I’ll never forget the anxiety of the first day of medical school. I was excited. I was enthusiastic. I was overwhelmed. But all of these emotions were humbly interrupted by my profound, palpable sense of otherness. I was surrounded by one hundred and sixty-seven brilliant peers, many from high-ranking undergraduate schools and each of whom had countless accomplishments in their already rich pasts. They clearly, unquestionably deserved to be here. As for myself? Maybe the admissions file got accidentally dropped in the wrong pile. Maybe the committee had naively misinterpreted my undergraduate GPA to actually mean that I had competence. Maybe they just happened to miss my MCAT score staring them squarely in the face. Whatever the stroke of luck that landed me here, it occurred to me that it would only be a matter of time before the mistake came to their attention. I knew that it would probably be too late to rectify, but no mistakes are ever too far-gone to be regretted.
On December 5, 2013, in a lecture titled, “Medical Education and the Emotional Development of the Physician,” at Northwestern’s Feinberg School of Medicine, Suzanne Poirier presented her analysis of more than forty book-length memoirs of the medical school experience. One theme that ran through most (if not all) of her sources was the prevailing sense that one didn’t belong. This belief, known widely as the “imposter syndrome,” is said to follow doctors-in-training through each new stage of their careers and has been hypothesized to contribute significantly to the growing isolation of medical professionals.
There is little doubt that humility is crucially important in medicine. Appropriate humility can literally save a life, and its absence can destroy many. However, it is important to point out that feeling like an imposter in the profession of one’s choosing is not at all what humility entails. Imposter syndrome has hindered, rather than enabled, my success and it only stunts, rather than enhances, one’s professional growth.
The interesting thing about imposter syndrome is that it requires one crucial ingredient to unleash its wrath in full: it entails the cooperation of classmates. As I showed up on day 1 of medical school feeling wholly unworthy of my place in the class, I looked around in hopes of finding others like me. Unfortunately, my cursory observations quickly confirmed the sneaking suspicion that I had. Everyone else really was impressive. They were smart, confident and not at all anxious. I truly was an imposter standing shyly among a class of promising physicians. Now for the irony: many of those brilliant future doctors felt exactly the same way I did.
We are all very good at bottling up our insecurities and putting on a brave face. What we sometimes forget is that our own impressive displays of confidence serve as confirmation to our peers that they stand alone with their imperfections. This subliminal message couldn’t be farther from the truth but, tragically, it is constantly reinforced. Statistically speaking, 50% of any one class will experience burnout over the first four years of medical training. More than 20% will suffer from depression within the first two years and up to 11% of any single class will have suicidal ideation before they even reach the Step 1 boards. Sometimes I wonder how much of this loneliness I can mitigate or entirely prevent simply by admitting my own failures in front of my peers and conceding my deep fear of their recurrence. I can only imagine how powerful it might be for a classmate to hear the simple truth that if he or she doesn’t belong here, neither do I.
What would our medical training look like if we owned up to our failures and our imperfections? How different would we feel about our place in this profession if we were willing to speak openly with each other about the tests that we fail, the critique we endure or, most notably, the criticism that we constantly give to ourselves?
It turns out that we are all deeply imperfect. We each have serious challenges (academic and otherwise) that we will need to overcome on our paths to being great physicians. But this doesn’t make any of us imposters. The only thing that does is our collective unwillingness to talk about it.
Aryeh Goldberg is a medical student.