Imposter syndrome, exponential growth, and finding a voice: Reflections on intern year

“I’m not sure I’m prepared to carry that many patients. Would you mind helping me out to start?” I sheepishly probed my upper level resident, nervous to start my first month on the pediatric wards. I had never carried that many patients on my own in medical school and now I was expected to be the frontline physician for double the amount of patients I was prepared for. I crossed my fingers, hoping that my upper level and my attending would be forgiving.

At the beginning of intern year, in June 2020, I was still drowning in thoughts of inadequacy and wondering when my supervisors and program leadership would find out I wasn’t meant to be here. The thoughts were like water swirling around a drain or cosmic debris orbiting a black hole, waiting to inevitably be sucked into darkness.

Thoughts like: ‘I can’t believe I was chosen to be in this program… Did they really mean to pick me?’ ‘Did they only pick me because I openly identify as gay? Could I be their token diversity recruit?’ ‘I am not prepared for this. My patients are not going to be safe with me as their doctor.’ ‘As a DO, am I as good of a doctor as my MD colleagues? Am I meant to be with all of these highly intelligent people?’

‘I can’t believe I was chosen to be in this program… Did they really mean to pick me?’

‘Did they only pick me because I openly identify as gay? Could I be their token diversity recruit?’

‘I am not prepared for this. My patients are not going to be safe with me as their doctor.’

‘As a DO, am I as good of a doctor as my MD colleagues? Am I meant to be with all of these highly intelligent people?’

These thoughts continually cycled through my mind, over and over and over again. I began my intern year of pediatric residency with many doubts and insecurities. Little did I know at that time how transformative, enlightening, and reassuring my first year as a physician would be.

Over the course of the year, I obviously gained quite a bit of clinical acumen, but it was the non-clinical lessons that truly fueled my growth and self-actualization as a fledgling physician. I few overarching themes emerged as I progressed through my clinical rotations and as I explored the different aspects of physician-hood. I’ve boiled these themes down to the three outlined below. I hope that this essay will serve as a source of reassurance and hope to those following in my footsteps. To the incoming interns and medical students advancing, I hope you find comfort in these words coming from someone who is waist-deep in the trenches of residency.

“I hope that this essay will serve as a source of reassurance and hope to those following in my footsteps.”

1. Imposter syndrome never goes away… and that’s okay.

As you could probably deduce from this essay so far, I came into residency with an overwhelming amount of imposter syndrome, and that feeling didn’t go away overnight. In fact, it never went away at all. I have learned that vulnerability is a highly valuable skill that can be utilized to connect more deeply with others. In being more vulnerable as a physician-in-training and expressing my struggles with imposter syndrome to mentors and colleagues, countless of those people identified the persistence of imposter syndrome through out their own career. Many of those people lamented about how imposter syndrome never completely dissipates; it lingers like a storm cloud full of fresh rain, waiting to release the torrent.

In becoming more comfortable with my own vulnerability, I have discovered that, although imposter syndrome never abates, it is possible to have those feelings and to live symbiotically with them. I have found comfort in knowing that I will never, ever, know everything there is to know about pediatric medicine and I will never be the perfect physician I dreamed of being. But, that does not diminish my strengths and my commitment to evolving and improving over time. The perfection of this career lies in embracing our own vulnerability and insecurities and knowing that it’s perfectly fine to ask for help or to second guess ourselves as clinicians. We are humans, after all: fallible, imperfect, and damaged to some degree. But these imperfections make us more relatable, make us more empathetic, make us more passionate. I believe we are better physicians because of our imperfections and imposter syndrome does not have to be an inhibiting factor to our success.

“The perfection of this career lies in embracing our own vulnerability and insecurities and knowing that it’s perfectly fine to ask for help or to second guess yourself as a clinician.”

This brings me to the next pervasive theme of my intern year:

2. Growth as a physician is exponential, but not unmanageable with a growth mindset

Especially during intern year, the learning curve and growth trajectory really do approach exponential increases. It felt overwhelming many times to face the fact that things were happening so fast and my job as an intern was not only to keep up with the growth but to ensure the best care for my patients.

One of my mentors reminded me that embracing a growth mindset really is the key to succeeding, not only in medicine, but in life generally. Learning and developing experience overtime require us to be inquisitive, to embrace challenges, and to learn from setbacks and criticism. The hardest part for me this year was learning how to accept and incorporate criticism without letting it wear down my self efficacy. Retraining my mind to embrace criticism as a natural part of my career growth and a stepping stone to attaining higher levels of competence truly released some of my inhibitions and allowed me to gain a deeper understanding of myself.

“Retraining my mind to embrace criticism as a natural part of my career growth and a stepping stone to attaining higher levels of competence truly released some of my inhibitions…”

Again, in owning my vulnerability, I have been able to create a safe mental space for myself to make mistakes, to incorporate criticism into my future actions, and to forgive myself for not being perfect. Vulnerability has allowed me to adopt a growth mindset in any situation, to persist in the face of adversity, and emerge a stronger and more well-rounded human being. Moving forward, I know there will continue to be difficult times and roadblocks, but I feel more prepared to face them with confidence and humility.

Sitting comfortably with my own imperfections and being vulnerable has opened up many doors for me to be a positive representation for others, setting the stage for my final and most important revelation:

3. The title comes with a(n) (in)credible voice

The most influential discovery that I made over the course of the past year was that I have a voice more powerful and credible than I give myself credit for. With imposter syndrome and self doubt comes second-guessing my own credibility as a physician. I think it is common for new physicians-in-training to feel as if they are not qualified to express themselves on issues in medicine as “the expert”. I came to realize that I am an expert and that my voice as a pediatrician carries a significant amount of weight when heard by the right audience.

I explored multiple avenues for advocacy this year, utilizing my voice to affect change in large scale arenas with which I previously did not feel comfortable engaging. This included a multitude of advocacy pathways, such as writing, speaking, leading, and collaboration. It wasn’t until I embraced my power as a pediatrician and my influence on topics about which I am passionate, that I began to gain confidence as a physician advocate. This confidence also spilled into other areas of my life, both within and outside of medicine. Having these avenues for advocacy and pursuing passion projects in medicine through out intern year brought me back to my “why” and the core reason I became a pediatrician in the first place. It also carried me through the tough times that otherwise might have led to burnout.

“Having these avenues for advocacy and pursuing passion projects in medicine … brought me back to my “why” and the core reason I became a pediatrician in the first place.”

To anyone beginning their career in medicine, and particularly those looking wide-eyed at the darkness to come in intern year, I say this: You are here for a reason, your strengths will carry you through, and your power and passion as a physician will keep you grounded. Residency is difficult, there is no doubt about that. It doesn’t, however, have to be a black hole of stress and uncertainty. There is light and goodness, and you as a trainee have the power to change (and save) lives while growing, leaning into your confidence, and learning about yourself.

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