Imposter Syndrome in Veterinary Medicine
“Slowly, I’m learning to quiet the voice
that tells me I don’t belong here,
that what I have isn’t enough
didn’t do enough
didn’t know enough,
didn’t care enough . . .
Slowly, I accept, confess, acknowledge
my anxieties I’m primed to overthrow them
distance growing between
the thoughts and me” — Jamee Schoephoerster [1]
This is an excerpt from a poem, Imposter Syndrome, written by Jamee Schoephoerster, who at the time of this publication is a third-year medical student. Through her honesty and willingness to be vulnerable expressed what other healthcare professionals have reported during their education, training, and early careers. To be clear, Imposter Syndrome is not exclusive to healthcare professionals or other professionals; research indicates up to 80% of people have reported at least one episode of Imposter Syndrome in their lives. [2]
This article discusses recognizing and addressing Imposter Syndrome in veterinary medicine.
What is Imposter Syndrome?
The term, Imposter Syndrome or what is also referred to as Imposter Phenomenon was first reported in 1978 by Clance and Imes who were studying “high achieving women” who, despite their professional and academic accomplishments did not see themselves as successful. [3] The women in this study attributed their accomplishments to mistakes or other external factors such as luck.
Imposter Syndrome “describes high-achieving individuals who, despite their objective successes, fail to internalize their accomplishments and have persistent self-doubt and fear of being exposed as a fraud or imposter.”
Imposter Syndrome is found across genders, occupations, education stages, cultures, and age ranges. [2,4,5,6]
While not officially recognized as a psychiatric disorder, Imposter Syndrome has been found to coexist with low self-esteem, insecurity, depression and anxiety. [6-8]
Persons living with Impostor Syndrome have also been reported to experience job dissatisfaction, burnout and compassion fatigue. [2, 9-10]
Any individual can experience imposter syndrome, and several studies revealed that individuals from marginalized groups may experience Imposter Syndrome, [6,11] and this may have negative impacts on their mental health and wellbeing. [12-13]
Characteristics of Imposter Syndrome
As previously discussed, Impostor Syndrome affects many people from different backgrounds, education levels, across socio-economic groups, and in different occupations. The underlying characteristics of the Impostor Syndrome include:
Fraud or perceived fraud
Fear of being found out
Anxiety
Difficulty internalizing their successes
Dismiss praise
Devalue themselves
Self-sabotage
Self-doubt
Other self-defeating behaviors [14-16]
In order to better understand how Impostor Syndrome evolves, it is helpful to see it as a progressive pattern that repeats itself to the detriment of a person’s wellbeing. Sakulku and Alexander adapted the six characteristics of Clance’s Impostor Phenomenon [3] into a flow chart in order to visualize the cyclical nature of the Imposter Cycle.[5] A person only needs a minimum of two characteristics in order to be considered as experiencing Impostor Syndrome.
Characteristic 1: The Impostor Cycle
The Imposter Cycle begins with a task that is achievement oriented, either at school or work, which causes fear of being found to be a fraud, and then leads to anxiety-related symptoms. When the task is completed whatever positive feelings of accomplishment are experienced, they are short-lived and not internalized as a success. Their success is attributed to either over-preparation or luck. Whatever praise(s) is offered by others, persons with Impostor Syndrome dismiss and/or devalue their contribution.
Characteristic 2: The Need to be Special
“Impostors” are driven by a need to be the very best and were often at the top of their class. Once enrolled in college or university they are now competing with other highly driven students and the “Impostor” is no longer at the top of his or her class. No longer believing they are exceptionally talented; they now dismiss their own accomplishments and devalue their educational attainment.
Characteristic 3: Superwoman / Superman
The need to be the very best is also referred to as being perfectionistic, with high expectations that are unrealistic. This leads to feelings of being overwhelmed, discouraged, and internalized feelings of being a failure.
Characteristic 4: Fear of Failure
Once someone with Impostor Syndrome begins making mistakes, they fall into a pattern of seeing themselves as failures leading to feelings of shame and humiliation. They begin to overwork themselves in an attempt to ensure they will not fail.
Characteristic 5: Denial of Competence and Discounting Praise
Because Impostors cannot internalize their accomplishments, they attribute their success to external factors. They do not accept praise and downplay positive feedback, instead focusing on what they did wrong.
Characteristic 6: Fear and Guilt about Success
Impostors fear success as they do not believe they will be able to replicate their accomplishment again or sustain the level of performance. Anxiety levels increase as they worry that higher demands will be made of them with future projects.
How to Address Imposter Syndrome in Veterinary Medicine
Individual Intervention
Overcoming Impostor Syndrome has been discussed in both the medical and veterinary literature by addressing it through the utilization of individual techniques to increase resilience as well as through institutional interventions. In veterinary medicine the following techniques can help become more resilient and learn effective coping strategies.
Recognize when an adverse event occurs in patient care that the problem is not “you,” but the fact that not all illnesses can be resolved successfully. When a medical error is made, practice self-forgiveness and the acceptance that veterinarians are humans and we all make mistakes.
Seek peer-support by speaking with other veterinarians who are at similar points in their careers or find a mentor who can offer guidance and support (in the mental health profession this is referred to as “peer consultation”)
Use positive self-talk and remind yourself of past successes and accomplishments which is referred to in positive psychology as “appreciative inquiry”
Align your personal values with your professional values, which can help improve your wellness and professional identity
Replace perfectionism with realistic high standards: failure is going to happen in the course of everyone’s life and career; but failure is also when growth occurs. [17]
Coaching Intervention
“Growth-mindset”-focused coaching focused on facilitation and support (positive features) has been shown to achieve a significant and sustained reduction in Impostor Syndrome. The “growth-mindset” approach views people as not only having the ability to grow despite having failed at something but to thrive in the face of challenges. This coaching method establishes a collaborative relationship between the coach and the participant setting goals and making modifications as needed. [18]
Coaching Intervention
With Impostor Syndrome prevalence rates in the general population varying between 40-80%, veterinary schools can address this by utilizing a curriculum similar to medical schools. [19] With some minor adjustments veterinary schools can incorporate into their curriculum facilitator-guided wellness workshops and small group discussions including a topic on Impostor Syndrome. The Impostor Syndrome curriculum can include topics such as:
Define Impostor Syndrome and ways it can manifest
Identify risk factors associated with Impostor Syndrome
Develop strategies to overcome Impostor Syndrome [19]
Additional Resources
How to Overcome Imposter Syndrome: 14 Tests & Worksheets. A free resource from Positive Psychology website that is helpful in both assessing and addressing Impostor Syndrome. This article explores techniques and worksheets to help identify and overcome imposter syndrome directly and indirectly by confronting what prevents us from believing in ourselves.
Imposter Syndrome: What it is and how to manage its impact—An online resource from The University of Edinburgh. This resource provides you with insight on the experience of imposter syndrome and strategies and advice on how to best deal with its impact.
What is imposter syndrome and how can you combat it? A TED Talk by Elizabeth Cox who is an Associate Editorial Producer at TED Conference.
Books
The Impostor Phenomenon: Overcoming the Fear That Haunts Your Success – Pauline Rose Clance, Ph.D.
Presence: Bringing Your Boldest Self to Your Biggest Challenges – Amy Cuddy, Ph.D.
The Gifts of Imperfection: Let Go of Who You Think You’re Supposed to Be and Embrace Who You Are – Dr. Brené Brown, Ph.D.
The Diversity Advantage: Fixing Gender Inequality in the Workplace – Ruchika Tulshyan
The Imposter Cure: Escape the Mind-Trap of Imposter Syndrome – Jessamy Hibberd, Ph.D.
Conclusion
Imposter Syndrome is an internal belief that one is not competent and is a fraud waiting to be found out by colleagues. Impostor Syndrome is more common with over 80% of people experiencing it at least once in their lives. It cuts across all socio-economic groups, age ranges, education levels, occurs in multiple ethnic groups and in both genders. Its effects are debilitating and have been found to coexist with depression and anxiety as well as other self-defeating thoughts and behaviors.
Individual veterinarian interventions for Impostor Syndrome include being realistic about veterinary medicine, i.e., not all illness can be resolved successfully; seek out peer support; use appreciative inquiry; aligning your personal values with your professional ones; and letting go of perfectionism. Institutional interventions include incorporating wellness and Impostor Syndrome workshops into the curriculum during veterinary training.
As with other challenges in veterinary medicine, creating and maintain a wellness plan is central to maintaining a healthy life.
References
[1] Schoephoerster J. Imposter syndrome. Journal of Minnesota Medicine. 2021;July/August:104(4). https://www.mnmed.org/getattachment/news-and-publications/mn-medicine-magazine/Past-Issues/Past-Issues-2021/Jul-Aug-2021/070821_ImposerSyndrome-(1).pdf.aspx?lang=en-US. Accessed July 8, 2022.
[2] Bravata DM, Watts SA, Keefer AL, et al. Prevalence, predictors, and treatment of impostor syndrome: A systemic review. Journal of General Internal Medicine. 2020;35(4):1252-75. DOI: 10.1007/s11606-019-05364-1.
[3] Clance PR, Imes SA. The imposter phenomenon in high achieving women: Dynamics and therapeutic intervention. Psychotherapy: Theory, Research and Practice. 1978;15(3):241-247.
[4] Chae JH, Piedmont RL, Estadt BK, Wicks RJ. Psychological evaluation of Clance’s imposter phenomenon in a Korean sample. Journal of Personality Assessment. 1995;65(3):468-485. DOI: 10.1207/s15327752jpa6503_7.
[5] Sakulku J, Alexander J. The Imposter phenomenon. International Journal of Behavioral Science. 2011;6(1):73-92. https://doi.org/10.14456/ijbs.2011.6.
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[11] Cokley K, McClain S., Encio A, Martinez M. An examination of the impact of minority status stress and impostor feelings on the mental health of diverse ethnic minority college students. Journal of Multicultural Counseling and Development. 2013; 41:82-95. DOI:10.1002/j.2161-1912.2013.00029.x.
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[13] Stone S, Saucer C, Bailey M, et al. Learning while Black: A culturally informed model of the impostor phenomenon for Black graduate students. Journal of Black Psychology. 2018;44(6):491-531. https://doi.org/10.1177/0095798418786648.
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[15] LaDonna KA, Ginsburg S, Watling C. “Rising to the level of your incompetence:” What physicians’ self-assessment of their performance reveals about the impostor syndrome in medicine. Academic Medicine. 2018;93(5):763-768. DOI: 10.1097/ACM.0000000000002046.
[16] Susmita P, Wasser T, Donato A. Impostor syndrome in hospitalists- a cross-sectional study. Journal of Community Hospital Internal Medicine Perspectives. 2021;11(2):212-215. DOI: 10.1080/20009666.2021.1877891.
[17] Ruple A. Overcoming imposter syndrome. American Association of Bovine Practitioners Conference Proceedings. 2020;54(2):5-6. DOI: https://doi.org/10.21423/aabppro20207954.
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[19] Baumann N, Faulk C, Vanderlan J, Chen J, Bhayani RK. Small-group discussion on impostor syndrome. MedEdPORTAL. 2020;16:11004. https://doi.org/10.15766/mep_2374-8265.11004.