Navigating Imposter Syndrome in Pharmacy Residency: Lessons Learned by Bryce Ashby

I am sitting across from my preceptor, about to complete an end-of-rotation evaluation. 

"This is it," I think to myself. "They are going to tell me I don't belong here, that I haven't met the rotation's expectations, and that I'm a fraud." 

To my relief, instead, they list numerous ways in which I excelled during the rotation. Then came helpful and accurate feedback on areas for improvement. I have found myself in some iteration of this cycle countless times since I started my rotational experiences as a student. It may sound familiar to you as well. It wasn't until my final year of pharmacy school that I learned there is a name for these types of thoughts and feelings: Imposter syndrome.

What is imposter syndrome?

Imposter syndrome (sometimes known as “imposterism”) is a nagging voice in your head that tells you that you are not good enough, that you do not belong and that you are going to be found out as a fraud at any minute. Those who struggle with imposter syndrome doubt their abilities, attribute their success to external factors or luck, discount or minimize praise and have a fear of failing. In an attempt to overcome these feelings, they may also obsess about being an overachiever. Imposter syndrome is especially common among high-achieving individuals, where there may be increased expectations of knowledge and competence.

But isn't that also the same thing as humility? Humility is an important and necessary trait. There can be a fair amount of overlap between humility and imposter syndrome, but humility crosses into imposter syndrome when it occupies your thoughts so much that your ability to focus is impaired. Anxiety follows, then self-deprecating thought patterns. Pastor Rick Warren sums up the difference: "Humility is not thinking less of yourself, it is thinking of yourself less."

Lessons learned living with imposter syndrome

So, how do we manage imposter syndrome? As I have personally wrestled with these feelings of inadequacy during my time as a student and through two years of pharmacy residency, I have learned several valuable lessons that I want to share.

Lesson #1: Know it exists

This may seem obvious, but a defining moment for me was being able to take a step back and examine my thoughts and feelings to realize how these aligned with imposterism. Just learning that imposter syndrome exists and that there is a name for these feelings was incredibly liberating.

Lesson #2: Be kind to yourself

In the field of health care, there is an infinite amount of knowledge to be gained. It is impossible to know it all! Despite this, a common thought of imposterism is that we should know everything. After practicing mindfulness and identifying my thoughts as imposter syndrome, I now remind myself that I am not expected to know everything; that is why I am here!

Lesson #3: Know you are not alone

Those who struggle with imposter syndrome tend to think that they are alone and that nobody else has these feelings. We often pit our weaknesses against other's strengths (not a fair comparison!). Recently, I had the chance to talk about imposter syndrome with my fellow Legacy Health pharmacy residents and discovered that all of us had experienced these feelings and thoughts! It doesn't end there; many high-achieving people have also experienced feelings of imposter syndrome, including Albert Einstein, Serena Williams, Tom Hanks, Maya Angelou, among many others.

Lesson #4: Practice mindful self-compassion

This has been a crucial and central tool for me, and I highly recommend it to anyone who experiences imposter syndrome. A great deal of research has been conducted on the practice and effect of self-compassion, much of it led by Dr. Kristin Neff and Dr. Christopher Germer. Together, they created a workbook called “The Mindful Self-Compassion Workbook.” A few years ago, on the recommendation of my counselor, I purchased the book. But being in the middle of a move, I did not open it for nearly a year. What a tragedy that was! The book’s research-based practices and exercises changed the way I approach these difficult thoughts. It certainly takes practice. At times, when I feel overwhelmed by feelings of imposterism, I often realize that I have fallen out of practicing what the workbook taught me, and I then re-dedicate myself to its teachings. We use the word “practice” because it certainly takes practice!

Some may think: “Self-compassion? That just sounds like being soft.” However, research actually shows that self-compassion increases resilience and builds inner strength. Perhaps my delay in opening the book is representative of some skepticism that I had. Any skepticism quickly dissolved as I began to experience the benefits of exercising the principles presented therein.

Lesson #5: Talk about it with a mentor

Near the beginning of my second year of residency, I confided in a preceptor and great mentor of mine about the challenges I face because of imposter syndrome. She expertly listened to my concerns, made me feel heard and validated those feelings. As I’ve continued to work with this mentor, she has regularly checked in on me and has pointed out some of her own mistakes as a means of normalizing imperfections.

We all need a mentor (or several) to help us navigate residency, career and life. In relation to imposter syndrome, a good mentor can validate the mentee’s feelings and provide a less biased, more objective point of view. The best mentors are also forthcoming about the struggles they've gone through and the mistakes they've made in their careers.

Lesson #6: Save and review positive feedback

It’s funny how we can be so quick to forget the positive and focus only on the negative. Someone with imposter syndrome may be told ten things they excel in but one thing they should improve upon. They are likely to focus on that one area of improvement but completely ignore the ten positives. Of course, we need to focus on areas of improvement but those with imposter syndrome may tend to ruminate and define themselves negatively, while completely forgetting about those ten positives! I have noticed this pattern in myself.

When imposterism sets in and I begin to define myself only by my mistakes or shortcomings, I find it useful to review positive feedback I have previously received and remind myself of what my preceptors have told me. And wouldn’t you know it, when I do this, I have a little more compassion for myself. This gives me motivation and positivity towards effectively addressing that area of improvement. Residency is convenient because all of our positive feedback is compiled into PharmAcademic, which makes it easily accessible.

Lesson #7: Embrace it!

Finally, I have learned and accepted that these feelings are not something that I will deal with once and never again. They will continue to resurface. I'm learning through mindfulness and self-compassion to treat them like an old friend.

When I start to experience feelings of angst, I now quickly identify and label them in my head or even verbally. I say, "Oh yeah, that's my imposter syndrome." Accepting the feelings instead of resisting them leads to a quicker resolution. When we resist or try to suppress unwanted thoughts or feelings, they tend to become stronger and more prolonged. Embracing my imposter syndrome has also enabled me to recognize situations or circumstances that are likely to trigger these feelings, so I can be mindful of them before I start to resist. 

Residency is a unique experience that enables accelerated growth and opportunity. Don’t let imposter syndrome get in the way of this valuable time. Whether you experience these challenges or are a mentor to someone who does, I hope the above lessons can help.