Have you ever felt like every other doctor is smarter, more accomplished, and downright better at their job than you are? Even though you are just as qualified and accomplished? 

I certainly have. However, by understanding the symptoms of what’s known as imposter syndrome, we have a better chance of overcoming it.

It's my first week as an intern (aka a baby doctor). I’ve just graduated from medical school, where the last 6 years have been spent poring over textbooks, fighting sleep during never ending lectures and tagging along as the proverbial dead weight behind ward rounds. Now, I find myself on the renal ward of the largest tertiary hospital for a thousand kilometres, wearing a lanyard which says "Dr Nisha" and an annoying work phone that doesn't stop ringing. 

Here it goes again...

Renal Nurse: Hi, is this the doctor?

Me: No, it’s the medical stud.....oh wait, yes, this is the renal intern.

Renal Nurse: I've got Mr B here on dialysis. He needs his warfarin adjusted. Can you do that?

Me: Ummm sure

Renal Nurse: Good, his INR today is 3.8, his target range is 2-3 and he's on 5mg of warfarin daily. What would you like to change the dose to?

Me: Ummm let me ask the other (real) doctors and I'll give you a call back.

Renal Nurse: (Sighs deeply in disappointment) Fine, but I need to know within the next 20 mins. He is about to come off dialysis and go home.

This is just one example of a time when I felt way over my head as a junior doctor. I felt like I didn't know anything or belong in this fast-paced world. I felt like an Imposter.

However, you would be interested (and relieved) to know that over one in three junior doctors feel exactly the same way. Furthermore, it is totally normal to feel this way. In fact, there's a name for it. It's called Imposter Syndrome.

What is Imposter Syndrome?

Imposter Syndrome refers to an internal experience of believing that you are not as competent as others perceive you to be. Basically, you feel like a fraud. Delightful isn't it.

Imposter syndrome goes by a lot of other synonyms too. It's been called Imposter Phenomenon, Imposter Experience, Imposterism, just to name a few.

The concept of Imposter Phenomenon/Syndrome was first studied by Pauline Rose Clance and Suzanne Imes, two female psychologists in 1978. They studied 150 highly successful women and found that despite their academic excellence (we're talking multiple PhD's, scholastic honours, high achievement on standardised tests), they considered themselves to be "imposters." They often attributed their achievements to luck, misgrading or faulty judgement of their professors. You can read more about their study here.

What does Imposter Syndrome feel like?

Often Imposter Syndrome is associated with feelings of generalised anxiety, lack of self-confidence, low mood and frustration at trying to meet very high self-imposed standards.

Based on Clance's Imposter Phenomenon Scale (CIPS), common symptoms of Imposter Syndrome include:

• Feeling like success is impossible
• Feeling incompetent despite demonstrating competency
• Feeling like past successes were only due to luck
• Fear of not meeting another person's expectations
• Feeling incapable of performing at the same level every time
• Feeling uncomfortable with receiving praise or congratulations
• Feeling stressed, anxious or depressed from feelings of inadequacy

You can even take her Imposter Test here.

Speaking from personal experience, Imposter Syndrome does not feel fab. As a GP Registrar, I often have an underlying feeling of anxiety that I don't know enough medicine or that I have to please everyone to be a good doctor or that my patient's must think I'm stupid. These feelings can be quite overwhelming, especially when you are just trying to get on with the job.

What is reassuring is that all of the above feelings are NORMAL. Imposter Syndrome is not a psychiatric disorder. You won't find it in the DSM-V or ICD-10 scoring systems.

Who does it affect?

Imposter Syndrome doesn't discriminate. It has been observed across gender, age, race and profession. A 2020 study showed that it affects up to 82% of people.

In Clane and Imes’ original study, they observed that men tended to experience Imposter Syndrome less frequently and less intensely than women. However, since then, numerous studies have shown that men and women, across many professional settings and among multiple ethnic and racial groups are affected by Imposter Syndrome.

Even the big wigs experience Imposter Syndrome. People like Albert Einstein and Maya Angelou (two very accomplished individuals) are known to have suffered from the phenomenon. Albert Einstein described himself as an "involuntary swindler" who's work "didn't deserve as much attention as it received". Similarly, Maya Angelou said “I have written eleven books, but each time I think, ‘Uh oh, they’re going to find out now. I've run a game on everybody, and they're going to find me out.”

When the man who discovered the theory behind our universe feels unaccomplished, it really goes to show that there is no threshold of accomplishment that can ever rid you of the "imposter" feeling.

We develop a fear of making mistakes and normalise staying silent about them. - Dr Nisha Nangrani

What Kind of Imposter are You?

Dr. Valerie Young, author of The Secret Thoughts of Successful Women: Why Capable People Suffer from the Impostor Syndrome and How to Thrive in Spite of It, has identified five types of “impostors.”

The expert will not feel satisfied when finishing a task until they feel that they know everything about the subject. The time spent searching for information can make it hard to complete tasks and projects.

The perfectionist experiences high levels of anxiety, doubt, and worry, especially when they set themselves extreme goals that they are unable to achieve. A perfectionist will focus on areas where they could have done better rather than celebrate their achievements.

Natural geniuses master many new skills quickly and easily, and they may feel ashamed and weak when faced with a goal that is too hard. Learning that everyone needs to struggle to achieve some goals may help.

The soloist, or “rugged individualist,” prefers to work alone, fearing that asking for help will reveal incompetence. The person may turn down help in an attempt to prove their self-worth.

Superheroes often excel due to extreme effort, as in “workaholism.” This can lead to burnout, which can affect physical and mental well-being and relationships with others.

Why is Imposter Syndrome so prevalent in Medicine?

You would be hard pressed to find a medical student or doctor who has never experienced Imposter Syndrome. If they say no, they are probably lying.

Many academic reviews describe imposter phenomenon in those, "with advanced degrees, those who have the traits of conscientiousness, achievement orientation, perfectionistic expectations, and people who work in highly competitive and stressful occupations." That is medicine in a nutshell.

There is no secret that medicine attracts people who have very high standards, both of themselves and of others. As a result, we have a very strong desire to constantly perform at our best. Thus, it's not hard to see why so many medical students and doctors suffer from this phenomenon.

Why don't we talk about it?

So far, we have established that Imposter Syndrome is a completely normal phenomenon. However, what is not normal is how little it is discussed. It really is medicines best kept secret.

Since medical school we are ingrained with this notion that we have to know everything to pass exams and to practice as a doctor. In our pre-clinical years, we are taught didactically through long and arduous lectures. In our clinical years, we are interrogated during ward rounds about medical conditions and their management. Neither of these scenarios are conducive to developing a safe and open space for learning. We develop a fear of making mistakes and normalise staying silent about them.

As we progress to become junior doctors, we are left with the feeling that everyone around us knows more than we do (even if the evidence indicates otherwise). We become too scared to discuss our insecurities or share them with our colleagues for fear of being perceived as 'inadequate' or a 'bad doctor'.

In my own experience, it wasn't until I began talking to other interns and junior doctors that I realised our experiences were shared and that most of us suffered from Imposterism. For example, when I spoke to every other intern who had worked on the renal ward, they voiced exactly the same concerns and misgivings that I had felt during those first 12 weeks. This pattern continued throughout almost all of my rotations as a junior doctor. If you've had similar experiences or thoughts, it's important to know you are not alone. There are many people around you or those who have come before you who felt exactly the same way.

When does it strike?

Imposter syndrome has been observed in everyone from the medical student to the fatigued junior doctor, the competent registrar and the esteemed specialist. Basically, everybody can experience imposter syndrome regardless of rank or experience.

For some, Imposter Syndrome strikes at certain transition points in our career. This can be when starting medical school or transitioning from a medical student to an intern. It can also occur when stepping up from a resident to a registrar or finally qualifying as a consultant. For others, Imposter Syndrome can be present throughout their career. It is something that never really goes away.

Personally speaking, my Imposter Syndrome peaked when I first started working as an intern and has resurfaced in my current role as a GP Registrar. Nowadays, when I hear my patients refer to me as their doctor, it feels a little strange. After all, three months ago I was just a junior medical officer, running around the hospital at 3am on an after-hours shift, armed with expert skills in peripheral intravenous cannula insertion and electronic medical documentation. Now, I am responsible for managing a patient's complex Type 2 diabetes or screening them for cancer. I'm not sure when (or if) my Imposter syndrome will ever go away, but for now it remains as the invisible elephant in my consultation room.

However, regardless of when and where Imposter syndrome strikes, there are a number of strategies you can use to tackle it.

How to Tackle Imposter Syndrome

Number 1: Recognise that you've got it!

The first step to dealing with Imposter Syndrome is first evaluating whether or not you actually suffer from it. If you don't, pat yourself on the back and thank your lucky stars and proceed along your merry way. If you do, read on. 

Number 2: Reflect & Accept

If you do have Imposter Syndrome, break this down further. What feelings do you experience? What situations or scenarios trigger those feelings? Is it every time a patient asks you a question you don't know? Or is it when the consultant looks at you disapprovingly when you answer a question incorrectly? Remember that the way you feel about something doesn't necessarily resemble the facts.

If you work in medicine, learn to accept that Imposter Syndrome may never go away. After all, what are the chances you will know everything in medicine or that your patients will always like you? Instead, approach Imposter Syndrome as something to be managed rather than eliminated.

Number 3: Talk to Someone (Anyone) about it

The best way to tackle Imposter Syndrome is to talk about it. Find someone you trust and are comfortable feeling vulnerable around. This could be a colleague, friend or mentor. You can also join peer support groups offered by your hospital (RMO societies).

Failing the above, there's always the internet. Check out #MedTwitter and join the conversation. Or seek out an appropriate forums like MedicGuild’s Atlas community discussion group, or Facebook pages such as e.g. Creative Careers in Medicine (CCIM). If you find yourself in a marginalised group, seek out people in a similar situation. For example, women in surgery, international medical graduates, doctors with disabilities or medical mothers. Regardless of who you are, there is always help available including DRS4DRS, Beyond Blue and Lifeline Australia.

Number 4: Develop a Growth Mindset

Medicine is a long, seemingly endless journey. Developing a "growth mindset" (i.e. the belief that you can improve your abilities with effort and persistence), will bode well for you in the long run.

Focus on improving things that are in your control. For example, actually understanding how to manage heart failure is more important than being able to recite the management to a consultant in a high pressure scenario.

Set goals and reward yourself for EFFORT rather than ACHIEVEMENT. For example, set a goal of attempting 10 cannulas in a rotation as a medical student. It doesn't matter if you miss all 10 but reward yourself for trying.

Also, seek opportunities to fail in a safe environment. For example, put your hand up to lead a simulation resuscitation on a mannequin. What's the worst that could happen? They're already made of plastic.

Learn to embrace failure. We all make mistakes. No one is perfect. Learn to learn from your mistakes rather than beat yourself up about them. I'm still working on this one too.

What to Remember 

Imposter Syndrome is a thing. If you're a doctor or medical student, you've probably experienced it. It probably won't go away but there are things you can do to tackle it:

1. Recognise that you have it
2. Reflect and accept it
3. Talk to someone about it
4. Develop a growth mindset

Most of all, recognise that Imposter Syndrome is normal. It is something that should be discussed, celebrated and encouraged. To the new generation of junior doctors, normalise talking about Imposter Syndrome. Always remember - you have talent, you are capable, and you belong.

If you would like to read more about my experiences as a junior doctor/GP registrar, you can find them on my weekly blog. Alternatively, you can find me sharing memes on Instagram, Twitter and Facebook. 

May you recognise your own glorious and spectacular competence,

Doctor Nisha