Imposter syndrome: when you feel like you don't belong

You're three months into your first registrar position when the consultant asks during the morning handover, "What's your differential diagnosis for this patient's acute abdominal pain?" The room falls silent, and your mind goes blank. A fellow registrar confidently rattles off a comprehensive list and supporting evidence. You feel exposed, incompetent and convinced that everyone can see through your facade of medical knowledge. The familiar voice in your head whispers: "You don't belong here."

What is imposter syndrome?

Imposter syndrome is a psychological phenomenon where individuals doubt their accomplishments and fear being exposed as a ‘fraud’, despite evidence of their competence. It can affect anyone, particularly high-achieving individuals, such as doctors.

It's like having persistent cognitive dissonance between your actual clinical abilities and your perceived inadequacy. You might experience symptoms similar to anxiety: racing thoughts, increased heart rate, and avoidance behaviours.

A universal experience in medicine

You're not alone in feeling this way. Research shows that up to 70% of healthcare professionals experience imposter syndrome at some point in their careers. It's particularly common during transitional periods – moving from intern to resident, resident to registrar, or taking on new clinical responsibilities.

The reality is that your consultant probably felt the same way during their training. That confident registrar who seemed to know everything? They likely went home and questioned whether they really understood the pathophysiology they just described. Even experienced clinicians regularly encounter situations where they feel out of their depth.

The medical profession's culture of perfectionism and high-stakes decision-making creates fertile ground for these feelings. You're expected to know vast amounts of information, make critical decisions under pressure and continuously learn while caring for patients. It's natural to sometimes feel overwhelmed.

Adding to this challenge is the isolation many registrars experience. Registrars might not get to work directly alongside peers, often working independently or with more senior colleagues. So, you have limited opportunities to gauge your abilities against others at your stage of training. This professional isolation can amplify feelings of inadequacy because you simply don't know how you compare to your contemporaries.

The hidden impact on your career

Imposter syndrome can significantly affect your professional development. You might avoid applying for competitive training positions, hesitate to contribute during multidisciplinary meetings, or decline teaching opportunities. These behaviours can limit your career progression and rob you of valuable learning experiences.

Many early career doctors develop counterproductive coping strategies. Some overcompensate by working excessive hours, while others become paralysed by perfectionism. You might find yourself avoiding challenging cases or constantly seeking reassurance from colleagues, which can actually hinder your clinical growth.

Building genuine confidence

The transition from feeling like an imposter to becoming a confident clinician requires intentional effort. Here are some strategies that could help:

1. Reframe your perspective on knowledge gaps – Every ‘I don't know’ moment is a learning opportunity, not evidence of incompetence. Senior consultants respect colleagues who acknowledge their limitations – it demonstrates good clinical judgement and patient safety awareness.
2. Document your achievements – Keep a record of positive patient outcomes, feedback from colleagues and successful procedures. When imposter syndrome strikes, reviewing these concrete examples of your competence can provide much-needed perspective.
3. Seek mentorship actively – Find senior colleagues who can provide guidance and reassurance. A good mentor will help you understand that feeling uncertain is part of professional growth, not a character flaw.
4. Recognise that everyone has different strengths – That registrar who confidently recites the latest guidelines might struggle with patient communication or procedural skills – areas where you excel. Medical training encompasses diverse competencies, and no one excels in every domain simultaneously. Your colleagues' visible strengths don't negate your own abilities.
5. Reflect on your personal progress – Compare yourself now to where you were as a first-year medical student, intern, or resident. The transformation is likely remarkable. You've developed clinical reasoning skills, learned to manage emergencies, and gained the trust of patients and colleagues. This perspective helps counter the imposter syndrome narrative that you haven't grown or don't belong.
6. Acknowledge areas for development – It's completely normal to have aspects of your practice that need work. Recognising these areas isn't evidence of incompetence, it demonstrates insight and professionalism. Every doctor, regardless of seniority, has skills they're actively developing. Growth is an integral part of medical practice, not a sign of inadequacy.
7. Practice self-compassion – Treat yourself with the same kindness you'd show a colleague facing similar challenges. Medicine is inherently difficult. You're not expected to have all the answers immediately.
8. Utilise available support resources – There are many places you can find support. Colleagues, family and friends are often a good starting place. Additionally, various helplines and support services are available both within your workplace and through external organisations. See resources below.

Moving forward with confidence

Remember that competence in medicine develops gradually through experience, reflection and continuous learning. Feelings of inadequacy often reflect high standards rather than incompetence.

The difference between those who thrive and those who struggle isn't the absence of self-doubt, but rather learning to work alongside it. Trust in your abilities, embrace the learning process and remember, becoming a confident doctor is a journey, not a destination.

Resources

Key support services

Hand n Hand peer support