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Am I Really Cut Out for This?

Imposter syndrome and how the little monster brings us down.

by Ashley Brodrick, OMS-III

This article was originally published in the July/August issue of the Tarrant County Physician. You can read find the full magazine here.

“Am I really cut out for this?” A question most medical students have asked themselves time and time again. Imposter syndrome is this little monster in the back of our minds that tells us we are inadequate; it grows every week, with every test, and with every medical encounter. It tells us we are destined to fail. It tells us we are never going to make it, we are never going to learn, and we are never going to be good doctors. This little monster puts doubts into our minds about our ability to be successful physicians. If you are lucky enough never to have been visited by this little monster, I applaud you.

Medical school is this arduous four-year journey that tests us mentally, physically, emotionally, and sometimes even brings us to our breaking point. Why is medical training so taxing on our emotions, leaving us feeling empty, drained, and questioning if we are made for this career? Medical school is competitive by nature, with a national acceptance rate of 43 percent. This means you must be the “best of the best,” graduating with extraordinarily high GPAs, and performing well on the MCAT. Don’t get me wrong, being a doctor is no easy task. You are responsible for another person’s life, something that I consider to be a tremendous honor. However, at what point do we start to take a step back and reconsider this competitive atmosphere that we have fostered for so long and look at applicants on a holistic level and not just a statistic on a sheet of paper. I can tell you I would rather have a doctor that understands my concerns and listens to me than one who scored in the 99th percentile on their standardized exams but never questions their diagnosis. I would rather have a doctor that IS questioning their diagnostic and treatment decisions for me—not because they don’t know the proper protocols, but because they care about getting my treatment right for me as an individual. M

I am no stranger to imposter syndrome; however, this little monster did not visit me until my second year. My first year of medical school was the year I thrived, leading me to believe that maybe I could make it through without letting that little monster get the best of me. My grades were above average, I was making friends, and I was becoming more confident in my ability to talk to patients (even if it was standardized and following a script). The real challenge for me came during my second year, when my self-doubt started setting in. I was having difficulty connecting the dots and putting everything together. My classmates seemed to be following the right path, understanding how the different diseases connect across organ systems, whereas I felt like I was stumbling every step of the way. Each block presented a new challenge and fed that little monster even more. While I could understand the information and explain it flawlessly to my friends, it was just not coming together on the tests. This inability to perform well on exams did a number on my mental health. You don’t realize how deep into a hole you are until you turn around and realize you can no longer see any light, making it impossible to escape. Each day I would wake up with my heart racing, but you know what I did? I told myself this was normal; this is what medical school is supposed to be like. Stressful, hard, and exhausting, it takes everything out of you along the way, while proving to everyone that you are the “best of the best,” having the highest level of education, being in the top 0.29 percent of the population. The one thing I did not tell myself was that medical school did not have to be this way.

Medical school puts you in a bubble, one that is hard to escape. You are surrounded by medicine 24/7, and during my first two years I found it difficult to talk about anything other than medicine when I was with my friends and family. Every time I went home it was always, “How is school going? Any recent tests? What are you learning now? Making good grades still?” It was never, “How are you handling everything? Is there anything you need help with?” I knew they were trying to show an interest in my education, and genuinely wanted to know what I was learning, but I did not have the energy to go into detail. So, I found myself falling into the same routine of saying, “School is going well, just the same every day. I spend 10 hours in the library and when I get home I take Sadie on a walk, then sit on my couch and watch TV until I do it all over again.” This wasn’t always the case. I was hanging out with my friends, going to dinners, TV show watch parties, doing normal adult things, but whenever I would tell people about this, I would be hit with, “Shouldn’t you be studying? How do you have time for all of that?” I decided it was not worth it to try to please everyone and explain myself, so I shut down and didn’t tell anyone outside of medicine what was going on in my life. To some degree I felt this fed that little monster even more, because I was not sharing all the extraordinary things I was learning. I was not sharing how I was learning to properly perform a physical exam on patients. I was not sharing the complex pathology behind diseases and how to treat them. I was not sharing how I was developing my communication skills with our standardized practice patients. I was not sharing how I was constantly being uplifted and supported by not only my classmates and friends, but also my professors and faculty advisors. Looking back, I think the main reason I decided to suppress and not discuss was because of my imposter syndrome. I felt that if I started to talk about a subject and got one thing wrong, then my months of learning proved nothing, showing that I didn’t belong in this field.

I had this grand idea in my mind of what my clinical years in school would be like, but the pandemic added hurdles and setbacks, which further contributed to my imposter syndrome. I’ve spent most of my third-year rotations online— 60 percent, to be exact—which has left me questioning if I really am ready to begin my residency. I’ve never witnessed a code, never rounded on in-patient care, my note writing skills are lacking, and frankly, I just have not had the experience I feel is necessary to graduate medical school. Thus, imposter syndrome is in full effect for me right now. I made it halfway through my third year when I realized I was just getting to my first full in-person rotation. Thankfully it was OB-GYN, the field I have fallen in love with and will be applying for in the 2022 residency match. I felt comfortable taking a gynecologic history, performing PAP smears, delivering placentas, assisting in the OR, and even having the incredible opportunity of catching a baby. Now, as I am nearing the end of my third year, I realized I had the expectation that I would know so much; however, I feel like I know so little and find myself looking forward to the day when it will all come together. When I look around at my other classmates, I realize I am surrounded by people who were at the top of their class, and while I am one of those people, I still find myself feeling inadequate. I still find myself wondering how they can connect the dots on their rotations and see the big picture. I still find myself wondering how they know what questions to ask. I still find myself wondering simply how they make it look so easy. The one benefit of spending most of my clinical time online is it has allowed me to have time for self-reflection. This year has allowed me to foster relationships with my friends in ways that would not have been possible with a full work schedule. This year has allowed me to make myself and my mental health a priority. Most of all, this year has shown me the amazing support system I have cheering me on every step of the way, especially during the hard times.

So, while I try my best to contain this little monster, there are days when it breaks free from the room it is kept in, and I sometimes am still unable to contain my feelings of being inadequate. When these days come, I’ve learned how to work through them. I remind myself of how far I’ve come to get here. I remind myself of the years of education and knowledge I have gained on this journey. I remind myself of the countless individuals who have supported me, encouraged me, and helped me on this path. I remind myself of what lies ahead, and while it is a long and arduous road, it is one I am happy to be on. Sacrificing the best years of my life to being confined to the library, where I am studying and absorbing an overwhelming amount of information, has been worth it to me. Some might ask why, and the only answer I can give is that whenever I am asked what I would do if I wasn’t in medicine, I honestly do not have an answer. So, this is how I lure the monster back into its room—by reminding myself of my worth, my perseverance, my triumphs, and my successes throughout this journey.

Part of me is curious if it is the competitive culture of medicine that contributes to imposter syndrome, or if it is the self-doubt we carry in ourselves because of how difficult the road is to becoming a doctor. My biggest question going into my fourth year is how do we combat this? How do we tell medical trainees that it is okay to have these doubts; that they are normal, and that you are still learning and absorbing everything around you? How do we tell them that medical school is hard, but you don’t have to endure it alone? I think the answer to these questions is acknowledging that everyone experiences imposter syndrome at least once, and it is okay to have these doubts. It is okay to take a step back and say, “Wait a minute, was that the right call? Was that the right diagnosis? Should I have treated my patient’s condition in a different way?” Acknowledging this monster allows us to not become complacent in our careers, ensuring we are doing the best job that we can. This is a big part of the reason I chose to pursue medicine—the constant educational and learning opportunities, the inability to ever become complacent in your job. My time in medical school has opened my eyes to the type of physician I want to be. I want to encourage and reassure the medical students I will one day work with that it is okay to not know the answer to everything. It is okay to ask questions out of curiosity, even if the answer is something that I view as common knowledge. It is okay to be nervous, it is okay to be scared, it is okay to simply not know things. Medical students are exactly what they are called: students. Here to learn, here to observe, and here to take in everything around them. They should be able to do this without fear of humiliation or being deemed incompetent. I want to be the type of resident that shows my students that I too suffer from imposter syndrome right there with them, and that with the right tools and strategies, it is possible to cage the monster.

My challenge to this generation of physicians is to look back on your time in medical school and think of a resident or preceptor that showed an interest in your education and made you feel like you belonged. Do you think you could have survived that rotation without their help? If you find yourself answering “yes,” I give my applause to you, but if you find yourself answering “no,” hold on to that thought, remembering it for when you have students of your own.

We don’t have to be alone on this journey. We should work together to normalize the conversation around the mental exhaustion medical school creates in individuals. We should work together to lift and encourage our peers. We should work together to ultimately say it is okay to have imposter syndrome, but here is how we can deal with it before it becomes something greater than we can contain.

Beyond the Biology

by Arianne Felicitas, OMS-II

This article was originally published in the May/June issue of the Tarrant County Physician. You can read find the full magazine here.

My stomach somersaulted as I sipped on another cup of coffee, preparing for a long night of studying cardiology. I realized it was my fifth cup by that point in the afternoon, but I—or more specifically, my grades—could not afford rest. This was my first semester of medical school, when I struggled to see if I truly belonged. It seemed as if everyone around me was adjusting so well, making friends and staying on top of the material, while I was getting buried underneath hundreds upon hundreds of PowerPoint slides each week and felt like I was losing touch with what the art of Medicine meant to me. Whenever this feeling stirs up, I reflect on the experiences that remind me of the humanity behind Medicine.  

“Can you help me?” asked one of the residents on the shift. I was part of that summer’s Project Healthcare team, a group of pre-health students volunteering at the emergency department of Bellevue, the country’s oldest hospital. As a volunteer who constantly felt self-conscious about being in the way, I was eager to help. I held an emesis container as the patient, a woman in her 30s, vomited. Afterward, I conversed with her and discovered she was in the ED due to severe abdominal pain. “Maybe it was the spicy food I ate,” she speculated. The resident returned to the bed, preparing to insert a nasogastric tube. As he explained the procedure, the patient became nervous, fearing the pain that was about to compound what she already felt. She asked me if I would hold her hand during this procedure, which I agreed to do. Although I could not alleviate her medical issue, I felt honored and humbled. The patient placed trust in my presence and allowed me, for a brief moment, to provide comfort through physical touch during a painful procedure. 

During my undergraduate years, I also volunteered at MD Anderson Cancer Center. I had the opportunity to assume different roles, but the one that shaped me most was being an in-patient unit volunteer. This entailed visiting patients on the floor I was assigned to and seeing if they were in the mood to converse. As someone who primarily spent time with my peers, I pushed myself out of my comfort zone and learned how to strike up conversations with individuals of different ages from varying walks of life. While I felt a slight wave of nervousness every time I knocked on a door, I became more confident in my ability to interact with patients. Although time to converse with patients is much more limited now that I am a medical student instead of a volunteer, I hope to carry over the conversational skills I developed to establish rapport and instill trust in my future patients. 

These experiences shaped my time before medical school. However, as a pre-clinical medical student, it is still important for me to seek experiences that show me what type of physician I would like to be. An activity that I have found incredibly rewarding is writing letters advocating for the release of individuals at immigration detention centers for medical reasons during the COVID-19 pandemic. I review relevant patient medical records and compose the letter in collaboration with an attending physician and an attorney. Not only do I learn more about the medical conditions of the patients but also how I can apply the knowledge I am spending years gaining to help improve someone’s environmental conditions.   

The science behind Medicine has allowed us to achieve great feats in the prevention and treatment of disease, such as the creation of hemodialysis and the discovery of penicillin. Thorough knowledge of anatomy, physiology, and pathology is foundational in Medicine but is insufficient in our role as physicians. We see people in their most vulnerable states and owe it to our patients—and ourselves—to seek experiences that show us what it means to be human beyond the biology of our bodies.

UNTHSC Medical Students COVID Vaccinate the Public

by Steve Martin, MD, City of Burleson PHA
Sarah Andrade, OMS-I

This article was originally published in the May/June issue of the Tarrant County Physician. You can read find the full magazine here.

Pictured from left to right: Assistant Fire Chief Casey Davis; Melson Mesmin, OMS-II; SarahAndrade, OMS-I; Alexander Nguyen, OMS-II; Salma Omar, OMS-I; Fire Chief K.T. Freeman; Steve Martin, MD     Not pictured: Caleb Reagor, OMS-I and John Griswell, MD

To provide access to COVID-19 vaccines to citizens in our area, the City of Burleson’s Public Health Division established a Vaccination Clinic allowing large-scale vaccinations in a former High School basketball gymnasium called “The Pit” in the heart of Burleson.

Beginning with 100 doses per week of the COVID-19 Moderna vaccine in January of 2021, the clinic has since grown substantially. As of late April 2021, as many as 6,000 doses per week were being provided. This is due to a group effort put forth by the Burleson Fire Department chiefs and firefighters, the City of Burleson manager, mayor, and city council, the Burleson Police Department, Burleson librarians, Burleson Citizens on Patrol, Burleson ISD, THR Huguley nurses, and the City of Burleson Public Health Division. The clinic has vaccinated over 35,000 people since opening, recently averaging 2,000 inoculations per day when the vaccine is available.

Several of the area nursing and medical teaching institutions have expressed a desire to have their students gain the experience of COVID-19 inoculations and community volunteerism. With this in mind, they have begun sending their interested students to the Clinic to participate.

Medical students from the University of North Texas Health Science Center (UNTHSC) in Fort Worth, nursing students from the AdventHealth Nursing School in Keene, and EMT students from Tarrant County College have spent time learning to administer COVID-19 vaccines. They are overseen by active and retired RNs and physicians.

The social interaction with a multitude of extremely grateful vaccine recipients has been a truly rewarding opportunity. Below are specific personal experiences and statements made by volunteers:

“I will never forget the 45-year-old woman who sat in front of me to be vaccinated as she broke down in tears, crying uncontrollably, clutching a picture of her recently deceased husband, a COVID-19 victim.” 

-Donna Martin, RN

“I loved volunteering at the clinic because I get to share in the excitement and gratitude of the community members who are so excited to finally be getting immunized.” 

  -Caleb Reagor, OMS-I 

“Through the Burleson Vaccination Clinic, I administered vaccines to individuals from all walks of life who were impacted by COVID-19 in various ways. While many individuals were eager to help end the pandemic with their vaccination, there were individuals who were uneasy about the vaccine due to the side effects seen in social media and heard through word of mouth. After listening to the reasons for their reluctance, I kindly worked to defuse their anxiety and clarify their questions. Through these discussions, they were much more on board to get vaccinated. These interactions served as a reminder for why I chose to pursue Medicine, and I hope to continue guiding patients towards better health outcomes and improved quality of life as a physician.”

     -Kendrick Lim, OMS-II

“Volunteering at the City of Burleson Vaccination Clinic has been a very rewarding experience because I was able to serve the community and help distribute the vaccine that protects from a very deadly illness. As a future healthcare professional, preventative measures are an important aspect of public health and I am proud to be a part of this program as it continues to grow!”

     -Melson Mesmin, OMS-II

The students have approached this effort with great enthusiasm and interest and have been a big help in vaccinating a large number of persons efficiently. We are so very appreciative of their willingness to join us on this adventure. We hope that there will be many more opportunities in the months to come for our area students to participate at the Burleson COVID-19 Vaccination Clinic and assist in our community’s effort to slow down the pandemic and instill hope.

Medical student Kendrick Lim vaccinating a patient

Medical Student Ashley Broderick vaccinates apatient as Burleson Fire Chief K.T. Freeman looks on. 

Medical students from the Texas College of Osteopathic Medicine (Salma Omar, OMS-I; Melson Mesmin, OMS-II; and Alexander Nguyen, OMS-II) help administer COVID-19 vaccines to the public.

Medical student Maria Nguyen vaccinating a patient.

Drinking from the Fire Hydrant

by Chandler O’Leary, OMS-II

This article was originally published in the March/April issue of the Tarrant County Physician. You can read find the full magazine here.

Medical school has one primary goal: passing on humanity’s medical knowledge to a new generation. There are a few challenges to accomplishing this goal. First is a static problem, i.e., the sheer magnitude of information. Second is a dynamic problem, i.e., the rate of change of this information. Humankind’s medical knowledge is growing and being refined at an incredible rate. These forces are constantly at play in medical school, and they only become more obvious the deeper one’s understanding of a topic becomes. Learning more means absorbing all of the idiosyncrasies and all of the exceptions as well as confronting the burden of complexity. This is a problem that our species has been dealing with forever. Just take the ancient story of Adam and Eve; life was simple until they ate the apple and had to deal with the consequences of knowledge. 

“Drinking from a fire hydrant” is the analogy often used to describe the intensity of learning in medical school. This is what medical students volunteer for beginning in year one, and it will continue until we retire. The best and only solution is old-fashioned hard work and careful thinking. This is the reality that you have to accept if you choose to be a doctor. Unfortunately, this same reality of drinking from a fire hydrant now applies to our whole society that is woefully unprepared for the flood of medical knowledge and information. 

Our society’s fire hydrant does not come in the form of a pathology textbook, but in the form of the Internet and social media. Everyone is bombarded with health content, and the mishandling or misinterpretation of this information has many potential problems. These can range from wasted patient resources to creating false expectations—they can even lead to physical harm. As doctors we become familiar with information overload and have the opportunity to develop strategies to handle it. We learn to be skeptical, research thoroughly, test our assumptions, and rely on experts. It is sometimes easy to assume the whole world has some of these strategies too, but this is obviously not the case. I don’t even need to give a specific example, just browse Twitter or Facebook for a few minutes and I am certain one will present itself. Ideally, everyone would have instant access to a healthcare worker to help them navigate the things they see online. This is currently impossible, so many patients will have to sort through the overload of truth and misinformation on their own. In light of this problem, I am reminded of a famous quote by a pillar of our profession:

“One of the first duties of the physician is to educate the masses”1

Sir William Osler.

I believe that we can benefit society by educating our patients about strategies to sort through medical information they find online. Strategies like having some skepticism toward this information, researching it through reputable sources, and trying to disprove something they see on social media before they believe it. Strategies that we have had the opportunity to develop through our medical education.

I am like most second-year medical students and I am probably too eager to share what I have learned with those around me. What has been surprising to me is that most of the health questions my friends and family ask or the incorrect assertions I hear are different from what I expected. For every time I get to explain how someone’s medication works, there are five times of disputing something someone saw on social media. I understand that not everyone has the benefit of medical school, but I fear that the massive amount of online health information has the potential to cause harm if people do not have basic strategies to handle it.

In closing, I will admit that the quote I used was not complete. The full quote says that “One of the first duties of the physician is to educate the masses not to take medicines.” I completely misrepresented the quote because it demonstrates how the simplest strategies can be used to check the validity of something you read. One Google search is all it takes to gather evidence that I was not being completely truthful with Dr. Osler’s claim. That being said, if Osler were alive today, I believe he would agree with the sentiment that “One of the first duties of the physician is to educate the masses not to believe everything they see online.”

1Osler, William, Robert Bennett Bean, and William B. Bean, Sir William Osler Aphorisms: from His Bedside Teachings and Writings, (New York: Schuman. 1950).