Tips for New Doctors: Dealing with Impostor Syndrome

Most doctors experience a degree of impostor syndrome, especially at the beginning of their career but often longterm. This is the internalised belief that you are not as competent as people think you are and feeling like a fraud who may be caught out by other people. Almost all doctors experience this as some point, even if they don’t admit to it. You are definitely not alone if you feel this way. 

This feeling comes in part because despite the fact that you’ve spent time on the wards as a medical student and you have a sound knowledge of medicine that has allowed you to pass your exams, you often have yet to learn some of the key skills needed to function as a doctor working in a hospital. These include the ability to prioritise (which depends in part on clinical experience), the ability to manage and organise a high workload and knowing how to navigate the systems in your new hospital. This is NORMAL. Nobody should expect you to know how to do all these things immediately when you first start. You’ll learn how to do all of them, and pretty quickly too – It’s a steep learning curve. 

Many of us are also perfectionists who have come to expect a very high standard of ourselves. Perfectionism is known to be associated with Impostor syndrome. It’s really important to try and lower any perfectionist expectations you have of yourself, especially whilst you learn the ropes, though ideally more permanently. It can help to try and shift your mindset from a fixed mindset – believing you are as good today as you will ever be – to a growth mindset – the idea that the knowledge and expertise you have now can only grow and develop with time & effort. Of course you would have put in large amounts of effort already as you’ve passed your exams, but that doesn’t mean the learning stops now. Take notes of cases you see and read the relevant pages relating to these cases in the Oxford Handbook of Clinical medicine or the Oxford handbook for the Foundation Programme. Do this on your commute home if you take public transport, or as soon as you get home.  Don’t be afraid to ask questions of your seniors when you want to know more about a case, or (importantly) to clarify the indication for investigations – ESPECIALLY radiology. The radiologist will ask you why you want them! Every interaction in hospital is an opportunity to learn.  

Try to detach your self-worth from your clinical performance and don’t beat yourself up. Just because you can’t do something yet or think you need to improve on something doesn’t make you a bad doctor or a worthless person. Keep a note on your phone of things you did really well that you can refer back to later, as well as things you need to improve on. Go about addressing the latter with more learning or practice or asking for more support. 

It doesn’t help that we as doctors often struggle to be vulnerable with one other.  I will never forget a story that my Intensive Care consultant told me once when I was a Foundation Year 2 Doctor (second year as a doctor in the UK). The Obstetric consultant had called to ask him to admit a patient with a complex and rare obstetric condition to intensive care. The Intensive Care consultant asked a few questions and agreed the patient would likely need admission. What did he do next? He furiously googled what the condition was – he had never heard of it before! This isn’t because he was a bad consultant. The field of medicine is growing all the time and as we become ever more specialised and sub-specialised it’s impossible for any one doctor to know everything about every condition. I still find it hilarious that he couldn’t admit this to the obstetric consultant though (even though he disclosed it to me). It would seem that even consultants can suffer from Impostor Syndrome.

Many of us come from competitive academic backgrounds and learn not to openly disclose uncertainty for fear that it will be perceived as weakness. We are often told to “fake it till we make it” – both a dangerous as well as a bad piece of advice. Not only does this encourage new doctors to act outside of their limitations, it also encourages the adoption of a kind of silent stoicism that can lead to a feeling of intense isolation. If you can’t share your insecurities or your worries with someone it can be a really lonely existence. Try to talk to people about your feelings if you can – other junior doctors, mentors etc. You’ll often find others feel the same way too.