"Rising to the Level of Your Incompetence": What Physicians' Self-Assessment of Their Performance Reveals About the Imposter Syndrome in Medicine.

PURPOSE: Mistakes are ubiquitous in medicine; when confronted by error, physicians may experience anxiety, guilt, and self-doubt. Feedback may be useful for navigating these feelings, but only if it matches a physician's self-assessment; self-doubt and the imposter syndrome are examples of inaccurate self-assessments that may affect receptivity to feedback. The impact of real or imagined underperformance on seemingly competent physicians is poorly understood. This study aimed to develop a deeper understanding to identify strategies to support all physicians who struggle.

METHOD: In 2015, 28 physicians were interviewed about their experiences with underperformance. Early in the data collection process, participants spontaneously identified the imposter syndrome as a feature of their experiences; questions about the imposter syndrome were probed in subsequent interviews.

RESULTS: Many participants-even those at advanced career stages-questioned the validity of their achievements; progressive independence and career advancement were variably experienced as "rising to the level of your incompetence." Not all participants identified as imposters; the imposter syndrome occurred at the extreme end of a spectrum of self-doubt. Even positive feedback could not buffer participants' insecurities, which participants rarely shared with their colleagues.

CONCLUSIONS: Self-doubt variably affects clinicians at all career stages. Frequent transitions may cause a resurgence of self-doubt that may affect feedback credibility. Medical educators must recognize that it is not just the underperforming or failing learners who struggle and require support, and medical culture must create space for physicians to share their struggles.