Did you sometimes doubt your skills during residency, convinced that you might be exposed as a âfraudâ? Have you ever been promoted to a higher positionâonly to wonder if you possess the talent and experience necessary to effectively lead others?Ěý
You are not alone. Imposter syndrome is a psychological experience that occurs when âhigh-achieving individuals have a pervasive sense of self-doubt combined with a fear of being exposed as a fraud, despite objective measures of success.â1 This phenomenonâwhich can affect well-being and lead to burnoutâcan 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 (JACS)âone of the top five most-downloaded JACS articles in 2021â98% of residents reported âmoderate,â âsignificant,â or âsevereâ imposter syndrome.1,2Ěý
âPeople might not want to talk about imposter syndromeâbut it looks like they certainly want to read about it,â said Anuradha R. Bhama, MD, FACS, a colon and rectal surgeon from the Cleveland Clinic, OH, and lead investigator of the study. âThe prevalence of imposter syndrome in residents is impressive and unexpected,â added Dr. Bhama. âIn 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, thereâs 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.â
Coauthor Muneera R. Kapadia, MD, FACS, professor of surgery, gastrointestinal surgery at the University of North Carolina at Chapel Hill, reflected on her own experience. âWhen 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 surgeryâI think thatâs 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?âĚý
According to the studyâs authors, a multivariable analysis of the 141 respondents identified no predictive factors based on demographics or academic achievement. âItâs important then to approach all trainees with empathy. Donât assume, for example, that simply because a resident is a male that he is tougher and can handle more pressure,â said Dr. Bhama. âOne 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 someoneâs mind based on what they show you at the surface level. He did a fantastic job, and I wonât forget that this project all started with his work.â
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
âMy imposter syndrome started very early in my training, in the late 2000s, when I was told point-blank, women shouldnât be surgeons, women arenât as good as male surgeons, or women canât make difficult clinical decisions because they are too emotional,â said Dr. Bhama. âAs a young resident, hearing your program director say that the attendings are âinfatuated and attractedâ 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, âSurely they value my hard work and abilitiesâbut maybe thatâs still not good enough?ââ
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.Ěý
âWhen I was a resident at the University of Iowa, I noticed that my imposter syndrome diminished because I felt that environment was very enriching,â she explained. âThey 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.âĚý
Fellowship
Adam M. Kopelan, MD, FACSâchair of the department of surgery and director of surgical services at Newark Beth Israel Medical Center, NJ, and Chair of the ACS Board of Governors Physician Competency and Health Workgroupâexperienced imposter syndrome at a pivotal point in his surgical training.Ěý
âI 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,â Dr. Kopelan shared.Ěý
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.
âI learned to use my intellect against any distorted thoughts. I had an âahaâ moment when I was challenged with the simple question of, âWhat makes you think that you are not qualified to become a highly successful surgeon?â because I could not answer that question logically. That realization set me on my way,â he said.Ěý
After seeking advice from mentors, Dr. Kopelan found an opportunity that was an ideal fit for his career goals.
âI 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,â Dr. Kopelan explained. âI 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.â
Two years into practice
âWhen I was a junior faculty, about 2 years into practice, I had a patient have a devastating complication, and she required multiple reoperations,â said Dr. Kapadia. âIt 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, âOh my gosh, you saved my life.ââ
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. âEven though I knew that I could do those operations I was thinking about this patient,â she said. âOver 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 recoveredâbut it took several months.â
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 âthe flip side of giftedness [that] causes many talented, hardworking, and capable leadersâmen and women who have achieved great thingsâto believe they do not deserve their success.â4
âMy imposter syndrome kind of shifted from âDo I belong in surgery?â to âCan I do this role that Iâve been tasked with?ââ admitted Dr. Bhama. âI 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 experienceâIâve 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, âI donât know how to do this.ââĚý
Dr. Bhama said that strong mentorship, particularly from the department and institute chairs, has been key to her success in this position.Ěý
âI recently changed jobs and moved to the University of North Carolina, where I have had the opportunity to take on new roles,â added Dr. Kapadia. âFor 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. Iâm 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.â
For Dr. Kopelan, battling his inner voice is a constant challenge. âAnytime Iâve been asked to serve in a leadership role, the first question I ask is, âAre you sure that I am the right person?ââ he explained. âWhat 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, Iâll just say, even simply being asked to lead this work group for the ACS and the Board of Governors, I thought that it was out of left field, honestly. But Iâve put a fair amount of energy toward understanding how to make this role successful and how I can give back to the ACSâand 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.Ěý
âOne 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,â said Dr. Bhama. âFor 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.â
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 failureĚý
âEffectively managing imposter syndrome starts with being comfortable discussing these things and the ability to be vulnerable,â added Dr. Kopelan. âVulnerability is a key component of leadership and, as surgeons, we are all trained to be leaders, whether itâs 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.âĚý
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. âMy fellowship groupâthere are five of us who graduated togetherâoften helps me think through a problem, whether itâs about a case or another issue at work that Iâve never experienced before,â Dr. Kapadia said. âTalking about issues helps me to decompress.â
Diminishing the Stigma
As the study published in JACS 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.Ěý
âI think itâs crucial to note that even very minor microaggressions can have a long-lasting impact on the people who are experiencing them,â said Dr. Bhama. âJust 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 itâs important to be cognizant of that. I know I still think about when I was told that I couldnât be a surgeon and, well, here I am.â
