For students, medical school is more than just an educational opportunity: it’s a major stage of life that can evoke profound self-reflection. Between classes, clinical experiences, and interactions with classmates, one of these reflections may be the following: Do I really have what it takes to be here?
This is known as imposter syndrome, a phenomenon whereby a person’s perception of their merits or skills doesn’t match their actual accomplishments, leading them to doubt that they deserve them in the first place.
In medical school, many environments and contexts can trigger imposter syndrome. Some of my classmates have said:
“It really hits me when I’m with structured patients. Even though I know it’s not real, I think: Who am I to be talking to them about their health?”
“Whenever we’re studying in a group, I feel like other people know way more than me. And it makes me feel like I’m not as smart as them, or that somehow I’m missing something important.”
“Getting exam scores back and comparing with classmates can make me feel like I shouldn’t really be in med school.”
In this article, we’ll explore how imposter syndrome comes up for medical students, some factors that may be involved, and some ways that students can overcome it.
Why imposter syndrome happens
Normally, our self-perception develops when we internalize the cues that we receive from our environment, such as the positions that we achieve, the rewards that we obtain, and feedback given to us by others. In imposter syndrome, this process of healthy internalization is disrupted, leading us to deny the reality of these achievements in the first place.
This was exactly the finding that led Clance and Imes (1978) to first define imposter syndrome, when they observed that during regular psychotherapy sessions, many women—whose accomplishments ranged from obtaining PhDs to running large companies—nonetheless felt that they didn’t truly deserve these impressive accomplishments.
Kolligian and Sternberg (1991) obtained data on imposter syndrome and found that it was more prevalent among those who repeatedly self-monitor and have self-critical thoughts. This suggests that making comparisons between ourselves and others is a major determinant of imposter syndrome.
And medical school may be a hot spot for such comparisons. Surrounded by high-achieving classmates, students must also contend with differential performances on exams and rotations, whether they’re displayed through class rankings or shared during regular conversations.
Two major psychological theories explain how imposter syndrome arises:
- Cognitive theory says that imposter syndrome happens when we use implicit biases and assumptions in our thinking, leading us to erroneous conclusions about how our merits compare to those of others. For example, a person may assume that outward details are accurate indications of success, leading them to underestimate their own abilities and overestimate those of their peers.
- Gestalt/narrative theory says that imposter syndrome results from certain “life scripts” that are fixed, influence our interpretation of our present circumstances, and result from impactful past experiences. For example, a sibling rivalry in early childhood may lead somebody to an introjected sense of being the “less successful” child, something that persists even in the face of undeniable accomplishments.
The impacts of imposter syndrome
A large meta-study by Bravata et al. (2019) found that higher measures of imposter syndrome were associated with higher rates of depression, anxiety, low self-esteem, somatic symptoms, and social dysfunction. And in a pilot study of imposter syndrome among medical students by Villwock et al. (2016), imposter syndrome was associated with higher rates of exhaustion, emotional exhaustion, cynicism, and depersonalization, factors that the authors noted were also correlated with burnout.
Of course, these are only correlative studies. My classmates can attest to the direct effects of imposter syndrome:
“Participating in [small-group] class is difficult because I’m worried about saying something wrong. The idea is, if I say enough wrong things, people are gonna think I don’t belong here.”
“It makes me more sensitive to negative feedback. I want to be able to be a learner, but some of the feedback I get can trigger my feelings of imposter syndrome, so it becomes hard to hear.”
“It just doesn’t feel right to explain things to a patient. And I can tell that this makes me more uncertain, and I’m sure that comes across. It’s like a self-fulfilling prophecy!”
Overall, it seems clear that imposter syndrome is more than just an “annoying feeling.” It can have real effects on a person’s mental health, susceptibility to burnout, and level of functioning during medical school.
Overcoming imposter syndrome
If cognitive biases and fixed life scripts contribute to the “symptomatology” of imposter syndrome, it follows that addressing these can help to alleviate it. For that reason, an assessment of the biases and assumptions in our thinking about ourselves and others can help us to “reality-check” them away. Furthermore, a thoughtful reflection on our past experiences, and the implicit messages that we’ve taken from them, can rid us of the self-critical narratives that we tell ourselves.
On a more structural level, instructors, mentors, and classmates can reduce imposter syndrome by being more transparent about their doubts and struggles, normalizing negative feelings in a way that makes idealization less likely. This could be especially helpful in the context of long-term professional relationships.
Conclusion
Imposter syndrome happens when a person is unable to internalize external markers of success or merit, leading them to believe that they don’t deserve them. Medical students appear to be highly susceptible to imposter syndrome, and its effects may include increased stress, increased depressive affect, and decreased assertiveness. A thoughtful exploration of a person’s cognitive biases and implicit life scripts can help somebody to better internalize their successes and improve their performance.
Overcoming imposter syndrome can help medical students to develop a secure self-concept, founded on a realistic appraisal of their abilities and accomplishments, allowing them to achieve their full potential during medical school and beyond.
Farid Alsabeh is a psychotherapist and medical student.
