S3E5: Imposter Syndrome in Med School

Harjit: It's a party.

Margaux: It's a party in the USA.

Harjit: Hi, everyone. It's Harjit and Margaux in the studio. It's been the two of us for the past couple of weeks, right?

Margaux: Yeah. That's because Bushra and Leen left us.

Harjit: Crying emoji, crying emoji, crying emoji, crying emoji.

Margaux: That's a lot of crying emojis for a good reason though. It's excusable. They left to do their away rotations. So during fourth year you have the opportunity to go to other medical schools and do a four-week rotation in whatever specialty you're considering at a school that you really want to get into or want to explore. So it's a great opportunity. So right now, Bushra and Leen are on emergency medicine rotations away. Far, far away from us.

Harjit: So Bushra's at Duke University in Durham, North Carolina.

Margaux: Okay. We're going to call her.

Chloe: There's a lot of coordination going on here.

Harjit: I know Chloe, this is fancy. It's like a fishy.

Margaux: Hello?

Harjit: Hello.

Bushra: Hi.

Harjit: Hi, Bushra.

Margaux: Hey.

Bushra: How is it going?

Margaux: Sorry, I didn't hear you. What did you say?

Bushra: Can you hear me?

Harjit: Yeah, I can hear you. It's going really good. Margaux's here too.

Margaux: Hey, hey.

Bushra: Hey, Margaux.

Margaux: Hey, how's it going?

Bushra: How are you? How are you all doing?

Margaux: How is it in the South?

Bushra: I didn't realize that North Carolina was the South until I got here. I knew it was the East Coast, but I didn't know it was the South. That sounds a really dumb, but like I didn't know. Apparently, this is what I learned, from Maryland down is technically the South. FYI.

Margaux: Is that the Mason-Dixon line?

Bushra: Girl, [inaudible 00:01:53] everything.

Harjit: What do I know more about it? I never paid attention in American history, so I don't know anything.

Margaux: Anyways, how's it?

Bushra: So it is different here than Utah. First of all, just like navigating where I'm going is different just because Utah's nice and easy. You got that grid lock system to like you wouldn't get lost. But here I'm like using my GPS everywhere, but otherwise I like the city here. It's not like a huge city. It's on the smaller end, but there's like so much to do. It's like a foodie town. It's a little dangerous just because like, you know . . .

Harjit: We love food.

Bushra: Girl, I know me too, but it's the problem. You know what I'm saying? I can't be spending all my money on food.

Harjit: I know.

Bushra: The hospital, like the ER setup is a little different than The U in that we're all in like pods. So there's three different pods, and so every pod has an attending, a resident and then sometimes there's a PA and then a student. So you get to work one on one with the attending a lot, which is really nice. And your patients are your own, and they use Epic here too, which is the electronic medical record. And so I have experience with that from the hospital. And then something that I really appreciated about this program is like the residents really make an effort to like get to know you and like hang out with you outside of the hospital.

Margaux: That's awesome.

Bushra: And they set up things to like let's go to a pub or less or we're having a barbecue. You guys should come over and like they text us and like meet with us one on one for coffee and stuff like that. It's been a really good experience.

Harjit: Awesome. That's so nice.

Bushra: I have really, really enjoyed the sub-I experience here. I just, I've learned a lot and I've been involved in a lot. It's been a good experience for sure.

Harjit: I have a question. What is the coolest thing that you have done?

Bushra: So far?

Harjit: Yes.

Bushra: You guys know I'm a little bit of a trauma junkie though. We got a patient that had like a collapsed lung and bear in mind they were like hemodynamically stable and everything. I don't think they would've let me do this otherwise, but the attending talked me through how to put in a chest tube and that was like my first chest tube I've ever done.

Margaux: Awesome.

Harjit: Wow, that's so cool.

Bushra: Like I had so much fun that day. It was awesome. I guess you put in an IO like drill an inner osseous line into somebody's tibia. Yeah, so like they get you involved, which I really, really appreciate.

Harjit: You'll be good doctor.

Bushra: Yeah, I know, right? That's the scary part. Next year I will be a doctor.

Harjit: That's so cool.

Bushra: It's good to see like pathological processes that you wouldn't have otherwise here.

Margaux: Totally.

Bushra: Yeah, and I can't wait to be back in the studio with you guys again. By the way, what are you guys even talking about today?

Harjit: So today we thought we'd talk about imposter syndrome

Bushra: # relatable.

Margaux: Well, we wish you were here to discuss with us, but we also hope you continue to have a great time in Duke and come back and hang out with us soon.

Bushra: For sure. I'll see you soon.

Harjit: Bushra, can you say your bye-bye?

Bushra: Yeah. Until next time folks, bye-bye.

Margaux: Thank you.

Harjit: Okay, thanks, Bushra.

Margaux: Bye, Bushra.

Harjit: Okay. We did it. We did a girl.

Margaux: Sounds like she's having fun. It sounds like the ED residents are way better.

Harjit: So we are so excited that we got to call Bushra. It had been a while since we talked to her. I think I've talked to her a little bit, but Margaux, this was the first time you talked to her?

Margaux: Yeah, since she went away.

Harjit: So like Bushra just asked us today we are going to talk about imposter syndrome. I think this was a term that I heard of in first year. Margaux, when was the first time you heard of this term?

Margaux: I think I really heard it in first year, but I want to say that I had heard it before . . .

Harjit: You had?

Margaux: . . . in terms of like the grad students that I was working with in my research job before medical school, but it wasn't a concept that I had really like identified with.

Harjit: Can you tell me what your understanding of it is?

Margaux: I was actually going to look this up, and I think you have looked it up. I don't think it's like a DSM five criteria or anything, but it's an actual phenomenon or syndrome where a person feels like they're not qualified to be where they are and so they feel like you don't belong. You're afraid that people are going to know that you don't belong, and so you have a lot of anxiety and fear that you're not where you belong even though you've worked so hard and obviously somebody accepted you into the position that you are in, you still have this like over looming, you still have this weight on your shoulders that you are not good enough.

Harjit: So Margaux, I also had a very similar understanding of what imposter syndrome meant. Exactly like what you said, you know, pretending to be something that you are not deserving of. So I thought, let me actually look this word or imposter syndrome up and see what it really means. So, the definition that I have is, "The persistent inability do believe that one's success is deserved or has been legitimately achieved as a result of one's own efforts or skills." And I think that listening to that definition, it's kind of a similar one that we both thought of.

And I remember when I was in first year of medical school, that term came up a lot where a lot of students were like, "Oh, I feel like I have imposter syndrome." Just like throwing the term around because it was very much like, "Oh, do I actually deserve to be here? Is this really the place that I'm supposed to be? I feel like I'm faking it. I feel like people will figure out that this is really who I am and what I'm doing." And that got me thinking about what it means to deserve something. So I kind of wanted to talk to you about that, Margaux. Like what does it mean to deserve something?

Margaux: That's a really good question. I think it can have multiple levels, but I guess I'll start with the first time I think I sort of identified subconsciously with imposter syndrome was during orientation for medical school when we were meeting our new classmates for the first time and you sort of get to talk to people and learn about their experiences and what research they did or jobs they had or what they did before medical school that led them to get into medical school. And I think hearing all of that kind of makes you doubt yourself and feel like sort of judge yourself against them and be like, well, I don't have that great of experiences.

Harjit: Yeah. I remember literally I'd meet people in, they tell me something about them. I'm like, "Oh my God, this person's amazing. They're my classmate? I actually know them?"

Margaux: And so, yeah, you have this off for other people and I think you have to remember that they probably feel the other way about you. And so, I think that was the first time that I sort of had that mentality of feeling kind of questioning, but at the same time I also thought it was really cool.

Like you just said, Harjit, to hear about the diversity of experiences that our classmates had, you know, anything from traveling to being a ski bum to having like a PhD. And so it was nice to also recognize that like not everyone had the same story. And so, in a way, if you could like bring your mind there, you can appreciate that you were selected because you have unique experiences ideally. That's what the admission process does. But so back to your question, what does it mean to deserve something, I think is really heavy.

Harjit: Yeah. And that's I think kind of why I wanted to touch on because what does it mean to deserve something is heavy and it is multifactorial and it might be different for different people.

And then you also have to understand that when we get something, we're a part of an institution, right? We're a part of an educational institution. There's a medical institution, there's a government institution, there's like so many different institutions that kind of qualify people for they deserve this or they deserve that or they don't deserve this or they don't deserve that. I think it's interesting that we jumped to this conclusion that, "Oh, we don't deserve this." But then to really think what does it mean to deserve something?

And I think that's where the power lies, that we need to empower ourselves to feel like we do deserve the things that will lead us closer to our passions or to be the person that we want to be. You know?

Margaux: So yeah, on a surface level, I think for medical school, what does it mean to deserve is in the application, right? You get the target MCAT score, the target GPA, you check off all the classes that you're supposed to have taken and get good grades in them. And on top of it, you're volunteering at like 15 places and you're doing research. Like I think that's what a lot of people think on the surface level it means to deserve it. But when you think deeper, does that mean that the person who had to take the MCAT three times and study their ass off is less deserving of a spot in medical school than the person who could get a super high MCAT score on the first try? I don't think so.

Harjit: Yeah. And it's all about perspective, right? And that's where I think we even cloud our own lives with perspective in the sense that when I failed my first test to medical school, I was like, I don't know if I deserve to be here. But had that happened to another student, maybe they wouldn't have thought that way. You know? And it's all about our perspective in the way that we see things.

Margaux: But at the same time, there's still this like filter for who deserves it or not, which we've talked about before, the flaws of the application system and the barriers that it presents for people who may be very deserving and passionate about medicine . . .

Harjit: But just don't get that platform or the opportunity.

Margaux: Exactly. So you can check out our other episode. I forget which one it is, but just listen to them all, you'll find it. I think when you get here at a medical school, it's so easy to fall into the trap of like feeling like all the work you've done will never be good enough. I don't know where that stems from though. How have we as a society come up with that?

Harjit: I actually love that you say that statement, Margaux, because I too never really understood. So I got to work with, during my sub-internship I got to work with Dr. Murray. He's the psychiatrist here at the University of Utah. So he was teaching me about Erickson stages of development and he basically was saying, and I think we learned this with Dr. Steinmann, who's our course director for psychiatry as well. There are several stages that you go through and it's not that you complete one stage and you've passed and then you move on to the next. It kind of carries forward.

So if you, for some reason didn't get all of the outcomes of the first stage, they kind of would follow through to the following stages. He said something that was really impactful to me. He said, "Do you remember when you were a kid?" And I said, "Yeah, I do." "Do you remember when you did something? Did your parents appreciate your effort, or did they get angry at you for doing something in the wrong way?" And I was like, "That's such an interesting question." And he said, "Do you notice how some of the colleagues you work with, or you'll notice some even attendings who will be doctors and they'll feel like they're an imposter?"

And he's like, "What is imposter syndrome even?" And it was like, "I don't know, you tell me." Right? Because he's like teaching me this. And he was basically saying that people feel like they don't deserve something because at some point in their life they weren't validated for something that they did. So they feel like they're chasing this thing that I can never deserve this. Like I could never get there.

And he said, that doesn't make sense because they worked hard, they got into medical school, they trained in residency, they have learned medicine, you know, because it is a practice and it's evolving and you kind of grow with it. And he's like, why don't they deserve it? They totally deserve it. Like he was like, I would take my kids to these doctors.

I love how you said that because I think it meant to me that we should have confidence in where we are in our life. There's some reason we're there. And I think his point was we shouldn't be overconfident and think there's nothing to learn but there should be a sense of confidence that, yes, I've gotten to this step. I'm here and this is where I should be. Why should I put myself somewhere else?

Margaux: I really like that. I didn't have the chance to work with Dr. Murray, but it sounds like it was an insightful conversation. My question then is if our propensity for imposter syndrome stems from experiences growing up, how do we change that now? If we had those experiences that sort of set us up to think like an imposter syndrome, how do you, let's just do personal examples, how have you overcome imposter syndrome?

Harjit: The key is to believe in your work. I think that's the key.

Margaux: True, but coming back to psychology, it's easy to say, be confident. You know, we can say that now and we're calm, but you can go 10 minutes now and be surrounded by colleagues and have that feeling. How do you pull that out of your subconscious into your mind to make it be present with it? I think that's something that's really hard to do.

Harjit: It is 100% difficult and I won't say I have mastered this. I will promise you I still question things like, "Oh, you know, I'm in fourth year of medical school. How did I make it so far?" Like it's not an on and off switch. Definitely not. This isn't like a black and white thing, but it's a process and that's, I think, again, coming back to psychology, everything is a process.

And I think the largest thing is we need to shift systems, which we've been talking about since day one. That's how we eradicate the problem but how do we work on the issues now is by discussing them and then thinking about them and being aware of them. And then that daily practice of just reminding yourself, I feel like that's the process that we need to go to.

Margaux: So what do you tell yourself every day?

Harjit: So what I usually tell myself every day is whenever I have that thought creeping up in my head, I'm like, okay, I thought I've had that thought. Let me pause, let me take it in. Let me think about it. Then I usually, because I don't know if this is maybe this "scientist" in me, but I like logically go through it and I'm like, but okay, I don't know how to do this one thing, but I'll learn it, right? And I can get good at it if I just practice. Remind myself that there is a process and that I shouldn't let my doubt shadow the work I've put in.

Margaux: I think that some people tend to be more logic thinkers like you and I would say that's the same for myself, but I also understand that being more emotional or I forget what the other words are for the test that we had to take, but I would just say it's also okay to, you know, experience those emotions and then recognize them later.

That's what a lot of people have to do in the beginning, is sort of go through the whole roller coaster, right? You may go to orientation for medical school and feel, you know, really down on yourself and feel really overwhelmed and like an imposter and not recognize that that's how you're feeling until maybe like a month or two out. You know what I mean?

Harjit: No, it does.

Margaux: It might take a while to recognize that you're actually have imposter syndrome reflection. Self-reflection is always a good thing and if it works for you like writing down, you know a quote like Harjit was saying, telling yourself like I am enough or think logically about your emotions. Just some little reminder written somewhere on a sticky note in your bathroom or in a journal or on your book or on your laptop somewhere where it'll like actually trigger you to start thinking about it and your emotions can be a good way to reflect back because I think it's really hard to be in the moment, have those feelings and actually recognize that you're undergoing imposter syndrome.

Harjit: Yeah, and Margaux, I do like how you say that it does take a lot of people time and space to process things. And when you asked me that question that, "How do you go through this every day?"

I will tell you that this is my fourth year of medical school. I had this whole like what does imposter syndrome even mean when I was a first-year medical student. So it too has taken me a lot of time to get to this position. I will say that I'm not there, I'm not fully there. And like I said, I still think about this thing. I still do. I still question do I deserve this? Like why am I different? Why did I, you know, get this opportunity versus everyone else? But then I remember that everything again is a process. And I think I've said this word a couple of times is that it's a process to get to the point where you feel like you deserve what you deserve in life.

Margaux: And even what you deserve, what you want and what your heart has and like your passion.

Harjit: Right, exactly. And I think that a lot of it is again, clouded or complicated by our identities, right? I think in general as women, correct me if I'm wrong, Margaux, but I feel like as a woman I have always felt like I have had to do an extra thing to just deserve something or maybe because I didn't get it when I just did the bare minimum.

And I think even as a person of color, I have that feeling a lot too. I think it takes a lot for me to feel like I deserve something or not deserve something. But as I have deconstructed, you know, my thoughts and my understanding of what it means to be a woman in medicine, what it means to be a woman in this country, what it means to be a woman in this world or what it means to be a person of color in America, I think that step-by-step helps me and reminds me of why I deserve to be where I am. But it's not something I was born with.

Margaux: Imposter syndrome. I would say everyone experiences throughout their life, no matter what career you're in or what stage of life you're in, people experience imposter syndrome. It's okay to experience that. Don't be hard on yourself for it. But like we've been talking about, I think it is really important to self-reflect, identify what you really want in life and actually in going through applications right now, Harjit, writing my CV has probably been one of the best things to help with my imposter syndrome because like you said, now it's been four years in medical school and I've looked back and I'm like damn, I've actually done a lot.

And I think we don't every day take into consideration all the little moving pieces that we do. But when you write it down and you have it all in front of you on a piece of paper, it makes it a lot easier to appreciate how far you've come and all the things that you have done and accomplishments you've achieved.

So I think what's also great is just kind of looking back and reflecting on the positives of what you have done and don't compare it to anyone else. Just say, look what I have done. And if you're a first year and you look at your CV and you're not happy, well, look in your heart. What are you passionate about? What do you want to see on that paper. Not what other people want, what do you want?

Harjit: Right. And then I think Margaux, the advice that you gave of actually writing things down is so powerful because now that we are, I also have gotten that feeling like, "Oh, I actually did do this and I did do this." And I think that's important to remember and also do all our listeners, I think that something that we've been reiterating in this episode and also in our podcast is just really know what you want to do in life and what you want to be, work for it and then believe in your work. Trust your work because your work is just as important as anybody else's.

And I think sometimes there's hundreds of different paths to get to your goal and every person has their unique path and it doesn't need to match another person's. And so just follow your path, follow what you want to do.

We actually had a follower on our Bundle of Hers Instagram page that shared an experience of them feeling like an imposter. So, this is what Emily Callie Howard has to say. "I'm currently trying to finish my bachelor's so that I can apply to medical school. I'm a nontraditional. I was an accounting major. I'm a mom. I'm a wife and I work a full-time job. It's obvious there's a lot of stumbling. I feel like an imposter almost every day. It's hard to go down this path and have people take my goals and dreams seriously. Maybe because I'm a female or because I have a family. I didn't do so well my first go around in college, but I wasn't passionate about what I was doing. Now I am passionate, but it's a steep climb to get to my goal. It's definitely hard to constantly remind myself of the goal and that I am capable and deserving for a chance."

We want to thank Emily so much for sharing this experience. And I think it really gels well with everything that we talked about in this episode about what it means to deserve, about being passionate about what you want to do and really going for it.

Margaux: You go girl, Emily. Another thing I think kind of goes with this imposter syndrome is our sort of motto for a Bundle Of Hers, which is stumbling gracefully through medical school because nobody does it perfectly. Nobody is marching beautifully through medical school. We are all stumbling some more gracefully than others. But in honor of this motto, we've made pins that you can put on your white coat or whatever.

Harjit: They are so cute. Not just self-endorse but they are so cute.

Margaux: They're super cute. We love them. You can check them out on our Instagram. We have a post-up with one of them. Yeah. Let us know if you want a pin. Also, if you have anything to add your own story about feeling like an imposter or anything else that you would like to hear about or spark a discussion about, we'd love to hear it. We love, love, love, all the love you guys give us on Instagram or social media. Check us out at Bundle of Hers.

Harjit: Bye-bye.

Margaux: So sad.

Harjit: Sorry. Okay, Bushra, I can't do it like her. Bye.

Margaux: Bye-bye.

Harjit: See you later, alligator.

Margaux: There you go.

Chloe: Cut and paste Bushra in it.