Impostor Phenomenon (aka Impostor Syndrome) in Medicine, Part 2

Okay, last week, we looked at the definition, demographics, and some concepts around Impostor Phenomenon (IP), aka Impostor Syndrome. This week, I want to review how it shows up and why it matters. There are real side effects to living in the Impostor Cycle, especially for those with frequent or intense impostor tendencies. I’ve listed common ones below:

Avoidance of personal and professional advancements:

    Avoid difficult situations or risks

    Don’t risk advancement

            Function at the level of incompetency

            Hold back on spontaneity and creativity

            Don’t progress to top goals or fail to set goals altogether

Psychological distress:

            High levels of stress

            Emotional instability

            Mistakes (falling short of perfect) lead to shame and hiding rather than growth.

            Constantly feel failure/shame/need to hide

            Decreases job performance/satisfaction

            Leads to poor coping mechanisms such as numbing

            Leads to anxiety, depression, and burnout

Actions reinforce detrimental beliefs:

            Hard work is seen as “I’m not a natural.”

            Asking for or needing help is seen as a sign of failure

            Making a mistake is seen as proof of inadequacy

     Even after repeated successes – explanations are found to reinforce

      unworthiness.

Relationship issues:

              Diminished self-worth and lovability impacts connectedness

Partners/Friends often feel dismissed/ineffective when trying to help

Based on more recent research done by Drs. Lisa and Richard Orbé-Austin, we know that it tends to present differently for men than women. Men more commonly avoid striving for advancement. They tend to shy away from goals and feedback. However, they also seem to fluctuate between the extremes of overconfidence to dramatic insecurity more often. On the other hand, women tend to take on challenges but suffer the consequences enduring more impostor side effects. They work longer and harder to make up for their self-perceived inefficacy, all the while reinforcing the fraud identity.

I’ve coached residents that really believe it’s a fluke that they got into medicine. They are afraid to ask questions on rounds for fear of exposure. Some over-prepare for rounds, spending excessive time at the expense of sleep, relationships, and self-care. Some avoid challenging patients at all costs. The amount of extra emotional distress the impostor cycle imparts is overwhelming. 

I’ve coached faculty and other family medicine attendings that have identified they are experiencing frequent IP tendencies. They discuss how they are so in their heads about others' perceptions that they don’t offer their best recommendation. The negative thoughts keep them from interacting authentically with trainees, staff, colleagues, and patients.

The good news is that there are tools for relief. We will look at an overview of those next week.

To close, I’d like to provide an actual example for hope. One faculty member relayed how she consulted a specialist because she wasn’t sure of the best treatment plan. She felt judged by her residents and the specialist, which reinforced her own belief that she’s not cut out to be faculty because she’s not intelligent enough. After unpacking her story and distilling the facts, I asked her to tell me her strengths. (She had been doing some work in this area, so she was able to give them to me.) I then had her retell the story from her strengths – two of them being collaboration and humility. After retelling it from this perspective, she saw the positives, not only for her patient but for the residents. They got to see an attending being authentic and admitting uncertainty. She identified that residents observing such behavior might have more realistic ideals for themselves. She modeled a core competency for good patient care. She then could see she was actually being true to herself and her values by appropriately seeking expert opinion in a difficult situation. The added stress of her old narrative was replaced with a bit of appreciation and a smile.

Have a joy-filled week!

Tonya

Do you know a resident or faculty member who is struggling? Our 6-week reset program may be just the thing they need.