10-31-24 MEDG: Overcoming Imposter Syndrome: Strategies to Promote Belonging in Medical Education with Aba Black, MD, MHS

Transcript

• 00:00Everyone, and thank you so
• 00:01much for coming. Happy Halloween
• 00:04to those who celebrate.
• 00:06We wanted to let you
• 00:07know that, we'll be recording
• 00:09this session for our colleagues
• 00:10who cannot be here live.
• 00:12My name is Jeanette Tetrault,
• 00:13and I currently serve as
• 00:14the vice chief for education
• 00:16for the section of general
• 00:18internal medicine.
• 00:19And our section's delighted to
• 00:21come back together,
• 00:23with the Center for Medical
• 00:24Education for one of our
• 00:26co hosted GIM
• 00:28Center for Medical Education,
• 00:30medical education discussion groups for
• 00:32the academic year.
• 00:34And we're absolutely thrilled to
• 00:36welcome GIM's own Doctor. Abba
• 00:38Black,
• 00:39who wears many hats, but
• 00:40she serves as the associate
• 00:42program director for diversity and
• 00:43inclusion
• 00:44for the residency program and
• 00:46a vice chief in our
• 00:47section for diversity, equity, and
• 00:49inclusion. And Janet will formally
• 00:50introduce her in a moment.
• 00:53But please do check out
• 00:54the Center for Medical Education
• 00:56website for a full calendar
• 00:57of upcoming events.
• 00:59Our next GIM co hosted
• 01:02session will take place on
• 01:03March twenty seventh,
• 01:05where we'll be welcoming doctor
• 01:07Elizabeth Gausburg from Harvard Medical
• 01:09School to speak with us.
• 01:11It's truly another can't miss
• 01:12event, but, without further ado,
• 01:14I'm gonna turn the virtual
• 01:15podium over to
• 01:17Janet to introduce,
• 01:19Abba.
• 01:21Terrific. Thanks a lot, Janet,
• 01:22and I feel honored to
• 01:24be introducing. We Thank you.
• 01:26All of you. Oops. Someone
• 01:28has to be muted there.
• 01:29To introduce you all to
• 01:31Abba. And yes. So she
• 01:33went to medical school at
• 01:34University of Rochester,
• 01:36and then she was in
• 01:37our first cohort of our
• 01:38master's program, our MHS in
• 01:41medical education.
• 01:42And her scholarly work and
• 01:44scholarship is outstanding, I have
• 01:46to say, especially around the
• 01:48issues of diversity.
• 01:50She's an assistant professor in
• 01:51the Department of Internal Medicine.
• 01:53And as Jeanette highlighted, she
• 01:55is the associate program director
• 01:58for diversity, equity, inclusion
• 02:00in the residency, the primary
• 02:01care residency.
• 02:03She's also the vice chief
• 02:04for diversity, equity, and inclusion
• 02:07in your general internal medicine
• 02:10division.
• 02:11Again, she's the director of
• 02:13the DEI and vice chief
• 02:14of the department in internal
• 02:16medicine. So, Ava, you do
• 02:17wear many hats, and I
• 02:19feel so proud that you're
• 02:21not only wearing these hats,
• 02:22but doing tremendous scholarship
• 02:24and research in these areas
• 02:26and really disseminating your work.
• 02:30She has been very involved
• 02:32in our Center for Medical
• 02:33Education, has done many talks
• 02:35here,
• 02:36regionally and nationally,
• 02:39around bias
• 02:40and, of course, the hidden
• 02:42costs implicit in bias training.
• 02:45So she's really well recognized
• 02:48with
• 02:49a very strong emerging national
• 02:51reputation.
• 02:52She worked a number of
• 02:54her articles with,
• 02:55Dowan Boatwright, who's now at
• 02:57NYU,
• 02:58when you look back, of
• 03:00understanding sort of workplace experiences
• 03:02of minority residents. So when
• 03:05we see your work, Abba,
• 03:06and where you're
• 03:07bringing all your skill to
• 03:09us today, I really appreciate
• 03:11you talking with us about
• 03:13this important topic.
• 03:15And the one that
• 03:16and, please, everybody, text your
• 03:19so you receive your CME
• 03:21credits to four five nine
• 03:22three nine to that number.
• 03:24And we have that slide
• 03:25up. You can take a
• 03:26picture, and we'll put it
• 03:27up
• 03:28throughout the session.
• 03:30What I've also been very
• 03:32excited to share with you
• 03:34that the clinician educator milestones
• 03:37at the
• 03:39Accreditation
• 03:40Council for Graduate Medical Education,
• 03:42ACGME,
• 03:44has universal pillars. And what
• 03:46we've done is we've aligned
• 03:48all our talks with the
• 03:49pillars, and this one falls
• 03:51under well-being. And what you
• 03:52can really do when you
• 03:53think of the milestones, it
• 03:55really helps you focus
• 03:57how you make selections when
• 03:59you choose CME
• 04:01sessions. Not only here, but
• 04:03you can be thinking of
• 04:04it when you also go
• 04:05to SGIM and and other
• 04:07meetings. And this one really
• 04:08falls under the educational theory
• 04:11and practice learning environment.
• 04:13And, of course, it is
• 04:14around well-being, the diversity, equity,
• 04:17and inclusion. And what you
• 04:18can really do is almost
• 04:20map as you make your
• 04:21selections.
• 04:22And what we're trying to
• 04:23do in the center is
• 04:24have a variety of choices
• 04:26that fit in with the
• 04:27milestones,
• 04:28and that's why we've mapped
• 04:29them. So, Ava, I am
• 04:30thrilled
• 04:31to hand this over to
• 04:32you, and thank you so
• 04:34much for what you're doing.
• 04:36Thank you so much, Janet,
• 04:38for the kind introduction, and,
• 04:39Jeanette, to you as well.
• 04:41I owe a great deal
• 04:42of my career to the
• 04:43Center for Medical Education and
• 04:44all the amazing mentorship that
• 04:46I've received. So I'm really
• 04:47grateful to be here, and
• 04:48to share a little bit
• 04:49about a topic of of
• 04:51great importance to me. And
• 04:52just to give you some
• 04:53background,
• 04:54the
• 04:55the the ideology of this
• 04:56talk was kind of thinking
• 04:57about some of the work
• 04:58that I've done with the
• 04:59residents around imposter syndrome. And
• 05:01for the last several years,
• 05:02I've led a workshop during
• 05:03our intern retreat for the
• 05:05ill primary care program where
• 05:06we've taken some time to
• 05:08define imposter syndrome and to
• 05:09help strategize around how to
• 05:11navigate it in in medical
• 05:13education. And it it occurred
• 05:14to me that it would
• 05:15be really helpful to
• 05:16have a similar conversation among
• 05:18our educators,
• 05:20because we are also instrumental
• 05:21in terms of creating, an
• 05:23atmosphere of belonging and helping
• 05:24our learners navigate through this.
• 05:26And, certainly, it's not only
• 05:27our learners who who face
• 05:29imposter syndrome, but also several
• 05:30of our faculty members. So
• 05:31I hope that this will,
• 05:33be the beginning of a
• 05:34a really important conversation and
• 05:36also ultimately help to equip
• 05:37us with skills to make
• 05:39sure that every one of
• 05:40our every member of our
• 05:42community experiences a sense of
• 05:43belonging.
• 05:44So as far as my
• 05:45learning objectives, I hope by
• 05:46the end of the talk,
• 05:47you'll be able to describe
• 05:48imposter syndrome and really think
• 05:50critically about its prevalence, its
• 05:51character characterizing features and impact.
• 05:54And as I mentioned, really
• 05:56coming away with some tangible
• 05:57strategies on how to mitigate
• 05:58imposter syndrome in our medical
• 06:00education environment,
• 06:01and hopefully to recognize some
• 06:02frameworks for supporting
• 06:04learners to ultimately promote professional
• 06:06belonging.
• 06:08We'll do that by starting
• 06:09off with some context, just
• 06:10to give you a bit
• 06:11of a didactic piece and
• 06:12and understanding the literature around
• 06:14imposter syndrome. We'll then break
• 06:15up into a small group
• 06:17activity.
• 06:18And then I'll really go
• 06:19into the section to describe
• 06:20some of the strategies that
• 06:21have been noted in the
• 06:22literature to both recognize and
• 06:24mitigate imposter phenomenon,
• 06:26and hopefully leave some time
• 06:27both for a little bit
• 06:28further discussion, some closing thoughts,
• 06:30and some questions.
• 06:32So to begin, I would
• 06:34love for you to join
• 06:35a brief poll. I promise
• 06:36it's painless, just asking you
• 06:38to to think about what
• 06:39word comes to mind when
• 06:41you hear the term imposter
• 06:42syndrome. So for those of
• 06:43you who are familiar with
• 06:44Poll Everywhere, this will be
• 06:45familiar to you. But if
• 06:46not, it's relatively straightforward. I
• 06:49just ask you to take
• 06:50out your phones.
• 06:51You can text ABBA black
• 06:53four zero five, ABBA black
• 06:54four zero five to the
• 06:55number listed there. That's three
• 06:57seven six zero seven.
• 06:59Or, alternatively, you can follow
• 07:01the link that is listed
• 07:02there, pol ev dot com,
• 07:04slash aba black four zero
• 07:06five.
• 07:07And your task is simple.
• 07:08Once you've joined the poll,
• 07:09either by texting or going
• 07:10to the site, you're just
• 07:12gonna identify a single word
• 07:13that pops into your mind
• 07:15when you hear the term
• 07:16impostor syndrome.
• 07:18So I'm gonna stop sharing
• 07:19my screen, but if you
• 07:20didn't get a chance to
• 07:21to see it, don't worry.
• 07:21It'll come up in a
• 07:22second,
• 07:23as I go to if
• 07:24I as I switch to
• 07:25the Poll Everywhere site. So,
• 07:26again, a word that comes
• 07:28to mind
• 07:29when you hear the word
• 07:30imposter syndrome.
• 07:34Great. We already have some
• 07:36responses
• 07:37coming through.
• 07:41If you can't didn't get
• 07:42a chance to join earlier,
• 07:43you're just coming in. You
• 07:44can see the instructions for
• 07:45joining the poll,
• 07:47up there.
• 07:53Yeah. So insecurity is is
• 07:55coming in,
• 07:56quite prominently there.
• 07:59Doubt, fraud,
• 08:01anxiety,
• 08:02inadequate.
• 08:06All really important terms. Fake.
• 08:07Yeah.
• 08:09Inferiority,
• 08:10outsider,
• 08:12complex, doubt,
• 08:13fear.
• 08:18Yeah. This is excellent.
• 08:21So as as we move
• 08:22along in the talk, I
• 08:23I just want to encourage
• 08:24you all to to think
• 08:25about this word cloud because
• 08:27clearly oh, exposed. I love
• 08:29that one. Vulnerable.
• 08:30Clearly, there's already some some
• 08:32thoughts that come to mind
• 08:34when we hear this term.
• 08:35It sounds like the the
• 08:36most prominent ones have really
• 08:37been around feelings of insecurity,
• 08:39anxiety, doubt,
• 08:40inadequacy, feeling like a fraud.
• 08:43And you can imagine that
• 08:44particularly for our learners to
• 08:45be in a high pressure
• 08:47environment where people are are
• 08:49looking to be successful and
• 08:50to thrive, to have these
• 08:51kinds of feelings. I'm seeing
• 08:53also new words like unwelcome,
• 08:54loneliness, failure. That's a lot
• 08:56to navigate,
• 08:57as you are,
• 08:59trying to promote yourself and
• 09:01and go through your medical
• 09:02education environment to have all
• 09:04this kind of in your
• 09:05mind and feeling this way,
• 09:06you can imagine, can really
• 09:07diminish your your academic performance.
• 09:09And so thank you for
• 09:11for participating in that. There's
• 09:13already some some really great
• 09:14thoughts, coming to mind.
• 09:16So I'm gonna stop sharing
• 09:17that screen and switch back
• 09:18to my PowerPoint.
• 09:22And what we're gonna do
• 09:23now is talk a little
• 09:24bit about what's, in the
• 09:26literature. So in terms of
• 09:27defining the terms, it's actually
• 09:29a very old term, imposter
• 09:30syndrome or imposter phenomenon,
• 09:32that can be used interchangeably.
• 09:34It's really this inter internal
• 09:36feeling of intellectual phoniness. Right?
• 09:38And so Clance and colleagues
• 09:39were really instrumental,
• 09:41in defining these terms and
• 09:42characterizing some of the features.
• 09:44Can also be thought of
• 09:45as a collection of feelings
• 09:46of inadequacy. So I love
• 09:47that inadequacy was one of
• 09:48the the main words that
• 09:49came up in the word
• 09:50cloud.
• 09:51And really importantly, those feelings
• 09:53persist despite evidence of success.
• 09:55So these are people who
• 09:56are high achieving,
• 09:58who have a number of
• 09:59elements, you know, in their
• 10:00professional CV that would,
• 10:02make you think on the
• 10:03surface that they'd experience a
• 10:05sense of belonging because of
• 10:06all the accomplishments.
• 10:07But despite that evidence of
• 10:08success, nonetheless, they there's this,
• 10:11persistent feeling that they don't
• 10:13quite measure up.
• 10:15And so chronic self self
• 10:16doubt is a huge part
• 10:17of the way that imposter
• 10:19syndrome operates. Feelings of fraudulence
• 10:22and a really challenging time
• 10:23internalizing
• 10:24success. And so kind of
• 10:25rationalizing it must be due
• 10:27to something else. Maybe I
• 10:28just got lucky,
• 10:29you know, as opposed to
• 10:31actually thinking one success is
• 10:33due to one's own work
• 10:34work ethic,
• 10:35energy,
• 10:37and, you know, time investment.
• 10:38There are alternate explanations that
• 10:40internally one attributes to success.
• 10:43So a common internal dialogue,
• 10:45if we think about the
• 10:46way that that, you know,
• 10:47the the internal structures that
• 10:49people might be adhering to,
• 10:51I feel like a fake,
• 10:52I must not fail. It's
• 10:53a very sort of high
• 10:54pressure situation because there's already
• 10:56this feeling of not belonging.
• 10:58So any,
• 10:59any piece of failure immediately
• 11:01becomes a threat.
• 11:02Or, you know, I just
• 11:03got lucky to be here.
• 11:04It's random. I think I
• 11:05saw the term random, pop
• 11:07up in the word cloud.
• 11:08It was just a fluke.
• 11:09You know? Who knows what
• 11:10happened with the admissions committee?
• 11:11I I'm just here. I'm
• 11:13just around.
• 11:15In terms of prevalence, importantly,
• 11:16there's around seventy percent of
• 11:18people that are estimated to
• 11:19be affected by imposter syndrome
• 11:21at some point in their
• 11:22lives. That comes from a
• 11:23study back done back in
• 11:24twenty eleven.
• 11:25And a more recent study
• 11:26done just a couple of
• 11:27years ago found that sixty
• 11:29three percent of resident physicians,
• 11:31experienced imposter syndrome, so extraordinarily
• 11:33common among our medical trainees.
• 11:37Importantly, I think it's really,
• 11:40it's essential to highlight kind
• 11:41of the the way that
• 11:42the the syndrome operates in
• 11:44terms of it's starting out
• 11:45with this fear of being
• 11:47found out, right, because of
• 11:48the feelings of fraudulence, the
• 11:49idea of being an intellectual
• 11:50phony.
• 11:51So there's constantly this fear
• 11:53that's, kind of being operated
• 11:55on, and then you go
• 11:56into this perfectionist approach to
• 11:58work. Because, again, any mistake,
• 12:01any,
• 12:02failure really feels like a
• 12:03threat if one,
• 12:05to begin with, doesn't experience
• 12:06a sense of belonging, doesn't
• 12:07feel like they've earned their
• 12:08place. And so people tend
• 12:10to develop these very perfectionistic
• 12:12approaches to their work.
• 12:14And then what ultimately happens
• 12:15for most folks is that
• 12:17because they were high achieving
• 12:18in the first place, they
• 12:19have successful outcomes, and they're
• 12:20doing well, and,
• 12:22they're going here and there,
• 12:23adding to their CV,
• 12:24getting positive feedback.
• 12:27But instead
• 12:28of correctly
• 12:29attributing the success to one's
• 12:31own talent, work ethic, etcetera,
• 12:34Ultimately,
• 12:35those people who are dealing
• 12:37with imposter syndrome ended up
• 12:39believing that their success was
• 12:41actually result of these perfectionistic
• 12:43work habits. And so then
• 12:44it ends up kind of
• 12:45reinforcing,
• 12:46this unhealthy cycle that I
• 12:48must continue to work hard
• 12:50and be perfect.
• 12:51Otherwise, someone will find out
• 12:53that in fact, I'm a
• 12:54phony, I'm a fake, I'm
• 12:55a fraud, I don't actually
• 12:56belong here. So you can
• 12:57see how this is a
• 12:57very cyclical,
• 12:59kind of phenomenon.
• 13:01Importantly, this was one of
• 13:01the more helpful,
• 13:03frameworks that I encountered when
• 13:04when studying imposter syndrome that
• 13:06it really can be broken
• 13:07up into five different phenotypes.
• 13:09And certainly, there's a lot
• 13:11of overlap in terms of
• 13:12these characterizing features, but I
• 13:13think it's important to take
• 13:15a moment to describe ways
• 13:17in which imposter syndrome might
• 13:18manifest.
• 13:19So starting on the left,
• 13:21you might call this a
• 13:22superhuman
• 13:22phenotype. And this is really
• 13:24the person who feels like
• 13:26in order to be successful,
• 13:28they must do it all.
• 13:29And so it it doesn't
• 13:30matter if they have a
• 13:32fair amount of success in
• 13:33one area. If they're not
• 13:35constantly juggling a million different
• 13:36things and doing them all
• 13:38at an a plus level,
• 13:39then it's failure. It's not
• 13:41good enough. Again, it's reinforcing
• 13:42this idea of not belonging.
• 13:44Then you see the picture
• 13:45of Einstein, the natural genie
• 13:47genius phenotype,
• 13:49which is really those folks
• 13:50for whom
• 13:52if a piece of information,
• 13:54you know, acquiring
• 13:55a particular knowledge or skill
• 13:57set doesn't come immediately without
• 13:59having to work very hard
• 14:01at it,
• 14:02or investing much time, if
• 14:03they're not, quote, unquote, a
• 14:05natural genius,
• 14:06then that is what really
• 14:07kind of reinforces
• 14:09this sense of being a
• 14:11fraud, being a fake. So
• 14:12even having to study to
• 14:14look at something, you know,
• 14:15multiple times, have to,
• 14:17really engage in a topic
• 14:18before
• 14:19mastery of of the material,
• 14:21that in of itself,
• 14:23reinforces their sense of imposter
• 14:25syndrome.
• 14:26And then you have the
• 14:27figure in the middle,
• 14:29which we'll call the soloist,
• 14:31the person who's pushing up
• 14:32this heavy ball,
• 14:33up a hill all by
• 14:34themselves.
• 14:35And the picture is really
• 14:36meant to denote folks for
• 14:38whom anything that is done
• 14:41with help from other people
• 14:43equals failure. So this might
• 14:45be, you know, an intern
• 14:46on an inpatient service who's
• 14:48being offered help
• 14:50by a resident or a
• 14:51fellow and an attending,
• 14:53and they're caught constantly pushing
• 14:55away that that assistance and
• 14:56that support because for them,
• 14:58if they're not able to
• 14:59do something independently
• 15:01and without collaboration from other
• 15:03people, that is actually what
• 15:04is making them feel like
• 15:06they're a fraud, they're a
• 15:06fake, they don't belong.
• 15:08Then you have the perfectionist,
• 15:10in the top right there.
• 15:12And this is the person
• 15:13who has to do everything
• 15:15exactly right, with no mistakes,
• 15:17no learning curve,
• 15:19and will, you know, spend
• 15:20perhaps, you know, twenty hours
• 15:22working on one presentation because
• 15:24they wanna make sure every
• 15:25detail is is spotless.
• 15:27Because again, that if not,
• 15:28then it's going to make
• 15:30them feel even more vulnerable
• 15:32and even more exposed.
• 15:33And lastly,
• 15:35to the bottom right here,
• 15:36you have the expert who's
• 15:37sitting on a number of
• 15:38books. And this is a
• 15:39person for whom
• 15:41they only really give themselves
• 15:42license to contribute to a
• 15:44conversation,
• 15:46to a project,
• 15:47or even to speak up
• 15:49if they feel like they
• 15:50are expert at it. And
• 15:52so it might be someone
• 15:53who gets multiple degrees because
• 15:55getting the degrees
• 15:56really fuels this sense of,
• 15:58well, once I have, you
• 15:59know, a million letters under
• 16:01after my name, perhaps then
• 16:02I feel like I have
• 16:03a place or I have
• 16:04a I I belong. And
• 16:05so you really might find
• 16:07that person in the person
• 16:08who's hesitant to speak unless
• 16:10they feel like they have
• 16:11full mastery on a a
• 16:12subject.
• 16:14So importantly,
• 16:15people having imposter syndrome,
• 16:18certainly does lead to negative
• 16:19sequelae.
• 16:20There are lots of studies
• 16:21that have been done that
• 16:22show a correlation certainly in
• 16:23mental health with anxiety, depression,
• 16:25and suicidal ideation.
• 16:27And certainly, there's been more
• 16:28attention paid to health care
• 16:29professional burnout over recent years.
• 16:31So clearly, this is a
• 16:32topic of much significance.
• 16:34There's also data to suggest
• 16:35that dementia's ability
• 16:37for folks to perform at
• 16:38their personal best, and so
• 16:39there's actually a loss in
• 16:40terms of their performance at
• 16:42an institution for clinical care,
• 16:44research, educational pursuits, etcetera,
• 16:47and obviously, you know, increasing
• 16:49rates of professional burnout,
• 16:51which is the antithesis
• 16:53of of what we're looking
• 16:54to do.
• 16:55So at this point, I'm
• 16:56going to, read for you
• 16:58a a case,
• 16:59and I'll explain what we'll
• 17:00need to do after, I
• 17:02get a chance to read
• 17:03the case, but it'll be
• 17:04a chance for us to
• 17:04think more about how imposter
• 17:06syndrome can show up in
• 17:07our medical education environment and
• 17:09do some brainstorming
• 17:10around,
• 17:11how we can optimize,
• 17:13these these kinds of situations.
• 17:15So doctor Stone is an
• 17:16internal medicine intern. She's been
• 17:18rotating with you on a
• 17:19general medicine inpatient service over
• 17:21the last week,
• 17:23And she's about halfway through
• 17:24intern year at this point,
• 17:25so you've been a little
• 17:26bit surprised as maybe her
• 17:28attending or her fellow,
• 17:30to see that she hasn't
• 17:31shown more autonomy in patient
• 17:32care. She's very timid on
• 17:34rounds, doesn't speak unless spoken
• 17:36to,
• 17:36And you checked in with
• 17:38her senior resident who said
• 17:39that she's, you know, she's
• 17:40doing what she's supposed to
• 17:41do as far as intern
• 17:42level tasks throughout the workday.
• 17:44There are no major red
• 17:45flags.
• 17:46But the resident does note
• 17:48that on almost every clinical
• 17:49decision that's made
• 17:55prescribing Tylenol. She she wants
• 17:56to make sure that's okay
• 17:57for a patient.
• 17:58And so
• 18:00you find that when you're
• 18:00asking, doctor Stone questions on
• 18:03rounds to explore her clinical
• 18:04decision making,
• 18:06she usually responds automatically with
• 18:08I don't know.
• 18:09Nothing nothing else said, just
• 18:11responds with an I don't
• 18:11know. And you kind of
• 18:13pride yourself on creating a
• 18:15safe learning environment. You don't
• 18:16think of yourself as, you
• 18:17know, an intimidating educator. So
• 18:19So you gently try to
• 18:20give her feedback to to
• 18:21let her know you want
• 18:22to hear what she has
• 18:23to say, but nothing's really
• 18:24changing, and it's been a
• 18:25week and you know that
• 18:26there's only one more week
• 18:28left in the rotation.
• 18:29So that's that's the case.
• 18:31And
• 18:32at this point, Ed is
• 18:34gonna help us, break up
• 18:35into small groups in in
• 18:37just a moment.
• 18:38And you're gonna have ten
• 18:39minutes in your small groups
• 18:41to chat about the case.
• 18:43I put a QR code
• 18:44here because once you're in
• 18:45the small group, I know
• 18:46you might wanna take another
• 18:47look at the case and
• 18:48the discussion questions. So the
• 18:50the session questions are listed
• 18:52here. How might imposter syndrome
• 18:54actually be affecting doctor Stone?
• 18:55So talk a little bit
• 18:57about where you might see
• 18:59evidence of imposter syndrome with
• 19:00doctor Stone and if there
• 19:02are phenotypes, like the one
• 19:03we ones we just went
• 19:05over, like superhuman,
• 19:06perfectionist,
• 19:07soloist, etcetera, that she might
• 19:09be displaying.
• 19:11And thinking through how our
• 19:12group identities or lived experiences,
• 19:14things like race, gender, socioeconomic
• 19:16status, how do you think
• 19:17that might interact with imposter
• 19:19syndrome? Could that be showing
• 19:20up in the case or
• 19:21more broadly in terms of
• 19:22exacerbating
• 19:23imposter syndrome?
• 19:25And lastly,
• 19:26if you were,
• 19:27you know, her attending or
• 19:29her fellow, what steps would
• 19:30you recommend doing? How would
• 19:32you,
• 19:33kinda navigate this situation?
• 19:35As someone who is interested
• 19:37in promoting education and promoting
• 19:38belonging, what suggestions might you
• 19:40have?
• 19:42Any questions before we, break
• 19:44up into our small groups?
• 19:45Again, you'll have about ten
• 19:46minutes, and then, we'll we'll
• 19:48bring
• 19:49everyone back at that point.
• 19:52This is your task. And
• 19:53I forgot to mention, please
• 19:54do identify someone who
• 19:56will, be the volunteer to,
• 19:59do the report out when
• 20:00we come back, and we'll
• 20:01debrief as a large group.
• 20:05Alright.
• 20:06Ed, you can go ahead
• 20:07and, send people off. Thank
• 20:09you so much. Alright. Opening
• 20:11rooms now.
• 20:35Like, folks are coming back.
• 20:36Welcome back, everybody.
• 20:38So for the next few
• 20:39minutes, we're just gonna take
• 20:40some time to debrief the
• 20:41small group activities. So thank
• 20:42you for engaging in the
• 20:44conversations, and I know there
• 20:45are a few folks who
• 20:46came in a little bit
• 20:47later. So just to give
• 20:48a brief overview of the
• 20:49case,
• 20:49we were chatting about doctor
• 20:51Stone, who's an internal medicine
• 20:53intern, and
• 20:54the attending or a fellow
• 20:56has noticed that she's very
• 20:58reticent on rounds, very,
• 21:00timid, doesn't, you know, speak
• 21:02unless spoken to. And if
• 21:03asked a question, usually it
• 21:05says something like I don't
• 21:06know. And so we were
• 21:07working through a number of
• 21:08questions to kind of think
• 21:09through how imposter syndrome might
• 21:11be relevant
• 21:12to the case. And so
• 21:13for that first question that
• 21:15I had to tackle,
• 21:16I'd love to hear from
• 21:17some of our,
• 21:19dedicated,
• 21:20report out folks, to chat
• 21:22a little bit about what
• 21:23your group thought in terms
• 21:24of the first question, which
• 21:25was really around how impostor
• 21:27syndrome might be affecting her,
• 21:29performance, and if you saw
• 21:30any of those phenotypes that
• 21:32we spent some time chatting
• 21:33at towards the beginning that
• 21:34were evident in the case.
• 21:35So So love to hear
• 21:36from a couple people. Feel
• 21:37free to unmute yourself and
• 21:39and speak.
• 21:43Hey. I'm I'm Jim Scarls.
• 21:45I came from group nine.
• 21:48Hi. Hi. We we we
• 21:49we thought there would be
• 21:51some overlap with actually all
• 21:52five phenotypes, but we just
• 21:53didn't have enough information
• 21:55to kind of pin
• 21:57some of the other phenotypes.
• 21:58But we thought
• 22:00maybe doctor Stone felt she
• 22:01should be more expert
• 22:02and more of a perfectionist,
• 22:04and maybe that's what's suppressing
• 22:06her from speaking out.
• 22:08Yeah. I love that. Thank
• 22:09you, group nine. I think
• 22:10definitely the the part in
• 22:12the case that says she's
• 22:13very quick to say I
• 22:14don't know.
• 22:15I remember actually that was
• 22:16that was me in in
• 22:17medical school. I remember one
• 22:18time I was on a
• 22:18rotation and someone was asking
• 22:20me for a differential,
• 22:21or or not just a
• 22:22differential, but, like, what I
• 22:23really thought was going on.
• 22:24And because I didn't feel
• 22:25like I had the ultimate
• 22:26answer, I felt like I
• 22:27didn't have permission to speak.
• 22:28And so I was like,
• 22:29I don't know. I I
• 22:30don't know. I don't feel
• 22:31like I have the hundred
• 22:32percent, you know, correct answer,
• 22:33but what I learned over
• 22:34time is she was just
• 22:35interested in learning about my
• 22:36thought process. And I certainly
• 22:37had some thoughts about the
• 22:38the case, the patient, and
• 22:40what could likely happen, but
• 22:42I I didn't wanna speak
• 22:43unless I felt like I
• 22:44was a hundred percent sure.
• 22:45So I think there's definitely
• 22:46some elements of the expert
• 22:47as well as the perfectionist
• 22:49really wanting to do everything
• 22:50right. So great. Other thoughts
• 22:52on that first question about
• 22:53any ways that folks saw
• 22:55imposter syndrome, you know, relevant
• 22:57in in the case?
• 23:03I'm Miriam O'Neil.
• 23:05I'm one of I'm a
• 23:06fellow.
• 23:07I'm reporting for,
• 23:09I think we were group
• 23:10fourteen.
• 23:11We also concurred,
• 23:13with group nine in terms
• 23:15of the perfectionist as well
• 23:16as the expert,
• 23:18and,
• 23:19kind of surrounding our discussion
• 23:21was was how this could
• 23:23ultimately
• 23:24delay care,
• 23:26for the patient because of
• 23:28constantly questioning and and, you
• 23:30know, not kind of feeling
• 23:31free to move forward.
• 23:33I guess I'll I'll hold
• 23:34further questions or answer, you
• 23:36know, discussions that we had
• 23:37until we get to the
• 23:39other parts.
• 23:40Yeah. Thank you, Miriam. I
• 23:41love that point because I
• 23:42think one of the things
• 23:43that we don't discuss as
• 23:45much with imposter syndrome is
• 23:46that it it can have
• 23:47a cost, not only in
• 23:48terms of kind of mental
• 23:49health and and performance, but
• 23:51also in terms of clinical
• 23:52care.
• 23:53I think you can imagine
• 23:54that if someone's constantly withholding
• 23:56their contributions, their observations,
• 23:58it can definitely impede, the
• 23:59team and and can be
• 24:01pertinent for for, patient safety.
• 24:03That's great.
• 24:04We'll go ahead and move
• 24:05on to the second question,
• 24:06which was me asking you
• 24:08all to think a little
• 24:08bit about how lived experiences
• 24:10and group identities,
• 24:12things like, for example, race
• 24:13and gender, although certainly not
• 24:15an exhaustive list, could play
• 24:16a role in imposter syndrome.
• 24:19And, you know, we don't
• 24:19have much information about doctor
• 24:21Stone's identities besides that she
• 24:23identifies as a woman.
• 24:25But beyond that, you know,
• 24:26just kinda thinking broadly, I'd
• 24:28I'd love to hear from
• 24:28a couple of groups about
• 24:30how you thought group identities
• 24:31could intersect with the the
• 24:33concept of imposter syndrome.
• 24:38I can report.
• 24:39My name is Trina Salva.
• 24:41I'm a new GYN attending.
• 24:42Hi, Trina. Welcome. Everybody.
• 24:45So I don't remember what
• 24:47group number we were, but,
• 24:49we agreed with perfectionist.
• 24:52You know, we talked a
• 24:53lot about,
• 24:55trying to explore
• 24:56thoughts about her culture, her
• 24:58upbringing. She may be someone,
• 25:01you know, not only as
• 25:03a
• 25:04woman, but,
• 25:06perhaps she comes from a
• 25:08culture that sort of prioritizes
• 25:11deference,
• 25:12or respect.
• 25:13So,
• 25:15and we talked about that
• 25:16in terms of her upbringing,
• 25:17but also in terms of
• 25:19what kind of clinical experiences
• 25:21she might have had so
• 25:22far because she is the
• 25:24intern. We don't know
• 25:26team dynamics.
• 25:28You know, her her the
• 25:30approach of her senior residents,
• 25:32the approach of her attendings,
• 25:34may have really sort of
• 25:36shaped her experience in the
• 25:37way she's acting now. So
• 25:40Absolutely.
• 25:41All excellent points, Atrina. Thank
• 25:42you. And, I think the
• 25:45the point about sort of
• 25:46cultural norms and expectations, I
• 25:47think, is super important. I
• 25:49can tell you personally, my
• 25:49family's from Ghana,
• 25:51and I would say that
• 25:53sort of meekness and humility
• 25:54is very much prized, generally
• 25:56speaking, in the culture. And
• 25:57so I think something that
• 25:58I had to transition is
• 26:00to is, you know, understanding
• 26:01that kind of, like, speaking
• 26:02up or,
• 26:03what might be thought of
• 26:04as self promotion in my
• 26:05culture is more kind of
• 26:07normative,
• 26:08in in academics in general.
• 26:10And so that was certainly
• 26:11a transition point for me,
• 26:12and you can imagine that
• 26:13there there could be many
• 26:13other layers to that, depending
• 26:15on the context.
• 26:17I would love to hear
• 26:18from another group as well,
• 26:19to add on to what
• 26:21what you are thinking in
• 26:22terms of group identities and
• 26:23lived experiences.
• 26:25Group nine reached the same
• 26:27conclusions, by the way. Very
• 26:28similar conclusions.
• 26:29Great. Thanks, Jim.
• 26:31Hey, Abba. It's Andrea. I
• 26:33forget our group number,
• 26:36but we and so apologize
• 26:38for that. Maybe someone else
• 26:39in my group can chime
• 26:40in and remind us. But
• 26:42It's okay.
• 26:43I think, you know, we
• 26:44talked actually a lot about,
• 26:46prior experiences
• 26:47in terms of clinical rotations
• 26:49and events that might have
• 26:50happened that could perpetuate someone's,
• 26:52you know, subsequent behaviors or
• 26:54inform how they are engaging
• 26:55in in
• 26:57interactions within the medical environment.
• 26:58But then I think and
• 26:59we didn't get too much
• 27:00into this, but we talked
• 27:01a little bit about,
• 27:03how gender might play into
• 27:04the norms here as well
• 27:06as, just touched on a
• 27:08little bit of under folks
• 27:09who are underrepresented in medicine,
• 27:11you know, might not necessarily
• 27:12feel
• 27:13as comfortable or safe, you
• 27:15know, in an environment where
• 27:16there aren't as many people,
• 27:18you know,
• 27:19like themselves,
• 27:21might also be something at
• 27:22play here, but we don't
• 27:23know too much about doctor
• 27:24Stone as it relates to
• 27:25that.
• 27:26Yeah. Excellent. Thank you so
• 27:27much, Andrea, and and to
• 27:28the group for those comments.
• 27:29I think,
• 27:30gender is huge. You know,
• 27:31I think when as being
• 27:32in the equity space, I
• 27:33often hear a lot about
• 27:34people's experiences, especially our trainees,
• 27:36and, you know, very common
• 27:38for women to, you know,
• 27:39either be called sort of
• 27:40unprofessional
• 27:41things like sweetheart and honey
• 27:42by patients or families,
• 27:44but also a lot of,
• 27:45like, mistaken professional identity, which
• 27:47I'm sure people are aware
• 27:48of, you know, being mistaken
• 27:49as a nurse or a
• 27:50medical assistant despite introducing themselves
• 27:53as doctor.
• 27:54And so those kinds of
• 27:55things over time can certainly
• 27:56wear on one sense of
• 27:57identity and belonging.
• 27:59Certainly the case also with
• 28:00underrepresentation,
• 28:02and people having adverse experiences
• 28:04in the past and make
• 28:05them feel like perhaps they
• 28:06they shouldn't speak up, because
• 28:07when they did previously maybe
• 28:09it had a negative consequence.
• 28:11So so really important points
• 28:12there. Thank you.
• 28:14We're gonna transition to the
• 28:16last question, which is asking
• 28:17you to think critically about
• 28:19if you were that attending
• 28:20or you were that,
• 28:21fellow, you were kind of
• 28:22in a role of of
• 28:24supervision,
• 28:25how might you think about
• 28:26navigating next steps if if
• 28:28you suspected that imposter syndrome
• 28:30was playing a role in
• 28:31doctor Stone's performance?
• 28:34I'll go. I'm Anisha. I'm
• 28:36a hospitalist. I'm from group
• 28:37eight. We had a lot
• 28:38of great discussion around,
• 28:40number three. There were some
• 28:42awesome ideas.
• 28:43One person suggested,
• 28:45you know, potentially giving,
• 28:47her a learner to have
• 28:48the opportunity to share and
• 28:50impart knowledge might be,
• 28:52an opportunity to kind of
• 28:53reflect on actually how much
• 28:55she does know,
• 28:57and sort of change her
• 28:58perspective in terms of her
• 28:59her knowledge base.
• 29:01There
• 29:03with a suggestion, like, could
• 29:04you potentially review the times
• 29:06that she asked for confirmation
• 29:08around the plan and kind
• 29:09of review how many times
• 29:10did the plan actually diverge
• 29:11from what she had proposed
• 29:13and sort of see if
• 29:15we could build her confidence
• 29:16around her clinical decision making
• 29:17that way.
• 29:20Potentially exploring, like, the mental
• 29:22and physiologic
• 29:24signals to her when she's
• 29:25starting to feel that anxiety
• 29:27around an imposter syndrome type,
• 29:30response and whether
• 29:32there's a way to start
• 29:33recognizing that signal in herself,
• 29:36just as an awareness mechanism.
• 29:39And then the last suggestion
• 29:40that we had was, you
• 29:42know, maybe
• 29:43in a learner like this,
• 29:45we need to, as teachers,
• 29:47kind of change how we're
• 29:48assessing,
• 29:49her knowledge base or her
• 29:50plan. So either changing the
• 29:52setting
• 29:52to be a more safe,
• 29:55psychological setting or changing the
• 29:56type of assessment where it's
• 29:58not necessarily like
• 29:59on rounds in front of
• 30:00everyone you're being asked to
• 30:02give an answer.
• 30:04Absolutely. I I love those,
• 30:05and I see a comment,
• 30:07also in the chat from
• 30:08Chris. Important to make sure
• 30:09that an attempt to discuss
• 30:10with doctor Stone does not
• 30:12reinforce the, unfortunately, typical gendered
• 30:14be more vocal feedback, which
• 30:15is a really great point
• 30:16as well.
• 30:17And I love that some
• 30:18of the suggestions were sort
• 30:19of a mix of thinking
• 30:21about ways to support her,
• 30:22and I love the idea
• 30:23of giving her someone more
• 30:24junior to give her a
• 30:25chance to demonstrate what she
• 30:27knows. We'll actually chat about
• 30:28that in a moment.
• 30:30As well as also thinking
• 30:31about the way that our
• 30:32our environment can be adjusted
• 30:33perhaps to make her help
• 30:34her thrive more, and so
• 30:36kind of thinking about that
• 30:37from both lenses, which is
• 30:38great.
• 30:39We are gonna move on
• 30:40in the interest of time.
• 30:41I love those
• 30:42responses. I it's clear to
• 30:44me that those are very
• 30:44rich discussion groups. So thank
• 30:46you for participating.
• 30:48So now we're gonna segue
• 30:50into a little bit of
• 30:51a discussion about kind of
• 30:53concrete ways to identify imposter
• 30:55syndrome in your learners and
• 30:56then wrap up with some
• 30:57of the strategies.
• 30:59So common symptoms. So as
• 31:00as some of this was
• 31:01clear in the case, but
• 31:03I think it's really important
• 31:04that when we
• 31:05see someone who's,
• 31:07seems reticent to speak up,
• 31:09like on rounds or in
• 31:10another kind of public setting,
• 31:12that we don't automatically assume
• 31:13that it's because of a
• 31:14knowledge deficit
• 31:15or some other kind of
• 31:16gap. But it could be
• 31:17driven by imposter syndrome, I
• 31:18think in many cases maybe.
• 31:21Again, as I mentioned during
• 31:22the perfectionist,
• 31:24kind of phenotype of impostor
• 31:25syndrome, if we see someone
• 31:27who's always late on their
• 31:28progress notes or, you know,
• 31:29maybe missing deadlines constantly on
• 31:31scholarly projects, we should at
• 31:33least bear in mind that
• 31:34part of this might be
• 31:35due to impostor syndrome.
• 31:38Because folks with imposter syndrome,
• 31:40may have the soloist phenotype
• 31:42of feeling like they're successful
• 31:43only when they're doing it
• 31:44all on their own, if
• 31:46we see that, they're kind
• 31:47of pushing people away when
• 31:49help is offered, that could
• 31:50also be a sign that
• 31:51this is going on. Defensiveness
• 31:53to constructive feedback because already
• 31:55there's this kind of, baseline
• 31:57view of not belonging. So
• 31:58if anyone says something that
• 32:00is perceived in any way
• 32:01to be critical, that can
• 32:02reinforce the sense like, oh,
• 32:03of course, I'm a fake.
• 32:04Someone just told me I
• 32:05need to improve on my
• 32:07oral presentation. So, you know,
• 32:08clearly, I don't belong, you
• 32:09know, I don't,
• 32:10deserve to be here. I
• 32:11don't belong here. And then
• 32:13lastly, discounting the reinforcing feedback
• 32:15because, again, there's a sort
• 32:16of duality of,
• 32:18not why the constructive feedback
• 32:19because it can push at
• 32:21that sense of not belonging,
• 32:22but also having trouble when
• 32:23people say things that are
• 32:25reinforcing or positive because,
• 32:27they'll automatically want to attribute
• 32:29that to something else but
• 32:30their own success.
• 32:32So importantly, I I like
• 32:34to think about this kind
• 32:35of in the sense of,
• 32:35like, being a differential. Right?
• 32:37So I'm not implying that
• 32:38imposter syndrome is the only
• 32:40reason that one might see,
• 32:42these manifestations,
• 32:44but I think it definitely
• 32:45should be considered as part
• 32:46of what might be going
• 32:47on in, you know, in
• 32:49any kind of scenario with
• 32:50a learner.
• 32:51And oftentimes, as we all
• 32:52know, many times if someone's
• 32:54not performing well or if
• 32:55if certain things or patterns
• 32:56are noted, it's usually multifactorial.
• 32:58So you can think that,
• 32:59you know, imposter syndrome might
• 33:00might be related.
• 33:02So,
• 33:03importantly, creating an, you know,
• 33:05an inviting learning environment is
• 33:06is one of the ways
• 33:07to to help reduce the
• 33:09ways that imposter syndrome can
• 33:10manifest.
• 33:12I think asking open ended
• 33:13questions proactively
• 33:14about learner experiences can be
• 33:16really useful.
• 33:17You know, something that I've
• 33:18started to do with my
• 33:19advisees
• 33:20is,
• 33:21when I first meet them
• 33:22as part of our sort
• 33:23of intro session where I
• 33:24we talk about their goals
• 33:26and how I can be
• 33:26helpful and anything else they
• 33:28want me to learn about
• 33:29their background,
• 33:30I I started have started
• 33:31added. I've started to add
• 33:33something like, you know, this
• 33:34might not be part of
• 33:35your experience while you're here,
• 33:37but just so that you
• 33:38know,
• 33:39I know that I've encountered
• 33:40lots of learners who who
• 33:41don't feel like they belong
• 33:42here and they may be
• 33:43experiencing imposter syndrome. So if
• 33:45that's ever something that's on
• 33:46your mind where you you're
• 33:47feeling like a fake or
• 33:48you're feeling like you don't
• 33:49belong here, please know that
• 33:51that's something that you can
• 33:52come to me with. And
• 33:52so that just kind of
• 33:53opens that door and also
• 33:55normalizes that this is an
• 33:56exceedingly common,
• 33:58phenomenon because I think one
• 34:00of the ways in which
• 34:00imposter syndrome thrive thrives is
• 34:02if it stays in isolation.
• 34:04People stay in their own
• 34:05heads. They have that cycle,
• 34:06that internal dialogue, and they
• 34:07tend to think that they're
• 34:08really the only person who
• 34:10doesn't experience a sense of
• 34:12belonging,
• 34:13which is which is clearly
• 34:14not the case.
• 34:15And then sharing your own
• 34:16experiences as an educator,
• 34:18times where you were unsure
• 34:19of yourself when you may
• 34:20have felt like an academic
• 34:21fraud, again, can help to
• 34:23enhance a culture of psychological
• 34:25safety, vulnerability,
• 34:27and helps to to prevent
• 34:28that isolation.
• 34:30Curiosity curiosity and humility also,
• 34:32I think, are extraordinarily important
• 34:34in terms of supporting our
• 34:35learners. So creating space for
• 34:37learners to express their concerns.
• 34:39You know, perhaps they have
• 34:40been in unsafe learning environments
• 34:42in the past, and that's
• 34:43actually exacerbating
• 34:44their learning environment because of,
• 34:46you know, race, gender, religion,
• 34:49another underrepresented
• 34:50or stigmatized status. And so
• 34:53being able to, again, open
• 34:54those lines of communication to
• 34:55understand that context is very
• 34:57important.
• 34:58Making sure that when we're
• 34:59engaging with our learners, I
• 35:00think one of the best
• 35:00things that we can do
• 35:01is say when we don't
• 35:02know something or when we
• 35:03have to look something up
• 35:04so that they don't get
• 35:05the sense that all the
• 35:07people who are educating them
• 35:08have, you know, perfectly understood
• 35:10everything that's going on and
• 35:12never need to study something
• 35:13or get clarification,
• 35:14it can really enhance that
• 35:15sense that we're all lifelong
• 35:16learners,
• 35:17as well as taking accountability
• 35:19when, you know, we could
• 35:20have done something better,
• 35:22so that we can model
• 35:24sort of that practice of
• 35:25taking accountability for missteps and
• 35:27having more of this kind
• 35:28of growth mindset.
• 35:30So as far as concrete
• 35:31strategies that you may be
• 35:32able to share with your
• 35:33learners,
• 35:34I think personal experiences are
• 35:36huge.
• 35:37So if you encountered imposter
• 35:39syndrome and, you know, have
• 35:40had experiences where you feel
• 35:41like you don't belong, Share
• 35:43what you have done to
• 35:44try to navigate that. And
• 35:45clearly from the discussion groups,
• 35:46there's already a lot of
• 35:47wisdom, in that direction because
• 35:49I think that can really
• 35:50promote professional belonging
• 35:52and normalize conversations
• 35:53about this topic.
• 35:56Lifelong learning in medicine is
• 35:57just part of of being
• 35:58a health care professional, and
• 36:00so you might find that
• 36:01your learners are misattributing,
• 36:04a gap in some clinical
• 36:05knowledge as some kind of
• 36:07internal fixed deficit as opposed
• 36:09to the fact that
• 36:10they're here on a a
• 36:11journey. They will continue to
• 36:12learn and grow. They're not
• 36:14expected to know everything.
• 36:15And even if they're noted
• 36:17to be below the curve,
• 36:18there's ways to provide coaching
• 36:20and support to get them
• 36:21to where they need to
• 36:21be. And as I had
• 36:23mentioned earlier, that growth mindset,
• 36:24I think, is so huge.
• 36:25And I think, you know,
• 36:26we talk about that a
• 36:27lot in medical education, but
• 36:28it's so important particularly for
• 36:30folks who face imposter syndrome
• 36:32because
• 36:33instead of criticism
• 36:34being viewed as, again, like,
• 36:36this part of me that
• 36:37I I just can't I
• 36:38can't get rid of, it's
• 36:39again it can instead be
• 36:41translated into an opportunity to
• 36:42learn, and grow, which is
• 36:44ultimately what what we want,
• 36:45to instill in our learners.
• 36:47So,
• 36:48these are some strategies that
• 36:50have been really vetted in
• 36:51the literature, that again you
• 36:52can share with, any of
• 36:54your learners who who seem
• 36:55to be navigating imposter syndrome.
• 36:57Really the power of recognition,
• 36:59and naming the feelings when
• 37:00they emerge in of itself
• 37:02can take away some of
• 37:03that power of that intern
• 37:04internal dialogue. It helps,
• 37:06make it such that it
• 37:07doesn't thrive and continue to
• 37:08perpetuate in one's mind. If
• 37:10someone's just able to identify,
• 37:12I'm having an imposter moment
• 37:13right now. This doesn't say
• 37:14anything about, like, who I
• 37:15am or what I can
• 37:16contribute.
• 37:17That really goes a long
• 37:18way. Verbally processing feelings so
• 37:20that, you know, if you're
• 37:21in a group of people
• 37:22and you're able to share
• 37:24these moments when you're feeling
• 37:25like a fraud and they're
• 37:26able to reaffirm for you
• 37:28your value and your contributions,
• 37:29that is huge.
• 37:31There's a good amount of
• 37:32data about reflective practices such
• 37:34as journaling and mindfulness based
• 37:36practices
• 37:37to recognize strengths because I
• 37:39think for a lot of
• 37:40folks who are dealing with
• 37:41imposter syndrome, they tend to,
• 37:43really perseverate on the gap
• 37:45areas as opposed to recognizing
• 37:47all the strengths that they
• 37:48bring to the table. And
• 37:49so in their mind, they're
• 37:50just replaying all the areas
• 37:52where they should have done
• 37:53better, could have done something
• 37:54differently instead of remembering that
• 37:56there's an incredible amount,
• 37:57that they're actually doing well.
• 38:00Considering the context is an
• 38:02important one. I often share
• 38:03this with the residents. You
• 38:04know, I'll have interns who
• 38:05are so frustrated that, they
• 38:07don't know everything, but I
• 38:09remind them that, you know,
• 38:10if they knew everything and
• 38:11they're as competent as their
• 38:13senior residents, then they probably
• 38:14wouldn't need to go to
• 38:15a residency program, right, and
• 38:16so helping people reframe what
• 38:19they may see as gaps
• 38:20or what might be contributing
• 38:21to their sense of not
• 38:22belonging in a space and
• 38:24reminding them that they're here
• 38:25to learn, they're here to
• 38:27grow,
• 38:28and, you know, the July
• 38:29of intern year is not
• 38:30the time to to decide
• 38:31whether or not you're gonna
• 38:32be successful in medical education.
• 38:35Reframing task completion habits, I
• 38:37think that's a really practical
• 38:38tip. I think it can
• 38:40really come to mind in
• 38:41terms of, you know, people
• 38:42who may have more of
• 38:43that perfectionist
• 38:44phenotype of imposter syndrome.
• 38:46So sometimes people might actually
• 38:48need to be given
• 38:50a concrete,
• 38:51period of time to complete
• 38:52a task. So if there's
• 38:53someone who, again, like, spends
• 38:55twenty hours
• 38:59they wanna make sure they
• 39:00get you know, they cross
• 39:01every t and dot every
• 39:02I,
• 39:03you might help them think
• 39:05about reducing the current amount
• 39:06of time that they're spending
• 39:08on a task. Because ultimately,
• 39:10what that'll help them do
• 39:11is understand that even with
• 39:12a more compressed period of
• 39:14time, they're still able to
• 39:15do a task successfully. Another
• 39:17example might be, you know,
• 39:18pre rounding. Sometimes interns, when
• 39:20they're first starting, they feel
• 39:21like they have to show
• 39:22up at four AM, because
• 39:23they wanna get everything perfect
• 39:24before it's time for rounds.
• 39:26And so helping them think
• 39:27about, here, let's slowly, you
• 39:29know, dial that back and
• 39:30and show you that you're
• 39:31really able to be successful
• 39:32despite,
• 39:33your current habits.
• 39:35And then lastly, of course,
• 39:36as with everything, you know,
• 39:37kindness and patience to oneself
• 39:39and encouraging them to tap
• 39:41into their support system,
• 39:42to engage with professional counseling
• 39:44if if that's, you know,
• 39:45applicable and would be helpful
• 39:47to them, are all kind
• 39:48of useful things to navigate
• 39:49imposter syndrome.
• 39:51Power in numbers. So seeking
• 39:53out mentorship is huge.
• 39:55One, because again imposter syndrome
• 39:56is so common that chances
• 39:57are a mentor will be
• 39:59able to share personal experiences,
• 40:01and help again normalize what,
• 40:03learners might be thinking of
• 40:05as gaps,
• 40:06in in their education.
• 40:08And then this kind of
• 40:09goes back to an earlier
• 40:10point of, you know, maybe
• 40:11for doctor Stone, having her
• 40:13work with a student, help
• 40:14her show what she knows.
• 40:15This is actually very clear
• 40:16in the literature. If you
• 40:17spend time coaching those who
• 40:19are in earlier stages, it
• 40:20reminds you of everything that
• 40:22you can contribute and everything
• 40:23that you've learned. It reminds
• 40:25me of, interns usually in
• 40:27the spring, you know, when
• 40:28they're about to meet the
• 40:29the incoming crop of interns.
• 40:31It's not until those new
• 40:32interns come that they recognize,
• 40:34you know, wow. A year
• 40:35ago, I can I wouldn't
• 40:36would not have been able
• 40:37to do anything that I
• 40:38was that I'm now teaching
• 40:39to this new class? And
• 40:40so it actually can be
• 40:41quite powerful to engage with
• 40:43folks in earlier career stages,
• 40:45and then, of of course,
• 40:45reaching out to support services
• 40:47and expanding that support network
• 40:48because these can be really
• 40:50weighty and really challenging,
• 40:52feelings and and thoughts to
• 40:54to to unpack.
• 40:56So I just wanna oh,
• 40:58go ahead, Janet. I I
• 40:59just wanna so Chris has
• 41:00a really important question, Ava,
• 41:02and he's asking,
• 41:03does it matter whether the
• 41:04imposter concept is voiced by
• 41:06the learner versus a supervisor?
• 41:08He's a bit fearful.
• 41:10If he tells a learner
• 41:11that I suspect they have
• 41:12imposter syndrome,
• 41:13it may be experienced as
• 41:15a judgment of diagnosis.
• 41:17I love that. That's a
• 41:18great question, Chris. And I
• 41:19think as much as it's
• 41:21possible
• 41:21to kind of guide the
• 41:22learner to recognize that for
• 41:24themselves,
• 41:25I think that is probably
• 41:27the most ideal situation. I
• 41:28think that's done when we,
• 41:30you know, we talk about
• 41:31imposter syndrome proactively
• 41:32before someone maybe has even
• 41:34encountered it so that they
• 41:36feel, you know, a sense
• 41:37of confidence in in bringing
• 41:38that up that they wouldn't
• 41:39be judged.
• 41:40I think it can be
• 41:41challenging to tell someone that
• 41:43you think they have imposter
• 41:45syndrome. But, you know, I
• 41:46think depending on the relationship,
• 41:47like, the mentoring relationship, they
• 41:49might actually view it as
• 41:50a support,
• 41:51structure.
• 41:52I think if there's any
• 41:54feeling that as an educator
• 41:55that would come off as
• 41:56as too judgmental, I would
• 41:57think about, you know, other
• 41:59members of the support team,
• 42:00you know, people with equity
• 42:01roles, for example, or, like,
• 42:03an Ubud's person who might
• 42:04be able to navigate that
• 42:05conversation.
• 42:06But I I really love
• 42:07that, you know, there's that
• 42:08sensitivity to that question because
• 42:10I think the last thing
• 42:11you wanna do is is,
• 42:12you know, make someone feel
• 42:14feel worse about
• 42:16it. Yeah. Because then he
• 42:17actually has a really good
• 42:18comment
• 42:19about role modeling, sharing one's
• 42:21own experience.
• 42:23Exactly. Exactly. And I will
• 42:24often share my personal experiences
• 42:26just as I did here
• 42:27with learners so that they
• 42:28know, again, that they're not
• 42:29alone,
• 42:31and, you know, it it
• 42:32helps make them them feel
• 42:33like it's it's something that's
• 42:34pretty common in our professional
• 42:36space. That's excellent excellent questions
• 42:38and excellent point. Thanks. And
• 42:39then, Yadira is also saying,
• 42:41the certain amount of trust,
• 42:42which Yes. One of your
• 42:44slides up, I just really
• 42:45wanna point that out about
• 42:46the environment
• 42:48and really creating the trust
• 42:49right from the beginning and
• 42:51setting that up seems really
• 42:52important.
• 42:53Absolutely. Thank you.
• 42:55So just a few things
• 42:56in closing here. You know,
• 42:57we talked about how certain
• 42:59group identities can exacerbate,
• 43:01imposter syndrome. So certainly, you
• 43:03know, being doing your best
• 43:05to be mindful of your
• 43:06blind spots and your personal
• 43:07biases,
• 43:09Evaluating learners using really behavior
• 43:12based performance metrics,
• 43:14thinking about mindfulness because, again,
• 43:15that can help attenuate our
• 43:16sort of fast brain to
• 43:18slow brain
• 43:19tendencies,
• 43:20sharing in the equity work
• 43:21in your,
• 43:22department or your section because,
• 43:24again,
• 43:25groups who are underrepresented
• 43:27tend to to experience imposter
• 43:29syndrome more prevalently,
• 43:31and then create, like, tangible
• 43:32spaces where you hear concerns
• 43:33from learners.
• 43:34Because once that trust is
• 43:36built, they will share their
• 43:37stories, and I think it
• 43:37can really add to the
• 43:38richness of the conversation and
• 43:40help to diagnose a learner.
• 43:44I'm putting this QR code
• 43:45up just as a additional
• 43:46resource.
• 43:47I think if you have,
• 43:48the kind of mentoring relationship
• 43:51where you feel comfortable bringing
• 43:52this up, one thing that
• 43:54can actually be quite liberating
• 43:55to learners is to know
• 43:56the extent to which they
• 43:58experience impostor syndrome. And I
• 44:00always tell people, you know,
• 44:01it's not this is not
• 44:02a test that they're then,
• 44:03like, sending their score to
• 44:04me. This is just for
• 44:05their kind of personal knowledge
• 44:07because it,
• 44:09it actually will give you
• 44:10a sense of how,
• 44:12profound you might,
• 44:14how profound your imposter syndrome
• 44:15features may be. And just
• 44:17for your own personal knowledge,
• 44:19I think it can help
• 44:20you right size your responses
• 44:22to particular situations if you
• 44:23know that you're someone who
• 44:24has very strong feelings of
• 44:26imposter,
• 44:27phenomenon. And so they'll give
• 44:29you out a score
• 44:30that kinda separates into these
• 44:32categories of few, moderate, frequent,
• 44:34or intense. And I've had
• 44:35learners just provide feedback that
• 44:37it was,
• 44:38really helpful for them to
• 44:39know this and to to
• 44:41to recognize that that wasn't
• 44:42something inherently wrong with them,
• 44:44but to know that it
• 44:44was actually imposter syndrome.
• 44:47So in closing here, I
• 44:48I love this quote by
• 44:49doctor Valerie Young. She's an
• 44:50expert, in imposter syndrome, has
• 44:52written extensively and speaks, nationally
• 44:54on this topic.
• 44:55She says the goal is
• 44:56not to never feel like
• 44:57an imposter. The goal is
• 44:58to get people the tools
• 44:59and the insight and information
• 45:01to talk themselves down faster.
• 45:03They can still have an
• 45:04imposter moment,
• 45:06but not an imposter life.
• 45:07And I think that really
• 45:08just kind of encapsulates
• 45:09if we use these strategies
• 45:10and we, do our part
• 45:12to promote
• 45:13professional belonging in medical education,
• 45:15we can start to diminish
• 45:16the extent to which those
• 45:17imposter moments, you know, turn
• 45:19into an imposter life.
• 45:21So with that, I would
• 45:22just encourage you to make
• 45:23a personal commitment,
• 45:25in terms of what you
• 45:25might think about doing differently
• 45:27as an educator to support,
• 45:29learners who might be navigating
• 45:30imposter syndrome. Maybe like I
• 45:32have done, you'll start just
• 45:33mentioning the concept to folks
• 45:35as you establish mentoring relationships
• 45:38or you'll take some time
• 45:39to read more about it,
• 45:40just to kind of think
• 45:41critically about how we can
• 45:43all do our part to
• 45:44promote professional belonging.
• 45:46So with that I'll just
• 45:46put this screen up here.
• 45:47We we really value your
• 45:49feedback,
• 45:50and we thank you so
• 45:51much for your time and
• 45:52attention.
• 45:54Thank you so much, Aubin.
• 45:55Please everyone,
• 45:56it just takes a minute,
• 45:57but your feedback is really
• 45:58important to us. Sarah also
• 46:00put it in the chat,
• 46:02and we're seeing lots of
• 46:03wonderful
• 46:05thank yous, incredible talk, Abba.
• 46:07So it really was. And
• 46:09I think that by paying
• 46:10attention and naming it
• 46:12and allowing this psychologically safe
• 46:14environment, I really I think
• 46:16you've given us very rich
• 46:17tips. We probably have time
• 46:19if someone while we're filling
• 46:20out the eval, does anyone
• 46:21have a question?
• 46:29It's not really a question.
• 46:32I'm sorry. I'm just not
• 46:33in a place where I
• 46:33have a great camera. My
• 46:34name is Arielle. I'm a
• 46:35medical student doing the MHS
• 46:37medical education, and that was
• 46:38a wonderful talk. Thank you,
• 46:39doctor Black.
• 46:41But just to kind of
• 46:42comment, I'm actually working on
• 46:44a research project involving imposter
• 46:45phenomenon
• 46:46at the moment, and we
• 46:48were doing some ex extra
• 46:49exploratory questions. And
• 46:52we're it's still kind of
• 46:53in progress,
• 46:54in terms of the publication
• 46:56about it. But being made
• 46:57to feel incompetent at any
• 46:59point automatically started to increase
• 47:01the number of points that
• 47:02people had on their imposter
• 47:04phenomenon or that they perceived
• 47:05that they were being made
• 47:06to feel
• 47:07less than in any way.
• 47:10And so just
• 47:12knowing that the perception of
• 47:14it exactly, as you said,
• 47:15doctor Black, cannot have a
• 47:16direct correlation with imposter phenomenon
• 47:19scale points,
• 47:21may kind of help
• 47:23provide a
• 47:25objective way to talk about
• 47:26it with people without having
• 47:27to make it be quite
• 47:27as personal by just talking
• 47:28about it as points on
• 47:29a scale.
• 47:30Absolutely. Such an important point.
• 47:32I'm so glad to hear
• 47:33that you're doing some scholarship
• 47:34in this area because I
• 47:35think, the more we know
• 47:36about the phenomenon,
• 47:38the more that we can
• 47:38promote it in our, you
• 47:39know, our medical education academics,
• 47:41I think, would be very
• 47:42beneficial, not only to our
• 47:43learners, but, again, for all
• 47:45these contributions that are sometimes
• 47:45missed if if people don't
• 47:45feel like they have license
• 47:45to speak up and and
• 47:45to really contribute richly to
• 47:46our environment.
• 47:55Terrific. Well, it's one o'clock.
• 47:57I really thank you, Abba,
• 47:58and thanks to My pleasure.
• 47:59Thank you. For the rich
• 48:01discussions.
• 48:02Wonderful.
• 48:03Thanks so much. Thanks for
• 48:04coming, everyone.
• 48:06Excellent. Thank you so much,
• 48:07Abba. Yeah. Of course. Thanks,
• 48:09Jeanette.
• 48:10Appreciate the invitation.