The great pretender

With all of the responses and comments I got about last week’s post on women and the confidence issue, it inspired me to take on a different facet of the same set of issues.

The impostor phenomenon or impostor syndrome.

First described in 1978 by Pauline Rose Clance, the fundamental premise is that despite tremendous professional accomplishment, those who are affected by the impostor phenomenon persist in sincere denial of their capability and believe that they have “fooled” others and the system to achieve their status.  Found disproportionately among high-achieving women, the impostor phenomenon is characterized by minimizing achievement, be it a promotion, a high test score, or a specific achievement that is meaningful in a woman’s professional world.  The fear that underlies this syndrome is that of being “found out”- for example, the anxiety harbored by many young women surgeons that when they take their certifying exam, their examiners will discover that they actually have little to no surgical knowledge.  Admit it, ladies:  at least a couple of you felt this way (and yes, gentlemen, I know that some of you did too).  The impostor phenomenon is likely to also disproportionately impact women in male-dominated fields, meaning that academic surgery…well, let’s just say it might be a set-up.

Several months ago, our WIMS office at the University of Utah hosted a terrific panel in which several very accomplished female faculty members discussed how the impostor syndrome impacted them and their career development.  If I were to use the model they used, my introduction would start something like this:

” It all started when I was admitted to college.  They were going to allow me to start at age 17, the end of my junior year?  My senior year as I applied to graduate school I somehow was mysteriously offered scholarships for my graduate work from all 3 of my top choices.  Then my course correction into medical school- I had the “wrong” academic background coming from the liberal arts, and had bailed on grad school shortly before comps.  Why would medical school want me with that pedigree?  Every day in basic sciences I was certain that a mistake had been made.  For the first time in my life, something academic felt hard to me.  Really hard.  Then I hit my clinical years where I felt insecure but not like a true impostor.  Until I hit internship, that is.

I matched at my first choice program in general surgery with a profile that my Dean had told me was unlikely to result in success in applying for a residency at an academic surgical program (note:  all of my surgical mentors counseled otherwise).  In Fall of my intern year, after participating in the application pre-review process, one of my co-interns and I looked at each other and commented that we both were certain we had been rank list errors; everyone whose applications we were looking at seemed so much more accomplished than we were!”

Here’s the thing:  Impostor syndrome likes dark, quiet places to hang out, where people don’t talk about their fears and insecurities.  It feeds on the shame of inadequacy.  That moment with my classmate was illuminating for me because it was the first time that I had “come clean” about wondering how I got to where I was with someone I really respected.  To find that she had the same fears was a BIG deal and the basis for a lot of sanity-preserving conversations over the next 5 years- with her and with another resident who started the year after us.  We learned from each other to take credit when good things came our way, and we were able to normalize one another’s anxieties as women surgeons.  Most importantly, when one of us needed guidance and constructive criticism, we had a safe community to provide that.

I’ll admit that I still have moments of stopping to look around and be awed by where I am professionally, and humbled by some of the opportunities I receive.  I’ve also learned how to simply say, “Thank you, I appreciate the honor,” rather than bumbling through why it was predicated on luck or timing or who I know.  I have a community with whom I can be honest when I’m feeling overwhelmed and mentors who both nurture and nudge.  I still keep looking for ways to grow, professionally and personally.  Are these things cures for the impostor syndrome?  I’m not sure, but they certainly help keep it at bay.