Below are stories and reflections from medical students that have overcome their struggles with mental health and imposter syndrome. These are included to help motivate, inspire and educate people on the many ways that mental health impacts performance in medical school.

STORY #1:

“When I was about to take my first quiz in medical school, I was convinced I would fail while everyone else felt prepared and would score perfectly. While I floundered to believe in my mastery of the material, my peers seemed confident and secure. This couldn’t be farther from the truth: I was indeed prepared and ready to succeed in my academics as an M1, and many others were feeling the same sense of insufficiency as me. This experience of imposter syndrome, or chronically doubting your abilities and the fear of being discovered as a fraud, affects many people, including medical students, who find it difficult to accept their accomplishments and feel undeserving of praise or awards.

As medical school gets more difficult and residency spots become more competitive, the pressure of performing well on USMLE exams, getting publications, and scoring leadership positions can feel very overwhelming. The pressures surrounding medical school can kill the excitement, empathy, and hope that students enter with, leading to burnout and isolation even before they begin training. It has been reported that fourth-year medical students may feel imposter syndrome most acutely of any program year in response to the stress of matching, along with the thought of being called “doctor” in a few short months while they are still gaining confidence as a competent physician.

I wish I had been more open about my experience of imposter syndrome right from the beginning of M1 because talking about this sense of not being enough is one of the best ways to combat those emotions. Imposter syndrome cannot be ignored. It causes increased suffering, psychological distress, and burnout.

Here are some ways you can help combat imposter syndrome in medical school:

1. Talk about it. Share your experiences of feeling like an imposter with your friends and classmates: They may feel the same way. This can help everyone feel less isolated and more supported.
2. Remember you are a student. You are not expected to know everything the physicians and residents know. You are here to learn.
3. Acknowledge your success. Do not minimize your success. Embrace it; you earned it.
4. Seek out help, and seek it out early. Mental illness is an epidemic in medical school. Remember that struggling is not something to be ashamed of, and seek out help if you need it.
5. Discourage shame-based learning and “pimping.” Clerkships can be difficult when students are expected to learn and adapt quickly and perform excellently in new environments every day. On top of that, students can be asked questions by attendings in front of others, making them feel ashamed when they cannot answer. Stepping away from this type of learning, and towards a collaborative, conversational approach can help combat imposter syndrome.
6. Fake it till you make it. It is a skill. Don’t wait until you feel like an expert to take risks and feel confident.

You are becoming a doctor each and every day; it does not occur magically on graduation day. The transformation to physician evolves with every flashcard mastered, procedure observed, test taken (and perhaps retaken), and skill learned. Success in medical school is embracing the process of learning and getting better, which is why it is called the practice of medicine.“

• Margaret Hogan Smoot [Medical student]

STORY #2:

“During my first years in medical school, I never took any time for myself. I was so focused on studying and being this perfect medical student that I slowly became uninterested in what I was studying. I started oversleeping and not arriving to class. I failed a lot of exams, but I still pulled all-nighters every time I had a chance. I was crying every day and wishing I was dead. I even visualized how and when I was going to commit suicide.

One day, my mom took me to a psychiatrist, and boy am I thankful that she did. I was diagnosed with anxiety and depression during my second year of medical school (I was 21). I actually had no idea of what this disease was or what it meant. I thought that the oversleeping, over-eating, distancing from my friends was just what everybody went through in medical school because it was so demanding.

One of the key points in dealing with depression is the chronic fatigue you experience. I was always mentally drained and unable to do the simplest tasks, like showering or just reading. I started making a very strict schedule to follow so that I could finish all of my things.

I think those days where I gave myself a break were the epitome of what I did to really overcome my chronic fatigue. Trying to motivate myself with loads of work only made my anxiety worse, so giving yourself a day or two to unwind is really amazing.

Healthcare students are people, too—we can also have breakdowns. Taking a break is not bad. It is actually better for everyone who is going under a lot of stress and suffering from anxiety to just take a deep breath and decide to slow down—this will help students be more productive and stay focused.

• Mónica [Third year medical student]

STORY #3:

“After high school I had decided to move away, to travel, and ultimately pursue medicine. I was living in a beautiful country, but I had no family, no support system, and felt alone. I cannot recall which started first, the feelings of intense hopelessness or the overwhelming anxiety – but they both started off insidiously and grew to the point it was difficult to function. Simple daily tasks, even getting out of bed and ready for the day, became incredibly difficult.

I hid these struggles from others for various reasons, but primarily due to shame. Until one day I cracked. I called my mother in tears in the middle of one of my worst panic attacks. I knew I was not ok, and that was my very first step towards recovery. They say the first step is always the hardest, because you have to look inside yourself and admit that something is not right.

Getting Help:

Weeks later, I started therapy and now, my misery  had a name: clinical depression. Soon after, with the help of medication and a puppy as a therapy dog, I could see my condition improve. But I wasn’t over the hill quite yet.

I developed extreme social anxiety and agoraphobia. My wandering mind would visit the thought of how to end such a miserable existence.  My family begged me to come back home. After my third year battling depression, anxiety and agoraphobia, I left the country with Coco (my therapy dog) and started a new chapter in my life in my home country.

This was the second biggest step I took towards recovery: changing my physical state to change my mental state.

The third step was finding a reason to live. My thought process was that I cannot be happy, but by becoming a doctor, I can help others, make them happy, and live vicariously through them.

Adequate time to heal is necessary. One cannot rush this process, and it varies for everyone. It took me a year to change my mental state, which was facilitated by shifting life habits, like exercising regularly. The last and final step is to accept your past self and your present self. To see yourself not as a victim, but as warrior. There is no reason to feel ashamed. In doing so, you can become the best version of yourself, share your story and lessons learned with others, and empower others to overcome their challenges as well.”

• Andrea Dwek Schain [Medical Student]