The Impostor Phenomenon

The impostor phenomenon is an increasingly documented condition affecting highly accomplished individuals. A term originally coined in 1978, it is a self-inflicted level of incompetence and self-doubt. One feels like a “fraud” amidst evidence to the contrary.¹

An alarming number of women experience these feelings at some point throughout the course of their lives. Why are females a vulnerable population, one may ask? It could relate to the evolutionary process and societal stereotypes amidst our history, wherein success and career have been a notion of masculinity.

Foraying into the healthcare field, self-doubt can affect clinicians at all stages, and the aforementioned can become an internal conflict. A study reviewing 138 medical students published in 2016 by Villwock and colleagues revealed and reiterated the increased intensity and prevalence of impostor syndrome within the female population (49.4% of females in comparison to 23.7% of their male counterparts).²

As a underrepresented female working in cardiac electrophysiology, I am no stranger to the imposter phenomenon. Walking into a training program in which I was the only female, my thoughts were frequently the following:

1. Should I be here?
2. Do I deserve this?
3. Am I good enough, or is this just sheer luck?

In EP Lab Digest’s Women in Electrophysiology monthly article series, it is important to not only address these self-doubts and associated patterns of thoughts, but to discuss methods on overcoming them.

Along with my interest in cardiovascular anatomy and physiology, and the procedural intricacies and satisfaction of EP, I have had the privilege of working with healthcare providers who have been my allies and mentors, providing me with words of encouragement and wisdom throughout my career thus far. It is only now, in the early stages of my career, that I have attached a name to my behavior. My realization comes after years of worry. During my training phase, I would not infrequently question my qualifications. I queried my competency, which of course is not uncommon during any transition in one’s career:

1. How did I get here? Is this a mistake?
2. What do my mentors see in me?
3. Will my mentors be displeased with their choice for a trainee?

My feelings of inadequacy continued into my first year out of training. I will unlikely completely be rid of these characteristics, as any transitions or career advancement opportunities resulting in a step outside of one’s comfort zone could theoretically recreate these “impostors”. Is this bad? Not necessarily. My impostors are my motivational drivers.

One may ask then, why is it prudent to understand this phenomenon and to address it first-hand?

Internal impostors can result in stress-induced illness and psychological turmoil, significantly impacting one’s mental and physical being. This can further lead to suboptimal patient care. With physician burnout being increasingly rampant given the nature of our line of work, impostor syndrome can be additive.

Therefore, any woman with a career should consider learning how to circumvent these thoughts for personal and professional growth. Speaking from experience, the following are techniques to consider:

1. Remember your true value/self-worth. Your accomplishments and achievements are real. You have earned your position through hard work and dedication. Your success is your doing, and you deserve this. What makes you less qualified than your counterparts? Be proud. Be confident.
2. Use your failures as opportunities. Remember that failures exist with any successful career. Do not make comparisons. Do not question your abilities or qualifications. Do not let this destroy your confidence. This is your opportunity for personal and professional growth.
3. Discuss with your friends and colleagues. Knowing that impostor syndrome is an entity that exists in other people can ease internal conflict. It is not just you.

We are all highly competitive individuals. Fear as a result of self-doubt may in actuality be a sign of progress and success. This level of insecurity from stepping out of the confines of one’s comfort zone may be a driver of perfectionism. Nonetheless, the gender discrepancy intrinsic to impostor syndrome has implications not only in coping strategies but also in medical education. The key is to recognize this phenomenon and embrace it! 

1. Clance PR, Imes SA. The impostor phenomenon in high achieving women: Dynamics and Therapeutic interventions. Psychotherapy: Theory, Research & Practice. 1978;15:241-247.
2. Villwock JA, Sobin LB, Koester LA, Harris TM. Impostor syndrome and burnout among American medical students: a pilot study. Int J Med Educ. 2016;7:364-369.