From mentor to mentee: Two perspectives on overcoming imposter syndrome

By Emily Margosian, Assistant Editor, September 1, 2024

DermWorld talks to William James, MD, FAAD, and Paige Porter, MD, about what drives imposter syndrome in medicine and how to implement mentoring strategies to overcome it.

DermWorld: Tell us about your practice.

Dr. James: I am a general medical dermatologist and have practiced in academic dermatology throughout my career, much of it at the University of Pennsylvania.

DermWorld: What is impostor syndrome? How can it manifest among physicians and physicians in training?

Drs. James and Porter: Impostor syndrome is a term used to describe feeling like a fraud or impostor despite being high-achieving and qualified for a position. Although highly prevalent in the field of medicine, it also occurs in many other occupations. Impostor syndrome can manifest in physicians and physicians-in-training as lack of confidence and feelings of self-doubt and inadequacy. There can be a downplay of achievements, believing they are the result of luck rather than one’s ability, despite objective evidence of success due to competence. This can result in individuals passing up opportunities which may limit long-term achievements and prevent them from fulfilling their potential.

DermWorld: You recently co-authored a paper on imposter syndrome. What prompted your interest in this topic? Have you personally experienced imposter syndrome during your own medical training and career path?

Dr. Porter: My interest was prompted by my own experiences with imposter syndrome during medical school. Learning about the topic and bringing awareness to how common these feelings are have helped me cope healthily. As I begin my intern year, I’m taking on many new responsibilities and learning new skills. With this are natural feelings of self-doubt that most physicians-in-training feel as well.

Dr. James: The number of publications on the subject and my interest in resident education prompted me to work with Dr. Porter to express our opinions on the subject. I was a residency director for 32 years, so I’ve been involved in resident education for a long time. When I was a resident, I often thought about how well my peers were progressing and hoping I could become a proficient, competent dermatologist so I could deliver the best of care to my patients. In terms of having doubts about whether you’re good enough or if someone else could do it better — I think those feelings are certainly present in most people when they’re in the early phase of their training and career. It’s easy to get caught up in all the things that you believe you don’t know.

For example, when I came out of my training, I was a solo practitioner for a couple of years at West Point. There was nobody around in the clinic to confer with, and of course back then we didn’t have internet. I was a little concerned about how to provide phototherapy for psoriasis, because I didn’t have much experience actually doing it myself. However, as you work through those kinds of things, you find out that indeed you can do them. You can figure it out, get it done, and make people feel better. The more situations like that you face, the more it gives you confidence to solve the next problem that comes up.

I do think that, at least personally, there’s less doubt as you move through your career. However, with the rapid expansion of therapeutics and improved understanding of disease, I continue to learn. Having a growth mindset rather than fearing such explosion of information I find helps combat impostor syndrome.

DermWorld: Who in medicine does impostor syndrome most often affect?

Drs. James and Porter: Our publication addressed a statistic that nearly all dermatology residents experience impostor syndrome. This group is the most highly affected by feelings of insecurity in their knowledge base and competency. Our opinion is that upon entering a new field of study, it is natural to feel the need to improve, learn, study, and grow.

DermWorld: How does medical training potentially contribute to feelings of impostor syndrome?

Drs. James and Porter: During each step of medical training, there are massive amounts of information and many new skills to master. High-achieving individuals who work in this field often feel the need to be perfect, but the reality is that everyone has areas that need more practice or expanded knowledge. As long as these feelings move residents forward, they are helpful. However, there is a point where anxiety, depression, or burnout can result if perspective is lost.

DermWorld: What are some consequences of impostor syndrome? How might it affect a physician’s level of burnout or sense of professional fulfillment?

Drs. James and Porter: Imposter syndrome can cause feelings of inadequacy and self-doubt, and because of this, individuals may be less likely to seek or accept new opportunities and speak up in group settings. If left unchecked, imposter syndrome can progress from a phenomenon everyone experiences to some degree, all the way to mental health issues such as anxiety and depression.

Imposter syndrome can also take the joy and meaning from being a physician and replace it with inefficacy, low self-esteem, and burnout. As physician mental health is a concerning issue in our country, it is important to recognize when imposter syndrome has evolved into something more serious and detrimental to well-being.

“As soon as I feel a slight twinge of anxiety or self-doubt, I remind myself that I am qualified to be here, and everyone is likely feeling just like me.”

DermWorld: What are some strategies for discouraging or overcoming feelings of impostor syndrome?

Dr. Porter: For me, one of the best coping strategies is to practice self-awareness. As soon as I feel a slight twinge of anxiety or self-doubt, I remind myself that I am qualified to be here, and everyone is likely feeling just like me. I have also found it helpful to talk to my classmates from medical school and co-residents who I find are also feeling this way. The truth is that we feel this way because we care about this field and our patients. I would honestly be worried if physicians and physicians-in-training haven’t felt imposter syndrome at some point.

Dr. James: I agree with Dr. Porter. Self-reflection, maintaining a positive, growth mindset, realizing you are not alone in your doubts, and seeking help from your friends, colleagues, or your institution if needed, are all good ways for overcoming impostor syndrome.

DermWorld: How can physicians incorporate these strategies when mentoring trainees and/or staff?

Dr. Porter: I believe one of the best strategies for trainees is preemptively acknowledging that they will likely feel uncomfortable and timid when beginning a new position. Also letting them know it’s okay to not be perfect and ask for help.

Dr. James: It is always helpful for a senior physician to admit their similar concerns, areas of weakness, and mistakes. You want to make sure the residents know they’re in a supportive environment. Discussions about impostor syndrome, ways to move forward positively, and offering assistance are all important mentoring responsibilities.

During dermatology training, you want to inspire them. You want to make sure that they know that the primary interest of their training is the patient, and how to best treat the patient in the future. Their studying and hard work is because the patients who come to see them are going to need their dermatologic expertise to make them better. We want to inspire them to improve, but also let them know that they’re new at this and we don’t expect them to know everything all the time. We want residents to ask questions, because it indicates to us that they’re paying attention, and that they want to know more.

William D. James, MD, FAAD, is emeritus professor of dermatology and former director of dermatologic education at Perelman School of Medicine at the University of Pennsylvania.

Paige Porter, MD, is an intern who will be a first-year resident in the department of dermatology at the Louisiana State University Health New Orleans School of Medicine next year.

Their paper, ‘Impostor syndrome throughout medical training: Looking at impostor syndrome in a new way,’ appeared in JAAD International.

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