Feature Identifying the
impostor within Part two: Disrupting the cycle of impostorism By Hirschel McGinnis, MD
I felt a voice in the back of
my head telling me ‘You’re not smart enough, they’re going to find out’, and my brain became like a blank slate…despite having reviewed all the steps to the procedure four times that morning.”
—AN EARLY CAREER IR
In our last edition of IRQ, we introduced the topic of impostor syndrome, an internal struggle where those affected experience a temporary or ongoing cycle of dysfunction rooted in a deeply held sense of unworthiness. This is often found in high achievers who externally appear to be exceling but internally feel inadequate. Impostorism drives a cycle of compensational overwork with demonstrable success and a transient sense of accomplishment. Over time, and sometimes as a consequence of a poor patient outcome, feelings of inadequacy recur. Burnout and self-sabotage often accompany those affected.
Imposter syndrome thrives in high- pressure fields such as medicine. Statistically, it’s likely that at least one of your colleagues may experience it. You may experience it.
16 IRQ | SPRING 2022
“When I have to discuss an unknown case in front of my peers, I fear that
—AN IR TRAINEE
“Every time I entered the conference room, I had to brush away the fleeting
feeling of being
—AN IR TRAINEE
in a foreign country where I would never belong or welcomed.”
as being stupid and unworthy of being where I am.”
Measures of impostorism When diagnosing impostorism, one essential challenge is to differentiate between the typical anxieties and transient self-doubt that most proceduralists experience from the harmful Cycle of Impostorism. To do that, there are objective means. The most frequently used tool by researchers is the Clance IP Scale derived in 1985 by Pauline Rose Clance, PhD. It consists of a self-administered 20 question 5-point scale survey. Based on the total score, an individual is assigned to 1 of 4 categories. Higher scores correlate to the higher degrees of impact impostorism has upon an individual.
Other measurement scales include the Harvey Impostor Phenomenon Scale (J.C. Harvey, 1981); the Perceived
Fraudulence Scale (Kolligian and Sternberg, 1991) and Leary Impostor Scale (Leary, et al, 2000). None of these methodologies is a “gold standard” but do offer some insights.
Disrupting the cycle Impostorism isn’t perfectly understood. It’s a profoundly internal phenomenon that is initiated and perpetuated by different factors depending on the affected individual. Accordingly, there isn’t a unique solution. However, I’ve devised 3 broad categories of interventions that may prove helpful in disrupting the phenomenon: internal, interpersonal and institutional. These are just several of the 28 tactics I’ve derived as an overall strategy to dismantle impostorism. This list is by no means complete, and there may be as many solutions as there are people affected.
Internal Internal strategies allow those who are affected the ability to self-engage. This offers the advantage of early intervention with the hope of diminishing the initial negative impact of impostorism.
• Develop an awareness of the cycle of impostorism and what factors are most impactful in diminishing your sense of worthiness versus the most potent drivers of your cycle.
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