Authors: Sira Jaffri, Lakshmi Meenakshi Immaneni, Meghan Etsey, Yun Weisholtz MD-PhD on behalf of the AMWA Gender Equity Task Force

One, two, three.
Breathe in. Breathe out.

A routine for the inevitable nerves that come with morning rounds.

Early in training, you learn how much a medical student sticks out. On rounds, your body gives you away before you say a word, your heart is racing, your palms are damp, that familiar surge of adrenaline, like you have just been chased or you are about to bungee jump. You have rehearsed the presentation a dozen times, but it still feels like stepping onto a stage without a script. You try to blend in. Do not take up too much space. Do not step on anyone’s toes. You watch who speaks, who gets interrupted, and who gets corrected. You learn quickly that being wrong carries weight and that confidence does not guarantee protection. So you hedge. You soften your language. You make yourself smaller, just enough to be safe. The nerves are always there. Not because you are not prepared, but because you are constantly aware of how you are being perceived. You are learning medicine inside a system that reminds you, subtly and repeatedly, that your place is provisional.

Moreover, still, the advice comes: Be more confident.

However, what if that anxiety is not a personal shortcoming? What if it is the natural response to being trained in a culture where belonging has to be earned and can be questioned at any moment?

That voice inside your head that keeps you second-guessing yourself, holding back from speaking up, or feeling inadequate has a name: impostor phenomenon. Imposter phenomenon (IP) was coined by psychologists Drs. Pauline Clance and Suzanne Imes termed the internal feeling of intellectual fraudulence despite objective success and achievements, a phenomenon especially prevalent amongst high-achieving women (Clance, P. R., & Imes, 1978). It is the feeling that you have fooled those around you into thinking you are more intelligent than you actually are. Although this feeling may seem deeply personal, evidence suggests it is widespread amongst physicians. In a multivariable analysis, physicians reported higher levels of IP than those in other fields, with female physicians scoring higher than their male counterparts (Shanafelt, 2022). The prevalence of IP and feelings of disappointment with accomplishments amongst physicians, regardless of level of education, may reflect a culture of unrealistic personal expectations and perfectionism in medicine (Shanafelt, 2022). Working alongside other high-achieving colleagues can further amplify these feelings (Shanafelt, 2022). Rates of IP between female and male physicians differ across studies, with some showing lower rates among women, potentially due to differences in coping mechanisms (Shanafelt, 2022). 

The culture of invincibility in medicine, which frames seeking help as a sign of weakness, may perpetuate widespread self-doubt (Shanafelt, 2022). Findings from multiple studies consistently demonstrate that IP develops early in medical school and persists after training is complete. This may reflect how poor training environments and attitudes developed early in a career don’t go away (Shanafelt, 2022). Prior research suggests that academic performance may influence confidence and perceived ability to manage the demands of medical training (Chua et al.). As a student, this can manifest as a reluctance to ask a question out of fear of being perceived as unintelligent by a resident or attending physician. The feeling of relief when someone finally asks the question you were too afraid to ask shows you are not alone.

It does not end as a student. 

Residents in training report relatively high levels of Impostor Syndrome (IS) as they transition from the competitive matching process as students into new clinical responsibilities while continuing to train (Chua et al.). Transition points throughout medical training introduce unique stressors that require quick adaptation. Changes in the environment, increased responsibility, and a lack of faculty support may further contribute to a self-perceived lack of knowledge and clinical competence (Chua et al.).

It does not end as a resident.

Approximately one quarter of physicians report frequent or intense feelings of IP (Shanafelt, 2022). They are at 30% increased risk of reporting IP symptoms compared to workers in any other career and at 80% increased risk compared to those with a doctoral or professional degree in a different field (Shanafelt, 2022). Across multiple studies, it has been shown that women experience higher rates of IP than their male counterparts, and this is true at every stage of medical training (Chua et al.). Even after completing training, female physicians report higher rates of IS than their male counterparts, regardless of specialty or leadership position (Iwai et al.). 

So why do women across every level of medical training report higher levels of IP than their male counterparts? Do they believe they are inadequate, or are they repeatedly told they are?

A critical yet often unnamed feature of medical training is the environmental context that causes individuals to question their own competence and lived experience despite objective evidence of their ability. Professional gaslighting manifests structurally when institutions withhold necessary support and then frame the resulting struggle as a personal lack of ‘merit.’ This is compounded by daily microaggressions, such as being addressed by first names. In contrast, male colleagues are addressed as ‘Doctor’, which subtly excludes women from the professional circle, forcing them to navigate a constant, exhausting undercurrent of ‘not belonging (LaDonna et al., 2025). Rather than addressing the systemic and cultural factors that produce this dissonance, medical institutions frequently pathologize or fail to meaningfully address the individual’s response, effectively transforming external bias into an internal burden of doubt. To address this limitation, researchers have introduced the Intruder Paradox (IPx). This theoretical model reframes impostor phenomenon not as a purely internal psychological deficit from an internalized sense of “I do not belong” to a rational response to exclusionary and invalidating training environments that communicate “you do not want me here”, even in the presence of demonstrated competence (LaDonna et al., 2025). 

So, why does this distinction matter? 

There is a high prevalence of moral injury among female trainees, which is significantly associated with emotional exhaustion, depersonalization, and burnout (Syed et al., 2024). These feelings have tangible impacts on patient care and professional growth; for instance, 21.4% of women surgeons are hesitant to take on leadership roles due to self-doubt (McCall et al., 2024). Self-doubt can lead surgeons to avoid complex cases or even give up operating entirely, not because of a lack of skill, but because of the psychological toll of the environment (McCall et al., 2024). Self-doubt can be driven by workplace discrimination and internalization of negative feedback, resulting in decreased confidence in one’s own abilities (LaDonna et al., 2025). 

Addressing the root causes of self-doubt in women in medicine, whether conceptualized as imposter syndrome or the intruder paradox, is essential to understanding how women can feel psychologically safe and perform optimally in medicine. Current interventions aimed at alleviating imposter syndrome largely frame it as an internal cognitive distortion, focusing on individual coping strategies (LaDonna et al., 2025). However, this approach may overlook the role of the external environment in shaping and reinforcing self-doubt. Workplace culture, discrimination, and evaluation bias can contribute to internalized perceptions of inadequacy (LaDonna et al., 2025). Further research examining how environmental factors fuel self-doubt is warranted. Such work could clarify whether institutional dynamics function as confounding or mediating variables in women’s perceptions of competence within medicine.

References

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About the Authors

Sira Jaffri

Sira Jaffri is a medical student at St. George’s University. Her previous research centers on STEM student mental health and wellness, with a focus on student stressors, LGBTQ+ experience in STEM, and utilization of student support programs. She is passionate about exploring how diverse student backgrounds and institutions impact well-being and academic success, contributing to the broader conversation on promoting student wellness and preventing burnout in higher education.

Lakshmi Meenakshi Immaneni, OMS4

Meenu Immaneni is a fourth-year medical student at the Burrell College of Osteopathic Medicine. She has a Bachelor of Science in Public Health with a focus in Nutrition from the University of North Carolina at Chapel Hill. Passionate about patient advocacy and advancing equity in healthcare, Meenu is a dedicated member of the American Medical Women’s Association, where she serves on the Gender Equity Task Force. She is particularly interested in promoting mentorship, and championing women’s leadership in medicine. When she is not studying, Meenu enjoys spending time with her husband and their cat, playing board games, reading, and traveling to explore new places.

Meghan Etsey, MS4

Meghan Etsey is a fourth year medical student from St. George’s University. She has a Bachelors of Arts in Biology and a Bachelors of Arts in Nutrition and Dietetics from Bluffton University in Bluffton, Ohio. She served as the President of the St. George’s University’s Women in Medicine chapter in St. George, Grenada where she expanded relationships with the community and worked towards educating women and helping the youth. She is also a member of the Gender Equity Task Force and Sex and Gender Health Collaborative Committees within the American Medical Women’s Association. When she is not pursuing medicine, you can find her with her friends and family on different road trips and adventures exploring the world.