Imposter syndrome and tips for managing it

One of the growing problems in health care is that many highly competent health professionals, even in the highest positions, are struggling with feeling incompetent and that it’s only a matter of time before they are found out. This feeling of a lack of confidence and that they don’t deserve their own success — despite awards, promotions or other external evidence — is termed imposter syndrome or, sometimes, imposter phenomenon.¹ It typically occurs in top performers and can affect doctors^2-4, nurses⁵ and, no doubt, all other health professionals.

People struggling with imposter syndrome often respond by overworking or overstudying to address perceived knowledge or skills gaps. This can drive fatigue, burnout and anxiety. Others hold themselves back from taking opportunities because they don’t think they can do it.⁵ This has important implications for individual health professionals and the system as a whole.

It’s thought that imposter syndrome is underpinned by multiple interacting factors including: individual factors such as a tendency towards a perfectionistic and competitive personality style; system factors such as high stakes environment and hierarchical organisational structures; and cultural factors like shame-based teaching, blame and valuing bravado versus expressions of vulnerability.¹

How to build confidence

At an individual level, managing imposter syndrome and building confidence involves engaging in a program of personal and professional development focused on developing a growth mindset (see box).^1,6

For an individual, it’s important to take a reality check about actual competence levels that are not based on assumptions or comparisons. The Dunning-Kruger effect⁷ shows we are not very good at assessing our own competence. Top performers typically underestimate their competence, while underperformers are more like to overestimate their performance. So a good starting point is to accept that feelings are not facts, then follow that up with a more objective and honest look at an individual’s strengths and areas for growth.

This reality check helps people more accurately gauge their performance, where their strengths lie, identify areas for growth and positively engage in addressing any identified skills and knowledge gaps. This enables people to proactively self-manage their ongoing growth through developing personally valuable and meaningful learning goals, systematically assessing progress and finding opportunities for enhancing performance in the future.^8,9

People need to work on reconnecting with a sense of meaning in work, remembering what health care is really about and embracing challenges wholeheartedly and with courage and authenticity. It’s just not possible to feel like an imposter and authentic at the same time.

Getting support in building confidence

All this can be a hard to call to manage alone, so it’s important to create a supportive network of colleagues and mentors. Working with a coach can be a very effective way of helping people build confidence.

Leaders can play an important role in creating appropriate working environments that support confidence development (see box). This can include proactively identifying where people are doing well, helping them discover their strengths and accurately identify their growing edge, and helping set appropriate learning goals. Similarly, it’s important that leaders model appropriate and healthy self-talk about vulnerability, managing errors and finding courage in challenging situations. Leadership development training and working with a coach can help leaders build their own confidence and competence in supporting their staff.

 

Tips for building confidence

Tips for individuals Learn more about yourself by taking a validated strengths questionnaire. Do some reflective journaling focusing on what went well, why it went well and what your contribution was. Take practical steps to fill in any knowledge or skills gaps. Set personally valuable learning goals and track your progress. Think about what it means to be a health professional, what you hope to contribute to the world, develop a sense of authentic self and how you express that self as a health professional. Develop a network of supportive colleagues and mentors and consider working with a coach to help with your development.

Tips for leaders Encourage staff to build personal and professional development skills. Model expressing vulnerability. Coach your junior staff to set appropriate learning goals. Notice and praise improvements, success and contributions to positive outcomes. Shift blame away from individuals and reframe errors as valuable learning experiences. Build a sense of teamwork and community within and across professional silos. Consider working with a coach to help enhance leadership skills development.

 

*Dr Jocelyn Lowinger has an Honours degree in Medicine (1994) and a Masters of Science in Coaching Psychology (pending 2019). A former GP, Dr Lowinger now works in medical professional development including coaching health professionals. Visit www.coachgp.com.au.

References

1. Clance PR, Imes SA. The imposter phenomenon in high achieving women: Dynamics and therapeutic intervention. Psychotherapy: Theory, Research & Practice 1978;15:241.
2. Oriel K, Plane MB, Mundt M. Family medicine residents and the impostor phenomenon. Family medicine 2004;36:248.
3. LaDonna KA, Ginsburg S, Watling C. “Rising to the Level of Your Incompetence”: Exploring What Physicians’ Self-Assessment of Their Performance Reveals About the Impact of the Imposter Syndrome in Medicine. Academic Medicine 2017; Publish Ahead of Print.
4. Seritan A, Mehta M. Thorny laurels: The impostor phenomenon in academic psychiatry. Academic Psychiatry 2016;40:418-21.
5. Haney TS, Birkholz L, Rutledge C. A workshop for addressing the impact of the imposter syndrome on clinical nurse specialists. Clinical Nurse Specialist 2018;32:189-94.
6. Dweck CS. Mindset: the new psychology of success. 1st ed. New York: Random House; 2006.
7. Kruger J, Dunning D. Unskilled and unaware of it: how difficulties in recognizing one’s own incompetence lead to inflated self-assessments. Journal of personality and social psychology 1999;77:1121.
8. Locke EA. Motivation through conscious goal setting. Applied and Preventive Psychology 1996;5:117-24.
9. Carver CS, Scheier M. On the self-regulation of behavior. Cambridge, UK; New York, NY, USA; Cambridge University Press; 1998.

 

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