Med School Masquerade: Impostor Syndrome

There is a funny thing about medical school. Whoever you meet, whatever the background, most of us have had a similar run prior to starting off. We were one of the brightest among our peers, if not the brightest; at primary school, secondary school. We aced our GCSEs. We got the spotless grades we needed to at A-level, and even if we didn’t our grades at A-level were better than the vast majority of the general college population in that year. In medical school, we are all high achievers. Gifted and talented. The best of the best. The cream of the crop…

…except there’s now a new realisation. When you get 200, 300, 500 people who have all been ‘the best of the best’ throughout their lives, a new hierarchy must be formed. A new performance table. And this is where the shock comes in…because for a lot of medical students, they’re going to experience something they may not have experienced before. Being less than ideal.  Being ‘mediocre’. Or even for the first time in one’s life, finding yourself pulling up at the rear of the cohort.

I’d love to be able to say that I bounced into medical school feeling like a Marvel superhero and thundered through those years like a boss. I did, initially. But I descended quickly into anxiety. I became incredibly self-aware. I was the only black person in my graduate-entry cohort – how could one not be self-aware? Many had a private school education. Many had countless accomplishments. And then the first batch of exams happened. All of a sudden, for the first time in my life, I wasn’t top of the class anymore. It was sobering. It was different. And just like shadows, when that darkness descends your mind can begin to play tricks on you and make you perceive things which are not real or true…

I began to question myself. A lot. Do I know anything? Did I deserve to be here in medical school? Why did I decide to do medicine again? Gosh, someone’s made a mistake somewhere. Am I here just to fill an ‘equal opportunities’ quota? All sorts of madness! You begin to feel that if you are thinking those things, then it’s likely that everybody else is thinking them too…  Its difficult to fight past that feeling when you look around your class and don’t see people that look like you, don’t share your background, your formative experiences, your hobbies and interests. It only enhances your feelings that you are an anomaly. Not belonging. Lost.

During medical school, as we navigate the copious reams of knowledge we are expected to absorb and begin to develop numerous new clinical skills, we may experience some of the thoughts and feelings I’ve just described, which have been colloquially been called ‘impostor syndrome’. ‘Imposter syndrome’ is the fear of not belonging in a cohort, the fear of being exposed as a fraud as expectations and responsibility increase. It’s important to remember that from the moment we enter medical school, our careers involve making incremental progress toward competence and mastery. We should recognize and celebrate our progress along the way rather than focusing on our perceived shortcomings.

However, for medical students of African-Caribbean descent who are already part of the ‘ethnic minority’ in Western society, it can be easy to come to a place where you get that additional sense of not belonging. It is already well-noted that there are low-numbers of African-Caribbean students in medical education, which also presents in medical training. And while we all may have a measure of confidence and self-assuredness, there will come times where we feel isolated and doubt ourselves – and this feeling can be enhanced by our observations.