CHESTThought Leader BlogA Healthy Dose of Self-Doubt

A Healthy Dose of Self-Doubt

By: Kevin Swiatek, DO

This post is part of our Life as a Fellow blog post series, which features “fellow life lessons” from current trainees in leadership with CHEST.

The transition to my first job after fellowship was challenging. I moved halfway across the country to a new city, to work for a different system, in the middle of a global pandemic – things could have gone a little more smoothly. My situation is not unique, and these transitions are difficult for most new trainees and doctors. During years of graduate and postgraduate education we become creatures of habit, accustomed to the apprenticeship-model of learning. Unfortunately, this model of learning fails to prepare trainees for “life in the real world,” which – I believe – contributes to the insecurities we face in the years after fellowship.

I’ve been fortunate to have trained at many excellent centers around the country. My mentors and faculty spent significant time rigorously testing the boundaries of my medical knowledge so that I would become a competent independent physician. However, the reality is that one day you go to bed as a fellow and wake up as an attending. Suddenly, the whole team is staring at you and waiting for a final decision. Or, the patient is sitting one-on-one with you, the specialist, waiting for you to provide your expert opinion. While the transition from trainee to autonomous practitioner has been liberating, it is also terrifying. My mind wonders when they are going to check my credentials? Am I good enough to be here, or is this just dumb luck? Do I even belong here? Somehow, after 7 years of postgraduate training, my career is finally starting, and it is fair to say there is a healthy dose of self-doubt.

Thoughts creep in from time to time, mostly in my outpatient pulmonary practice. I often feel like an imposter when I am troubleshooting a specific scenario that I have not experienced before. Even though we have been trained as problem solvers, the feeling of, “huh, I’ve never seen that before…” is inescapable, no matter how many years of training we have. Recently, I was asked to lead the airway course for fellows and residents. I chuckled nervously to myself as I thought I had little to offer this group of learners but came to find out afterward that my training and experience on this subject was greatly appreciated.

Imposter syndrome was first described by psychologists Clance and Imes in 1978 as a constellation of feelings characterized by self-doubt, fear of being discovered as an intellectual fraud, and a perception of being less intelligent or competent than peers. The prevalence of imposter syndrome is widely reported among physicians, and it is estimated that up to 70% of physicians will experience imposterism during their careers. Rates appear higher in women and foreign medical graduates. The syndrome is associated with increased levels of burnout, decreased satisfaction in work, and suicide. Imposter syndrome is not a topic of conversation to be avoided; instead, we should bring it into the light so that we may better examine, and cope with, this phenomenon.

Over the past few months, I’ve found it helpful to call out my uncomfortable feelings by name, like self-doubt or imposter syndrome. Doing so helps me to compartmentalize those thoughts and recognize patterns. I use the feeling of self-doubt to pause for a moment. This self-reflection is an opportunity to check my own biases and consider what I think I know. I found this tool to be helpful for teaching in the medical ICU. For example, we recently considered a patient with a suspected upper gastrointestinal bleed, but the source could not be identified. While considering the management strategy, we paused as a team to examine options and appraise the evidence. In my gut, I knew the best approach. However, I sometimes experience a reluctance to commit to it with haste. I felt the need to confirm my initial thoughts by revisiting the evidence. My imposterism made me feel the need to reaffirm the conclusion I had drawn based on my years of training. Practicing ICU medicine requires a duality of confidence and humility to make the best decisions for our patients.

I am fortunate to belong to a community of practitioners who embrace and support their new partners. While imposter syndrome is undoubtedly associated with significant negative consequences, coping with this phenomenon with the support of colleagues may be an opportunity to improve one’s self-awareness and be a better doctor. As I speak with more of my junior partners, I find that we are not alone – the feeling is everywhere! As a community, we need to embrace this feeling and allow it to help us continue to grow. You deserve to be here. You have earned it. You belong – and are valued – in the medical community.

Kevin Swiatek, DO

Kevin Swiatek, DO

Kevin Swiatek, DO, is a board-certified physician specializing in pulmonology, critical care, and internal medicine. Dr. Swiatek earned his medical degree from Ohio University Heritage College of Osteopathic Medicine in Athens, Ohio. He completed his internal medicine residency at Riverside Methodist Hospital in Columbus, Ohio, and his fellowship in pulmonary and critical care medicine at Virginia Commonwealth University in Richmond, Virginia. He now practices pulmonary and critical care medicine at Spectrum Health, and serves as an Assistant Professor of Medicine at Michigan State University. His clinical interests include caring for patients with undifferentiated shortness of breath, asthma, chronic obstructive pulmonary disease, interstitial lung disease, pulmonary hypertension, and cystic fibrosis.