Growing up, I was one of those folks who did well. I achieved. I never thought I needed to be the best in college or med school, but I always did my best. I was the top student in my high school and near the top in college and medical school. I matched into my first choice of residency and then was picked to be a chief resident. Becoming chief resident was not something I had thought about. I did not even know the process. I was asked mid-way through the second year of a three–year residency. My impression was that the director thought I knew what I was doing, or perhaps he thought I was nice and organized. I was certainly not the best resident in my mind.
The first time I could identify my personal imposter phenomenon was in residency. I did not have a name for it then. Imposter phenomenon or imposter syndrome is when a person feels they are a fraud and where they think they do not know as much as others think they do. I believe we all had it to some degree at that time. Everyone seems to have a story where they were told: “you have to decide because you are the doctor” in some emergency or a code blue. It is one of those first realizations that you are a doctor, even if still in training.
During residency, I liked being supported by the older residents, fellows, and attendings. When I grew to the level where I was the support, it was harder to keep the confidence. There is always more to learn in medicine. One cannot know it all. And I think that contributes to this feeling of being an imposter.
One of my chief resident responsibilities was to run our morning report. This was attended by all the upper-level residents not working in the ICU/CCU, several attendings, our former dean who was an internist, and often our program director. A resident was assigned to present a clinical vignette while the chief resident wrote up the case on the whiteboard and asked questions to the group. We were not supposed to know the answers to the case. My co-chief resident loved doing this- it was his thing. However, I was always nervous and fearful that I would not know enough, and I would look like I did not know what I was doing in front of my recent resident peers and my new attending peers. Therefore, I often let him take this role, and I chose to focus on other aspects of our shared job.
I never felt I was good enough to pull up the data from my mind with a quick summary of a study as to “why we should do this.” I felt more comfortable saying “here is what we do” without the backup study. I felt like this was a fault.
In hindsight, as I learned about the imposter phenomenon and syndrome and how it is likely to come up in the transitions in one’s career/life, I know it was there for me at the start of residency and in my chief residency year.
I now think it influenced my decision as to what path to take after that chief year, i.e., stay in academics and do more teaching or go into private practice. Did that fear of being thought of as an impostor propel me to take the private practice job? Was “I did not know enough to teach others” a limiting belief? I certainly did not have an easy comfort doing it. Although being a chief resident for a year was a way to slowly come into the role of being the one in charge, it was confusing at times. For example, technically, a chief resident is a full-fledged attending but is a PGY-4 level in pay and parking lot seniority.
I did not experience the imposter phenomenon going into my private medical practice. However, I had seen it two more times recently when I was in different roles. In both circumstances, I was trying something new, another transition. In one scenario, I was teaching folks about wellness and coaching topics for the first time. In the second circumstance, I moved into a new clinical role with partners who are excellent teachers. Both times, those thoughts of inadequate knowledge to teach resurfaced.
By this recent time, I had heard of imposter syndrome, and I knew how to be more aware of my thoughts; I learned how to adjust those thoughts, and ultimately I knew how to have a different opinion of myself. I was able to see these limiting thoughts and reframe them. This is still a work in progress. To do this, I adjusted my thoughts and expectations of the meaning of how people responded to my teachings by determining what I wanted the purpose to be for me. I replaced the thoughts “I am not an expert, no one wants to hear what I have to say” or “I do not know enough” with “I am sharing what I know.” When comparing myself to others with more experience, I chose to believe “I have other valuable skills.”
As you navigate the transition of roles in your life, know that you always have something to learn and something to teach, and your thoughts can set you up for more joy during those times. Take it from a chief resident!Marion McCrary MD FACP is a practicing primary care general internist in North Carolina. She works with both physicians and non-physicians as a national-board certified integrative health and wellness coach. She is also a Women in White Coats Writers Fellow and Podcast Co-Host. Her website is http://www.marion-wellness.com, and she can be followed on Instagram and Facebook at marionmccrarywellness.
