I turned to my friend earlier this year on our way into town (probably for coffee, our lifeline) and explained a feeling that I’ve sat with for years, but until that point had rarely spoken about. “I constantly feel like I’m waiting to be found out”.
A shining example of this is when I am asked to take blood (venepuncture). This is a skill I learnt, practiced several times and was signed off as competent to do. In short, I am able to successfully and safely take blood on my own.
On one morning during our GP placement, I was asked to sit in on consultations and take blood when necessary, which was near enough every patient. As I prepared the equipment, at the back of my mind something niggled at me, telling me being allowed to do this is a mistake. I’d been signed off as competent out of pure luck. Every successful venepuncture up to this point had been a fluke.
Despite thinking I was a fraud and that each venepuncture would be the one to expose me, I was successful almost every time, breathing a sigh of relief that ‘I’d got away with it’. Of course the odd time that I wasn’t successful on my first try (completely normal I’m assured), it reinforced my belief that everything up to that point had been a fluke.
This is just one tiny element of my course, but these feelings of inadequacy are widespread. Starting in first year, when my main objective in anatomy sessions was to perfect my ‘I understand’ face, thinking if anyone knew how truly confused I was that I would be kicked out on the spot. To the exams, crying after my third year OSCE, completely convinced I had failed and that the year had finally come in which I couldn’t fake clinical competence any more. The latter was hell for everyone involved, especially my family, who year after year endure 2 weeks of my persistent “I’ve definitely failed this time”, before announcing that after all that, I had indeed passed (and normally well).
The fears aren’t only limited to the here and now either. I’ve had several conversations with peers that illuminate a common fear, that when the day comes and we are faced with a true emergency, we will freeze and not know what to do. Doctors who’ve been in that position telling us ‘you will just know’ , and the fact that we would have passed medical school finals somehow not reassuring at all.
It’s a difficult and often frustrating process, to have all the evidence you and others need of your own competency but insisting that it is down to luck, that you’ve only got this far because examiners saw you ‘on a good day’ or simply that you have managed to get through without ‘being found out’.
Although I was sad to hear my friend, one of the most competent people I know, also shared these feelings, it was a huge weight off my shoulders to discover that I wasn’t the only one.
As we discussed our mutual emotions, we described how it felt like constantly treading water just to appear competent. The fear of any day now we wouldn’t be able to tread anymore and deep incompetencies would be revealed.
Before the whole lockdown fiasco, I was starting to shift my mindset. Learning that imposter syndrome, for me, is more about the difficult transition between who I currently am and who I am trying to be. The transition from student to doctor is gradual (5 years at least), but we rarely accept that truth, feeling under internal and external pressure to be ‘doctor material’ from the get go. This expectation often makes it difficult for us to speak about things early on that could suggest that we are not ‘doctor material’, despite the glaring truth that A) we aren’t doctors yet and B) being a student is the time to be unsure and ask questions. Several times I have been asked what type of heart murmur I can hear when I am struggling to hear the basic Lub-dub over the hustle of the ward, my ears not quite trained enough to distinguish the subtle differences in sound. In that moment you have two options, to guess the most common murmur or come out and say look, I know I’m X years into my training but I’m struggling to hear the normal heart sounds. Both unpleasant options but you have to say something.
I used to guess (criminal) but then I started to be honest about what I could and couldn’t do, accepting that there is nothing to be ashamed of to learn. This changed my experience of placement a lot, from (very nervously) admitting to a doctor during gynae theatre that I had never felt a uterus during a bimanual, to openly saying I don’t have a clue what is going on in this chest x-ray. I first thought admitting these self-deemed incompetencies would hinder me, but in fact all of them turned into brilliant teaching from people who told me they once felt like me.
I feel very vulnerable talking about this, but I’m hoping speaking openly about it helps to open up the conversation. I’m positive that many medical students (and doctors) face the struggle of imposter syndrome, often on their own and without the knowledge that the people around them feel the same. Competence to me for a long time equated to being able to do everything effortlessly. It takes time to understand that competence comes from identifying what you don’t know and doing something about it, rather than glossing over it to keep up appearances. It’s tough, especially with elements of old-school medicine still influencing our experience of medical school, but ultimately being honest about what we can and cannot do encourages others to do the same, leading to a much needed healthy change!