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Imposter syndrome: feeling like a fish out of water

05 December 2018 | Dr Victoria Phan, Doctor in Training Medical Adviser, BMed MD, MClinUS, DCH, FPAA Cert, Avant

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, in this scenario the intern didn’t know the answer either, and 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. As for the consultant, after receiving complaints from the clinical school, they have been feeling like an outcast among their peers, so they were trying to ‘teach’ the students. Apparently the patient was the only one in the room who felt like they belonged there.

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

There is a constant battle with 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 give you the opportunity for you to learn under supervision, and the ward rounds provide invaluable lessons. Skipping these could mean you will have gaps in your clinical experience.

Students often feel like they are a burden to the team and unwanted, and no one is keen to teach them. However, it is a two-way street; senior doctors are not interested in teaching students who are uninterested. They want to help nurture students that will take 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 foster 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 all the 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 learn.

Key tips

From the day you become an intern, there will be an expectation that you will 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.

  • It is more pertinent to learn how to assess a patient, rather than 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
  • Learn how to break bad news well.
  • Practise inserting a cannula every chance you get on patients and on each other.
  • Learn to write 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

How to break bad news

Connecting with patients

Medical records - the essentials

Gathering diagnostic information

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