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Imposter Syndrome narratives in medical education

 

Requests for LAS Medical Coaching services increase after the first of the year and the increased demand often correlates with an increased prevalence of imposter syndrome narratives. As medical students prepare for their first or second USMLE Step Exams, first-year residents aim to take Step 3 before PGY2, and board certifying exams loom on the spring and summer horizons. Emotions can run high.

 

Descriptions about imposter syndrome are regularly interwoven with behavior such as procrastination and perfectionism and feelings of stress, anxiety, and burnout. These issues are entwined because emotions and learning are entwined. How we feel impacts how we learn and how we learn impacts what we think.

 

Consider the experiences as babies and toddlers learn to sit, crawl, stand, and walk; milestones that contain emotional involvement. Just like a standardized test, these actions can be a source of celebration, self-agency, frustration, and self-doubt. Understanding this relationship is fundamental to mitigating imposter syndrome and ought to inform how we teach in medicine and uphold a commitment to representation and diversity. This actionable step would narrow the healthcare access gap and could be transformational for millions. However, despite permeating the vernacular, imposter syndrome, and its predecessor, the imposter phenomenon, impacts learning, and thinking, but remains undiagnosable.[1]

 

According to the National Education Association (NEA), “You can’t teach if you’re not addressing mental health,” says Rene Myers, an intervention specialist in St. Paul, MN. This statement was the primary reason my graduate studies included degrees in curriculum design and clinical social. I saw the need to work at the border of two disciplines when teaching students to learn how to learn in adaptive and sustainable ways.

 

When the imposter phenomenon was first defined in the 1970s, it was used by psychologists Suzanna Imes and Pauline Rose Clance to describe clinical observations about their female clients — educated and academically high-achieving women who doubted their intellect. As an early career clinician in the ’90s, the imposter phenomenon wasn’t widely labeled among my colleagues. However, the term resonates today, mainly because it was reintroduced by social media and widely addressed as imposter syndrome. Today, this term is part of a colloquial speech, and its impact is a frequent discussion point during LAS Team Meetings.

 

LAS students and residents are not necessarily representative of all who enter medical education. However, I believe they are often the students and residents who will have the biggest impact on healthcare and access to its resources. Many of our students, though certainly not all, use she/her pronouns and most of our students are under-represented in STEM education, medical education, and medicine.

The more diverse the student body in medical schools, the greater the diversity of doctors in medicine. Representation in medicine increases access to healthcare for all. Anything less than that fortifies an imbalance in the provision of care and ultimately solidifies a barrier to access.

 

The LAS Mission is to uphold diversity, inclusion, and representation, eliminate barriers to academic success and remove the culture of silence and stigma associated with learning and psychological difficulties so that all students learn, achieve, and succeed in school and at work, with equal access to healthcare.

 

With increasing demands for medical coaching services, it is time that we focus on supporting students with academic difficulties and symptoms of imposter syndrome. Below are a few practices we use in the LAS Medical Coaching model to address these concerns.

 

  • Establish a professional and compassionate working alliance.
  • Implement reliable communication and follow-through.
  • Listen to students’ narratives and don’t try to refute or generalize them.
  • Discuss impressions and rationale for individual education planning.
  • Incorporate measurable goals.
  • Track empirical outcomes to measure progress.
  • Acknowledge achievements and setbacks.
  • Modify if needed but don’t reinvent the plan every week. Deadlines are deadlines.

 

For more information about LAS and our educational services, visit the LAS Website or contactus@lorenacademic.com.

 

[1] The Diagnostic Statistical Manual of Mental Disorders (fifth edition, text revision), referred to as the DSM-5-TR or DSM does not list imposter syndrome as a diagnosis. Yet, its impact on students is observable and real. The DSM is a manual we use as clinicians when communicating about mental disorders. It contains descriptions, symptoms, and other criteria for diagnostic information. With prevalence juxtaposed to unified interventions, how do we intervene?