Imposter syndrome: feeling like a fish out of water

You’re on the general surgery ward observing the rounds when the consultant asks “the patient has presented with acute cholangitis. What is the classical triad?” The registrar and the intern look at each other, and then they both look at you. It’s far too early for bedside teaching, or humiliation! You look at your fellow medical student in desperation. They then confidently answer “Charcot’s Triad - fever, jaundice and right upper quadrant pain.” They knew the answer, and you didn’t – how embarrassing. You immediately feel small and insignificant, and an absolute fraud. The anxiety sets in and you’re worried about attending future ward rounds because you fear being judged.

A common scenario

Feeling like a fish out of water is very common among medical students. However, before you beat yourself up, bear in mind that in this scenario the intern didn’t know the answer either, and probably felt even more stupid because they were outdone by a medical student. The registrar’s provisional diagnosis had been acute gastritis and wanted to discharge the patient. And as for the consultant, he was just trying to improve on the way he involved junior doctors and students, after receiving complaints from the clinical school. Apparently, the patient was the only one in the room who felt like they belonged there.

The reality is that all medical professionals, experience ‘imposter syndrome’ at some stage of their career. For medical students this gnawing dread of embarrassment becomes more pronounced when clinical placements begin. They just want to belong.

They’re dealing with the constant battle of balancing a social life, studying for exams and obsessing over long cases, all while attending mandatory ward rounds. It is not unusual for students to think “What is the point of me being on the ward round when I’m useless and no one notices if I’m there anyway? I could be studying for exams instead.”

Invaluable lessons and good working relationships

Clinical placements are an opportunity for you to learn under supervision, and the ward rounds provide invaluable lessons that won’t come from textbooks. Skipping these could mean you will have gaps in your clinical experience.

Students often feel like they are an and unwanted burden to the team, and no one is keen to teach them. However, it’s a two-way street; senior doctors are not interested in teaching students who are uninterested. They want to help nurture students who will take the initiative, whether it be volunteering to present the patient before the ward round or simply printing out the team list prior to handover.

Attending ward rounds will give you the opportunity to develop good working relationships with your peers, seniors, nurses and allied staff, who will be able to support you throughout your clinical placements and internship.

Along with ward rounds, time spent observing community nursing and outpatient clinics might be the last time you get exposure to the different facets of medical care without having to be responsible for anyone. So make the most of it.

Whether you are on the paediatrics or palliative care ward, there will always be a pearl of clinical wisdom to pick up.

Key tips

From the day you become an intern, there will be an expectation that you magically know how to do your job, and do it well. Here are some key tips for getting the most out of your clinical placements, so that you’ll be in a stronger position to hit the ground running when you move on to this stage of your training.

• It’s more pertinent to understand how to assess a patient, rather than recite the diagnostic criteria for disorders. Guidelines and criteria are always evolving.
• Learn how to take a history well. Examination and investigations should only further confirm your diagnosis.
• Practise inserting a cannula every chance you get. On patients and on each other.
• Learn how to break bad news well.
• Practice writing concise and structured notes in patients’ medical records.

Final thoughts

Take advantage of the all the positive and negative clinical placement experiences you are given. They will help shape your future practice as a clinician, and give you the confidence to be an integral part of a clinical team and that sense of belonging.

Useful resources

Medical records - the essentials

Video: How to break bad news - Avant by doctors for doctors

Fact sheet: Breaking bad news to patients - Avant by doctors for doctors

Writing a discharge summary