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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.

If you are fortunate to have not experienced Impostor Syndrome yet, I doff my hat to you. But pick up any medical school/junior doctor memoir or visit any medical student/junior doctor blog and in most you will find somewhere that the theme of not-belonging is a common trait which can present at any new stage of our careers. It can persist during your studies. It can crop up when you’re struggling to site those cannulas in your first weeks as a FY1, or when you can’t seem to get the hand of that procedure your clinical supervisor made out was ‘easy’. Impostor Syndrome is a deception, a trick of our minds – for when we do have those doubts about ourselves, many of those we see around us in medical school and in training feel exactly the way we do.

‘Imposter Syndrome’ is a common phenomenon. But it should not be confused with humility. It only hinders progress, stunts growth and stops you from becoming the awesome doctor you are supposed to be! It causes many doctors to flail helplessly under perceived glass ceilings which they could easily break if only they believed in themselves more.

I definitely struggled with feeling like an imposter for much of my time in medical school, which was hilarious given I had fought so hard to get there. I began to become a self-fulfilling prophecy – my work-ethic dipped, I struggled to retain information. Riddled with doubts and anxiety, exam performance took a dive and assessments even more so.

I did begin to believe in myself more heading into my final years. To be honest I didn’t have a choice! But the surge of confidence, and an increased sense of being deserving of my place in medical school translated into a big bounce in performance. I aced my final exams. And I’ve never looked back. I’m regularly rated extremely highly in my clinical assessments and ARCP. I feel great. Five years into working as a doctor, I still feel like I deserve to be in this career. But occasionally, very occasionally now, that little gremlin creeps back into my psyche.

It’s important to understand that there are no imposters among us. We all deserve to be where we are because we have fought for the right to take a seat at the table. There wasn’t a mistake at interview, or a mix-up in BMAT/UKCAT scoring! And this is why ventures like Melanin Medics are important – so we can read more stories about real people and their real experiences in the medical school machine. So we can bare ourselves and bring our difficulties to light, to encourage each other that no problem is new and no issue is insurmountable. So we can tap into a resource of mentors and have a safe space where we can explore our insecurities and our doubts.

If you’re struggling with impostor syndrome, take a step back and apply some perspective on things. Find someone you trust to talk to about how you feel and how you are thinking about yourself. Talk to a senior in your clinical team or a senior student, someone who may have been in your position once upon a time and could relate. And break the cycle!

I’ll end this with my favourite quote from Marianne Williamson. It’s a quote I wish I had come across earlier in my medical school career, and I hope it helps you, the reader, wherever you are in your education and training, to become more confident in your intelligence, your skill:

“Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our light, not our darkness that most frightens us. We ask ourselves, who am I to be brilliant, gorgeous, talented, fabulous? Actually, who are you not to be? You are a child of God. Your playing small does not serve the world. There is nothing enlightened about shrinking so that other people won’t feel insecure around you. We are all meant to shine, as children do. We were born to make manifest the glory of God that is within us. It’s not just in some of us; it’s in everyone. And as we let our own light shine, we unconsciously give other people permission to do the same. As we are liberated from our own fear, our presence automatically liberates others.”

Remember this quote the next time that little gremlin creeps into your mind and lies to you that you are an impostor and kick it back into oblivion. Don’t allow impostor syndrome to cause you to dim your light. You deserve to be a burgeoning medic – you are definitely not an impostor. So dust yourself down and get back to doing your best!

Written by Dr Jermaine Bamfo


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