Impostor Phenomenon (aka Impostor Syndrome) in Medicine, Part 4

For the past three weeks, we've been delving into impostor phenomenon – the definition, its effects, and helpful tips to improve. This week we look at two final aspects of impostor phenomenon. 1. Maintaining progress 2. How to help others experiencing intense or frequent impostor side effects.

Several of the books and authors mentioned last week highlight the importance of having a team of people you trust to play specific roles in maintaining a better self-assessment. I particularly like Dr. Lisa Orbé-Austin's explanation of positions you may find most helpful. I'm calling this your personal board of directors. 

Consider these board members (some people may fill more than one role, and you can have more than one person in any part):

- a therapist well versed in IP, depending on the level of impairment you are experiencing,

-a coach to help you find clarity and your own best answers,

-a mentor who can share wisdom and advice based on experience,

-an encourager who speaks to your abilities and successes and that you intentionally do not dismiss

-reality-checker who helps you stay grounded,

-an operations manager who helps you develop a plan for what you're facing

-a person with a 30,000-foot perspective to keep you from becoming myopic about tasks/issues that tend to become larger than life and to help keep you moving toward your goals,

-an accountability partner – one that understands your impostor syndrome where you can debrief about what triggers you're noticing and how you are moving forward or slipping back into those old patterns of automatic thoughts, feelings, and actions.

The key to your personal board is knowing that it will take time to develop. First, you need a foundation of some trust. Then, you can progressively grow in your transparency as the trust builds. It also requires you to take the initiative to build relationships in this manner. The good news is that as you get better at broaching the subject with individuals, the more associated shame shrinks. At times, you may need to dismiss board members who've outstayed their usefulness or broken trust and replace them – this is just life.

Now, let's say you have a close family member, friend, colleague, or trainee that disclosed to you their struggle. (I'd like to point out that without a person talking about it or you are inquiring about it, you cannot assume anyone is or is not experiencing frequent or intense impostor phenomenon. Physicians are great at masking. If you suspect it, you can ask if the concept seems relatable. From the TED talk by Dr Catherine Toomer, to the HBR article, the New Yorker article, and the 2023 Smith College commencement speech - many individuals, especially women or historically marginalized individuals, are hearing that they have impostor syndrome when in fact, they're striving to prove themselves as society isn't making room for them to belong, which is quite the opposite. And a third category exists as well, those trying to prove themselves while experiencing impostor phenomenon. Truly, there have been internalized messages from society on many fronts. 

Now onto those friends, family members or colleagues who do identify that they are feeling like it's a fluke that they got to where they are - what can you do to support them? Dr. Clance had several suggestions. I'll put a few here with some modifications from other resources.

First, I think it's important to depersonalize their reactions or behaviors. They likely have nothing to do with you. Educating yourself on the phenomenon is very helpful. This will keep you from becoming defensive or feeling personally dismissed or hurt if they don't listen or believe you or if they don't seek out help.

Second, see if one of the roles listed above seems fitting for you and offer to sit in that seat on the board. Again, don't take it personally if they don't. It's a slow process, but at least when they are ready, they know you are willing.

Third, when you give them praise – be specific. For example, "You gave practical, up to date information in your presentation in an easy-to-understand way that is helping the interns diagnose and treat ADHD appropriately." "Your patients always give you compliments on your bedside manner. They say your approach makes them feel heard and safe."

Don't use generalizations – "great job in clinic," "great presentation," "don't worry, you always succeed" – those are much easier to discount.

Sixth, never be dishonest in praise or muster false encouragement. 

Seventh, When they open up to you about their fears, don't be hasty to dismiss their concerns with a cheer. Instead, ask them questions. "What is the likelihood of that happening?" "Has that happened before?" And truly listen. You can then give an honest assessment that includes reassurance in a specific manner. "The way I see it, you have read more on this topic than most at your level, and while you may not know everything, you know more than the people you are teaching. You have gotten great feedback on your lectures before. I think it's important that you share your knowledge." Finally, inquire about the worst-case scenario. Help them reality set their fears and brainstorm solutions to bad outcomes.

Eighth, remind them that your admiration, support, and care for them are not dependent on their results of interactions, rotation or lecture feedback, or any other non-inherent consequence. This is more helpful than trying to reassure them that they won't fail, which will only make them worry more about how you may view them if they do fail. Tell them all the things you admire about them that have nothing to do with outcomes.

Ninth, normalizing IP among physicians lets them know they are not alone. Share your knowledge, books, and other resources. Tell them you're willing to talk and listen when they're ready. Let them know the power of affect labeling.

Finally, don't persist if you notice they're feeling uncomfortable with your discussion. Instead, end the conversation but let them know you're there and have resources.

I hope you found this month's topic helpful. I'd love to hear which part was most helpful if you did.

Have a joy-filled week!

Tonya