Annie Slater MD

“Without effort, your talent is nothing more than unmet potential. Without effort, your skill is nothing more than what you could have done but didn’t.”
― Angela Duckworth, Grit

 

I have been hearing a lot about imposter syndrome lately namely from the New York Times, but also by normal everyday physicians who have been vulnerable enough to share their experiences.

The definition of imposter syndrome is, ‘an internal experience of intellectual phoniness in people who believe they are not intelligent, capable or creative despite evidence of high achievement.’

In reading about it, I have also been thinking about how this topic relates to me, and how I have manifested it throughout my life. All of the articles I have come across make me feel as though I have been an imposter forever! In my experience, and the best way I can think of to describe it, it’s like always feeling as though someone is going to come around and ask me, “Where is the REAL Dr. Slater, because surely it can’t be you?!”

To be honest, I am not even sure where I developed it. If I think broadly–medical school, residency and fellowship were all very intense experiences. There was constant testing, evaluation, teaching, and judgment. Then came reprimanding, subsequent shaming for not doing something correctly, and fear. So much fear of being wrong, of getting the backlash for not catching on as quickly as my peers and fear of failing. When I look back, I can pinpoint specific instances that are burned in my mind, and probably together they helped to create the imposter syndrome I felt.

For me, it started once I entered medical school and was surrounded by hundreds of incredibly smart and motivated people. I began to question whether I belonged. I attended a rare 6-year medical school, where students graduate from high school and immediately enter an undergraduate/medical school combined program—this rigorous schedule at such a young age probably added to the pervasiveness of my imposter syndrome.

My first anatomy test is something I will never forget. I had to study really hard as I had not yet mastered the skill of memorizing. I remember studying while (it felt like) everyone else was goofing off and having fun. I distinctly recall those same peers getting A’s, while I performed average. At that moment I decided I am not as good. It was like I imprinted on my brain… ‘I am going to have to work extremely hard to be successful.’

In my second year, we had a no-nonsense physiology teacher who was known to have impossible tests and little sympathy for his medical students. On one of the major exams (that could define your grade in the class), I received a failing grade. The caveat, almost everyone was failing, because the average on the test was 60%.

It didn’t matter that the test was hard, I was still failing a class. At that moment I realized I was going to have to apply myself and work harder than I had ever worked in my life. I desperately did not want to fail. If you fail a class in the 6-year program you have to extend to 7 years. If you fail two classes you are removed from the program.

Quickly I learned how to study, sacrificed my free time and never failed a test again. I made it through the program not excelling, but completing. Justifiably, I continued to feel as though I was ‘less than,’ because of the level of effort I needed to put in to be successful.

Residency was the next step, and my feelings of inadequacy grew. I think I entered with the general thought that I wasn’t smart enough, and that I would continue to have to work harder than everyone else to be in-line with my peers. I felt like I had to fake it, fake that I was supposed to be there, fake that knew I what I was doing, tempered with being truly honest when I needed help.

I struggled during this time due to my imposter syndrome, but also because I struggled with the hours, I struggled with being away from home and without a family support system close by. My schedule was insane, I worked 80 hours a week, got one weekend off a month and two weeks off a year. Not only was it challenging to merely survive, I was also thousands of miles away from my family and my only friends were those in my residency.

In addition to a rigorous schedule, there was also endless feedback and conversations about what I needed to do to get better. These are all attempts to make us better doctors, but I think without a true support system, and with what feels like lots of negativity, it seemed like I wasn’t doing anything right. The natural conclusion is that I am not good enough and that I am not sure I am supposed to be here.

Despite these feelings, I found a true passion and niche in Pediatric Emergency Medicine. I matched into one of my top fellowship programs, and thus entered the final phase of my training. I was fully embodying my imposter syndrome at this point. I couldn’t really believe I deserved my fellowship spot and I just hoped that no one would notice that maybe I was chosen accidently.

When I became an attending, my imposter syndrome really came alive. I moved across the country for my first job, and found the hierarchy of medicine to be different on the west coast. On my first day, I had an intern (a recent medical school graduate) who openly questioned my medical decision-making. I was unprepared and unfamiliar with this level of challenging of authority and I was deeply unsettled by it. I felt like I had to prove myself, but I wasn’t sure if I could.

Then there were little instances that made my feelings worse. I was working a shift one day, and a much older and senior attending called me from home, asking me if I knew that one of my patients had a fracture. She was monitoring the ER board from home, looking at Xrays. My thought immediately was ‘am I that terrible of a physician that my colleagues are being entrusted to watch me work from afar and make sure I don’t screw up?’

There was a simulation I attended, where the person running the code was blindfolded. As a new attending, that person was me. The combination of trying to perform without a basic sense (eyesight) while being new, and concerned that everyone thought I was a fraud was disastrous. I was paralyzed. I couldn’t think, much less figure out a complicated patient case, all in front of about a third of my new colleagues.

All of these incidents happened within my first year of being an attending. I think together they would have shaken the confidence of the best, but mine was already questionable.

Fortunately, the colleague working from home apologized later, she was doing some study on fractures, and was abnormally stalking the ER board. The simulation folks realized their error when I was incapable of working through the simulation without my eyesight—as far as I know, they have never done a blind-folded sim again. I however, was destined to be an imposter for the next six years or so.

I lived with my imposter syndrome for a long time–and it always involved comparing myself to others, worrying about what everyone else was thinking, and fear that I would be discovered as being inadequate. 

I feel fortunate to be on the other side, to be able to say that these feelings eventually faded, and now they have all but disappeared. I think this is due to a combination of things, all happening as I gained experience and confidence.

I started volunteering at Camp. My worth as a physician was no longer just in the hospital. My passion for camp led to me becoming the Medical Director. In this role, I attended many meetings where I was the only physician in the room and my opinion and expertise were relied upon to make important camp-wide decisions. This experience helped me become more confident in my skills and knowledge.

The other thing that has made a difference is time on the job. I have been working full-time since I graduated from fellowship and I am now entering my 10th year of post-training life! Time builds confidence—I feel as though I have seen almost everything, but I have also seen enough to know that I don’t know everything.

Life experiences including loss, grief and becoming a mom have helped me to perceive my failings in a different light, to have more grace for myself, and to tame the judgment demons I used to suffer from so intensely.

I no longer focus on what everyone else thinks I do or do not know. I recognize now that I know a lot, and I have been through a lot. I also realize now that I am no longer an imposter. I no longer identify with those feeling I used to have.

A recent book I read, Grit, by Angela Duckworth, has also helped me to process through those former feelings of being an imposter. She talks about how talent is nothing without hard work, passion and drive. Now that I am 22 years into my career, I am realizing that it doesn’t matter that I didn’t ace my first anatomy test. I am still here, having worked extremely hard through training and continued to work hard post-training to be good at my job. It’s time to relax and give myself a break.

So, for all of you who are in the ‘imposter syndrome’ days, I understand. It is hard, and it can feel like you aren’t good enough on a daily basis. Just know that you are not alone, and it will get better. You can always watch Amy Cuddy’s TEDtalk on body language for some tips on “faking it.” Or read Grit. It will help you to get over feelings of inadequacy, as I can’t think of anyone grittier than those going through medical school and training.

What about you? Have you had challenges with imposter syndrome? How did you manage it? Do you have any good advice for our readers?