Impostor Phenomenon (aka Impostor Syndrome) in Medicine, Part 3

Over the last 2 weeks, we have discussed the definition, demographics, and major concepts of impostor phenomenon (IP) along with how it shows up and its negative side-effects. This week,  I’m giving you a smash-up of recommendations for improvement based on four key references (below) along with a smattering of conferences, podcasts, and my experiences, including personal, clinical, academic, and coaching. There exists much overlap - it's always a good thing when various experts agree.  Here is my best attempt at integrating the recommendations from the various sources into a concise overview of individual steps.

Dedicate some time for deep reflection in the following areas:

Awareness:

1. Reflect on the fact that IP exists and you’re in good company with other high-achieving individuals.
2. How does it show up in your life particularly?
3. What are your triggers/trigger patterns? For example, is it when you lack sleep, attempt new tasks, familiar tasks that always feel this way, or around certain people, places, or various times of the year?
4. What does your brand of perfection look like? What avatar do you choose to present to the world?
5. Journal your thoughts, feelings, and actions as you walk through this work. Be very curious without self-judgment.  
6. What benefits are you getting from the impostor cycle? What are your fears about letting go of unhealthy perfection and the persona you project?
7. Are there any cultural stereotype narratives that reinforce your impostor situation?
8. If so, review your thoughts and actions to uncover any potential attempt to distance yourself from a marginalized group to gain belief in yourself. If you have, do you think that’s because, on some level, you are buying into the stereotype?

Distance:

1. Lose the labels. You are NOT an impostor or a fraud. You are experiencing impostor side effects right now. IP is not an inherent trait - even if it’s been around a long time.
2. Label the emotion(s) you are experiencing around the situations that provoke your IP and about doing this work. Affect-labeling disarms the amygdala, so you can get back in front of your emotions and lessen outbursts or, more commonly, negative inward flooding.
3. Lose the other labels. You are not your feelings. Go from “I am (insert emotion)” to “I am feeling (insert emotion).”
4. Allow the feeling to be present and become the compassionate, fascinated observer of your thoughts and feelings. “Isn’t that interesting? It’s a habit for me to assume or think x,y,z. But, of course, I feel insecure when I think that. The brain is a wild place. Interesting that this emotion feels like x,y,z in a,b,c part of my body.”
5. Activate your parasympathetic system by performing breathing exercises.
6. Utilize regular meditation, positive intentions, and mantras to distance yourself from your default state.
7. Visualize taking on a challenge without fear or self-doubt or highlighting what others think. Use that amazing imagination of yours to feel what it’s like to be in that situation and make it through to the end confident, competent, and wholly successful.
8. Start to accept that your worthiness and lovability are not related to your performance. You are enough, just as you are. Imagine accepting yourself as 100% worthy, just like a swaddled newborn. They don’t need to do anything to earn their worth.
9. We all have an inner critic. Give yours a name to give yourself distance from it. What do they look like - someone from your past or a made-up character? When the inner critic talks to you, recognize you are not your inner critic. Be compassionate. How is the inner critic trying to keep you safe? Recognize its motivations maybe be good, but its methods are terrible.
10. Continuously and actively counter any stereotypical cultural narrative that reinforces you believing you aren’t deserving.

Reframe:

1. Remember to separate out thoughts from actual facts. Remember facts have no adjectives, assumptions, or judgments. Challenge yourself to see how your thoughts could be false. Thoughts are just sentences your brain is offering. Which ones are serving you and which ones are not helpful?
2. Examine the story you have about yourself. Then, write it down as it pertains to the areas of life you most feel like a fraud – why you believe you shouldn’t be where you are.
3. Tell yourself the actual WHOLE truth about your story.
4. Name your strengths. If you don’t know them, ask your friends, family, colleagues for what they value about you and a unique strength you possess. And/or take the Clifton strengths finder ($50) or VIA Character strengths (free) online. (I am not an affiliate for them.)
5. Now, retell a different narrative by adding the fullness of your life and the perspective from your strengths.
6. Reframe Feedback. Constructive – what can you learn, what’s inaccurate, move on. Positives – how is it possibly true? How can you own it, be proud of it, celebrate it without guilt or embarrassment?
7. Recognize that being in an IP state is actually evidence you are a successful high-achieving individual.

Practice patience and compassion with persistence:

1. When the automatic negative thoughts arrive, nothing has gone wrong. It’s going to take time to build up that new neural pathway. “Oh, right, I have a new narrative. I am telling my FULL story with my strengths.”
2. Challenge the thoughts, feelings, and actions the next time you start down a familiar pattern – is it just the habit of the cycle, or are you making a conscious choice for a reason you like? If it’s the cycle, what’s one small step you can take to change it up?
3. Quiet the Inner Critic. “Not so fast inner critic, I know you mean well, but I’m telling myself what I tell my kids to do. I’m only saying what is kind, necessary, and true.” “I’m energizing my inner fan by giving more time to encouraging words.”
4. When you face criticism, realize people can say things to you, but you don’t have to accept them. Is there something helpful for you to learn or not? They get to be wrong about you. You are in control of whether you receive their words or not. Picture a force-field around you and their words bouncing off.
5. Practice self-care. What is it you regularly need to give yourself in this regard? Are you giving yourself the basic physical needs – sleep, nutritious food, movement? Why or why not? What else do you need? Being a martyr is counter-productive to ridding yourself of the IP.

Build evidence:

1.  “Celebrate the wins.” Look for them daily. Write them down. Take + feedback and write them there too. Review it regularly. What you focus on expands.
2. Ask yourself, how a challenging situation or outcome be for you/your good? Then, start to see growth opportunities from obstacles.
3. Let the perfection mask slip a little. Start with low-stakes situations. Take note of what happens. Become more and more authentic as you go.
4. Set up wins by making short-term achievable goals. Regular forward progress builds evidence of your abilities. You can then grow into stretch goals.
5. Play a new role. If you feel as the leader on the inpatient service, you should be the expert and have all the answers, change that job description of that role for yourself. What if the leader on service plays the curious, non-judgmental, and supportive role without all the answers? What good can come from that? How does it help your intern?

I’ve put hyperlinks to more in-depth blogs on topics above and to the four key books I have found incredibly informative below. I’m not an affiliate for any of them.

I would love for you to know there is hope. I would love to normalize (but not overgeneralize) the fact that IP is common. When things like this are brought to light, shame fades. Peer-to-peer and mentor/advisor relationships may be helpful. If your IP is less intense, working through a list like this and having someone you trust to discuss it may be what you need. Maybe reading one of the books will be most helpful. Involve the behavioral science faculty in your program for the best resources. Consider getting a coach who can individualize a program for you or walk with you through one of the books and use it as a workbook together. If the IP feels debilitating most of the time, I encourage you to get a therapist experienced in IP. There is hope for recognizing your worthiness and gaining confidence as YOU – no mask needed.

Next week we will begin looking at building your personal advocacy board of directors and we will briefly touch on ways to support those around you stuck in an impostor cycle.

Have a joy-filled week,

Tonya

Subscribe to my twice-monthly newsletter for stories, tips, excellent resources, and fun in your inbox twice a month while staying up to date with our offerings. 

Books: 

 The Impostor Phenomenon: Overcoming the Fear that Haunts Your Success, Dr. Pauline Clance

Unlocking your Authentic Self: Overcoming Impostor Syndrome, Enhancing Self-confidence, and Banishing Self-Doubt, Jennifer Hunt, MD

Own Your Greatness: Overcome Impostor Syndrome, Beat Self-Doubt, and Succeed in Life, Lisa and Richard Orbé, PhDs

Trust Yourself: Stop Overthinking and Channel Your Emotions for Success at Work, Melody Wilding, LMSW