Shifting nervously in our seats amongst 180 of our fellow medical school classmates, we focused in on the front of the lecture hall as our deans began their annual orientation address. “Each of you has worked so hard to get here. No one has gotten to this point by mistake. But also be wary that each and every one of you will experience imposter syndrome during your time here. Everyone will experience it, I promise.”
This was our first time hearing those words strung together: “imposter,” as in a fraud, a deceiver, and “syndrome,” a term that medical students know all too well to refer to a condition with distinct symptoms. Together, these words refer to a phenomenon characterized by intense feelings of self-doubt in one’s own abilities. Someone suffering from imposter syndrome feels that they have only gotten to where they are by slipping through the cracks rather than talent or hard work, and they fear being exposed as a fraud to their peers. Imposter syndrome disproportionately affects ethnic minorities seeking higher education, meaning that those minorities not only have an inherent societal disadvantage in achieving admissions to tertiary educational programs, but also feel fraudulent upon attendance. But why does imposter syndrome exist as an affliction unique to humans? In order to truly understand imposter syndrome, we must dive into its evolutionary origin.
Imposter syndrome may have been beneficial, even essential, for the survival of our human ancestors. One theory postulates that the anxiety associated with imposter syndrome heightened our ancestors’ fight or flight response, allowing them to anticipate potential threats. In turn, this increased their chances of survival long enough to reproduce and pass these traits along to the next generation. Other theories suggest that the fear of failure associated with imposter syndrome may have led to the development of shame, which served an important function in maintaining close community ties. In the dangerous predatorial foraging lands, our ancestors relied on each other for survival, thus shame developed as a defense to prevent individuals from damaging their social relationships. This shame-based system allowed for regulation of member’s behaviors and kindled cooperation; in this way, we ensured survival.
With the evolutionary lens, imposter syndrome can be considered an evolutionary “mismatch” disorder because although it may have been beneficial in primitive environments, it is now considered to be debilitating. In modern society, those who suffer from the stress and anxiety associated with imposter syndrome can experience negative health outcomes, including a weakened immune system, hypertension, depression, and even heart disease. Furthermore, chronic imposter syndrome can lead to burnout, a topic that has gained much attention from the medical and lay communities. This is especially relevant to medical students and healthcare providers, as they are among the most susceptible to burnout due to the intensity of their career path.
Imposter syndrome runs rampant through the medical community, but tends to hit especially hard during medical school when high achieving students are thrust into an intense, fast-paced environment and are no longer the big fish in a small pond, academically speaking. Imposter syndrome in medical school is further cultivated by the stark differences in age and life experiences between students in a single class. Younger students may feel that they are highly inexperienced relative to their older counterparts, while older students may feel out of place amongst the newly minted college graduates. While the diversity is incredibly beneficial, medical school as a whole is inherently built to cultivate imposter syndrome, a “fake-it-til-you-make-it” attitude. It is only in private conversations that the cracks begin to show, and confessions of ignorance are made.
Although many medical school curriculums have integrated a wellness component, such as mandatory wellness checks, personal development courses, and reflection exercises, they must also address the realities of imposter syndrome and offer techniques to overcome its detrimental effects. The primary step is to break down the barrier of silence and to acknowledge that imposter syndrome affects nearly everyone in this field. Our academic institution did so, but many of our peers’ do not. We challenge medical institutions to work with students to cultivate healthy and realistic self-perception, or at least provide them with the space to do so.
In the time of coronavirus, with classes being held virtually, imposter syndrome’s effect on our fellow classmates and us have appeared to somewhat dissipate. Maybe reading the accounts of healthcare workers combating the pandemic, unsure of how to treat coronavirus patients, has shown us directly that even attending physicians can feel lost. Perhaps watching the number of cases rise has left us more determined than ever, past the point of indulging our self-doubt, to finish our training and join the frontlines. Regardless of the reason, our pandemic-driven virtual learning experience has been far less daunting than we had ever expected, enabling us to lessen the grip of imposter syndrome.
Kimia Zarabian and Mai Hasan are medical students.
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