After my last blog, a few of you brought up a very important topic I hadn’t really looked deep into before. I mentioned briefly how starting medical school stirred up anxiety and self-doubt. I questioned if I was smart enough for medical school. I wondered if I could keep up with my classmates. Would there be anyone else who looked like me and understood where I came from? Maybe my acceptance was all one big psychosocial experiment, hidden camera TV show, or colossal mistake.

[voice in my head] Would they all think I’m a fraud?

This my friend is called the IMPOSTER SYNDROME. Researchers Clance and Imes first described this psychological experience in their 1978 paper investigating highly successful female college students and professionals. It has been estimated that 70% of the general population also experiences this imposter phenomenon at some point in their lives. It is extremely common among medical students. Now, I am no expert at this but I would like to share some of my personal thoughts on the matter. As with many other challenges one is attempting to overcome, they must first admit they have a problem and recognize the reasons behind this so the cycle may be broken. Here are a few reasons one may be susceptible to this:

1. Upbringing

Many people who suffer from imposter syndrome were raised as children to always strive for perfection. Nothing you did was ever good enough and was rarely celebrated by those close to you. Failure was not an option and asking for help was looked at as being weak. This type of upbringing tends to lead to either high achieving personalities or the exact opposite. Making all A’s is expected of you and there is nothing overly special about this. As a child, when others outside of your circle complimented your excellence you naturally wondered why and said to yourself, “isn’t everyone supposed to be doing this?” Many of these children will not find it necessary to brag or even mention awards and recognitions because they truly feel as though there was nothing special they did to deserve it.

2. Stereotypes and Biases

This one affects most of us. Imposter syndrome can hit you really hard based on how you look physically, sound, dress, or where you come from. I was one of only two black males in a medical school class of roughly 200 students so it was very easy to stand out. At times I felt as though I was under the spotlight and couldn’t help but question why certain comments and attitudes were directed towards me. I have spoken with many women in medicine who tell me stories of people automatically assuming they are the nurse and continue to incorrectly refer to them as anything but the doctor despite their white coat. One may have a thick accent stemming from a tiny small town in Podunk, Mississippi and their intelligence may be questioned simply after hearing them speak. I learned in medical school to never judge a book by the cover but this is the world we live in. Attempting to fit into a new environment where you stand out can make one feel inadequate. If people assume a role upon you, it can cause you to become self-conscious and ultimately begin entertaining their thoughts.

3. Environment

A high critiquing audience can lead one to lose confidence. Many musicians, artists, models, and premed students are constantly being judged and tested. This can lead them to a constant feeling of being under a microscope or incite a competitive spirit. Entering a very competitive field such as medical school will easily make one begin sizing themselves up with others. Inability to appreciate that we are all flawed human beings may lead one to feel inadequate. As a medical student, outsiders will automatically assume you know things or possess certain talents which you may not at that point. I remember always telling my friends not to follow my introduction with, “he’s a medical student” because automatically eyes lit up and I was hit with a barrage of questions as though I was being tested. Maybe I was worried that if I was to miserably fail any of their pop quiz then their high expectations of me would be shattered and I would be labeled an imposter.

Well, these are a few reasons why I believe many are susceptible to the imposter syndrome. It certainly hit me hard when starting medical school and still comes back to haunt me every once in a while. I will share a few tips on how I combat this next blog. Do you have the imposter syndrome or worry you may deal with it someday? Consider taking this quiz below. I’d love to hear you did and your thoughts.

1. I have often succeeded on a test or task even though I was afraid that I would not do well before I undertook the task.

(not at all true, 1) (rarely, 2) (sometimes, 3) (often, 4) (very true, 5)

2. I can give the impression that I’m more competent than I really am.

(not at all true, 1) (rarely, 2) (sometimes, 3) (often, 4) (very true, 5)

3. I avoid evaluations if possible and have a dread of others evaluating me.

(not at all true, 1) (rarely, 2) (sometimes, 3) (often, 4) (very true, 5)

4. When people praise me for something I’ve accomplished, I’m afraid I won’t be able to live up to their expectations of me in the future.

(not at all true, 1) (rarely, 2) (sometimes, 3) (often, 4) (very true, 5)

5. I sometimes think I obtained my present position or gained my present success because I happened to be in the right

(not at all true, 1) (rarely, 2) (sometimes, 3) (often, 4) (very true, 5)

6. I’m afraid people important to me may find out that I’m not as capable as they think I am.

(not at all true, 1) (rarely, 2) (sometimes, 3) (often, 4) (very true, 5)

7. I tend to remember the incidents in which I have not done my best more than those times I have done my best.

(not at all true, 1) (rarely, 2) (sometimes, 3) (often, 4) (very true, 5)

8. I rarely do a project or task as well as I’d like to do it.

(not at all true, 1) (rarely, 2) (sometimes, 3) (often, 4) (very true, 5)

9. Sometimes I feel or believe that my success in my life or in my job has been the result of some kind of error.

(not at all true, 1) (rarely, 2) (sometimes, 3) (often, 4) (very true, 5)

10. It’s hard for me to accept compliments or praise about my intelligence or accomplishments.

(not at all true, 1) (rarely, 2) (sometimes, 3) (often, 4) (very true, 5)

11. At times, I feel my success has been due to some kind of luck.

(not at all true, 1) (rarely, 2) (sometimes, 3) (often, 4) (very true, 5)

12. I’m disappointed at times in my present accomplishments and think I should have accomplished much more.

(not at all true, 1) (rarely, 2) (sometimes, 3) (often, 4) (very true, 5)

13. Sometimes I’m afraid others will discover how much knowledge or ability I really lack.

(not at all true, 1) (rarely, 2) (sometimes, 3) (often, 4) (very true, 5)

14. I’m often afraid that I may fail at a new assignment or undertaking even though I generally do well at what I attempt.

(not at all true, 1) (rarely, 2) (sometimes, 3) (often, 4) (very true, 5)

15. When I’ve succeeded at something and received recognition for my accomplishments, I have doubts that I can keep repeating that success.

(not at all true, 1) (rarely, 2) (sometimes, 3) (often, 4) (very true, 5)

16. If I receive a great deal of praise and recognition for something I’ve accomplished, I tend to discount the importance of what I’ve done.

(not at all true, 1) (rarely, 2) (sometimes, 3) (often, 4) (very true, 5)

17. I often compare my ability to those around me and think they may be more intelligent than I am.

(not at all true, 1) (rarely, 2) (sometimes, 3) (often, 4) (very true, 5)

18. I often worry about not succeeding with a project or examination, even though others around me have considerable confidence that I will do well.

(not at all true, 1) (rarely, 2) (sometimes, 3) (often, 4) (very true, 5)

19. If I’m going to receive a promotion or gain recognition of some kind, I hesitate to tell others until it is an accomplished fact.

(not at all true, 1) (rarely, 2) (sometimes, 3) (often, 4) (very true, 5)

20. I feel bad and discouraged if I’m not “the best” or at least “very special” in situations that involve achievement.

(not at all true, 1) (rarely, 2) (sometimes, 3) (often, 4) (very true, 5)

SCORING

<40: Few imposter phenomenon characteristics

41-60: Moderate imposter phenomenon experiences

61-80: Frequent imposter phenomenon feelings

>80: Intense imposter phenomenon

Note. From The Impostor Phenomenon: When Success Makes You Feel Like A Fake (pp. 20-22), by P.R. Clance, 1985, Toronto: Bantam Books. Copyright 1985 by Pauline

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