Imposter syndrome: preventing it, overcoming it and the link to burnout

Angela Carrick, DO, didn’t think she measured up as an emergency medicine resident, not even after she scored in the top percentile for her board exams and got the highest score in her class.

“I thought I must have just gotten lucky because there was no way that was a true assessment of my knowledge,” says Dr. Carrick, an emergency medicine associate program director at Norman Regional Hospital in Oklahoma. “Looking back on it, I didn’t have the confidence to say, ‘I did deserve that,’ and give myself credit.”

Feeling less intelligent and competent than others think you are is a symptom of imposter syndrome. Often people who have imposter syndrome have extensive feelings of self-doubt or insecurity, despite their successes. These high achievers have difficulty internalizing a sense of accomplishment, expertise or skill.

How imposter syndrome affects the care you provide

In an International Journal of Medical Education study, 49% of female medical students experienced imposter syndrome in contrast to 24% of male medical students. Imposter syndrome was also associated with characteristics of burnout such as cynicism, emotional exhaustion and depersonalization, the study found.

One of the major symptoms of burnout is the inability to internalize your own accomplishments, according to Gail Singer-Chang, PsyD, senior executive director of the Office of Multi-Disciplinary Collaboration at Western University of Health Sciences College of Osteopathic Medicine of the Pacific.

“If you don’t have a sense of self-worth, how is empathy going to follow if you think your empathy wouldn’t be worth anything?” Dr. Singer-Chang asks. “It’ll be difficult to connect with others, which could lead you on a path towards burnout.”

When imposter syndrome is unaddressed, it can limit a person’s drive to pursue residencies, fellowships or promotions, because they might think they wouldn’t be selected, says Roozehra Khan, DO, an assistant professor of clinical medicine at Keck School of Medicine of the University of Southern California and an attending critical care physician.

“You’ll cut your potential to be the best physician you can be because if you think you’re an imposter, then subconsciously you’re going to behave that way too,” Dr. Khan says.

Overcoming imposter syndrome

1. Celebrate wins of all sizes

If you did well on a test or mastered a challenging topic, Dr. Singer-Chang suggests celebrating your win and giving yourself credit when you worked hard. Find small stepping-stones where you have had success and recognize the win for yourself.

“There’s a tendency when you’re stressed to filter out all the positives and only focus on the negatives, but bring the positives into the picture every day,” Dr. Singer-Chang says.

2. Create a support team

A support group of mentors and peers who can encourage you and recognize when you’re cutting yourself down can help put things in perspective.

If Dr. Carrick hears her residents using self-deprecating language, she will try to give them perspective by providing a concrete example of when they showcased their capabilities.

“I try to empower them and help them recognize that what they’re thinking is not true about themselves,” Dr. Carrick says.

3. Talk back to your negative thoughts

After Dr. Khan read “Lean In: Women, Work and the Will to Lead” by Sheryl Sandberg, which discusses imposter syndrome, she realized she wasn’t alone with her struggle. She started taking an active approach to shut down thoughts of self-doubt.

“Talk back to your negative self and when someone compliments you or acknowledges your accomplishments, really take that positive feedback and run with it,” Dr. Khan says.

4. Build a collection of positive memories and mementos

At Dr. Carrick’s hospital, physicians receive patient feedback in writing. She keeps positive notes and thank-you notes from students and residents in a book so she can look back on them when she’s having a hard day. Dr. Khan also collects positive notes.

“I can look through and read those and think wow, I did help someone, I made a difference and people appreciate me,” Dr. Carrick says.

5. Ask questions

Imposter syndrome is connected to perfectionism, according to Academic Medicine. Feeling the pressure to know everything can manifest feelings of anxiety and self-doubt when physicians can’t live up to the high bar they set for themselves.

“You need to be able to say you don’t know something and ask questions—that doesn’t make you an imposter,” Dr. Singer-Chang says.

In medical school, Capt. Kirsten Lederer, DO, struggled with imposter syndrome and documented her experience on her blog. When she started her residency in general surgery at Keesler Air Force Base in Biloxi, Mississippi, some of those feelings crept back.

She reminds herself that she is still in training and it’s OK that she doesn’t know everything yet.

“All the senior residents and attendings know that this is a transition period for us and they know that we will need a little more supervision and guidance over these next couple months,” Dr. Lederer says.

Preventing imposter syndrome

1. Establish your personal and professional identity

Medical school is a transformational process that lays the foundation of what it means to be a physician. Imposter syndrome may manifest during this time because students haven’t yet developed the coping skills they need for this new environment, Dr. Singer-Chang says.

She suggests completing strength, emotional intelligence and learning style assessments, such as Gallup’s CliftonStrengths, to affirm your identity. Discuss and reflect on identity-developing questions with peers and mentors, such as:

• What brought you to medicine?
• What does it mean to be a healer?
• What is your vision for medical school?

2. Check your expectations

Dr. Lederer felt ready for medical school, but after starting classes, she began to doubt her abilities.

“It’s a shock to be a high achiever and then you’re in medical school and you’re just average,” Dr. Lederer says.

Dr. Singer-Chang says some students hit a wall of dissonance when becoming a physician isn’t what they expected. Before entering a new environment, she suggests assessing your expectations to ensure they are balanced.

“Students will come in with a white-knight mentality, ready to save the world, but when the rubber hits the road, there can be a lot of tension and discomfort,” Dr. Singer-Chang says. “The expectations are so high and you’ve always been told you can do anything you want.”

3. Commit to a wellness plan

“When you have a bad day, it’s a snowball of negative thoughts,” Dr. Khan says. “A wellness plan in place really helps pull you out of all that self-doubt.”

Positive affirmations are a part of Dr. Khan’s wellness plan. She will remind herself of the difference she is making in the lives of her patients and students, and that she has worked hard to earn her role as a physician.

Additional reading:

On burnout: DOs and medical students open up

I tried capitated primary care, and it reversed my burnout

Addressing patient suicide risk: Communication is key