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Focus on Fellows and Early-Career EPs| Volume 8, ISSUE 12, P861-862, December 2022

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Imposter Syndrome

      I believe it began in college, when I was told by a peer that I wasn’t smart enough to get into a medical honors program. At that moment, gathered on the floor in a circle, I believed him.
      I was accepted into that medical honors program and have completed my training in electrophysiology, passed my boards, and have spoken at national and international meetings. Yet, I continue to wait for the moment when someone figures out that I have no idea what I am doing, I am a fraud. I am an imposter.
      “Impostor phenomenon” (now more commonly referred to as "Imposter Syndrome") was first described in 1978 by psychologists Clance and Imes in highly accomplished women.
      • Clance P.R.
      • Imes S.A.
      The imposter phenomenon in high achieving women: dynamics and therapeutic intervention.
      It is now known that men are also affected. Those who suffer from imposter syndrome attribute their success to external factors, rather than their own merit, and believe that most (or all) of their achievements are a result of chance or error.
      There are several features that are common to those who suffer from imposter syndrome
      • Clance P.R.
      • O’Toole M.A.
      The imposter phenomenon: an internal barrier to empowerment and achievement.
      :
      • Perfectionism
      • Dread of evaluation/terror of failure
      • Defining intelligence in a skewed manner (overestimating others and underestimating oneself)
      • Guilt about success
      • Generalized anxiety
      Imposter syndrome can be broken down into several subtypes
      • Chandra S.
      • Hubert C.
      • Crowley E.
      • Das A.
      Imposter syndrome- could it be holding you or your mentees back?.
      :
      • (1)
        The perfectionist: They believe that competence is defined by perfection and anything less than that is considered failure. They focus on what could have been done better.
      • (2)
        Natural genius: They measure their competence by how easily any achievement/success comes to him/her. Hard work/perseverance are viewed negatively, as success should have come more easily.
      • (3)
        Superman/Superwoman: They view competence as the ability to juggle multiple things at once and being successful at it all. Falling short in one area is viewed as a total failure.
      • (4)
        Expert: They measure competence based on their volume of knowledge/skill. They fear being exposed as inexperienced owing to lack of knowledge.
      • (5)
        Soloist: They measure competence by being successful on their own. Having to ask for help is considered a failure.
      Looking at the personality traits that draw us into medicine and allow us to excel in medical school, residency, and fellowship, it is easy to see how these same traits can become maladaptive. Surveys of medical students, surgery residents, and hospitalists have shown rates of imposter syndrome between 25% and 76%, with men and women affected similarly. Among hospitalists, there was no difference between years of experience or mentorship.
      • Villwock J.A.
      • Sobin L.B.
      • Kuestner L.A.
      • Harris T.M.
      Impostor syndrome and burnout among medical students: a pilot study.
      • Paladugu S.
      • Wasser T.
      • Donato A.
      Imposter syndrome in hospitalists- a cross sectional study.
      • Bhama A.
      • Ritz E.
      • Anand R.
      • et al.
      Imposter syndrome in surgical trainees: Clance Imposter Phenomenon Scale assessment in general surgery residents.
      Imposter syndrome can have a negative impact on performance. Overpreparing, procrastinating, and working longer hours to avoid errors (or to prove competence) can increase rates of anxiety, depression, and burnout. Additionally, physicians will avoid opportunities for promotion/growth owing to fears of being exposed. The lack of promotion reinforces feelings of inadequacy and self-doubt. Imposter syndrome is isolating. Physicians often suffer in silence owing to a fear of being “found out.”
      What can we do about it personally? Acknowledge your feelings. Discuss how you feel with a trusted colleague or mentor. Ask for truthful and objective feedback. Seek counseling for strategies to deal with anxiety, worry, or fear. Teach others—this will reinforce your knowledge base. Set reasonable goals and expectations. Take time to celebrate and relish your success before moving on to the “next thing.” Review your resume and reflect on your success. If you are in the room, you deserve to be there.
      What can we do to address imposter syndrome in our trainees? We could start with promoting a growth mindset. Failure is a part of growth, rather than proof of being an imposter. We should encourage self-reflection and goal setting, while creating a supportive environment that promotes learning rather than comparison to one’s peers. If a trainee attributes success to external factors, (“I got lucky,” “They must have needed a woman/minority for the role,” etc), redirect them by pointing out their technical skill set, knowledge base, or leadership skills. We need to increase diversity within our field to improve inclusion among our trainees. Lastly, we have the power to create a safe environment for the communication of self-doubt and vulnerability. Vulnerability is a strength, not the sign of an imposter.

      References

        • Clance P.R.
        • Imes S.A.
        The imposter phenomenon in high achieving women: dynamics and therapeutic intervention.
        Psychother Theory Res Pract. 1978; 15: 241-247
        • Clance P.R.
        • O’Toole M.A.
        The imposter phenomenon: an internal barrier to empowerment and achievement.
        Women & Therapy. 1987; 6: 51-64
        • Chandra S.
        • Hubert C.
        • Crowley E.
        • Das A.
        Imposter syndrome- could it be holding you or your mentees back?.
        Chest. 2019; 156: 26-32
        • Villwock J.A.
        • Sobin L.B.
        • Kuestner L.A.
        • Harris T.M.
        Impostor syndrome and burnout among medical students: a pilot study.
        Int J Med Educ. 2016; 7: 364-369
        • Paladugu S.
        • Wasser T.
        • Donato A.
        Imposter syndrome in hospitalists- a cross sectional study.
        J Community Hosp Intern Med Perspect. 2021; 11: 212-215
        • Bhama A.
        • Ritz E.
        • Anand R.
        • et al.
        Imposter syndrome in surgical trainees: Clance Imposter Phenomenon Scale assessment in general surgery residents.
        J Am Coll Surg. 2021; 233: 633-638