S5E6: The Different Manifestations of Confidence

Leen: I love how when she's cold-opening and I just can't remember anything.

Mariam: I know. I was literally like, "Well, I don't know how to have conversations."

Leen: Say something controversial and then it'll get me to start talking.

Harjit: What are your thoughts on pineapple on pizza?

Leen: I don't really care.

Harjit: I love pineapple on pizza.

Mariam: I think it's good. I think people who like pineapple on pizza are the people who like to party.

Harjit: Yes.

Mariam: They like a good time.

Harjit: They do like a good time.

Leen: Okay. Welcome back everybody to another episode of "Bundle of Hers." In the virtual studio, we have Harjit, and we have Mariam. Woop-woop. Okay, great. So today, our topic . . .

Harjit: Woop-woop.

Leen: Thank you. A little late. It works. Today, a topic that I wanted to talk about is something that I think really bugged me in medical school, as many topics that I love to talk about on "Bundle of Hers," right? This is the platform for that. But this one especially because I think I never really understood it. People would give me this feedback and I would be like, "I don't get it. I don't understand. I think I'm pretty confident." It'd always be the feedback that, "You're not very confident." They would say that in many different ways. So this topic today is going to be called the different manifestations of confidence and what our experiences have been with that.

I know originally I was trying to see is there even any data out there that describe different forms of confidence or anything of the sort? Because it seems like when you're in medical school and you're on the wards, even in residency, people are like, "Oh, you have to act a very certain way." So I'm like, "Where's a certain way documented?" Guess what? I can't find it documented anywhere.

In my experience so far going through all of this, I guess, to get to where I'm at, I've always been told, "If you're going to be a leader, you need to be the head of the bed," or the foot of the bed, I guess, depending on the situation. But, "You need to be able to stand your ground, be really serious, take things seriously, talk to people seriously," and all these things. And it just really takes the characterization of yourself out of it.

I would always get feedback, "She's always nervous," or, "She's timid," or something of the sort. And then sometimes I'd get completely opposite where it's like, "Oh, she's actually confident." So I'm like, "What is this? Nobody really knows what the heck they're giving feedback about at the end of the day."

That's why I want to have this conversation. I want to tell people that there are different forms of confidence, they exist, and we to start being open to them.

Harjit: Yeah, I'm really excited that we're talking about this today because I want to say a common feedback that's given to us as medical students is, "You need to work on your confidence." And this also has a whole conversation about feedback, which we can have another day, of how to give it and how to receive it and how that changes.

But I've been thinking about this a lot too because I'm like, "What does confident mean and what does it look like?" And I think often it's what the majority thinks it looks like, or let me be quite frank, it's what a white man does.

We live in a system where, let's be honest, is white supremacist. And so that's kind of what we have to aspire to be. And that's where I think the whole idea of everyone just is going along with everybody else. And if anything is slightly different, that's in ways punished.

And I say punished because I think evaluations are viewed very much as like, "Let me tell you where you need to correct yourself." That then reinforces the way a person should be and it further deteriorates people from being their authentic self.

Mariam: I completely agree with all of that. It's funny that you mentioned embodying white supremacy or embodying a white man as a form of confidence, because I was thinking a lot about this, even just in my preclinical years as a second-year med student. Consistently, every single time I get feedback from a facilitator in one of our small groups, there's always the feedback that I need to be more confident.

And initially, I take that feedback and I'm like, "Okay, I just need to take up more space. I need to speak up more." All things that I feel like are valid. But at times, I almost have to take a step back and kind of wonder, "Who am I trying to embody when I am taking up this space?"

Harjit: Mariam, I completely agree with what you said. I also think about what's so interesting is when I was always given feedback about confidence, it was, "It seems like you know your stuff, but you're just not confident." And then my question is, "If I know my stuff, why is that a bad thing?"

Mariam: Yeah.

Leen: Or why you're not confident.

Harjit: Yeah.

Leen: As a person, if you know your stuff, you know you're going to be doing whatever that is, why is your personality manifesting as who you are in that moment not considered confident? It bugs me so much.

Harjit: Yeah. And I think the reason that feedback was given because people would be like, "Oh, people won't listen to you. They won't take you seriously." And then I was like, "Well, then we all need to start reimagining people in these positions."

And if we all just go along with what's been happening for years, is that the right thing to do? That's what I think about all the time. That's me actively questioning that role and being like, "Okay, that makes sense. People won't take me seriously. But maybe we all collectively need to change the way we view what confidence looks like."

Mariam: And I think that's kind of the tricky thing, because what I've noticed is confidence, especially in medical school, just being a student, it's really shaped as the confident people are the go-getters, the ones that jump onto opportunities, that know how to pad their resume, who know how to speak up, who know all these things.

And going into medical school, a lot of people aren't like that. A lot of people get their confidence from other sources, right? It's not just about being the one that's always outspoken in the room or always has the right answer. But I think right away in medical school, you're taught that to get ahead, and I'm using quotes here, you have to be that person. You have to be the go-getter. I think in a lot of ways it's kind of toxic.

Leen: Exactly. And I think that's where we tend to struggle with the whole idea of how you can fight having imposter syndrome. The imposter syndrome to them is counter to not being solely what I imagine when you walk down a corridor in a medical school where there are photographs of the 1800s medicine. White men, all in a room, standing there in suits and they look like they're only giving you matter-of-fact statements to one up each other to deduce something, right?

It's like if you don't have that, then you're not going to feel adequate enough, which then leads to this imposter syndrome. Then they start labeling you with imposter syndrome. And then when you start become a resident staff, they're like, "Oh, why would you have this? You have the title, you have the place, you have the degree. So why do you have this?" And it's like, "Because my entire career so far has been deduced as, 'You're not what we perceive to be a confident image in medicine.'"

Harjit: Yeah, I completely agree with that, Leen. Thinking a little bit more, I guess I never had made that connection, but yeah, I'm thinking about that too. When so many people struggle with imposter syndrome, but a part of me is like, "How much of that is embedded into us?" It makes us start questioning why we're here and what we want to do and who we want to become.

It's really interesting because there are many forms of confidence, I personally believe. You can know stuff, do stuff. You can only talk about things. And I think that's where the focus always is, is how do we speak? But it's not very much of how we think and how we become critical thinkers.

That is honestly where I really struggle with the way our culture in medicine is, right? We take away the beauty of critical thinking and it's all about the speaking. And that's why you'll see some people rewarded for speaking, and people who critically think and maybe try something in a different way, they don't get the rewards that they should receive.

Mariam: Harjit, I'm kind of being reminded of something that you told me a few months ago. And I think I had voiced these frustrations about how in medical school, I've noticed people have no trouble speaking up, but the actions aren't necessarily matching what they're saying.

Harjit: Right.

Mariam: Harjit, you said something really interesting. You were like, "Mariam, people in a lot of different spaces, especially in medical school, act out of ego." And I think that's so interesting to kind of think about because I think confidence, at least the way that it's shaped in medical school, is about acting on that ego. And that's something that I've noticed even within myself.

I'll just go ahead and disclose I think last year, that pressure got to me, getting that feedback of, "You need to be more confident." And so I noticed myself trying to take up more space in a lot of different capacities as a medical student.

I think something that manifested out of that pressure to be "more confident" by these standards was rooted in ego for me eventually because I wanted to prove that I belonged in this space, even though . . . and, Harjit, you remind me of this a lot . . . we do belong here. We're really smart. We deserve to be here. Why do we have to prove that?

A lot of how I started taking up space, especially by the end of last year, was through ego. And I realized how inauthentic that was to me and how I wanted to be in medicine.

Harjit: Mariam, I now am remembering telling you this, but I forgot that I told you this. But yes, oh my gosh, now I'm having so many epiphanies, because that's completely true.

A lot of it is like, "What can I do? What can I show?" It's a lot about the performance. It's a lot about, "Let me show you what I know because I am so smart." But it's not like, "There's an issue or there's a diagnosis that needs to be reached. Let me think about it. Let me see how every factor is connected to another factor."

I think we are talking about this. We started this conversation. Leen and I have been through clinicals. But honestly, this is started and cultivated from preclinical years, like you said, Mariam. And we see this a lot in groups and extracurricular activities and research. Apparently, that shows confidence because you need to prove that you started some organization.

This goes back into the conversation of ticking the boxes. It goes back into the conversation of "Let me do something to show something" rather than "Let me do something because I feel like this is authentic and this is who I am."

Leen: And to a degree, I actually want to extend it to say that it is discriminatory. Here's the thing. In one culture to show yourself egoistic and say that you're better than others is actually a very negative thing in another culture. And it doesn't even have to be culture. It can be background, personal experience, family, life, whatever.

For you to say, "Oh, this person knows what they're doing and this person does not, and that makes this person confident, and thus that person not," is very discriminatory, in my opinion. You're not accepting the fact that there are different ways of thought in terms of presentation, in terms of whatever.

When you try to fit into these boxes, you end up almost challenging your authenticity. You end up challenging it, and eventually, it becomes a matter of survival for you rather than it becomes a matter of trying to show off who you are.

It becomes oppressive to yourself. You're now going through med school miserable that you're not as good as everybody else. You think this negative talk to yourself. You end up going into a spiral, like, "I'm not good enough. I'm not making the cuts. No matter what I do, whether I know the answer or I don't, I'm not getting the evaluations saying that, 'You're it.'"

Harjit: And that, in turn, impacts your confidence. It's like this whole spiral of rather than building up your confidence, you're building down your confidence.

Mariam: And I think something I've noticed even just within medical school in general, and I think this is just any medical school program, they really emphasize you putting a brand on yourself. Some things that I've noticed in school, I'm the refugee health expert. I'm the underserved, rural, things like that. And what I've also noticed is there's less of an emphasis on the lived experience and more on, "What can I put on paper?"

Leen: Lived experience scares people.

Mariam: It does.

Leen: Because it doesn't show the confidence that they know. It doesn't show the expertise that they know. Like, "Oh my gosh, is this really what's happening?" No. We need to quantify and box it into a way that we understand it in the form of traditionalistic methods that we have in medicine. If it's not on a paper, if it's not on an article, if you're not standing at a podium in a suit and trying to be matter of fact, oh, no, what is this experience you're telling me?

Mariam: Exactly. It's not palatable to the system. And it's something that I think about a lot because what I've noticed, even just in my preclinical years, we'll talk about social issues in medicine and the people who are the most outspoken in my class are the ones who are not impacted. And the people who don't speak out about these things are the ones who are just trying to get through it because they have been impacted.

I think about this a lot because I'm always asking myself, and I know the answer, "Who's going to be the better advocate for are patients who are truly underrepresented and underserved?" Is it going to be the person who, yes, is outspoken, but doesn't know that lived experience? Or is it going to be the person who does know that lived experience? I think we all know the answer to that. It's the latter.

I think I struggle because medical school is such a bubble. It is a very privileged bubble. And I think we all have learning to do, we should all approach this work with humility, but it's become such a trend in our program, or just generally in our training, to be these "experts," to brand ourselves, to match into good programs.

But what is that really doing in the long run? How are we actually going to be advocating for our patients? We don't really know what they're going through.

I mean, this whole branding, focus on appearances thing, I think it really gets to me. I think I'm on one right now, because there's a lot of that emphasis, especially now. So for my class, the class of 2024, our first board exam is pass/fail. So there's this huge emphasis on looking good on paper, to be competitive now. People are worried about publications. People are worried about extracurriculars.

That whole part of the process feels so inauthentic because then there's this emphasis on, "Oh, I know, for example, refugee health," or, "I know how to add for POCs in medicine." But it's so inauthentic because it's all about looking good on paper

Leen: That's going to end up being damaging to our patients, I feel.

Harjit: And this is actually, again, a perfect reason for everybody to listen to the last episode on research. This is exactly what we talked about, exactly the same theme.

I kind of want to go back to what Mariam said about this pressure to brand. In my opinion, I think the word branding is very oppressive because it's almost like, "Let me show you off and sell you," rather than not being branded, but just being your authentic self and showing the world who you are.

Medical training "tries to increase our confidence," but indirectly, or maybe it's direct because of systems, they make us less authentic and just like one another.

But let me remind you the way that problems are solved. May it be diabetes and insulin was invented, or penicillin was invented for infections, someone had to think differently. So if we all had the exact same thought process, we will not grow as a field. At some point, we will stop.

But I think the reason we don't stop is there are always those people who challenge this thought. And I hope that that's us. I hope that we are starting this process of challenging people, but it's very difficult.

I guess what my struggle then becomes is it's always the people that are marginalized, be it by any variety of their identities, that are then having to work extra freaking hard just so they can be their authentic self and challenge the thought of medicine so we can progress as a community.

That's the thing. I think a lot of us think about things in a communal way rather than "How will this make me better?" We think, "How will this make our communities better?"

And that's what I challenge our listeners to do, is be that person who thinks different, be that person who rejects brands and is authentic, and be that person who knows they're confident even if people say they aren't.

Leen: And I believe that there are forms of confidence. It's not all about the matter-of-fact confidence. Like I said, there's a timid confidence. There's even an anxious confidence. You can be an anxious person at baseline, but you can still be the leader you need to be and people will still look up to you for that.

I want to get that out there. Through whatever little change we do throughout our day with people, we need to change that system.

Mariam: Yeah. That was really, really well said, Leen.

This had me thinking of something that I told myself before I started med school, because the Mariam before med school was really wise, and I think sometimes I forget that. But I told myself that I never wanted to lose myself in this system. And I stand by that. I think it means something different now than it did before med school, and I think that will continue to change its meaning throughout my training.

But I think overwhelmingly what I mean by that is if somebody tells me that I'm not good enough or I need to change this fundamental thing about myself, that person is irrelevant. Because while this process will challenge me and make me grow, I don't want to lose myself in that training.

I think about this a lot because they talk a lot about physician burnout and mental health in the healthcare field in general. I mean, there's a lot of physician burnout. We're all going to experience physician burnout in this system. But what I don't want to do is lose myself to this system, and that includes the confidence that I have in myself baseline even before medical school started.

Harjit: I just want to urge our listeners, and even within our own "Bundle of Hers," I think a lot of us have struggled and will continue to struggle with evaluations that tell us that, "You're doing a great job, but you're just not confident." I want everyone to remember feedback is a person's perception of you. So always, always, always remember that that person's perception may not be 1000% accurate.

I will say, yes, it's important to speak up about your needs, advocate for what you know, and also get things done, but it doesn't have to look the way people want you to look.

And let me also remind everybody who's in training, me included, we are in training. We are learning. We are not supposed to know everything we need to know the first day we're on a job. This is just like any other craft. It takes years to perfect. It takes years to think about. And when we do get that feedback from anybody, we should always think, "Who is the feedback coming from, and how can I make myself better for my community and for myself?" rather than, "Oh, this is a feedback and now this is my destiny."

I think a lot of us then just feel like this is who we are. We are not confident. We're not going to be good doctors. And we're just going to continue to suck because everyone thinks the same thing.

I think that we also need to challenge what people tell us. And I just say that because I remember when me, Leen, Bushra, and Margaux were med students, there'd be countless times, Leen, that you would come and talk to us about the feedback you got and you would feel so sad.

And I just remember thinking when I saw you in pain . . . First of all, because you're one of my best friends, it would make me really sad, but also I can't believe that someone's words are breaking down one of the most authentic people I have ever met. That is what makes me sad.

We need to stop in a sense crushing who we are and we need to start collectively knowing that through our training, we will become knowledgeable and we will become good at our jobs if that's what we focus on. And our focus really should be being good at what we do rather than what can we show people.

Mariam: Harjit, I really like that you emphasize this collective aspect of feeling confident, because just even in medical school in my preclinical years, I felt the most confident when I met you guys. I feel the most confident when I have my community supporting me and reminding me of who I am.

As much as I try to internally validate myself and how that's really important to get through this process, we do need external validation.

Harjit: Oh, 100%.

Mariam: Especially those of us who are underrepresented in medicine. I can speak for myself. I do need to hear from other people I'm doing a good job, but I need to hear it from people who know me. Physicians who are evaluating me aren't always going to know me, my professors aren't going to know me, my peers in school aren't necessarily going to know me, but having that community that I can go back to, they know me and they can validate me.

And so I just wanted to put that out there because this level of confidence, it's not just an individual process. It's something that we gain collectively from each other as well.

Harjit: Yes.

Leen: Absolutely. And that tells to the power of having representation for . . . not necessarily to mirror. I don't think anybody is quite the same, but for you to relate to and say, "Oh, my gosh, there's a person who maybe somewhat has the exact same mannerisms, talks the same way as I do, thinks the same way I do, and look at where they are." That is so important.

As a med student, I didn't have that at all. I think that is the most amazing thing about community and sense of representation diversity that we need to start really pushing for more in medicine. We need it. We need to do it because at the end of the day, it's damaging. It's soul-crushing.

I like the word Harjit used, like crushing your soul in a sense. And immediately what I thought is, "Don't crush your authenticity for the grind of medicine." It's not what it's supposed to be.

I was never quoted on how much I know. I was always quoted on my personality. And now I'm actually quoted on what I know, and then they tie in my personality.

If now I have both those statements, the first statement that I so yearn to hear for so long tied to the second statement that I hear every single time I get an evaluation, there's no point.

Be yourself. This confidence is not going to be something they understand, and you're going to be the pioneer of it

Mariam: Yeah.

Harjit: Yeah. I think the ultimate confidence is that we are choosing our own path, and us just being here every day is confidence. And that's something I think everyone needs to be reminded of.

Mariam: Yeah, for sure. Leen, when you were talking about that feedback, I was just thinking, "Would she have gotten that feedback if she wasn't a woman of color?" I get so angry we're so subjected to that type of feedback too, right? I could be acting the same exact way as a white man and get fantastic, phenomenal feedback, but get this really sexist and racist feedback based on how people perceive me in their own biases about my identity.

And it just frustrates me so much, because I think we see it because we see it all the time in how people interact differently with certain types of people from different backgrounds. It's really frustrating, and I think it's also a really important part of this conversation.

Leen: No, it's exactly that. I'm sure we've all heard, is, "Oh, by the way, remember you are also a woman in medicine, so people are going to talk down to you. So you've got to step it up and be different." I always think about that statement and I'm like, "Okay, fine. I'm a woman in medicine. Maybe people won't respect that, but that's a them problem, not a me problem. I'm going to go in there the way I am." And it'll be amazing how much you connect with people on that level and they will start talking to you.

Harjit: Why are we taking away femininity out of medicine?

Mariam: I went to this really interesting event. We were talking to some female physicians. It was like a panel-style. And they got a question from the audience like, "How do you deal with sexism in medicine?" And they were like, "You just have to speak out, take up space," blah, blah, blah. And essentially, the answer was, "You need to act like a white man."

Harjit: Let's circle back to the very first thing we talked about in this episode.

Mariam: But really, there is just this . . . they want to push you into acting like this person that you're not. I couldn't act like a white man and be my authentic self. I'm not afraid to take up space and advocate for myself and what I believe in, but I'm not going to do it just to prove that I'm worth something.

And I think that advice . . . it was funny because when that physician said that advice, I think a lot of people really related to that advice. They really loved that advice. A lot of people were applauding and I was just like, "Wait, what? This doesn't make any sense." I think it just goes to show the different experiences in medicine and how we perceive confidence.

For me, the answer is not aspiring to have all the power, all the individual power, right? For me, it goes back to feeling like I'm in a community and feeling confident with my people in this profession.

Harjit: Yeah. That's perfect, Mariam. We want to heal together. Our confidence is healing.

Mariam: Yeah.

Leen: Completely agree. And there's something that Harjit always says that I absolutely love, and it's "be your truth." I think this is a big part of it.

And with that being said, I know that this conversation is definitely fiery and we talk about it all the time in medicine. It's something that I hope that we'll continue to talk about as we go through these new seasons "Bundle of Hers," as well as outside. And I hope we start to spark conversation outside of this as well.

If anybody has any experiences where you feel like, "Wow, that was more towards personality, towards my confidence, and what does this mean?" definitely share that with us. You're not alone in this. It can definitely put a toll on your mentality. It can put a toll on your . . . it can exhaust you.

Mariam: I always tell myself I don't need medicine. I don't need to be in this field, but medicine needs me. So if you ever feel like you don't belong in this space, trust me, you do 100%.

Leen: And with that, thank you everyone for listening to this very passionate episode. We hope that you will help us continue the conversation. Reach out to us. Connect with us at bundleofhers.com, or wherever you get your podcasts. We're also on Instagram @bundleofhers. Goodbye, everyone.

Harjit: Bye-bye.

Mariam: Bye.

Leen: Say that bye-bye with confidence.