Last week we dove deep into imposterism and how it shows up in medicine.
This week we will explore a few more facets of imposterism before looking at how we can mitigate its impact on us so that we can show up as our best selves!
Factors That Foster Imposterism
The first post on imposterism defined what it is, why we experience it, how it shows up, and how it impacts physicians.
So today we’ll continue our investigation.
There are four main factors that foster imposterism or exacerbate existing imposterism. I’ll separate out and spend more time dissecting the last factor vís a vís medicine.
They are:
- Sex
- Race/Ethnicity
- Self-Esteem
- Institutional Culture
1. Sex
As mentioned last week, the initial research into imposter syndrome focused on women. Much of ingrained social norms place women in nurturing, non-performance (i.e., non-career) roles. The downstream impacts of these explicit narratives (and implicit biases) include imposterism as well as pay disparities, disconnects in knowing their worth and negotiating for it, and guilt about family vs. work.
2. Race/Ethnicity
Non-dominant groups tend to be underrepresented in successful positions. Thus “making it” to one of these positions can be filled with more self-doubt and more attribution of success to luck or chance. Note that this applies to women above as well.
This is why it’s important for kids to see people who look like them in successful roles.
3. Self-Esteem
Low self-esteem leads to more imposterism. This makes sense because lacking confidence in one’s own worth or abilities juxtaposed with high achievement will inevitably lead to worrying about being a fraud (and being found out as one).
4. Institutional Culture
There are many facets to this factor that are germane to medicine so I’ll spend more time exploring it.
First, the lack of transparency involved in moving through the ranks of medical education and healthcare organizations means budding and established physicians often don’t know how the arduousness of their journey compares to those of their colleagues.
Stated differently: you may assume that others may have found the journey easy compared to you if it’s never discussed openly. You may feel like you barely succeeded, and if no one talks about it, that others must have been breezed through.
Bringing it up will only shine that spotlight on you that you want to avoid!
Second, medicine is steeped in meritocracy and patriarchy, both of which drive imposterism for reasons previously mentioned.
Gaslighting in the Name of Education
I’m pulling out the last facet of institutional culture under its own heading because it warrants special attention.
And that’s gaslighting.
Gaslighting is rampant in medicine and also exacerbates feelings of imposterism.
As a form of psychological manipulation (and a power trip, not to mention emotional abuse), gaslighting is designed to create self-doubt in the target.
How much of medicine’s so-called Socratic method of teaching (i.e., “pimping;” demonstrated to not actually fit the bill in this post) is actually simply calling into question the learner’s judgment. Often there is an element of ridicule or shaming involved that amplifies self-doubt and the resultant imposterism.
I’ve witnessed and experienced it at all levels of training. From nurses who denied being given orders or told different narratives about courses of events to attendings ripping apart trainees for no apparent good reason.
A particularly egregious example of this comes from my time on cardiothoracic surgery as a med student. During an endarterectomy, an attending convinced a fellow that he must have had amaurosis fugax for not seeing something and shamed him into going to the ED for evaluation!
Talk about absurd.
Factors that Protect Against Imposterism
I’d also like to briefly discuss those factors that help promote self-confidence and stymy imposterism. These will inform the framework to combat imposterism described later in this post.
The four main protective factors are:
- Social Support
- Validation of Success
- Positive Affirmation
- Personal and Shared Reflections
1. Social Support
It should come as no surprise that strong social connections that can help buffer against adverse life events and boost positive self-image would help mitigate imposterism.
Social supports can remind you of your successes. They can pull out that encyclopedia of achievement to show you the evidence to counter that denigrating self-critic who too often goes unopposed.
Is this your inner voice?
2. Validation of Success
Workplace culture that celebrates successes including the piecemeal groundwork that sets the stage for a bigger win can help employees take credit for the work they’ve done. Tying the success to concrete, smaller steps along the way further aids in this endeavor.
3. Positive Affirmation
Yes, reciting positive statements to yourself helps you challenge and eliminate negative or unhelpful self-talk.
Why? Because you’re practicing thoughts and slowly making them your default thoughts. You rehearse away the negative thoughts so they aren’t available to your brain for automatic recall.
4. Personal and Shared Reflections
Pausing to intentionally reflect on where you’re at and how you got there tends to engage more positive thinking.
I think this occurs because your focus is on comparing your current situation to the past. This makes it easier to see the gain or progress you’ve made and nurtures abundance.
Many only focus on where they want to be compared to their current situation. They only see where they’re coming up short.
An Imposterism-Busting Framework
The rest of this post will present a framework for helping you escape imposter-laden thinking and self-talk.
Step 1: List Out Why You Feel Like an Imposter
When you notice feelings of imposterism, pause and sit with your own thoughts. List them out. What comes up for you?
Here are some examples:
- I don’t know all the things.
- Everyone else knows more than me.
- I don’t read enough.
- A good doctor would/should ________.
- I used my ability to work hard to cover up <insert perceived deficiency>.
These are thoughts your brain offers you. An ingrained thought is a belief.
Step 2: Pick One Thought to Examine
From your list of thoughts, pick just one to focus on for now. (Don’t worry, you can repeat this process for other thoughts you want to target.)
Say it out aloud to yourself.
How does it feel? Not good, right?
Now tell yourself that it’s okay to have this thought. No shame. Your brain is doing normal brain things shaped by social conditioning.
And we know it’s incredibly common—70% of successful people have similar thoughts. So don’t beat yourself up (even if you think that’s the one thing you’re best at)!
Step 3: Ask Yourself if It's Possible It's Not True
Ask out aloud, “Is it possible that my thought ________________ is not true?”
This is a high-quality question that the query engine in your noggin will love to answer. See what comes up.
Step 4: Build Your Case Against Yourself!
What evidence do you have that that thought may not be true? Write it all down. Lay out the facts like a lawyer’s closing remarks before a jury!
Examples include:
- I got through college and med school*
- I completed X rotations and put in Y hours in med school!
- I did well enough on shelf and step exams!
- I got INTO residency!
- I got THROUGH residency!
- I care for X patients per year!
*Some of you by age 14, if this documentary is accurate!
Step 5: Pretend the Evidence is About Someone Else
Replace references to yourself with those for someone else—a fake person. Make up a name for them!
Now read the evidence out loud again. Does this person sound like a fraud…or a badass?
Step 6: Tell Them About Their Achievements
Seriously! Write down what you would tell this person about what all they’ve accomplished. Use their name here too!
Step 7: How Do You Think They Feel...
About all they have achieved? Write it out.
Step 8: Switch Back to You
Replace their name with yours in what you wrote down in steps 6 and 7.
This is the narrative you could start telling yourself! It’s easier to laud others’ successes, so here we’re bypassing the negative self-talk to see what thoughts our brain actually offers for such accomplishments!
Don’t get too carried away and try to assume someone else’s identity!
Step 9: Practice into Belief
If you’ve done the above steps, then you’ve journeyed from your current thought to a brand new thought.
Does it feel better than the original? If so, you’re already on your way to believing it (because it’s able to generate a feeling in you)!
Now, all it takes is repetition to make this the new default thought. You can read more about that here.
From Imposter to Impostar (Impossible Star)
There you have it—the framework to start dismantling those narratives telling you that you’re a fraud.
In addition to harnessing the power of this thought work, you should also strive to bolster the protective factors and minimize the negative ones discussed above. It’s never too late to start building a more robust social support system, for example.
I truly hope you start seeing yourself for what you are—a badass! This imposter-busting framework can help!
What do you think? Have you tried the framework? And…? Let me know in the comments section below.
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