Insights on Residency Training

Dr. Al-abcha is a Chief Resident in Internal Medicne at Michigan State University.

As chief resident, I have been in a position to observe and mentor students, interns, and residents. I have always believed in the importance of recognition and support in a workplace. On a recent encounter with an intern, as I was praising her for her work, she responded rather unexpectedly! She thanked me for recognizing her, as

IsabellaMont, CC BY-SA 4.0 , via Wikimedia Commons

she still had doubts about how well she carries out her work. Her reaction was unexpected, because she excels in performing her duties. I would have never recognized that she felt this way — but then I reflected on my first year in residency.

My Experience

I was an international medical graduate (IMG) in a completely different world — functioning with my second language, practicing in a system I wasn’t familiar with, and little things, like the cultural differences in approaching patients. “Was my U.S. clinical experience good enough?” “Do I really deserve to be here?” Those were the thoughts that recurred throughout my first few rotations as I tried to become the person I was expected to be. Looking back now, I can’t imagine anyone saw those doubts in me. I probably looked like I was performing my duties competently while these feelings of self-doubt hid in the back of my head, showing up uninvited in moments of uncertainty or second thought.

It’s common for trainees to be nervous, it’s also common to question your competence when you’re reaching high-level achievements and are in a position to make important decisions, let alone life-altering decisions for others. It’s a very big responsibility, and it can weigh heavily on anyone working in healthcare. I told my intern that many of us have experienced these feelings during our journey — and I  sent her an article about Impostor Syndrome.

Impostor Syndrome

Also known as Impostor Phenomenon (because Syndrome can feel overwhelming, and it implies that it requires some kind of diagnosis or cure). A quick Google search of the words “impostor syndrome” brought up 7,380,000 search results, so to refine my search, I typed “impostor syndrome in healthcare,” which resulted in just 508,000 search results. Like everything else in our world, there is a vast amount of information about this topic, from medical research to self-help books, assessments, and tools to navigate this phenomenon. However, many people still don’t recognize that their self-doubt and feelings of inadequacy are part of this common phenomenon and that it’s prevalent among their peers as well.

Who’s at Risk? 

Impostor Phenomenon was first described by Pauline Rose Clance and Suzanne Imes in 1978 when they reported their experience with highly successful women who reported a lack of internal sense of success. Research shows it’s prevalent, occurring in as many as 82% of professionals (J Gen Intern Med 2020; 35:1252). It’s crucial to note that these feelings can stem from being a minority in a workplace. The overwhelming feeling of being the first, the only, or one in a few in a workplace can raise self-doubt about reaching a certain position. Research shows that women, people from underrepresented minorities (URMs), and IMGs are more likely to experience this phenomenon (J Gen Intern Med 2008; 23:1090). Various tools are used to diagnose Impostor Phenomenon and to identify different types of impostorism. Some people suffer from these doubts throughout their entire careers, whereas others have episodes of increased feelings of impostorism as a response to different variables, such as starting a new job or getting a promotion.

Diversity and Impostorism

I find it especially important to discuss impostorism now, as we move toward more diverse and inclusive workplaces. As the condition of Impostor Syndrome is defined, many people feel like their achievements or positions are due to luck rather than their hard work and qualifications. They fear being discovered to be less than they are perceived, and this can lead to anxiety, burnout, and depression. Rather than waiting for this cycle to unfold, it is important to implement protocols to ensure this is prevented. Especially considering the difference in prevalence due to demographics (i.e., women, IMGs, URMs), it is essential to raise awareness that some trainees could be affected more than others. Fortunately, change is happening: Leaders in different specialties are creating the necessary space for support and growth, such as diversity, equity, and inclusion (DEI) initiatives by the ACGME, as well as similar initiatives in institutions across the U.S.

I will begin my fellowship training in July, and as much as I look forward to this new experience, I anticipate feelings of self-doubt. However, I am now more prepared to navigate these feelings, because I have experienced them in residency and found ways to work around them.

What worked for me:

• Recognizing these feelings. I believe that this is the most important step, because once I knew what I was experiencing, those feelings became easier to manage.

• Sharing my doubts with trusted friends, colleagues, and mentors.

• Avoiding perfectionism and setting up a reasonable definition of success.

Wishing you good luck and positive self-talk on your residency and fellowship journey!