Sole Purpose 11
Imposter Syndrome and Starting Medical School

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Imposter Syndrome and Starting Medical School

As someone who has been diligently journaling daily for what feels like an eternity, I recently stumbled upon a treasure while sorting through my belongings in preparation for the big move after graduation: my journal from the chaotic days of starting medical school. Flipping through its pages, I couldn't help but chuckle at the frantic entries from my first week of school. At that time, I was convinced that someone had surely made a grave mistake in allowing me to don a white coat. I penned things like, "How did I even get here? And WHO let ME become a medical student???", "Everyone is SO SMART and here I am drowning," and my personal favorite, "I'm already falling behind, and it's only been two days!" (reality check: I wasn’t behind at all). While mostly humorous, my heart does ache a bit for first-year student Savannah, as these exaggerated statements, though funny now, were classic examples of imposter syndrome.

What exactly is Imposter Syndrome?

Imposter Syndrome, in a nutshell, it's a psychological phenomenon characterized by persistent doubt about one's abilities, coupled with the fear of being unmasked as a fraud despite evidence of success.^1,2,3,5 My journal entries from that tumultuous first week of med school vividly illustrate my doubts about belonging at Western and the looming fear of failure (spoiler alert: I wasn't failing). And I'm far from alone in this struggle; imposter syndrome runs rampant, especially among physicians and those in training, with unmarried women taking the lead (yikes, that’s me).^2,3,6

But why me?

Imposter syndrome tends to target high achievers who struggle to internalize their accomplishments, much like the quintessential medical student thrust into a sea of overachievers. As I've joked before, I'm the epitome of the high-achieving eldest daughter in medicine. It's also more prevalent among minority populations, including women in medicine or individuals from specific ethnic backgrounds.^2,3,6

If I'm entirely honest, I do feel a slight chip on my shoulder when I enter the operating room and find myself the lone female, or when people are utterly shocked to hear me speak Spanish, and even more surprised that I do so fluently and proficiently. This chip drives me to push myself harder, to defy the expectations people hastily form upon seeing me. The notion that one must work twice as hard to prove oneself only adds fuel to the fire, but it seems no amount of fuel is ever truly sufficient, which is what leads to the increased incidence of imposter syndrome.

So, why am I sharing all of this?

Truth be told, imposter syndrome is like an unwelcome guest who refuses to leave the party. It lurks in the shadows, ready to undermine your confidence at every opportunity. While this feeling has never fully dissipated for me, I've come to recognize its tricks. I assure you I haven't spent all of medical school as an anxious wreck, lamenting my inadequacy in my journal. And I certainly don't want fellow medical students to experience the same. That's why I want to outline strategies for tackling imposter syndrome head-on.

What do the professionals say?

Imposter syndrome is a serious issue that can impact job performance and overall mental and physical well-being. The American Psychological Association offers the following advice for overcoming feelings of imposter syndrome.¹ I have detailed them below with my own examples.

1. Know the Facts

This step entails taking a moment to step back and assess the situation objectively, grounding yourself in the reality of the matter. As I've openly admitted, I tend to be overly dramatic and critical of myself. One recurring fear was that I somehow tricked my way into medical school and didn't belong. So, let's consider the facts of how I got into Western. I successfully completed four years of undergrad and navigated through a rigorous application process. Furthermore, my interview with Dr Labovitz, a respected figure in the podiatric community and now my dean, would have highlighted any red flags in my application. Additionally, admission to medical school involves multiple decision-makers, making it highly unlikely for me to have deceived them all. The truth is, I earned my place here because a significant number of people believe in my ability to succeed in podiatry.

2. Share Your Feelings

If finding comfort in your current reality seems elusive, confiding in a trusted person can be immensely helpful. Personally, when I'm not comfortable expressing my feelings openly, I turn to journaling for solace. There's a grounding effect that comes from pouring out raw, dramatic thoughts onto paper and then revisiting them to realize... wait, that's not the whole story, and I'm doing alright. When I'm not journaling, I'm fortunate to have a close group of friends I can share my feelings with. However, it's crucial to exercise caution about what you share and with whom. While I might casually text my medical school best friend saying, "I'm pretty sure I'm an idiot," and receive a supportive response like, "Aren't we all? What's going on?", I wouldn't dare utter those words to a preceptor or a residency director. Knowing your audience is key and I do suggest journaling!

3. Celebrate Your Success

One of the toughest challenges of imposter syndrome is feeling like your success isn't meaningful or sufficient. Taking a moment to recognize, share, and celebrate your achievements is a powerful way to acknowledge their significance. Personally, I often feel uncomfortable discussing or highlighting my successes, but I'm incredibly fortunate to have a large circle of family and friends who are eager to celebrate with me.

After match day, for instance, I decided to celebrate my match with my extended family over brunch since they couldn't attend the match day ceremony. While it felt awkward to acknowledge my accomplishment, witnessing the joy and pride in my family's eyes was heartwarming and made me feel truly appreciated and excited.

Another way I embrace celebration is by saving positive evaluations for rainy days. It's difficult to doubt my worth when I read a kind evaluation from a respected and beloved preceptor. In fact, I keep a screenshot of the most uplifting evaluation from my faculty mentor at Western, saved on my desktop under the title "for whenever I am feeling sad."

4. Let Go of Perfectionism (uh oh)

There's a significant correlation between perfectionism and experiencing imposter syndrome.⁴ It's the belief that if I didn't execute everything flawlessly, then I accomplished nothing at all. You're delving into the inner workings of someone who embodies perfectionism to the extreme, along with all its toxic tendencies.

The key here isn't about lowering your standards across the board but rather allowing your work to be good enough instead of obsessing over perfection. As someone deeply involved in research and writing, I've learned to celebrate milestones like completing a draft on time and feeling proud of my work, without fixating that someone, upon reading my draft, had to correct some minor grammatical errors. My work is still worth celebrating, even if I made small mistakes.

5. Cultivate Self-Compassion

This concept revolves around using mindfulness to redirect your focus. It involves taking a moment to step back, acknowledge your emotions, and recognize how you're feeling.

For me, one effective way to combat this is by keeping a picture of myself at around 4 or 5 years old on my mirror. When I look at young child Savannah, I can't fathom telling her that she's an idiot for getting a 7/10 on a practice quiz for her boards, or that she isn't intelligent enough and doesn't belong in graduate-level school. She loves science and playing doctor! Let her learn!

If you wouldn't speak to someone else or your younger self in such a harsh manner, why treat yourself with the same negativity?

6. Share Your Failures

Alright, I've dedicated a considerable amount of time in this article to acknowledging my shortcomings and flaws. However, I genuinely embrace this approach! I strongly believe that the field of medicine lacks transparency, and I'm more than willing to admit my own mistakes.

Please read Sole Purpose 3 - Some of My Most Embarrassing Moments of Externships if you’d like to laugh at my public sharing of my failures.

7. Accept It

Hi, my name is Savannah Santiago, and yes, I'm a card-carrying member of the Imposter Syndrome Club. I have repeatedly made mistakes in medical school and been filled with self-doubt causing me to mislabel myself as a failure or not good enough. None of that is true and I have consistently been working to be kinder to myself. I am actually a very good student who has had a lot of success in school and will be attending a phenomenal residency program that I am very excited about.

Imposter syndrome may come and go, but one thing remains certain: medical school is tough enough without being overly critical of ourselves. If I could go back in time, I'd reassure my first week of med school self that she belongs here, that she's brilliant, and that the best is yet to come. I hope you all can take a moment this week to acknowledge your amazing accomplishments and how much you deserve to celebrate them!

For more on imposter syndrome, you can enjoy Dr Shapiro’s article:
Practice Perfect 694 - Imposter Syndrome Among Physicians.