This is the time of year for new newcomers and new beginnings – between July and September, we welcome new medical students, housestaff, faculty, lots of clinical lab scientists (including many of our recent graduates). Existing faculty and staff take also take on new roles or begin new programs since this is the start of a new academic year and a new fiscal year. It is always exciting and invigorating to start something new – but often a bit daunting and even a little scary, too.

Because this is the season of change, I've been hearing a lot about imposter syndrome lately. Feeling like an imposter was a strong theme in the speech by the 4th year medical student speaker at the school's induction ceremony for new medical class of 2023 – she shared how, as a new student, she worried about whether she fit in and if she could measure up to her classmates who all seemed so accomplished. The faculty speaker who followed echoed these sentiments too. That very same week, a narrative essay about imposter syndrome was published in the Journal of the American Medical Association (JAMA).

Imposter syndrome is defined as feeling like a fake or a fraud because success is somehow just luck or in some way undeserved. This form of self-doubt is common and can affect anyone, but is most prevalent among high-achievers, those who seek to become experts (lije many of us in healthcare and science), as well as women and minorities who often feel that they have to work harder and be better just to measure up.

Since imposter syndrome is associated with transitions, I'll bet that lots of the new arrivals in our department and health system this summer have had a least some of the same self-doubt that goes along with feeling like an imposter.

I've felt like an imposter many times myself – maybe some of these examples resonate with you:

  • As a medical student, we had to do admission physicals for patients have elective surgeries the next day (yes, patients actually spent the night in the hospital before surgery back then). When I went to do the physical on a patient scheduled for an ACL reconstruction the next day, he tried to shoo me away because he and his girlfriend had plans to go out to dinner with at a fancy Chicago restaurant – I think the patient thought he had just checked in to the nearby Ritz-Carlton, not the hospital. As a female medical student in a time where patients were very unaccustomed to women physicians in any specialty, I didn't often command much respect and felt like an imposter. But I did get the physical done before he left for dinner.
  • As a brand new faculty member here at UCD, a more senior member of another department introduced me to a colleague as “an expert in fine needle aspiration (FNA)”. Having just been a fellow only a few weeks before, it felt strange and uncomfortable to be referred to as an expert. But in fact, I was an expert and not the imposter that I considered myself to be – cytology fellowships were uncommon in the 1980s, FNA was not widely used, and I had high-volume subspecialty expertise that few others had.
  • As a new chair, I felt a little shy about standing up to be introduced at the Association of Pathology Chairs' annual luncheon along with all of the other new chairs. Was I possibly as chair-like and deserving as the others in the room??? But why should I have doubted that? And I'm guessing that almost anyone would feel self-conscious about standing up to be introduced to a ballroom full of academic leaders.
  • And every time I give talk, I'm always thinking that there must be someone in the audience who knows more than I do – and I ask myself why I voluntarily accept this anxiety-provoking misery.

I think that some of the feelings of imposter syndrome can be used to our advantage. Though we can't let self-doubt interfere with our ability to be effective in our work, a little self-doubt can keep us from being cocky or over-confident.

A little self-doubt can also keep us humble – more humility in medicine and healthcare could be a good very good thing.

An online article in Forbes describes the importance of humility to being a top performer, and shares the following key traits to using this successfully. In many ways, these sound like the qualities of an imposter:

  • Recognizing the contributions of others in achieving one's success
  • Admitting to weaknesses and mistakes, and seeking to understand, change, and be better.
  • Accepting constructive feedback as valid and being thoughtful in responding.
  • Helping others.

Note that the last bullet in the Forbes list is about helping others. To accomplish this, I especially like the following advice from a medical student published in Academic Medicine:

We focus on the moments where we feel that we do not have enough experience; we are just “pretending” to fit in. Yet, we hardly ever reflect on the moments when we are not imposters. Instead, we relentlessly focus on what is next or where gaps in our knowledge exist. But for every moment when we feel inadequate, there is another moment when we realize a previous challenge is now mundane.

As we welcome our new students, housestaff, faculty, CLS and other staff, let's remember to help them celebrate the moments of inadequacy that get replaced by mastery and accomplishment. Facilitating the transition from self-doubt to a successful member of our workplace family should be part of the on-boarding that we all provide – formally or informally — just like showing new folks how to work the LIS, or where the bathroom is, or how to put in a vacation request. As the JAMA opinion piece on imposter syndrome concluded, we need to change the culture. In fact, it seems like most of my blogs end with culture change – its what progress is really all about.