Imposter syndrome—when a person believes themselves to be less competent than others despite external evidence to the contrary—causes even the most successful, outspoken leaders to question if they deserve their own success.
While not a clinical diagnosis in the DSM-5, imposter syndrome was first identified in the medical literature in 1978. Researchers have spent decades exploring its causes and repercussions. The results show no group is immune—men, women, trainees and all levels of faculty report feelings of imposter syndrome.
“Imposter syndrome is a constellation of behaviors and feelings.”
“Imposter syndrome is a constellation of behaviors and feelings,” said Maureen Gannon, Ph.D., associate dean for faculty development at Vanderbilt University School of Medicine. “It’s an inability to internalize and acknowledge your own accomplishments.”
After a 2011 professional development conference helped Gannon recognize her own imposter syndrome, she has written blogs and led over a dozen workshops worldwide on the topic.
Recognizing Imposter Syndrome
Gannon recalls, “I remember at that first conference identifying women I thought were outspoken, confident and brave. Yet when I attended a breakout session on imposter syndrome, those same women were there, sharing feelings of inadequacy.”
Today, Gannon recommends others to the Clance Imposter Syndrome Questionnaire, a validated tool that determines how frequently and intensely a person feels like an imposter. The questionnaire zeroes in on how a person deals with praise, and to what they attribute their successes.
“I’ve given it to high school students, postdocs, undergrads and senior faculty,” Gannon said. “I’ve found that having a little of these feelings is a good thing and keeps a person humble. The problem is when it causes stress and anxiety, or prevents a person from achieving and advocating for themselves.”
Repercussions of Imposter Syndrome
People with imposter syndrome often fear they will be “found out” as having overrated abilities. “Because you’re afraid of failure and disappointing the people who gave you opportunities, sometimes you set a lower bar for yourself,” Gannon said. “I’ve seen it prevent people from negotiating for more in the job market—especially when it comes to start up packages for physician scientists.”
Studies show imposter syndrome is increasingly common in medicine, particularly among trainees. One study found 28 percent of medical, dental, nursing and pharmacy students report imposter feelings. Females report higher rates of imposter syndrome than males—41 percent versus 24 percent in family medicine, as one example.
Importantly, people with imposter syndrome do not lack self confidence. They still take on challenges and believe they are capable—they just worry and inappropriately attribute their successes to other factors, such as luck or quota filling.
Supporting Those at Risk
“It’s an inner conflict between where you came from and where you are now.”
Gannon says people most vulnerable to imposter syndrome include those who lack effective role models. This includes people who choose a career path that deviates from their upbringing. Examples include first generation college students, like Gannon, or artists raised by lawyers or physicians. “It’s an inner conflict between where you came from and where you are now. You feel like you don’t belong in either place,” Gannon said.
People caught in the middle feel an extra push to perform. They may also receive opportunities unrelated to their abilities, such as economic-based scholarships that can leave them questioning their own validity.
Gannon recommends several strategies to manage imposter syndrome. “Symptoms can reappear at career transitions,” Gannon said. Creative visualizations can help, as can being proactive about seeking honest feedback from trusted friends and advisors.
Honest mentors are critical, says Gannon. “As faculty, we need to make sure our trainees—students and fellows—know that we’re human and make mistakes.” Otherwise, students with inklings of imposter syndrome may view senior faculty under a veil of perfection. They may never aspire to a role they could achieve, but have idealized out of reach.