‘Imposter phenomenon’, also known as ‘imposter syndrome’ and ‘imposterism’, is a psychological occurrence where people doubt their skills, abilities or achievements and have an internalised fear of being exposed as frauds. Despite external evidence to the contrary, those experiencing this phenomenon do not believe they are deserving of their success or position.
Typically, people experiencing the phenomenon will believe that it is unique to them and that everyone else is fine. The following are examples of things that postgraduate doctors and dentists have said during coaching sessions:
“Everyone else knows what they are doing”
“I am the only person in training who doesn’t understand this”
“All my colleagues come from a privileged background”
Tellingly, the belief is almost never related to actual level of ability. Also, since imposter phenomenon is almost never talked about openly, it’s impossible to know if other people experience it or not. This can lead to a belief ‘it's just me!’
Questioning what we do and self-reflection is a useful part of learning. Some self-doubt is normal and can be very helpful component of self-development. If we dismiss this self-doubt as something else, then we might be missing the opportunity to learn.
Imposter phenomenon can occur with anyone. However, there are some circumstances when it could be more prevalent:
It can be job specific. For example, Trainees can talk of being confident in all other aspects of life, apart from in their professional role. Or it can extend into other roles.
It could be prevalent during times of transition, for example when returning to training after a long gap or becoming a consultant for the first time.
It can also occur when we are not representative of our colleagues. For example, it has been claimed that it can sometimes be more common in successful women - Chance and Imes (1978).
It has been reported that 70% of people reported experiencing feelings of imposter syndrome [sic] – Matthews G, American Psychological Association (1984).
Medicine is a difficult profession to enter and this can contribute to feelings of not being good enough when comparing yourself to your colleagues. What you don’t know of course, is whom among your colleagues is comparing themselves to you.
The level of academic achievement required to get into medical school is is very high, followed by numerous exams to pass throughout training. Sometimes there are expectations to succeed, eg from self, from family, tutors, supervisors, and of course from patients. The risk of making a ‘mistake’ can be high. The hierarchy within medicine is something that is often commented upon. A Junior Doctor can still be ‘junior’ into their forties and sometimes beyond. All of these things add to the pressure to succeed. In fact, being able to say that you do not know something can be critical to practising safely.
At the Professional Support Unit Coaching Service we have worked with a number of postgraduate doctors who talk about their feelings of being an imposter in their job.
For example, Dr S was working as a registrar within anaesthetics. Despite receiving excellent feedback from patients, colleagues and his supervisors, he was starting to doubt his abilities and feeling like he didn't belong in his role. He often compared himself to his colleagues, whom he believed were more accomplished than him. He found it difficult to ask for help or seek guidance from more senior colleagues, fearing that it would expose him as incompetent. Coaching allowed a space for Dr S to talk openly about his concerns and to be listened to in a confidential space. It was also an opportunity for him to reframe his thinking, to contextualise his feelings and to focus on his strengths.
- Ask yourself: What is useful about my imposter phenomenon? This might seem like a strange question and is counter-intuitive. But if we accept that all behaviour has a purpose (none of us do anything for no reason) and that the purpose is likely to be driven by a positive intention (even if the result is not always positive) then it can help you to reframe feelings of being an imposter as something that could be useful.
- Recognise that it can be useful to act as a motivator, for example as a desire to succeed.
- Once you acknowledge and accept this, you can learn to control it instead of it controlling you.
- Key to this is reframing something as useful, not necessarily trying to get rid of it and then choosing to lose what is not useful to you.
- Focusing on your positive intention and the outcomes that you would like to have are usually much more powerful than thinking about what you don’t want to have. For example, I want to be confident and able to ask.
- Reframe any black and white thinking. Change either/or thinking (e.g. either I am clever or stupid) to both/and thinking (e.g. I can be both skilled at what I do and still not know some things).
- Be aware of ‘mindreading’. It is easy to assume you know what others are thinking about you (for example, they all think I’m not good enough) without actually knowing this. One way to challenge mindreading is to ask yourself; What do I know for certain?
- Know that sometimes, the person who appears supremely confident may be or they may not be that.
- Be aware of confirmation bias. That is the tendency to look for ‘evidence’ of what you already believe instead of looking for alternatives. Great doctors are able to ask of medical cases; And what else might be true? Ask this question of yourself.
- Talk to colleagues and supervisors. This might feel like a challenge because of the pressure to succeed, but as well as helping you, it can also help others who might be experiencing similar feelings.
- Good enough is enough. Perfection is not possible.
- Write down your strengths and record your achievements.
- Be kind to yourself. It’s an old cliché that doctors are very good at looking after others, not so much themselves. But, care of others starts with self-care and compassion for others begins with self-compassion.
- Recognise that we are all different. Accepting one’s own imposter phenomena can be useful for some. Giving something a name can help as it helps to contextualise and normalise feelings. For others, the label is not useful, especially if the thinking then becomes; I have this thing therefore I’m stuck with it. If something works for you, do more of it. If it doesn’t work, do something else.
- Seek help through coaching and / or counselling.
- Do some research and gain knowledge.
Information and articles on imposter phenomenon, what is it, how to manage it and how to embrace our vulnerability.
NHS England NHS England » Taming the voice within
The Awareness Centre Imposter Syndrome: What It Is And How To Overcome It (theawarenesscentre.com)
- BBC World Service BBC World Service - The Why Factor, Imposter Syndrome
Harvard Business Review https://hbr.org/2021/07/end-imposter-syndrome-in-your-workplace
Nick Cromwell, NHSE Professional Support Unit London KSS coach