Imposter Syndrome: Calling Out the Dysfunction in Modern Medical Training

by Kaley Capitano, DO

Imposter Syndrome. Every medical student, resident, and attending has had it or still experiences it. The seed is planted early during the exhausting pace of medical school. We are inundated with metrics that organize us by performance. Exams, GPAs, extracurriculars, USMLE and COMLEX exams. The ever-stressful overall class rank. We start to view our ability and our value as a budding physician by our position compared to our peers. Are we good enough? Do we deserve to be here?

But here is the kicker.

We are using single points in time – a specific test hour or day – combined with the same singular attempts at displaying mastery of different information over time to form our overall internal metric of value. Are doctors only as good as their ability to recall certain information at one single point in time? Of course not. Yet throughout medical school we are repeatedly reinforced that these singular moments determine our overall ability. There is no positive reinforcement for mastering medical information outside of a test. Even if it is recognized in the moment, it does not go into our academic records, it does not get integrated into our test score on that topic nor reflect in our GPA or class rank. Single evaluated moments go on in infamy while the other 95% of time does not. And these metrics are high stakes. A low board score derived from a single day performance can legitimately preclude us from our dream career. 

It’s no wonder we fall into a revolving cycle of self-deprecation and constant questioning.

This is then worsened by perceived peer performance which is oftentimes falsely bloated by none other than ourselves. Humans are inherently pack animals. Introverts and extroverts aside, we require community to thrive and a sense of belonging to feel comfortable. To be accepted by the pack, to be one of them, is protection. As we start clinical years and go on to residency, the stakes of our performance become higher. We are now the doctors making decisions that will directly affect another person’s health and illness recovery. No one wants a poor outcome for their patient, no matter how unintentional. But in this pursuit of good care, the falsely emphasized single-point-in-time metrics of our earlier training come back to haunt us. How do we garner confidence when we are coming from an environment that undermined that very development by telling us that we were only as good as singular point-in-time performances?

We turn to our pack.

We look for cues that tell us we are right on track, that we belong, that we are doing what our colleagues are doing. But there is a dark side, and it’s rooted in the false idol called Perfection. The field of medicine continues to portray an unhealthy need to be ‘perfect’ or to hide one’s flaws. The exact opposite of the growth mindset that is key to learning and success in medicine. We become embarrassed by forgetting things we ‘should’ know. We forget that our colleagues get things wrong because all we focus on are the times that they knew an answer we didn’t. So, we put ourselves down. We tell ourselves we don’t belong. That we are somehow skating under the radar. Except everyone else is thinking this too. We all mix up “easy” things from time to time. We all forget things. We all freeze up. We all remember something our colleague didn’t and vice versa. We are all human. Perfection isn’t the ideal. Perfection is automated, it is cold, it is mechanical. Perfection cannot be applied to the complexity that is an individual patient.

Practicing medicine isn’t about perfection.

The breadth of knowledge practiced in the field of Family Medicine has grown exponentially in the past 50 years. It is impossible for one single person to master it all. So why do we expect ourselves too? In 1971, diabetes was singularly managed with two types of insulin. It wouldn’t be until 1995 that Metformin would enter the market. Today, in 2021, there are nine different drug classes used to treat diabetes with multiple drugs in each class. So, what gives? Why are we so hard on ourselves?

While there are many aspects of medical training that are outdated and warrant restructuring, perhaps the most important is the need for perfection and inability to give ourselves grace. Just like the medical field, we are ever evolving. We don’t recognize how much we’ve grown until we look back to an earlier stage and pleasantly realize how far away the insecurities of that stage truly are. And then come new insecurities with our current stage. And that’s okay. Because we are human and we care about doing the right thing for our patients.

I urge you not to get overwhelmed by far away future goals or to get tied up in setbacks. When you get something wrong remember the dozens of times you’ve gotten that very same thing right. Reflect on how the culture of medical training has unintentionally set an insidious seed of self-doubt and that imposter syndrome is a normal reaction to baseline conditioning – and rarely legitimate. Remind yourself that humans are complex and multifactorial, patient presentations are not black and white, medicine is nuanced, and that you have worked tooth and nail to become an informed and trusted source of information for your patients.

You deserve to be here.

You have always deserved to be here.

Kaley Capitano, DO is a Family Medicine resident at The University of Utah. She completed her medical training at Midwestern University in Phoenix Arizona and graduated with a degree in Biological Sciences from the University of California, Davis. Her professional interests include Sports Medicine, LQBTQ+ care, and in-office procedures. In her spare time she enjoys an array of outdoor sports, curling up on the couch with a good sci-fi book, and spending time with her husband & rescue dog Jazzy.

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