The Fear of Being Found Out In Pharmacy: How Impostor Syndrome May Be Holding Us Back

By Jaclyn A. Boyle, PharmD and Sara E. Bonenfant, PharmD Candidate 2020

I do not deserve to be here.

Others will find out I am not qualified to be here.

It was through pure luck that I am here now.

These are just a few thoughts of Impostor Syndrome (IS) that we have experienced in our academic and professional careers. When being recognized for contributions to the profession or receiving a new position or promotion, fraudulent thoughts commence. Any success is directly attributed to luck or minimized. Negative inner talk and a self-created feeling of deceiving others into believing that one is qualified or deserving of an opportunity are commonplace. While a “thank you” may be verbally expressed in response to praise, an internal “this can’t be true” is the first thing that often comes to mind. These scenarios culminate ultimately in self-limiting beliefs and risk aversion, which limits high achievers’ ability to express their full potential.

Impostorism Thoughts Start Early
Before matriculating to pharmacy school, students are typically at the top of their class and frequently receive academic rewards. The shift to professional school can present a stark new reality as high-achieving students enter into a competitive and more rigorous academic environment. Along with this dramatic shift, feelings of being undeserving or being exposed as a fraud may emerge. Counterintuitively, it appears that fraudulent feelings only increase as one progresses in their academic training.1

What is Impostor Syndrome?
This phenomenon, first described as Impostor Complex by Clance and colleagues in 1978, is now commonly referred to as Impostor Syndrome (IS). While early evidence focused on high-achieving females, conflicting evidence exists regarding whether this is a gender-specific phenomenon. One study also indicates that there may be a correlation of feelings of IS and experiencing burnout.1 Given the evidence available regarding feelings of IS in high-achieving individuals like health professional students, it is clear that more solutions or support are needed.2

Link to Health Professions?
Feelings of IS are not specific to pharmacy. Henning et al. described a multidisciplinary study of medical, nursing, pharmacy, and dental students (n=477) in which 30% of survey respondents report experiencing IS.3 This was the only study found in a literature search of IS that included pharmacy students, which highlights the need for further research within our profession.

Long-term Effects
In addition to limiting one’s self-beliefs during school, IS often continues after graduation. One institution administered a survey to medical residents early in their residency year. Results demonstrated that 43.8% of residents identified as feeling like an impostor and 12.5% had feelings of burnout.4 Although there was no association between feelings of IS and burnout, another study demonstrated IS was associated with higher burnout scores related to exhaustion, cynicism, emotional exhaustion, and depersonalization.5 And though no evidence exists for pharmacists currently, with our experiences and through discussions with colleagues, impostor feelings are ubiquitous. From a faculty perspective, it would be interesting to see if this trend continues. The push to do more as one progresses through the promotion and tenure process could lead to overwork or potentially burnout. In light of several professional discussions around the importance of well-being and resilience as a priority, our profession has a tremendous opportunity to conduct more investigation in the area of impostorism and its association with burnout.

Overcoming IS
Given the myriad of limiting and potentially degrading consequences of IS, what strategies exist to combat it? While no evidence-based strategies exist, many opinion pieces have suggested ways to overcome IS including:5

  • Recognize IS exists. Identification and naming the issue could help you take action.
  • Change your inner dialogue. Often, our brains revert to negative self-talk that holds us back from taking risks or seeking opportunities rooted in an inner fear of being “found out.”
  • Accept imperfection. It is important to recognize that humans, by nature, are imperfect. While high achievers might prefer perfection, this ideal state is unrealistic.
  • Conduct a positive self-assessment. Reflect on your strengths and accomplishments. What are a few of your most recent achievements?
  • Discuss with mentors/peers. Discussing IS openly with colleagues and mentors can lead to constructive conversations that move you past your inner barriers.
  • Advise students. Discussing this topic with your students and allowing them to express their concerns can help them mitigate IS throughout their professional career.
  • Develop a new attitude towards failure. Accept that failure is imminent and approach failures with a learning mindset.
  • Visualize success. Lastly, what does success look like for you? Have you discovered what success means to you? Identifying a positive outcome can help calm inner impostor talk.

Impostor syndrome does not subside with time, experience, or success and we need to start talking openly about this important issue. How have you mitigated feelings of IS? What are the next steps in discovering how IS impacts our profession?

References

  1. Villwock JA, Sobin LB, Koester LA, et al. Impostor Syndrome and burnout amongst American medical students: A pilot study. Int J Med Educ 2016;7:364-369.
  2. Henning K, Ey S, Shaw D. Perfectionism, the impostor phenomenon and psychological adjustment in medical, dental, nursing and pharmacy students. Med Ed. 1998;32:456-464.
  3. Legassie J, Zibrowski EM, Goldszmidt MA. Measuring resident well-being: impostorism and burnout syndrome in residency. J Gen Intern Med. 2008;23(7):1090–4.
  4. Stahl A. Feel Like a Fraud? Here’s How to Overcome Impostor Syndrome. Forbes. Accessed on May 28, 2019.
  5. Clance PR, Imes SA. The imposter phenomenon in high achieving women: Dynamics and therapeutic intervention. Psychother‐T. 1978;15(3):241‐247.

imageJaclyn Boyle is an Assistant Professor of Pharmacy Practice at the Northeast Ohio Medical University College of Pharmacy. Educational scholarship interests include professional development, preparing learners for careers in academia, and evaluating novel teaching and assessment methods. Jaclyn is very active in professional pharmacy organizations. In her free time, Jaclyn enjoys spending time with her family & friends, spinning, and yoga.

imageSara Bonenfant is a fourth-year student pharmacist at Northeast Ohio Medical University College of Pharmacy. Sara’s educational scholarship interests include mentoring, student leadership, and professional organization involvement. She is also an active member in local, state, and national pharmacy organizations to help advance the practice of pharmacy. In her free time, Sara enjoys spending time with loved ones and loves being a dog mom to her two huskies.


Pulses is a scholarly blog supported by Currents in Pharmacy Teaching and Learning

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