Facing Imposter Syndrome on the Wards

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You’ve put in the work, and it's shown. You've accomplished a lot throughout your med school run and can be proud of what you've achieved.

And yet. You're finally stepping foot on the wards and, almost inexplicably, doubts are suddenly creeping in. Yes, your studies have been difficult, but you hadn't anticipated this: You're feeling like a fraud, like you shouldn't be there.

But it's an irrational, unreliable fear. This is imposter syndrome, and it's a common plague among students. But, while it can be a difficult feeling to shake, you can get through it. Take it from medical student Michael Dykstra, who faced those same fears on the first day of his sub-internship.

It was the first week of my medicine sub-internship. I was expected to function at the level of the intern, but with fewer patients. My responsibilities included knowing all relevant patient data, formulating comprehensive plans for each patient, communicating with consulting services, placing orders and discussing action items with nursing and other providers. I felt medical school had not prepared me for this.

To say I felt like I was drowning would be far too optimistic. In addition to forgetting everything I had learned in medical school, I lacked basic organizational skills to gather relevant information about patients, and at times while presenting on rounds even doubted my ability to speak English, my native tongue. My supervising resident needed to pick up my slack. In stark contrast to my performance, I was paired with another medical student named Liz. She knew her patients’ lab values when asked, could reason through the plan for the day for complex patients, and possessed a dogged tenacity to do what was best for all her patients. I could only hope to emulate her, and she was always kind enough to strategize with me about the best ways we could keep improving.

For me, in addition to feeling incompetent in very tangible ways, it was easy to forget my past and present accomplishments and allow self-deprecating thoughts to also become ingrained into identity. Instead of wondering, “How do I perform this task better?” the question becomes, “Am I good enough?” or even, “Do I belong here?” These are the beginnings of imposter syndrome.

Feelings like this are common in medical school. Despite whatever academic heights you accomplish before medical school, whether a top-10 medical school deemed you worthy of acceptance, or whatever “objective success” you achieve throughout medical training, you are still likely to have these feelings at some point in your medical career. Various studies have indicated that between 40% and 95% of medical students and residents report feeling at least moderate imposter syndrome. Women and minority ethnic groups are more likely to experience this, and it leads to increased rates of burnout.

The heavy expectations placed on medical students contribute to imposter syndrome; these span navigating the complex social dynamics of an operating room to mastering vast quantities of information for exams to completing extra-curricular activities like research. After years of stressful educational environments and high-stakes patient care, I have no doubts about the cause of premature gray hairs that many residents wear like a badge of honor for their trials. Medical training can also exacerbate underlying insecurities; low self-confidence, fear of failure and fear of success have all been associated with imposter syndrome.

So, what should we do? Well, at the end of the long week, Liz and I started chatting. “Wow, you crushed it this week, Liz. It’s been great working with you and learning from you.”

Aghast, she replied, “Are you freaking kidding me? You’ve been doing so well! Way better than me.”

“What?? No way, Liz. The team was super impressed with your performance. I didn’t even know my patient’s lab results or imaging findings when they asked me for them!” We spent 10 minutes in confused disarray, trying to reconcile our internal narrative with that of our partner. Perhaps both of us had actually done fine, but our own interpretation of our performance was distorted by perfectionist perspectives.

I learned a lot from this experience about what I would argue are the two greatest strongholds of impostr syndrome: isolation and inability to forgive oneself. Once Liz and I revealed we both felt this way, it made both of us feel better because we a) weren’t wearing masks anymore and b) weren’t alone. For patient care, we’ve been taught to ‘never worry alone,’ meaning that we should notify a superior if we think a patient may be too sick for us to manage. Regarding imposter syndrome, we also should not worry alone and should reach out to others who likely feel the same.

Finally, Liz and I were striving for perfection at a challenging job that we’d never done before. This is unrealistic. We should hold ourselves to a high standard, especially when patients are involved, but we are also destined to make mistakes as part of our learning. Key to not feeling like an imposter is that we must learn to forgive ourselves for our mistakes and not allow them to permeate into our identity.

Imposter syndrome is a widespread problem that affects many medical students regardless of institution or competence, brought on by a mix of intrinsic and extrinsic factors. As we journey together, let’s remember to do so openly with friends and to forgive ourselves for our mistakes.


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About the Author:
Michael Dykstra is between his 3rd and 4th year at Harvard Medical school. This year he will be doing a lymphoma diagnostics project in Botswana and for residency is deciding between radiation oncology and internal medicine. He enjoys photography in his spare time.


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