In our last edition of The Commitment, we introduced the topic of impostor syndrome, an internal struggle where those affected experience a temporary or ongoing cycle of dysfunction rooted in a deeply held sense of unworthiness. This is often found in high achievers who externally appear to be exceling but internally feel inadequate. Impostorism drives a cycle of compensational overwork with demonstrable success and a transient sense of accomplishment. Over time, and sometimes as a consequence of a poor patient outcome, feelings of inadequacy recur. Burnout and self-sabotage often accompany those affected.
Imposter syndrome thrives in high-pressure fields such as medicine. Statistically, it’s likely that at least one of your colleagues may experience it. You may experience it.
Measures of impostorism
When diagnosing impostorism, one essential challenge is to differentiate between the typical anxieties and transient self-doubt that most proceduralists experience from the harmful Cycle of Impostorism. To do that, there are objective means. The most frequently used tool by researchers is the Clance IP Scale derived in 1985 by Pauline Rose Clance, PhD. It consists of a self-administered 20 question 5-point scale survey. Based on the total score, an individual is assigned to 1 of 4 categories. Higher scores correlate to the higher degrees of impact impostorism has upon an individual.
Other measurement scales include the Harvey Impostor Phenomenon Scale (J.C. Harvey, 1981); the Perceived Fraudulence Scale (Kolligian and Sternberg, 1991) and Leary Impostor Scale (Leary, et al, 2000). None of these methodologies is a “gold standard” but do offer some insights.
Dismantling the cycle
Impostorism isn’t perfectly understood. It’s a profoundly internal phenomenon that is initiated and perpetuated by different factors depending on the affected individual. Accordingly, there isn’t a unique solution. However, I’ve devised 3 broad categories of interventions that may prove helpful in disrupting the phenomenon: internal, interpersonal and institutional. These are just several of the 28 tactics I’ve derived as an overall strategy to dismantle impostorism. This list is by no means complete, and there may be as many solutions as there are people affected.
Internal
Internal strategies allow those who are affected the ability to self-engage. This offers the advantage of early intervention with the hope of diminishing the initial negative impact of impostorism.
Develop an awareness of the cycle of impostorism and what factors are most impactful in diminishing your sense of worthiness the most potent drivers of your cycle.
Reexamine internal attitudes that equate self-worth with professional accomplishment. Everyone has inherent value beyond what can be enumerated in our CVs.
Understand the role of perfectionism in your career. Used strategically, it can yield high-quality work; overuse can lead to needless exhaustion with no derived benefit.
When doing something new, believe in the power of your preparation. Having anxiety about performing in a new endeavor is common and healthy. If you have prepared for the experience, find confidence in knowing your groundwork will fortify you in the new endeavor.
Interpersonal
Interpersonal techniques provide approaches where professionals or peers can engage with each other. An objective third party may be able to share personal strategies and insights to another suffering from impostorism. Just as IRs collaborate to find greater success in shared projects and procedures, a partnership can be a powerful way to overcome impostorism.
Work with an independent professional coach and cultivate a workplace mentor. The guidance of objective third parties can offer new insights and disrupt self-defeating patterns of behavior.
Express positive feedback and appreciation with team members contemporaneously. Fostering a culture of supportive encouragement builds esteem and fortifies a strong team.
Recognize the likelihood that impostorism exists widely in our IR peer group. Those affected may be reluctant to step into opportunities for professional development. Look for opportunities to partner with, champion, sponsor and mentor peers in whom you recognize nascent talent.
Institutional
Institutional or departmental approaches encourage leaders to act with intention to illuminate and mitigate impostorism in their workforce.
Promote initiatives within the diversity, equity and inclusion curriculum that teach what is known about impostorism. An open discussion may be beneficial to the entire organization.
Encourage leadership styles where individuals are recognized and praised beyond the typical ongoing professional practice evaluation and focused professional practice mechanisms, and which recognizes that practitioners don’t have to demonstrate monumental achievements to be deserving of feedback. Praising your colleagues isn’t emblematic of a cultural weakness. Everyone wants to feel a sense that their work matters, and personal recognition is a powerful way to raise the esteem of workers.
Structure the work schedule to allow staff time for adequate self-care. Normalize the expectation to leave work on time and discourage needless overtime contributions. Unnecessary overtime is the haven of first resort for those trapped in impostorism.
Conclusion
In these two articles, my goal has been to raise the awareness of the cycle of impostorism within the IR community. For some readers, it may be their first exposure to the phenomenon. Others have known about it perhaps not by name but in their lived experience. Many affected are unaware of impostorism and lack deep insights into their behaviors and how they relate to cycles of professional dissatisfaction, anxiety and moods as well as burnout and procrastination. Compounded over time and scope, the pernicious effects of impostorism in IR may be profound. The waste of human potential impostorism extracts from those affected is unacceptably high to those individuals and to our specialty as a whole.
Sadly, many of the key personality traits and drivers of impostorism may have become normalized and considered an inherent part of being a “good physician.” Selflessness, overwork, emotional detachment and perfectionism are some of the qualities we may deem admirable for ourselves and our most respected colleagues. As tools temporarily used for strategic development, they may serve us well, but when overused as a routine way of doing business, these skills may diminish the long-term effectiveness of individual providers and organizations.
Impostorism needs to be better understood, and the internal, interpersonal and institutional tactics used to dismantle it offered in this article are by no means a complete solution—but they are the start of a conversation. Impostorism thrives in high-achievers and is fueled by shame and secrecy. By naming and discussing the phenomenon, we bring it into the open as a means to better care for ourselves so we may be more effective in caring for our patients.
References
- McGinnis H. Identifying the impostor within: Part 1: What is imposter syndrome? IR Quarterly. 2022.
- Mak KL, Kleitman S, Abbot MJ. Impostor phenomenon measurement scales: A systematic review. Front Psychol. 2019;10.
