Overcoming Imposter Syndrome During Residency

August 7, 2023
Imposter syndrome” is a psychological phenomenon in which people doubt their own abilities, feel they don’t deserve to be where they are in life, and fear they will be exposed as fraud. The beginning of the academic year can heighten these anxieties among medical trainees as they climb the next rung on the ladder, taking on new responsibilities. This is particularly true for trainees graduating from the observational role of the medical student to the intern on the front lines of the care team.
It can be easy to let the anxiety of transitioning into residency overtake the excitement of being a newly-minted physician. However, rest assured that these feelings are common among others in your position, so there is no need to suffer alone! Keep reading to learn how prevalent these negative thought patterns are and to gain tools to reframe your mindset.

Five Classic Signs of Residency Imposter Syndrome

1. The “Imposter Mentality”

Here are some thoughts that are indicative of imposter syndrome: 

‘‘Everyone around me went to an Ivy League med school, and I come from a community program. I have no idea how I matched here.”

“I’ve been flying under the radar. If they ask me about _____, they’ll realize I really don’t belong.”

“I’m just the intern note monkey, I shouldn’t even be part of this leadership meeting.”

2. Downplaying Accomplishments/Opportunities

People with imposter syndrome often downplay their achievements, and may think things like: 

“I was lucky to get in this year– they must have had very few people apply.”

“People keep telling me why I’d be a great chief resident, but I just don’t see it.”

3. Constant Comparison to Others 

People with imposter syndrome may believe the following: 

“Everyone here is way out of my league.”

“I’d love to go to that conference, but I think my research poster would be embarrassing next to everyone else’s.”

4. Embarrassment/Discomfort with Praise 

Have you ever said something like:

“These positive performance evaluations are just people being nice so they don’t hurt my feelings.”

“I’m not going to tell my family about this award, I don’t think I even deserved it when there were other people way more qualified.”

5. Fixation on Past Mistakes

Finally, people with imposter syndrome tend to ruminate about previous errors, and make statements such as: 

“I missed that EKG finding, I could never be a cardiologist.”

“I really struggled on that oncology rotation at the start of intern year, I’m probably not cut out for it.”

These ways of thinking are some of the telltale signs of imposter syndrome. It can impact any young doctor, but are there certain members of the population that are especially susceptible to it?

Demographic Factors and Imposter Syndrome 

Nearly everyone will experience self-doubt at some point during their career, particularly in the early years when the knowledge gap between interns and attendings feels insurmountable. But there is abundant research that suggests (no surprises here) that those who have been traditionally excluded from medicine tend to struggle the most with feeling they don’t belong. 

For example, this 2020 article cites studies that found women and minority medical students reported the highest rates of imposter syndrome. This is despite the fact that women now enter medical school at a higher rate than men! (According to the AMA, 53.5% of students entering medical school in 2019 were women.) 

It’s common for these trainees to worry that shortcomings (either real or perceived) will reflect poorly on an entire group.

For example, a female orthopedic resident is keenly aware of the fact there are very few women in the field. She may obsess over a surgical complication thinking, “Because of my mistake, the program won’t want to recruit female surgeons. They will think we can’t do high-quality work like male surgeons.”

Meanwhile, a male resident who feels more deserving of his role might reflect on the same complication with a matter-of-fact, “That was a difficult surgery on a complex patient and this complication was expected.”

As these examples illustrate, the “imposter mindset” forces an inner examination while the “secure mindset” allows for logic, and more importantly, grace. Keep in mind that systems play an important role here, and it’s our responsibility as a society—not just as individuals—to create a more welcoming environment for those traditionally excluded from leadership roles in medicine.

9 Ways to Tackle Imposter Syndrome During Residency 

I started in the adult medical intensive care unit (MICU) on July 1st of my intern year. The only ICU experience I had in medical school was a NICU rotation and a COVID-era online simulation I’d hurriedly clicked through to fulfill the graduation requirement.

Needless to say, I was intimidated. In the days leading up to the rotation, I envisioned myself flailing about the MICU trying to order Tylenol while all around me there were patients crashing, families yelling, and seasoned nurses shaking their heads in exasperation at my incompetence. 

In reality, I found a welcoming environment where it was expected that I didn’t know how to do most things, and more knowledgeable team members (i.e. everyone) made it a point to help me without making me feel inadequate.

Ideally, everyone finds themselves in a supportive and understanding environment in July, but unfortunately, that’s not always the case. If you’re someone looking for guidance on how to handle the insecurity you’re feeling as a new resident, here are some tips that will help you get through that first year:

1. Talk to Your Colleagues—You’ll Realize You’re Not Alone

There’s a reason why the r/residency Reddit page right now is full of panicked posts by interns feeling overwhelmed and inadequate. They are seeking reassurance from others in our community that their feelings are normal.

The more you open up to those around you, the more you will realize how cathartic it is to share your fears and frustrations with your co-interns.

It’s also helpful to hear from seniors about how they got through the struggles of intern year. This is often more fruitful than sharing with family or friends outside of medicine which, despite good intentions, may leave you feeling isolated or misunderstood.

And of course, venting with your friends over a beer after work is much better than keeping it all in the call room.

2. Marvel at Your Progress

Being new at things is really hard. However, the most amazing thing about being brand new at something is that each day you make exponential progress. We’re talking logarithmic progress from day 1 to day 2 to day 3 as an intern.

With each new day of residency, your knowledge doubles. When you see it through the lens of how much you are soaking in rather than how much you don’t know, the days become more meaningful.

Admittedly, there’s a part of me that misses those first few weeks of intern year where at the end of each day I marveled at how much better I was at my job than the day before. As you progress through your career, you continue to learn. But the progress is slower and more nuanced because you are honing a large base of knowledge. Nothing compares to the leaps and bounds you make when you first start out. 

3. Praise Others 

Lean on your co-interns for support in the tough times, but be sure to celebrate each other, too! We have a “shoutout” section of our weekly chiefs email where residents can praise others for running an organized code, going above and beyond during a patient discharge, or pitching in during a wild ICU shift.

It lifts everyone’s spirits and reminds you that other people do recognize your hard work. On a day when you are the recipient of patients’ frustrations, sadness, fear, shock, or any other number of emotions (often for things outside of your control), the praise from an attending or co-resident means the world. 

4. Take Positive Feedback to Heart 

Do you give people fake compliments? Probably not. Most people are genuine. If someone compliments your presentation, says they are impressed by your research, recommends you for a leadership position, or just says you’re a rockstar- take it to heart!

5. Leave Work at Work 

This is often easier said than done, but turn off epic chat, push notifications, pages, and ignore your work email once you walk out of the hospital. Your time outside of work is your own, and you should feel free to brain-dump everything until you sign back in the next day.

If you have a lot of admin work via email, reading to catch up on, or outpatient messages to manage, try to squeeze these things in during the day or stay an extra 20 minutes after signout to tidy them up so that your mind is totally unburdened during your off hours. 

6. Don’t Be a Hero

Remember that the ultimate goal is to take good care of patients. If you’re worried you really aren’t well-equipped to make a decision, have a low threshold to “escalate” the issue. That’s why you have a senior, a fellow, and an attending on your team. 

The environment you work in should encourage open dialogue and should never make you feel like you need to make critical decisions for your patients without anyone to help. Even if you are embarrassed to ask something at the beginning because you’re worried how it will reflect on you, know that it’s in the best interest of your patient. 

7. Inquire About Mental Health Services Offered at Your Program

Residencies are expected to offer mental health services for free or through their health plan. Many of the counselors covered by the plan have worked with residents and are comfortable helping them with imposter syndrome. Just the act of scheduling an appointment will make you feel empowered and in control. 

8. Consider Keeping a Journal

There is age-old wisdom in the practice of getting your feelings down on paper. If you’re not the writing type, consider keeping an audio diary. Even if you never listen to/read back your entries, the act of getting your thoughts out of your head is therapeutic.

9. Give Yourself Grace

Most of all, remember whether you’re an intern, senior resident, or first-year fellow, you’re doing an incredibly hard job that you’re completely new at.

Over the course of a day, you must contend with difficult decisions where there is no right answer, time constraints, resource deficits, many different coworker personalities, discordant families, deeply emotional situations, combative or abusive patients, death and disfigurement, and so on. Then, you must go home and live your second life as a partner, parent, or any number of other roles which demand time and attention.

You can’t do it all perfectly. Recognize the amazing things you are doing every day. And most of all, give yourself grace.

Further Reading

While imposter syndrome may be common among new residents, know that you are where you deserve to be and you earned your spot at your residency program. You’ve worked hard to get to this point, so don’t let anyone (including yourself) tell you otherwise!

For more (free!) residency tips from tutors who have been in your shoes, check out these other posts on the Rosh Review blog:

By Amanda Tosi, MD

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