How to Overcome Imposter Syndrome in Pharmacy

Have you ever felt incompetent, despite the fact that those around you thought otherwise?

After a professional success or passing an exam, did you think that it was just luck that you succeeded?

Have you recently started a residency program and are worried that someone may find out that you don’t know something?

Have you recently been promoted to higher position, but feel that you don’t deserve it?

Have you ever felt that you won’t comment on some topics because you know too little about it and thought you will certainly embarrass yourself?

Imposter syndrome is a real challenge in pharmacy. The impostor phenomenon or imposter syndrome is described as a psychological experience of intellectual and professional fraudulence.

Individuals who experience these feelings may have the belief that others have inflated perceptions of their abilities and may be afraid of discovering their incompetence.¹ People who experience the impostor phenomenon believe that they are not worth their successes and doubt their knowledge, competence, and abilities.

The affected person feels out of place, unworthy of the successes, opportunities, and praise that befall them.¹ Imposter syndrome is not an official diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM–5); however, it is a real phenomenon, and it usually presents in certain situations—especially professional ones that we may perceive as stressful, challenging, or demanding.

Therefore, imposter syndrome is a phenomenon that affects self-confidence, significantly limiting the effectiveness of the professionals. This tendency has a negative impact on well-being and motivation, as well as reducing the effectiveness of action.

It represents excessively high expectations as to the standards we should achieve in knowledge and competence areas. The presence of the imposter syndrome is associated with:

• excessive perfectionism
• workaholism
• low self-esteem
• low self-confidence
• higher negative self-esteem
• high self-observation tendency
• depression
• anxiety
• burnout

Health care professionals may be affected by impostor phenomenon and the pharmacy profession is it not immune to that. Some self-report surveys presented that that those feelings were common among responding student pharmacists and faculty members.²

A study shows that impostor phenomenon was common among undergraduates and pharmacy students. Moreover, the authors highlighted that the impostor phenomenon does not discriminate by education, age, gender, race/ethnicity, year in school, or academic major.³

In another study, a survey on the prevalence of imposter syndrome among pharmacy residents indicated the residents have a significantly higher prevalence of imposter syndrome versus comparable groups.⁴

A pilot study on the impostor phenomenon among medical students showed that it lead to professional burnout.^5,6 Another study presented that perfectionism and the impostor are pertinent factors in the adjustment of health professional students, including medical, dental, nursing, and pharmacy students.

Those students experienced psychological distress, anxiety, and depression.⁷ The survey demonstrated positive associations between maladaptive perfectionism, impostor phenomenon, and suicidal ideation in medical students.⁸

There are no direct studies to show how impostor phenomenon may affect practicing pharmacists. However, there are some publications about how negatively impostor phenomenon affects the mental health of medical students, residents, and physicians, as well as how medical culture can train for and/or exacerbate predispositions to develop impostor phenomenon.^9,10

The estimated percentage of people who may experience impostor phenomenon in the overall population is 70%.¹¹ Previously, it was thought that women experience imposter syndrome more often.¹²

Later research indicates that both men and women experience imposter syndrome.¹³ Environment or institutionalized discrimination, may play a major role in developing impostor feelings. The affected groups include racial or ethnic minorities, women in STEM fields, or even international students.¹³

Health care professionals and students with imposter syndrome very often achieve great success. They are prone to perfectionism and set themselves with overly ambitious goals while fearing failure and enduring it much harder than other people; moreover, they do not get satisfaction from their successes.

They are also characterized by internal contradiction—on the one hand, they may need recognition and positive feedback from other people and on the other hand, they are not able to accept and fully believe in praise due to their negative self-image and low self-esteem.

Types of imposter syndrome are based on sets of destructive expectations adopted during the upbringing process. The first step in overcoming the imposter syndrome is to acknowledge what we are feeling and why it is happening.

Imposter syndrome was categorized it into 5 subgroups by Dr. Valerie Young, which include the Perfectionists, the Superman and Superwoman, the Natural Genius, the Soloists, and the Experts.¹⁵

Below are listed the destructive forms of expectations and beliefs with advice how to overcome them.

Perfectionists want to avoid mistakes.

Perfectionists strive for flawlessness. Perfectionists set the bar very high for themselves and when they fail to achieve their goal 100% in every aspect, they begin to doubt themselves.

They are often convinced that other people will complete tasks less carefully than them, so they try to control everything around them strictly or do everything on their own.

Advice: If you recognize yourself or other people with perfectionism tendencies, begin to be more indulgent with the mistakes of yourself and others. Treat them as a natural part of learning and improving.

Superman and Superwoman are individuals who strive to be "the best" in all fields of action in life.

These types of people have ambitions to fulfill 100% in all roles in their lives, both professional and private. They force themselves to work beyond their strength to meet their exacting expectations. As a result, their relationships and health begin to suffer and they are at risk of burnout. Workaholics may become dependent on their environment to assess how they function in a given role.

Advice: It is important that people affected by this type of syndrome reflect on their expectations in the context of functioning in various roles and make a time balance sheet. What is real and what is not taking into account your rest and being in close relationships. It is also good for them to learn to accept constructive criticism not in person, but in relation to the task performed.

Natural Genius is the belief that you may learn and do everything instantly, quickly and perfectly—sooner, faster, and better than others.

Brilliant people believe that it is important that the tasks are carried out, not only in the best possible and error-free manner, but also easily and quickly. If things don't come to them with the utmost ease and right away the first time, it is a failure for them.

Advice: Try to adopt a plan to improve your competences, recognizing that you will make many mistakes in the process. Make mistakes as a determinant on the way to your goal.

Being Soloists may lead to imposter syndrome because individualistic systems urge people to pursue personal achievement, which creates competition between individuals and may lead to social anxiety.

Individualists are always carrying out tasks on their own. Collaboration or the necessary help from others is treated by the individualist as a sign of their weakness and lack of competence.

Advice: Start asking others for help and appreciate yourself for this type of behavior, treat it as acquiring new competences. People value and like other people more when they feel needed.

Experts want to know everything about a given topic.

Experts are mainly focused on getting all the knowledge on a given topic. In this situation, even a small lack of knowledge means failure and shame.

Experts have unrealistic expectations that they should know everything, they fear that they will be exposed. It is worth distinguishing here a healthy pursuit of development and learning new skills from an exaggerated tendency to constantly seek more knowledge, which is a form of procrastination.

Advice: Start becoming a mentor to others who have less knowledge and experience. Appreciate yourself for your competences—those you already have.

How we may overcome or reduce impostor syndrome?

It is worth realizing that our intelligence, skills, and competences are flexible abilities that we can broaden and deepen to a large extent. Failure and mistakes should not be a cause for shame and resignation, but can instead be seen as valuable guidance as to what can be improved and what we can work on to be even better.

It is natural that to achieve many of our ambitious goals, even those that initially seem unrealistic, we need to put forth significant effort, regardless of our level of intelligence or potential. The development of self-understanding, greater tolerance for one's own weaknesses, and the ability to sincerely appreciate ourselves for what we know can also play an important role.

If someone has entrusted us with a role or position, most likely they judged us as competent enough to be able to cope with this challenge. People who hired you or choose you for a position saw talent in you.

Do not doubt the intelligence of those who hired you, promoted you, or offered you a chance. They have made deliberate decisions based on your experience and potential—you really deserve to be there.

Other tips to overcome imposter syndrome include:

• Choose someone you trust to tell them about your declining confidence and ask about additional support.
• Take responsibility for your achievements and for your success.
• When you achieve a goal or complete an important project, confirm out loud to yourself that it was achieved as a result of your talent and skill.
• Examine everything you've gained and reflect on the hard work you've done to get where you are right now.
• Practice listening to praise and wait for sincere compliments.
• Listen carefully at what you say at loud and reduce negative self-talk.
• Try mentoring—you have knowledge that you should share. Share it with someone who needs it. Not only will you notice how much you have to offer, but you will also discover your strengths during the process. Mentoring can reveal traits that you took for granted or mistakenly assumed were due to happiness. Besides, helping someone is a very empowering feeling.

References

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2. Boyle J, Malcom DR, Barker A, Gill R, Lloyd M, Bonenfant S. Assessment of impostor phenomenon in student pharmacists and faculty at two Doctor of Pharmacy Programs. Am. J. Pharm. Educ.https://www.ajpe.org/content/86/1/8474. Published May 1, 2021. Accessed February 1, 2022.
3. Medina M, Maerten-Rivera J, Zhao Y, Henson B. Impostor Phenomenon in Undergraduates and Pharmacy Students at a Small Private University. American Am. J. Pharm. https://www.ajpe.org/content/early/2022/01/13/ajpe8672. Published January 1, 2022. Accessed February 1, 2022.
4. Sullivan JB, Ryba NL. Prevalence of impostor phenomenon and assessment of well-being in pharmacy residents. Am J Health Syst Pharm. 2020 Apr 27;77(9):690-696. doi: 10.1093/ajhp/zxaa041. PMID: 32201891.
5. 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.
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8. ChenFeng J, Phillips A, Schreiber J, Young C, Wilkins K. Maladaptive Perfectionism, Impostor Phenomenon, and Suicidal Ideation Among Medical Students. Acad Psychiatry. 2021 Dec;45(6):708-715. doi: 10.1007/s40596-021-01503-1. Epub 2021 Aug 4. PMID: 34350548.
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14. Abrams A. Yes, Impostor Syndrome is real: Here's how to deal with it. Time. https://time.com/5312483/how-to-deal-with-impostor-syndrome/. Published June 20, 2018. Accessed February 1, 2022.
15. Imposter Syndrome Institute. https://impostorsyndrome.com Accessed February 1, 2022.