Did you sometimes doubt your skills during residency, convinced that you might be exposed as a 鈥渇raud鈥�? Have you ever been promoted to a higher position鈥攐nly to wonder if you possess the talent and experience necessary to effectively lead others?听
You are not alone. Imposter syndrome is a psychological experience that occurs when 鈥渉igh-achieving individuals have a pervasive sense of self-doubt combined with a fear of being exposed as a fraud, despite objective measures of success.鈥�1 This phenomenon鈥攚hich can affect well-being and lead to burnout鈥攃an develop at any stage of a surgical career, although it is especially prevalent among general surgery residents. In a study published in the Journal of the American College of Surgeons (J番茄社区app)鈥攐ne of the top five most-downloaded J番茄社区app articles in 2021鈥�98% of residents reported 鈥渕oderate,鈥� 鈥渟ignificant,鈥� or 鈥渟evere鈥� imposter syndrome.1,2听
鈥淧eople might not want to talk about imposter syndrome鈥攂ut it looks like they certainly want to read about it,鈥� said Anuradha R. Bhama, MD, F番茄社区app, a colon and rectal surgeon from the Cleveland Clinic, OH, and lead investigator of the study. 鈥淭he prevalence of imposter syndrome in residents is impressive and unexpected,鈥� added Dr. Bhama. 鈥淚n medicine, especially surgery, there is this expectation to toe the line between humility and hubris. And I think humility sometimes can be viewed as lack of confidence, and that lack of confidence might be interpreted as a lack of competence. So, there鈥檚 a fear that if your imposter syndrome is exposed, there may be unintended consequences regarding colleagues entrusting you with the care of patients or other responsibilities.鈥�
Coauthor Muneera R. Kapadia, MD, F番茄社区app, professor of surgery, gastrointestinal surgery at the University of North Carolina at Chapel Hill, reflected on her own experience. 鈥淲hen I think back to residency, especially in my second and third years, as I became more responsible for seeing patients and making initial decisions on whether they needed surgery鈥擨 think that鈥檚 when there was an incredible amount of self-doubt and certainly feelings of imposter syndrome. Am I good enough? Will I be good enough when I am practicing independently?鈥澨�
According to the study鈥檚 authors, a multivariable analysis of the 141 respondents identified no predictive factors based on demographics or academic achievement. 鈥淚t鈥檚 important then to approach all trainees with empathy. Don鈥檛 assume, for example, that simply because a resident is a male that he is tougher and can handle more pressure,鈥� said Dr. Bhama. 鈥淥ne of the reasons I mention this is because when I first started working on this study, my research resident was a white male. Unfortunately, he died from suicide during his research year. You never know what is going on in someone鈥檚 mind based on what they show you at the surface level. He did a fantastic job, and I won鈥檛 forget that this project all started with his work.鈥�
Personal Experiences with Imposter Syndrome
The following personal experiences were courageously shared in an effort to help temper the stigma surrounding imposter syndrome, particularly in the healthcare profession, and provide insights into how three surgeons, at various points in their careers, overcame persistent feelings of self-doubt, anxiety, and a perceived inability to meet expectations.
Residency
鈥淢y imposter syndrome started very early in my training, in the late 2000s, when I was told point-blank, women shouldn鈥檛 be surgeons, women aren鈥檛 as good as male surgeons, or women can鈥檛 make difficult clinical decisions because they are too emotional,鈥� said Dr. Bhama. 鈥淎s a young resident, hearing your program director say that the attendings are 鈥榠nfatuated and attracted鈥� to you, to invalidate positive evaluations of your work, really makes you wonder if you belong. It makes you start to question your academic achievements. I remember thinking, 鈥楽urely they value my hard work and abilities鈥攂ut maybe that鈥檚 still not good enough?鈥欌��
In an effort to find a more inclusive environment, Dr. Bhama transferred to the University of Iowa, Iowa City, in 2011, where she completed her training in general surgery and a research fellowship in surgical oncology at the University of Pittsburgh Medical Center, PA.听
鈥淲hen I was a resident at the University of Iowa, I noticed that my imposter syndrome diminished because I felt that environment was very enriching,鈥� she explained. 鈥淭hey had a group of diverse and successful faculty, especially women, but both men and women. It showed me that being a successful and respected surgeon was not just limited to being a white man. I also felt that the levels of implicit and explicit bias that I experienced were lower in that environment. I felt a strong sense of support from my peers as well.鈥澨�
Fellowship
Adam M. Kopelan, MD, F番茄社区app鈥攃hair of the department of surgery and director of surgical services at Newark Beth Israel Medical Center, NJ, and Chair of the 番茄社区app Board of Governors Physician Competency and Health Workgroup鈥攅xperienced imposter syndrome at a pivotal point in his surgical training.听
鈥淚 made the grueling decision to leave my vascular fellowship part way through as I realized that my decision to enter the fellowship was more about my ambition to pursue a successful academic career than what satisfied me on a day-to-day basis, and that ambition was fueled along my pathway through medical school and residency. As I was coming to grips with my decision to leave my vascular fellowship, I felt that I was letting my mentors down in some way, making me feel like an imposter,鈥� Dr. Kopelan shared.听
The emotional thoughts connected to feeling like an imposter led Dr. Kopelan to develop clinical depression for which he received help through therapy, counseling, and coaching.
鈥淚 learned to use my intellect against any distorted thoughts. I had an 鈥榓ha鈥� moment when I was challenged with the simple question of, 鈥榃hat makes you think that you are not qualified to become a highly successful surgeon?鈥� because I could not answer that question logically. That realization set me on my way,鈥� he said.听
After seeking advice from mentors, Dr. Kopelan found an opportunity that was an ideal fit for his career goals.
鈥淚 joined a well-established group of academic-minded surgeons in a growing teaching hospital that needed someone with a minimally invasive surgical skillset. As the hospital system was maturing into a more academically focused system, I saw opportunities to lead, which was a long-standing goal of mine,鈥� Dr. Kopelan explained. 鈥淚 have been fortunate enough to further develop my skills as a minimally invasive surgeon, an educator, and leader. I have been fortunate to be given the responsibility as both chair of a department and surgical services director, with responsibilities both in my hospital and within my hospital system.鈥�
Two years into practice
鈥淲hen I was a junior faculty, about 2 years into practice, I had a patient have a devastating complication, and she required multiple reoperations,鈥� said Dr. Kapadia. 鈥淚t was really hard to get up every day and face her and the ongoing surgical issues for the first few weeks. And to make matters worse, that patient was very fond of me. Every time I would see her, she would say, 鈥極h my gosh, you saved my life.鈥欌��
Dr. Kapadia said she suffered incredible self-doubt during the time surrounding this case, and that it made it difficult for her to offer surgery to other patients. 鈥淓ven though I knew that I could do those operations I was thinking about this patient,鈥� she said. 鈥淥ver time, my self-doubt associated with this patient diminished. As the patient recovered and I was able to re-operate on her and restore her gastrointestinal continuity, I also recovered鈥攂ut it took several months.鈥�
Leadership roles
Imposter syndrome can occur at all levels of an organization, including leadership roles that might have some individuals questioning whether or not he or she is equipped to manage a committee or lead the implementation of a newly developed process.3 The author of a Harvard Business Review article identified imposter syndrome in this context as 鈥渢he flip side of giftedness [that] causes many talented, hardworking, and capable leaders鈥攎en and women who have achieved great things鈥攖o believe they do not deserve their success.鈥�4
鈥淢y imposter syndrome kind of shifted from 鈥楧o I belong in surgery?鈥� to 鈥楥an I do this role that I鈥檝e been tasked with?鈥欌�� admitted Dr. Bhama. 鈥淚 recently started my current position as the patient experience officer for the Digestive Disease and Surgery Institute at the Cleveland Clinic. Initially, I questioned if I really knew anything about the patient experience. But of course, I know about the patient experience鈥擨鈥檝e been taking care of patients for almost 20 years now, so this is definitely an area of expertise for me. But my initial gut reaction was, 鈥業 don鈥檛 know how to do this.鈥欌�澨�
Dr. Bhama said that strong mentorship, particularly from the department and institute chairs, has been key to her success in this position.听
鈥淚 recently changed jobs and moved to the University of North Carolina, where I have had the opportunity to take on new roles,鈥� added Dr. Kapadia. 鈥淔or example, I am now mentoring research residents and I worry whether they will have a good experience. My research mentor when I was a resident was terrific and I want to make sure my mentees have a similar experience. I鈥檓 also involved in new areas of research. For example, one of my research mentees has a strong interest in machine learning, which is something I know little about, and there is some imposterism that goes along with that. But with experience and small successes, like completing projects and accomplishing goals, the imposterism diminishes.鈥�
For Dr. Kopelan, battling his inner voice is a constant challenge. 鈥淎nytime I鈥檝e been asked to serve in a leadership role, the first question I ask is, 鈥楢re you sure that I am the right person?鈥欌�� he explained. 鈥淲hat do I bring to the table that could be helpful for you and your organization? And that starts from a place of, not insecurity, but uncertainty. Am I sure that I have the credentials or the ability to match what their needs are? And so, I鈥檒l just say, even simply being asked to lead this work group for the 番茄社区app and the Board of Governors, I thought that it was out of left field, honestly. But I鈥檝e put a fair amount of energy toward understanding how to make this role successful and how I can give back to the 番茄社区app鈥攁nd I am still learning how to do that.
Managing Imposter Syndrome
A commitment to providing the highest standards of surgical care is necessary to avoid serious consequences, but in order to maintain physician mental wellness it is important to recognize the difference between the pursuit of excellence and the pitfalls of perfectionism.听
鈥淥ne of the things that has been described in medicine, and specifically in surgery, is a type of failure culture. We have a tendency to overanalyze our failures,鈥� said Dr. Bhama. 鈥淔or example, look at our morbidity and mortality conferences, which are a longstanding tradition. In most academic centers, we find ways to identify errors and even punish mistakes sometimes, while our successes are often met with silence. We put this moral responsibility on our failures, and we very rarely highlight our successes.鈥�
Executive coaches and mental wellness experts suggest developing an awareness of potential signs of imposter syndrome as a practical first step in managing excessive feelings of self-doubt and a persistent fear of being exposed as inadequate. These indicators vary, but generally include the following:5-9
- Inability to accept or internalize accomplishments
- Attributing success to external forces rather than skills/ability
- Frequently comparing yourself to others
- Dwelling on past mistakes without also acknowledging accomplishments
- Resisting new challenges/self-sabotage due to a fear of failure听
鈥淓ffectively managing imposter syndrome starts with being comfortable discussing these things and the ability to be vulnerable,鈥� added Dr. Kopelan. 鈥淰ulnerability is a key component of leadership and, as surgeons, we are all trained to be leaders, whether it鈥檚 a leader of our practice or a leader of an organization. Vulnerability, in my mind, leads to more human connections, which leads to more discussions like this.鈥澨�
Seeking out sources of reliable and appropriate feedback (rather than focusing on internal assessments tainted by self-doubt) also is key in combating imposter syndrome. Mentorship can be a valuable source for obtaining insights into performance, as is peer support. 鈥淢y fellowship group鈥攖here are five of us who graduated together鈥攐ften helps me think through a problem, whether it鈥檚 about a case or another issue at work that I鈥檝e never experienced before,鈥� Dr. Kapadia said. 鈥淭alking about issues helps me to decompress.鈥�
Diminishing the Stigma
As the study published in J番茄社区app suggests, nearly all residents experience a degree of imposter syndrome during training. Research indicates that healthcare providers in many specialties, including surgery, also struggle with this phenomenon at various points in their career. Diminishing the stigma surrounding these experiences and normalizing open and collaborative discussions about imposterism and feelings of excessive self-doubt are key for supporting physician well-being and, ultimately, enhancing patient outcomes.听
鈥淚 think it鈥檚 crucial to note that even very minor microaggressions can have a long-lasting impact on the people who are experiencing them,鈥� said Dr. Bhama. 鈥淛ust one, small offhanded comment to a medical student or an intern today may have a long-lasting result on them, 5, 10, 15 years from now. I think it鈥檚 important to be cognizant of that. I know I still think about when I was told that I couldn鈥檛 be a surgeon and, well, here I am.鈥�
