Imposter Syndrome and Its Invisible Grasp on Medical Students

Imagine both helping to bring one of modern medicine’s most fundamental procedures to America and preventing an epidemic. Now, imagine doing all this and not receiving credit for it.  In our world ruled by copyrights and publications, this situation can be difficult to imagine. However, in 1721 this was far from reality.  An excerpt in chapter 2 of Medical Apartheid recounts the story of Onesimus: the man who helped make inoculation mainstream in the United States. When Onesimus shared his knowledge and experiences of the procedure in Africa with the man who kept him enslaved, Cotton Mathers, Mathers used this information to advocate for widespread smallpox inoculation in Boston. He also submitted a report to the Royal Society on the topic, and as a result reaped acclaim for preventing an epidemic and making inoculation a widespread Western practice. On the contrary, the mastermind behind the technique, “came to share the fate of nearly every slave who contributed to medical research: facelessness” (73). I interpreted this “facelessness” as a forced separation of Onesimus from his contributions. This alienation he experienced reminded me of more modernly acknowledged phenomena: imposter syndrome. People with this condition often feel uncomfortable acknowledging that they are wholly responsible for their successes. This condition is very common, especially for people in the medical field, but it is still not recognized by many: including its victims. In my writing I hope to both raise awareness of what imposter syndrome is and why it occurs, as well as how we can combat it so that more people can feel valid and responsible for all that they have accomplished.

According to this article in the Harvard Business Review, “Imposter syndrome can be defined as a collection of feelings of inadequacy that persist despite evident success”; this feeling of inadequacy can result in people accrediting their accomplishments to luck, and feeling as if they are not as competent as they appear to others. The phenomenon was first brought to the public eye when a 1978 study by Pauline Clance and Suzanne Imes investigated feelings of “phoniness” that they observed in very high achieving women of the time. To this day, the alienation people feel regarding their achievements parallels what was forced upon Onesimus centuries prior.

One sector, among many, that houses these “high achievers”, is medicine. Although all of those who practice in medicine are very accomplished, I wanted to focus my writing on imposter syndrome’s grasp on students in medical school.  This, more recent, study aimed to see who exactly is affected by imposter syndrome in medical school, and how it may contribute to burnout in the medical field. Prior to contrary belief, possibly due to the 1978 study’s focus on women, imposter syndrome can afflict anybody. Despite this fact, the study concluded that women and people who belong to underrepresented groups experienced imposter syndrome at a higher frequency than others. While about a quarter of men in medical school are afflicted, which is significant on its own, half of women and almost a three quarters of those who do not identify as white or asian suffer from imposter syndrome. Aside from being debilitating on its own, the study also found that imposter syndrome was associated with burnout in medicine: something that should be avoided at all costs for those who have invested so much into helping others.

To avoid imposter syndrome, it is essential to understand its origins. As mentioned in this article, perfectionists are often sufferers. This often occurs when they fail to accomplish every single goal they have, despite enjoying great success otherwise. Many people who are often considered as “natural geniuses” will also feel inadequate when they fail at a task or need to work hard, as they see this indicative of failure. As I have learned, growth and achievement happen through hard work and occasional failure. However, for myself (and I imagine many pursuing medical school) it can be difficult to realize this.  Yet another risk factor mentioned, that is outside of an individual’s locus control, is discrimination and feeling out of place in a group. I can see this being especially prevalent among women and people who are underrepresented in medicine, where in 2018-2019 the AAMC reported that only around 7 percent of students enrolled in US medical schools were African American. Roughly same figure applies to students who identify as Hispanic or Latino, and even more surprisingly less than .25 percent of students identified as Native American.

So, how can we fix this problem and educate generations of more self-assured physicians?  On the individual level it is recommended to practice self-talk in order to recognize these feelings as they emerge, view failures as learning experiences, and know when to seek the support of others. For those who feel out of place, this source advises people to join groups with those of similar backgrounds in order to share advice. Personally, I also think that diversity initiatives in medical schools could be a proactive measure to fight feelings of isolation before they happen. Additionally, I imagine peer-mentoring could be helpful, especially with underclassmen. With a mentor, students can both have outlets to seek advisement and view somebody similar to themselves in a position of success.

In 1721, Onesimus felt faceless when his ideas were advertised without giving him credit. Today many students of medicine, among others, also feel a facelessness when they reflect upon their accomplishments. Although the mechanisms for these feelings differ between modern students and Onesimus, both parties are unrecognized (either by others or themselves) in the extent of their success. Through awareness of imposter syndrome, combined with mentoring and initiatives for more representative medical schools, hopefully we can begin to allow all individuals to feel wholly responsible and proud of all that they have achieved.

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