PA School and Imposter Syndrome Vol. 4 Remedies for Internal Imposter Syndrome

Imposter syndrome in graduate medical education is extremely common. We have a cross-section of the population in our cohorts that is already predisposed to it: perfectionists, high-achievers, and a course of study that takes on responsibility for human lives. Faculty and professors are hardly less likely to deal with the condition, because of factors like intense scrutiny of their performance, responsibility for student education, heavy workloads, and bureaucratic red tape that they navigate in their jobs.

In our last newsletter, I discussed the ways in which we may inadvertently exacerbate imposter syndrome in underrepresented populations with external factors. Today, let’s follow up with remedies for the internal aspects of imposter syndrome. These tips can help anyone who is suffering imposterism, but I’ll only reiterate that if a student is marginalized, fixing their “internal” viewpoint may improve their mood or strengthen their resolve, but it will not solve the problem.

Nevertheless, for students – or anyone – who feels the discomfort and doubt of imposter syndrome, here are some tips for remembering how much you do belong right where you are. 

• Celebrate success. It may seem excessive to congratulate oneself on passing a test that everyone else passed too. It’s not. Every accomplishment deserves to be acknowledged.  That test was hard; you worked hard; you performed well. Give yourself a high-five.
• Make a list of the things you did to get here. Any time you feel like an imposter, remind yourself of every class, test, service hour, sleepless night, application, interview, textbook you read, or hoop you jumped through, to put yourself in this place. 
• Accept credit when it’s due. When your hard work, contributions and efforts are acknowledged or complimented, don’t brush it off. “Oh, it was nothing, no big deal, I just got lucky…” Many of us were raised to believe that “pride goeth before a fall,” and humility is the preferred behavior.  But there is nothing wrong with owning your hard-earned successes. Feel free to say, “Darn right, I worked hard on that, and I appreciate you noticing!”
• Remember that graduate medical education is a challenge. High achievers are accustomed to picking things up quickly. You may grow frustrated if something is difficult, suddenly doubting your intelligence or aptitude. This may be the first time in your life when school is truly a challenge. Focus on your own learning style and speed, and aim for constant improvement rather than perfection. 
• Allow some things to be “good enough.” This is for the perfectionists out there who want to have the highest score on every test. You don’t have to be the best. A passing grade is still a passing grade – whether it’s a 99% or an 89%. 
• Be cautious of overworking and of giving up. Imposterism has a couple of different behavioral results, neither of which is positive. You may believe you must throw yourself 24/7 into working for the unattainable goal of perfection, which will quickly lead to exhaustion and burnout, but definitely not to the success you hoped for. On the other side of the spectrum, you may feel like giving up, because your self-doubt is so severe that you think “what’s the point of even trying?” In both cases, your behavior is self-sabotaging.
• Limit to comparing yourself to others. This may sound impossible in an educational environment, where almost everything comes down to testing. But this recommendation is really about limiting personal comparisons: he learns faster than me; she remembers everything; the faculty all respect his insights; she’s always so self-assured before tests. There’s nothing wrong with aspiring to be like those we admire and bettering ourselves, but we must be fair. Fixation on the actions of other people is faulty, first, because we make many assumptions while doing so, and second, because it makes us feel negative about ourselves.  
• Accept that you feel imposter syndrome. Imposter syndrome often goes away once we become more comfortable and a situation is no longer “new” to us. Soon you may see that you’re in the same boat as everyone else, and feel better. However, if time proceeds and the feeling of being an imposter worsens, reach out for help, particularly if:
• Imposter syndrome affects your performance negatively, with stress, anxiety, and decreasing capability; or
• You believe that there is an environmental factor (bias) that is causing or worsening this feeling. 

In our next issue, we’ll wrap up this series on imposter syndrome in PA school by looking at some important distinctions in coping with this issue.