Health care leadership in action: Overcoming impostor syndrome

What is impostor syndrome?

Impostor syndrome is a psychological pattern of fear and self-doubt. It interferes with people’s belief in their own accomplishments and burdens them with the persistent, internalized fear of being exposed as a fraud — despite evidence of their abilities.

Research has found that people who suffer from impostor syndrome often attribute their success to external factors such as luck, error or personal connections.

They feel they are “fooling everyone” and worry that in time people will learn “the truth”. It doesn’t matter how high their grades are, how many certifications they’ve earned, how often they’re requested by patients or how many kudos they receive from superiors—they believe they are less intelligent and competent than others perceive them to be.

What impostor syndrome looks like

In a 2016 TED Talk, Lou Solomon outlined some typical behaviours of physicians suffering from impostor syndrome:

• Passing up on opportunities because they don’t think they’re qualified
• Downplaying achievements
• Overpreparing and overachieving 
• Self-sabotage 

Physicians struggling with impostor syndrome may feel anxious, depressed, burned out or dissatisfied in their current role but afraid to seek a new one. One study found they may also be paid less and get fewer promotions.

Prevalance among physicians

Impostor syndrome goes by several different names, including “impostor phenomenon”, “fraud syndrome” and “impostor complex”. A study in the journal Medical Education found that in many physicians, impostor syndrome usually begins in medical school and may persist throughout their careers.

Rates of impostor syndrome range from 22% to 60% among practicing physicians and physicians in training. Studies have also shown that women have a higher risk of impostor syndrome. 

As reported in the International Journal of Medical Education, the risk factors for impostor syndrome include low self-esteem, perfectionism, hierarchy in medical education and medical culture. Other risk factors include:

• The high level of competition to enter medical school
• Unrealistic self-standards
• The challenge of transitioning between career stages 
• High expectations and pressure to succeed
• Exposure to constant criticism 

An article in Human Resource Development International reports that factors protecting against impostor syndrome include social support, validation of success and positive affirmation. Research in Medical Education adds personal reflections and sharing common experiences with peers to that list.

Seven tips to overcome impostor syndrome

The Lou Solomon TED Talk included suggestions for anyone seeking to overcome impostor syndrome:

1. Seek constructive criticism. Take control of the situation by proactively asking, “What should I stop doing? What should I start doing? What should I continue doing?"
2. Focus on your strengths and accomplishments. Keep a tally of moments you’re proud of, to recognize your achievements and strengths.
3. Learn to welcome praise. Simply say thank you.
4. Reflect on your own history and circumstances. Think about what or who might have affected your self-confidence. Work to discover what’s at the heart of your impostor syndrome. 
5. Invest in positive relationships. Focus on colleagues, friends and mentors who are in your corner and see your strengths.
6. Rethink how you define failure. Being a good physician doesn’t mean you’ll never make mistakes: it happens to the very best practitioners. Getting things wrong is key to learning and growth.
7. Don’t be afraid to ask for help. This can be formal or informal. 

A personal story of impostor syndrome

The following story is based on a summer 2019 interview with then third-year medical student Chika Stacy Oriuma. At the time, she was also completing her master’s degree in systems leadership and information at the University of Toronto. Chika graduated in June 2020 as the first black female chosen as sole valedictorian in the University of Toronto Faculty of Medicine.

“In my first year of medical school I was looking forward to being in a diverse student body after being the only black student in my undergraduate cohort at McMaster. 

About a week before orientation, the U of T Black Medical Students’ Association held a dinner for incoming black medical students. I was the only one there from my class and wondered if other black people were simply not present. But at my stethoscope ceremony, there was no one else of the black ethnicity. That was incredibly jarring for me. 

On the first day of orientation, someone asked, ‘Did they somehow make it easier for you to get into medical school? Did they lower the criteria or give you special accommodation?’

I was completely taken aback because I had received no special treatment. That planted the seed in my head that I didn’t naturally belong in this space. I began to wonder what everyone else was thinking. I really struggled in my first year of medical school with my mental health because I felt alienated. I thought I needed to represent my race and hold myself to a standard where there was no room for error, which drove my perfectionistic tendencies. 

Then I began struggling with depression and had to get mental health support from a therapist. I really tried to unpack everything I had experienced, being at a dark spot and feeling so tense, always anxious, on edge, terrified, in a low mood, and being unable to sleep or eat. I felt hopeless about having to go through another four years of microaggressions with no one to turn to. I had no sense of hope, no ability to feel comfortable in my skin. I felt inherently different and thought I had to hide my blackness.

It took me a long time to stop feeling uncomfortable about being black and in medicine. 

I wanted to share my experiences but was afraid that shining a light on them would make everything worse. 
I owe a large part of my strength throughout this journey to the mentors I had, predominantly black female physicians who have really taken me under their wing and have been my support system. They always made sure that I could reach out and talk to them because they knew exactly what it feels like. Just having that sense of solidarity made all the difference. 

My relationship with these mentors encouraged me to become a mentor too, formally and informally, through my advocacy role, public speaking, keynotes and writings I publish.

I felt a lot more empowered going into my fourth year.

There was a certain strength that came through being an advocate and empowering other people. I'm now very proud of my identity, I’m proud to be a black woman in medicine, but my fears in certain ways still persist.

They don't stop me from doing my work, but the fears are there. they just are a little bit quieter.” 

Epilogue: Chika has since successfully graduated and launched her career in medicine. There were 24 black medical students admitted to the University of Toronto Faculty of Medicine for the class of 2024. To learn more, read the CBC article from June 2, 2020.

Check out the resources below to learn how to overcome impostor syndrome, be your best self and give your patients the highest-quality care possible.

If you are experiencing impostor syndrome and need support, reach out to your provincial physician health program.

Topics

Leadership and professional development Relationships Depression Burnout