Have you ever had the sensation in your professional life that you don’t know what you’re doing, that you’re a fraud, and that one day someone is going to catch you out? If so, you’re far from alone: what’s known as ‘impostor syndrome’ seems to be surprisingly common in medicine.
A recent study of nearly 150 American medical students found that around half the women and just under a quarter of the men suffered from impostor syndrome, which is characterised by chronic feelings of self-doubt and fear of being discovered as an intellectual fraud. And that far from improving as the students progressed from year to year, their symptoms actually got worse. What’s more, the study found a strong correlation between impostor syndrome and some of the components of burnout, such as emotional and physical exhaustion, cynicism and depersonalisation – a disturbing association that the study authors say “cannot be ignored”.
But it’s not just med students who are affected by impostor syndrome. And among doctors, it’s not just the younger, less experienced ones, either: impostor syndrome cuts across all ages and career levels, another recent study has found. Based on interviews with 28 specialists, the Canadian study found that even doctors at advanced stages of their careers often questioned their abilities and the validity of their achievements. One of the interviewees reported that after many years of practising, “I still think someone is going to send me a letter saying ‘actually it was all a mistake. You weren’t supposed to get into medical school, therefore we’re taking it all away.’”
The authors from the University of Ottawa note that the medical profession “neither sufficiently prepares physicians to grapple with mistakes nor adequately supports them to share their insecurities”.
Once they enter clinical and academic medicine, doctors can get shaken by a seemingly endless series of setbacks such as bad clinical outcomes, patient complaints, poor evaluations and rejected grants or manuscripts, all of which can be fodder for insecurity.
With limited support, the authors say, doctors wrestling with errors and self-doubt can become immobilised by fear. This can come at a considerable cost not only to their mental health and well-being, but also to their career.
Female doctors seem to be at particular risk of impostor syndrome, which may be to do with a traditional lack of female role models in the higher echelons of medicine, despite the rising numbers of women graduating from medical school. A position paper published this month on achieving gender equality in medicine singles out impostor syndrome among women as one of the barriers. Impostor syndrome “may bar women’s success if it causes them to pass up career development opportunities”, the paper says.
In a culture where revealing self-doubt is seen as a weakness, doctors suffering from impostor syndrome may be difficult to identify and help. The challenge, the authors of the Canadian study say, is to develop an awareness and understanding that feelings of insecurity in medicine are both common and recurrent, and that features of the medical culture may actually foster those feelings of self-doubt.
“It is critical to develop opportunities for practitioners to safely acknowledge and share their feelings. Rather than ignoring or ‘punishing’ mistakes, medicine needs to cultivate safe spaces to share struggle, and to develop opportunities that transform failure into a teaching tool,” the authors conclude.