I've found that vocalizing these feelings to others in residency helps me to move beyond them. In particular, sharing these feelings in moments when they are heightened forces me to recognize that this overwhelming self-doubt as it relates to my skills and knowledge are internally derived, and not necessarily shared by those I work with.
What advice do you have for residents who experience imposter syndrome?
The first step is to acknowledge that these feelings of inadequacy and self-doubt stem from imposter syndrome and they are more common than you might think. Although it requires making yourself vulnerable, talk to co-residents and attendings who you trust about this. They may have experienced very similar feelings at some point, as well.
Secondly, I think we all need to give ourselves some grace and often need reminders that residency is a learning process. If you already possessed all the knowledge and skills required to be a plastic surgeon, there wouldn't be a need for residency. Even the best of us make mistakes. The goal is to learn from your own and others, so as not to repeat them.
Finally, try to celebrate your wins and successes as much as you dwell on your mistakes. They serve as a reminder that being a resident physician and budding surgeon did not happen to you because of some fluke in the system. You earned your place and worked just as hard – if not harder – as others to be in this position. You deserve to be here.
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Ryan Badiee, MD
PGY-3, University of Washington, Seattle
How do you define imposter syndrome?
Imposter syndrome is a clandestine feeling of inadequacy that often takes root in situations where we err or are uncertain – in spite of a past record of competence. Even when accomplishing complex and technically difficult feats, one small mistake can engender internalized self-doubt, that our prior achievements can be attributed to luck and that we didn't deserve the opportunities afforded us.
How has imposter syndrome manifested itself in you?
Imposter syndrome has manifested when my surrounding circumstances trigger pre-existing insecurities or preoccupations. For example, I expect myself to become more knowledgeable and independent over the course of each rotation with repeated exposure to the same problems and protocols. However, the disorientation associated with transitioning to a new service every month – and across a broad array of specialties – rendered it impossible to constantly uphold this high standard of competence.
The resulting feeling – that I'm less capable than I had thought and that my self-confidence was misguided – is a common manifestation of my imposter syndrome. Perfectionism, which is arguably a necessary precursor to matching into a competitive field such as plastic surgery, also made me vulnerable to imposter syndrome. As an intern, I still harbor some residual stress from my experiences as a medical student, when I overprepared for any interaction with my seniors and attendings to avoid being perceived as incapable or ignorant. As a result, even small mistakes can elicit self-doubt in my abilities.
My background and educational path were also contributing factors. My program largely matches students who completed a clinical rotation here, as it is less "risky" to recruit a trainee whose strengths and weakness are already known. However, I first met most of my senior residents and faculty while working with them as an intern. Thus, my errors feel graver than my peers' – and can leave me thinking that my program made a mistake in allowing me to train with them. This is further compounded by my personal background, as Latino physicians constitute a disproportionately small fraction of trainees in plastic surgery.
How do you handle these feelings – and how do you move beyond them?
At times, I internalized my self-doubt and believed that I'm an incompetent intern who lacks the skills required to be successful in my role. In some ways, this mindset can be motivational rather than maladaptive. Typically, with the start of each new rotation, I find myself putting in extra hours to learn both the clinical knowledge that I require in my new practice setting and how to navigate the systems that I work in. This is effective in overcoming the steep learning curve that accompanies many of our rotations and, consequently, improving my self-confidence.
I also rely primarily on three groups as a source of support. First, I check-in once or twice per month with my senior residents and attendings to ask about my most pressing areas for improvement. Having concrete, actional advice is helpful in reaffirming my strengths and identifying my weaknesses. Second, my co-interns are an invaluable source of support, as many of our difficult experiences are shared, and there's reassurance in the discovery that others are facing similar challenges. Finally, my family and friends outside of medicine keep me grounded and remind me of the tremendous progress I've made in my personal development, both as a physician and as a person.
What advice do you have for residents who experience imposter syndrome?
I often hear that forging an identity and sense of self-worth outside of medicine is the best way to overcome imposter syndrome, but that's difficult when the vast majority of our waking hours are spent working. I find it helpful to know where my "resilience resources" lay: mentors and loved ones who can talk through my struggles, mementos that remind me of proud moments in my life and hobbies that help me forget about my stressors.
A supportive environment that minimizes threats to imposter syndrome is crucial, especially for interns. I would ask my superiors to engage with us when we present misguided ideas or make mistakes, identify where our errors lie and help us develop improved schemas to use moving forward, rather than scoff at our ignorance.