Imposter Syndrome In The Medical Field

Authors

Brenda Varriano and Matthew Welch

Part 1: Imposter Syndrome and Current Model (Brenda Varriano)

“You’re a genius.” I am sure many medical students heard this claim. While I am confident my peers are intellectually gifted, I still question my own acceptance. How did I make the cut-off, and do I really belong here?

Much of this self-deprivation stems from the concept of Imposter Syndrome (IS). IS is a psychological pattern in which an individual doubts their skills, talents or accomplishments and has a persistent fear of being exposed as a “fraud.” The concept of IS was first described in an article by Clance and Imes in 1978. However, it is likely that IS had been around before its appearance in the literature. Many highly respected individuals such as Meryl Streep and Albert Einstein have reported experiencing IS. (Buckland, 2017) IS is the opposite of the Dunning-Kruger effect, which is a cognitive bias in which an individual overestimates their ability. While it is possible that some physicians and medical students overestimate their ability, IS is something experienced by most of my peers and my mentors in the ED. Therefore, the goal of this article is to discuss IS, it’s prevalence in the medical field, the current model used to describe it, how it is identified, treated and what we can do at the individual level when there are no other solutions. This article is timed when IS is highest in many US Medical students, when we prepare for our STEP 1 Boards Examination, the most important exam in our medical career. Therefore, I invited my colleague Matthew Welch to co-author this article with me, as we navigate studying and avoid the negative implications of IS.

IS was first described by Clance and Imes in a group of high achieving women (Clance and Imes, 1978). The authors noted that no matter how accomplished these women had become, they mostly expressed feelings of inadequacy, and that they were not deserving of their successes (1978). Research from academic settings has built on the work of Imes and Clance, stating that IS has been associated with certain personality traits (Langford and Clance, 1993). Some of these traits included introversion and trait anxiety (1993). Moreover, IS has been linked to a desire to appear intelligent in front of one’s peers, a propensity to experience shame and is more common in those with a non-supportive family (1993). In a study of 2,612 medical students that attended Jefferson Medical College between 2002-2012; it was found that IS was highly linked to burn out (Villwock et. Al, 2016). Furthermore, there appears to be differences among gender in those who are impacted from IS (2016). Females appear to be more likely to experience IS compared to males, however, there is a high level of burnout in both males and females that suffer from IS (2016). Villwock purports that the reason for burn out in medical students may be due to the environment of a medical school, where shame-based learning, may be a contributor to IS (2016). In such an environment, students experiencing IS may be less likely to participate in medical learning and can experience psychological distress, which may be contributing to burnout (2016). A more recent study has supported findings from Villwock, stating that gender and institutional culture were associated with higher rates of IS, and as a result, led to high rates of burnout among physicians and physicians in training (Gottlieb, 2020).

Figure 1: Clance’s (1985) model of the Imposter Cycle, as depicted in Sakulku & Alexander (2011).

To date, the concept of IS is based around the imposter cycle (Sakulku, 2011), as depicted in figure 1. The imposter cycle describes the theory behind IS, and the futile cycle between accomplishments and feelings of inadequacy. First an individual has a goal, which leads to anxiety, self-doubt and worry. In order to achieve this goal, the individual describes either procrastination or over preparedness. Once achieving the goal, the individual attributes it to luck if they had procrastinated to achieve it or effort if they had over-prepared. Despite the method to achieve the goal, accomplishment of the goal does not result in positive feedback, but leads to feelings of fraudulence, self-doubt, depression and anxiety.

Part 2: Solutions and Pitfalls (Matthew Welch)

My name is Matthew Welch, I am a second-year student at the Central Michigan College of Medicine. I am the first in my family to obtain a college education. Subsequently, the topic of IS is quite personal. In reviewing the literature, it has become apparent that the pitfalls and solutions to IS should be divided into three distinct categories: (1) Personal actions (2) Institutional actions (3) Actions for peers. Table 1 summarizes our findings regarding both the solutions and the pitfalls within each category.

Table 1: A summary of solutions and pitfalls of addressing IS in medical students divided into three categories based on the literature: (1) Personal actions (2) Institutional actions (3) Actions for peers.

Within the category of self, the consensus seems to be that a focus on one’s own mindfulness and emotional regulation can be successful in combating IS. I began a personal mindfulness meditation practice during my M1 year, and my experience aligns with the literature. By practicing mindfulness meditation for 10 minutes daily, I have noticed a dramatic difference in my ability to recognize and soothe my feelings of inadequacy. Beyond my anecdotal experience, research has shown that daily mindful practice leads to a significant reduction in activity within the amygdala, the brain’s stress center (Kral, 2019).

The strengths and weaknesses of institutional contributions to IS is vast. One theme that remains steady among all the literature however, is the effect of transitional periods. For example, IS seems to be higher during periods of transition from one life “chapter” to another. As anyone in medicine can attest, the years of training to become a physician often feel like a series of transitional periods. Beginning in undergraduate education, we transition into preclinical years, followed by clinical years and residency where expectations of our competency are continually increased.  After residency we are independent and expected to have an all-encompassing grasp on the vast information, we spent our entire medical education acquiring. While every step of this path is necessary for educating physicians, softening the harsh transition from one step to the next may be an area to explore solutions to the IS epidemic in medicine.

Finally, the subject of how our behavior affects our peers can be best summarized by a quote from Dr. Edward Hundert, Dean of Medical education at Harvard University;

Hundert likens this to a duck swimming in a swift current. On the water’s surface, the duck sits serenely, floating without effort, while below it is paddling furiously.

Miller, 2020

To help our peers, we must stop masking our own feelings of insecurity with blind confidence. Despite research showing rates of IS in medical students being somewhere in the range of 40% (Villwock, 2016). Any medical student will tell you that number is larger than reality. Moreover, the worst part of IS is the feeling of isolation. Therefore, as medical students, residents, and practicing physicians, we should be willing to admit that we are equally impacted by IS. While I frame this as a personal issue, I also recognize that medical education is designed to breed this behavior. We are constantly told that we are the “best-of-the-best,” and while some schools have moved to pass-fail curriculums, many of us are still continually ranked against our peers, even if inconspicuous in nature. This mentality can have a negative impact on student wellness in the classroom and beyond.

Finally, in the United States, it has only been recently announced that our score on the USMLE Step 1 examination has been altered to a pass fail. For example, previously if you scored below the 96th percentile, specialties such as dermatology/neurosurgery are no longer feasible options. While Brenda and I still must take part in this Hunger Games practice, I am happy that we are the last class to do so. In reducing the burden of the Step 1 examination, I believe we are supporting the mental wellbeing of students. However, IS still exists, and future discussions are warranted to reduce its impact and support the well-being of medical students and physicians at any stage in their career.

Acknowledgments

A special thanks to my colleague Matthew, who worked with me on this paper, which I believe is a particularly important topic in medicine. Please join me for my next article.

References and Further Reading

  • Atherley A, Meeuwissen SNE. Time for change: Overcoming perpetual feelings of inadequacy and silenced struggles in medicine. Med Educ. 2020;54(2):92-94. doi:10.1111/medu.14030Buckland, F. (2018). Feeling like an imposter? You can escape this confidence sapping syndrome. The Guardian, Health and Wellbeing, 1–8.
  • Clance, P. R., & Imes, S. A. (1978). The imposter phenomenon in high achieving women: Dynamics and therapeutic intervention. Psychotherapy: Theory, Research & Practice, 15(3), 241–247. https://doi.org/10.1037/h0086006
  • Dyrbye, L. N., Thomas, M. R., & Shanafelt, T. D. (2006). Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students. Academic Medicine, 81(4), 354–373. https://doi.org/10.1097/00001888-200604000-00009
  • Ingraham, B. L., Lerner, R., Nagai, A. K., & Shepard, J. D. (2001). Letters to the editor. Society, 38(2), A5–A6. https://doi.org/10.1007/s12115-001-1047-0
  • Jensen, D. M. (2018). 肌肉作为内分泌和旁分泌器官 HHS Public Access. Physiology & Behavior, 176(1), 1570–1573. https://doi.org/10.1038/s41395-018-0061-4.
  • Klassen, R. M., & Klassen, J. R. L. (2018). Self-efficacy beliefs of medical students: a critical review. Perspectives on Medical Education, 7(2), 76–82. https://doi.org/10.1007/s40037-018-0411-3
  • Ladonna, K. A., Ginsburg, S., & Watling, C. (2018). “Rising to the Level of Your Incompetence”: What Physicians’ Self-Assessment of Their Performance Reveals about the Imposter Syndrome in Medicine. Academic Medicine, 93(5), 763–768. https://doi.org/10.1097/ACM.0000000000002046
  • Langford, J., & Clance, P. R. (1993). The impostor phenomenon: Recent research findings regarding dynamics, personality and family patterns and their implications for treatment. Psychotherapy, 30(3), 495–501. https://doi.org/10.1037/0033-3204.30.3.495
  • Miller, J. (2020). Tailored for Perfection. Harvard Medicine Magazine, 1–40. https://hms.harvard.edu/magazine/skin/tailored-perfection
  • Sakulku, J. (2019). Impostor Phenomenon. Encyclopedia of Personality and Individual Differences, 1–5. https://doi.org/10.1007/978-3-319-28099-8_2332-1
  • Villwock, J. A., Sobin, L. B., Koester, L. A., & Harris, T. M. (2016). Impostor syndrome and burnout among American medical students: a pilot study. International Journal of Medical Education, 7, 364–369. https://doi.org/10.5116/ijme.5801.eac4
Cite this article as: Brenda Varriano, Canada, "Imposter Syndrome In The Medical Field," in International Emergency Medicine Education Project, July 26, 2021, https://iem-student.org/2021/07/26/imposter-syndrome-in-the-medical-field/, date accessed: October 18, 2021

Recent Blog Posts By Brenda Varriano

Intern Survival Guide – ER Edition

Intern Survival Guide - ER Edition
In some parts of the world, Internships consist of rotating in different departments of a hospital over a period of one or two years depending on the location. In others, interns are first-year Emergency Medicine residents. Whichever country you practice in, an emergency rotation may be mandatory to get the most exposure, and often the most hands-on. Often, junior doctors (including myself)  find ourselves confused and lost as to what is expected of us, and how we can learn and work efficiently in a fast-paced environment such as the ER. It can be overwhelming as you may be expected to know and do a lot of things such as taking a short yet precise history, doing a quick but essential physical exam and performing practical procedures. I’ve gathered some tips from fellow interns and myself, from what we experienced, what we did right, what we could’ve done better and what we wish we knew before starting. These tips may have some points specific to your Emergency Medicine Rotation, but overall can be applied in any department you work in.
  • First things first – Always try to be on time. Try to reach your work a couple of minutes before your shift starts, so you have enough time to wear your PPE and feel comfortable before starting your shift.
  • Know your patients! Unlike other departments, ER does not always have rounds, and you do not know any of the patients beforehand, but it always helps to get a handover from the previous shift, and know if any of the patients have any results, treatment plans or discharges pending, to prevent chaos later on!
  • Always be around, inform your supervising doctor when you want to go for a break, and always volunteer to do more than what you’re asked for. The best way to learn is to make yourself known, ask the nurses to allow you to practice IV Cannulation, Intramuscular injections, anything and everything that goes around the department, remember the ER is the best place to learn.
  • Admit when you feel uncomfortable doing something, or if you’ve done a mistake. This makes you appear trustworthy and everyone respects someone who can own up to their mistake and keeps their patients first.
  • Breath sounds and pulses need to be checked in every patient!
  • Address pain before anything else, if their pain is in control, the patient will be able to answer your questions better.
  • Never think any work is below you, and this is one thing which I admired about ED physicians, you do not need someone to bring the Ultrasound machine to you, you do not need someone to plug in the machine, you do not need someone to place the blood pressure cuff if you can do it yourself. Time is essential, and if you’re the first person seeing the patient, do all that you can to make their care as efficient as possible.
  • Care for patients because you want to, and not for show. Often junior doctors get caught up in the fact that they are being evaluated and try to “look” like the best version of themselves. While it may be true, remember this is the year where you are shaping yourself for the future, and starting off by placing your patients first, doing things for their benefit will not only make it a habit, the right people will always notice and will know when you do things to provide patient-focused care, or when you do them to show that you are providing patient-focused care.
  • Teamwork will help you grow. Not everything in life has to be a competition, try to work with your colleagues, share knowledge, take chances on doing things, learn together, trying to win against everyone else only makes an easier task even more stressful and can endanger lives.
  • Learn the names of the people you work with! In the ER, you may across different people on each and every shift and it may be difficult to remember everyone’s names, but it’s always nice to try, and addressing people by their names instantly makes you more likable and pleasant to work with!
  • Keep track of your patients and make a logbook of all the cases you see and all the procedures you observe/assist in/perform. This not only helps in building your portfolio, but also in going back and reading about the vast variety of cases you must have seen.
  • Always ask yourself what could the differential diagnosis be? How would you treat the patient?
  • Ask questions! No question is worth not asking, clear your doubts. Remember to not ask too much just for the sake of looking interested, but never shy away from asking, you’d be surprised to see how many doctors would be willing to answer your queries.
  • Don’t make up facts and information. If you forgot to ask something in history, admit the mistake, and it’s never too late, you can almost always go back and ask. It’s quite normal to forget when you’re trying to gather a lot of information in a short span of time.
  • Check up on the patients from time to time. The first consultation till the time you hand them the discharge papers or refer them to a specialty shouldn’t be the only time you see the patient. Go in between whenever you get a chance, ask them if they feel better, if they need something. Sometimes just by having someone asking their health and mental wellbeing is just what they need.
  • Take breaks, drink water and know your limits. Do not overwork yourself. Stretching yourself till you break is not a sign of strength.
  • Sleep! Sleep well before every shift. Your sleep cycles will be affected, but sleeping when you can is the best advice you can get.
  • Read! Pick your favorite resource and hold onto it. A page of reading every day can go a long way. The IEM book can be a perfect resource that you can refer to even during your shifts! (https://iem-student.org/2019/04/17/download-now-iem-book-ibook-and-pdf/)
  • Practice as many practical skills as you can. The ER teaches you more than a book can, and instead of looking at pictures, you can actually learn on the job. Practice ultrasound techniques, suturing, ECG interpretation, see as many radiology images as you can, learn to distinguish between what’s normal and what’s not.
  • Last but most important, Enjoy! The ER rotation is usually amongst the best rotations an intern goes through, one where you actually feel like you are a doctor and have an impact on someone’s life! So make the best of it.
If you are a medical student starting your emergency medicine rotation, make sure to read this post for your emergency medicine clerkship, and be a step ahead! https://iem-student.org/2019/10/04/how-to-make-the-most-of-your-em-clerkship/  
Cite this article as: Sumaiya Hafiz, UAE, "Intern Survival Guide – ER Edition," in International Emergency Medicine Education Project, May 26, 2021, https://iem-student.org/2021/05/26/intern-survival-guide-er-edition/, date accessed: October 18, 2021

Recent Blog Posts By Sumaiya Hafiz

Social Media Ethics for Medical Professionals

ethics

From Twitter to LinkedIn, every single one of us use social media every day. While using social media is not an obligation (obviously), imagine how you would be surprised by someone who has no social media account. Our posts on social media are meant to be there forever, carefully protected from deletion by Terms and Conditions of the social media site we used. Once you shared a post, it takes its place in the digital world as our footprint. “Who cares?”, you might ask. Well, the answer is EVERYBODY. Employers routinely check social media accounts of the individuals to grasp an opportunity to “reveal” their identities and and use this data in recruitment processes. Advertising companies are using our “share/like” data to select  “suitable” ad contents for us. States constantly monitor the soical media contents of their citizens.

In one sense, social media profiles are like the diaries of the past. However, there is a fundamental difference: While diaries are meant to be a confidante of the individual, social media “diaries” are notoriously verbose speakers ready to ruin us.

Statements

American Medical Association’s (AMA)  “Professionalism in the Use of Social Media” webpage emphasizes some basic (yet vital) rules. They can be summarized as follows:

  1. Physicians should be aware of patient privacy standards at all times, and must refrain from posting identifiable patient information online.
  2. When using social media for educational purposes or to exchange information professionally with other physicians, follow ethics guidance regarding confidentiality, privacy and informed consent.
  3. Physicians should use privacy settings to safeguard personal information and content to the extent possible, but should realize that once on the internet, content is likely there permanently. Thus, physicians should routinely monitor their own internet presence to ensure that the personal and professional information about them is accurate and appropriate.
  4. If physicians interact with patients on the internet, they must maintain appropriate boundaries of the patient-physician relationship.
  5. Physicians should consider separating personal and professional content online.
  6. When physicians see content posted by colleagues that appears unprofessional they have a responsibility to advise against it. If the behavior significantly violates professional norms and the individual does not take appropriate action to resolve the situation, the physician should report the matter to appropriate authorities.
  7. Physicians must recognize that actions online and content posted may negatively affect their reputations among patients and colleagues, may have consequences for their medical careers (particularly for physicians-in-training and medical students) and can undermine public trust in the medical profession.

World Medical Association (WMA) issued a statement on the professional and ethical use of social media in 2011 which has some additions to the rules mentioned above:

  1. Physicians should study carefully and understand the privacy provisions of social networking sites, bearing in mind their limitations.
  2. Physicians should consider the intended audience and assess whether it is technically feasible to restrict access to the content to pre-defined individuals or groups.
  3. Physicians should adopt a conservative approach when disclosing personal information as patients can access the profile. The professional boundaries that should exist between the physician and the patient can thereby be blurred. Physicians should acknowledge the potential associated risks of social media and accept them, and carefully select the recipients and privacy settings.
  4. Physicians should provide factual and concise information, declare any conflicts of interest and adopt a sober tone when discussing professional matters.
  5. Physicians should draw the attention of medical students and physicians to the fact that online posting may contribute also to the public perception of the profession.
  6. Physicians should consider the inclusion of educational programs with relevant case studies and appropriate guidelines in medical curricula and continuing medical education.

British Medical Association’s (BMA) “Ethics of Social Media Use” page has detailed information on both benefits and risks of social media. Its “Social Media, Ethics and Professionalism Guidance” emphasizes the arguably most important reminder: “You are still a doctor or medical student on social media”. Touché!

Tips from Experts

The rules and codes are of course very important in theory. However, experts in this field will know best how to apply them in practice. For this article, we asked the leading names of the #FOAMed World the following question: “What is your FIRST RULE while using social media?”

Here are their answers:

Skin in The Game

“If you haven’t somehow got skin in the game, your opinion is probably worthless and/or unwanted.”

– Karim Brohi [*]

Stick to the Science

“Dr. Sapna Kudchadkar’s basic Twitter rules applies to all social media.

Always remember “a tweet is forever” it does not disappear.

Stick to the science and be collegial are my rules.”

-Yonca Bulut [*]

Dr. Sapna Kudchadkar’s Basic Twitter Rules

“Don’t ever give specific medical advice or try to diagnose online.

Don’t write about actual patients or cases.

Don’t ever sacrifice collegiality due to a difference of opinion.

Don’t forget to cite the source.

Don’t tweet slides of unpublished data.”

-Dr. Sapna Kudchadkar

No regrets!

“I never post anything I might regret in the future.”

-Shanta W. [*]

Vice Versa

“Don’t just try to project the best version of yourself on social media. Try to become more like the better version of yourself that you want to project on social media.”

-Elias Jaffa [*]

THINK

“One word: THINK. T: Is it true? H: Is it helpful? I: Is it inspiring? N: Is it necessary? K: Is it kind?”

-Manrique Umana McDermott [*]

Know the Rules

“So many important things to consider….one of the bigger ones is know your institution’s rules and guidelines… Most have them—some are strict and some aren’t. But know the rules. Many institutions literally have someone assigned to watch social media output among employees.”

-Rob Rogers [*]

A Force for Good

“Be a force for good in the world. Don’t say anything you wouldnt say in front of my mother & chair.”

-Seth Trueger [*]

Once You Write…

“Every single letter is a long lasting prey of the web.”

-Nicolas Peschanski [*]

Not an Online Hospital

“1- Patient privacy rules are also valid here.

2- Social media is not an online hospital.

3- Social media is not a scientific journal.

4- Social media is not a suitable platform to debate with colleagues.”

-Fatih Beşer

Think Before You Speak

“The best tweets are the ones you don’t ever send. You should consider not sending the vast majority of tweets.”

-Bruce Lambert [*]

Conclusion

“What should I be known for?” A social media account that you have shaped around this simple question will undoubtedly lead to incredible opportunities. In any case, there is no escape from using social media.

By carefully reading and implementing the rules mentioned in this post, you can prevent social media from doing you more harm than good.

Cite this article as: Ibrahim Sarbay, Turkey, "Social Media Ethics for Medical Professionals," in International Emergency Medicine Education Project, April 26, 2021, https://iem-student.org/2021/04/26/social-media-ethics-for-medical-professionals/, date accessed: October 18, 2021

Video Interview – Rob Rogers – Part 3

Great messages for medical students, interns and new EM residents!

Watch the part 3 here!

You can listen full interview here!

Video Interview: Tracy Sanson – Part 3

Are you ready to meet the genuine people behind the professional?

iEM team proudly presents the ICON360 project. In this pleasantly educational series, world-renowned experts will share their habits, give advice on life, wellness and the profession.

Our guest is Dr. Tracy Sanson.

Dr. Sanson is a practicing Emergency Physician. She is a consultant and educator on Leadership development and Medical education and Co-Chief Editor of the Journal of Emergencies, Trauma and Shock; an Emergency Medicine international journal.

Part 3

The full interview is 10 minutes long and includes many advice on life, wellness, and our profession. We will be sharing short videos from this interview. However, the full interview was published as an audio file in our Soundcloud account. 

This interview was recorded during the EACEM2018 in Turkey. We thank EMAT.

The interview was recorded and produced by

Arif Alper Cevik

Elif Dilek Cakal

Murat Cetin

Video Interview: Tracy Sanson – Part 2

Are you ready to meet the genuine people behind the professional?

iEM team proudly presents the ICON360 project. In this pleasantly educational series, world-renowned experts will share their habits, give advice on life, wellness and the profession.

Our guest is Dr. Tracy Sanson.

Dr. Sanson is a practicing Emergency Physician. She is a consultant and educator on Leadership development and Medical education and Co-Chief Editor of the Journal of Emergencies, Trauma and Shock; an Emergency Medicine international journal.

Part 2

The full interview is 10 minutes long and includes many advice on life, wellness, and our profession. We will be sharing short videos from this interview. However, the full interview was published as an audio file in our Soundcloud account. 

This interview was recorded during the EACEM2018 in Turkey. We thank EMAT.

The interview was recorded and produced by

Arif Alper Cevik

Elif Dilek Cakal

Murat Cetin

44% Female Contributors in iEM

62 out of 142 contributors are female professionals.

iEM Education Project

We have 62 female contributors (emergency medicine doctor, resident, intern, medical student) out of 142. This is 44%, and we need more. Please share with your colleagues, students. We need you!

How to be a contributor!

Video Interview: Tracy Sanson – Part 1

Are you ready to meet the genuine people behind the professional?

iEM team proudly presents the ICON360 project. In this pleasantly educational series, world-renowned experts will share their habits, give advice on life, wellness and the profession.

Our guest is Dr. Tracy Sanson.

Dr. Sanson is a practicing Emergency Physician. She is a consultant and educator on Leadership development and Medical education and Co-Chief Editor of the Journal of Emergencies, Trauma and Shock; an Emergency Medicine international journal.

Part 1

The full interview is 10 minutes long and includes many advice on life, wellness, and our profession. We will be sharing short videos from this interview. However, the full interview was published as an audio file in our Soundcloud account. 

This interview was recorded during the EACEM2018 in Turkey. We thank EMAT.

The interview was recorded and produced by

Arif Alper Cevik

Elif Dilek Cakal

Murat Cetin

Five Tips About Well-being During and After Medical School

Even the best of us suffer from burnout from time to time. It is utterly human as training in medicine is very demanding itself and combined with the life issues it can be weary. Well, we can control the chaos. Here are five tips for creating a system to support long term-term success and a happy life.

1

Adopt a healthy lifestyle and be persistent: Back to basics: Embrace a sustainable, healthy diet; drink approximately eight glass of water; sleep at least eight hours a day and exercise regularly. You need to take care of your body: A healthy diet and adequate water enhance stamina; regular and enough sleep promotes learning, memory, stress relief and performance; exercising helps you to relieve stress and increases endurance. Sacrificing any of these for studying more does not miraculously help you reach success. Building a career is a long path: You have to stay strong.

For more on this topic: National Health Service, Why We Sleep by Matthew Walker 

2

Regulate your time wisely: Have you ever met an astonishingly successful professional who seems to be participating in every social activity? Do not fret! Learning how to manage your time will get you there. Let me share a few tricks with you: Decide your priorities and learn to say “no” to the rest. Spending ten minutes to planning your day will sometimes save you a few hours – hours that you may spend on your hobbies or with your family or friends. Conquer procrastination and do it now! Create a study area and be minimalist about it. Get rid of your phone (and your social media accounts!) while studying. If you feel you lose your focus, it is probably time for a break. A bullet journal is an excellent way to plan your day, month and future.

For more on this topic: Eat that Frog by Brian Tracy, Bullet Journal, Work Life Balance

3

Regulate your Energy Wisely: Managing your time is essential but not enough. If you have ever struggled not to sleep in the second half of a 2-hour lecture, then you are not alone. Energy management, a newer concept than time management, is about to change our beliefs related to performance and happiness. Here are a few basics: According to Jim Loehr and Tony Schwartz, you must be physically energized, emotionally connected, mentally focused and spiritually aligned for long-term performance, health and happiness. Overuse and underuse will hinder your energy, you need to balance your energy expenditure by intentional challenges and resting in between. Studying continuously will damage your performance in the long term.

For more on this topic: The Power of Full Engagement by Jim Loehr & Tony Schwartz

4

Recognize and change your values: Identify your priorities. If you are prioritizing medicine over your health and happiness, you are in the wrong. You and your well-being are your top priorities. Your job or your academic performance does not define you, you are more than that. Determine your personal and professional long-term goals, then create a road map. Check and update your goals regularly. Do not let the first bump on the road demotivate you; if you stay persistent, you will reach your goals sooner or later.

For more on this topic: How To Make Work-Life Balance Work by Nigel Marsh

5

Spend quality time with your family and friends: If you think that you can accomplish all by yourself, think again. Spending quality time with your friend and family has numerous personal and professional benefits: It helps you to relieve stress, create an early network and a supportive net, diversify your area of interests, rest your mind by distracting it away from medicine. Always remember: “If you want to go fast, go alone. If you want to go far, go together.”

For more on this topic: Why It’s Important to Spend More Time with Friends and Family, 4 Reasons Friends And Family Are Good For Your Health

ICON360: Tracy Sanson – Full Interview – Audio

iEM team proudly presents the ICON360 project. In this pleasantly educational series, world-renowned experts will share their habits, give advice on life, wellness and the profession.

In this episode, we shared the full interview of Dr. Tracy Sanson. 

Who is Dr. Sanson?

Dr. Sanson is a practicing Emergency Physician. She is a consultant and educator on Leadership development and Medical education and Co-Chief Editor of the Journal of Emergencies, Trauma and Shock; an Emergency Medicine international journal. A frequent speaker for Emergency Medicine programs, Dr. Sanson also serves as a core faculty member for the American College of Emergency Physicians. Dr. Sanson has consulted and lectured nationally and internationally on administrative and management issues, leadership, professionalism, communication, patient safety, brand development, personal development, womenäó»s issues and emergency medical clinical topics for a wide range of health care organizations. Dr. Sanson’s experience spans 20 + years in Emergency Medicine Education and ED management and leadership development. She has held director positions in the US Air Force, University of South Florida and TeamHealth for the past 15 + years. Dr. Sanson trained at the University of Illinois at Chicago for medical school and her emergency medicine residency. She is well versed in leadership, patient safety and medical management issues having served on TeamHealth’s Medical Advisory Board, Patient Safety Office Division Director and faculty in their Leadership Courses. (resource: https://feminem.org/author/tracy-sanson-md/)

iEM team proudly presents the ICON360 project. In this pleasantly educational series, world-renowned experts will share their habits, give advice on life, wellness and the profession.

The interview was recorded and produced by

Arif Alper Cevik

Elif Dilek Cakal

Murat Cetin

Professionalism and social media

Some reflections by Dr. Amila Punyadasa

It seems like nearly everyone, certainly from the Generations Y and Z, is using Facebook or Twitter these days for one reason or another. Although not a fan myself, I do concede that when used with prudence, social media and the Internet is an invaluable resource for teaching and learning. It can support physicians’ personal expression, improve camaraderie and improve the dissemination of public health messages. Equally, it risks broadcasting unprofessional content online that reflects poorly on individuals, their affiliated institutions, and the medical profession alike.

Just saw an 18-year-old unmarried G5P0, with Chlamydia, herpes, and gonorrhea. Disgusting!

Hypothetical tweet

Physicians' SOCIAL MEDIA USE

 physicians must be cognizant of patient confidentiality and privacy and monitor their Internet presence

For example, let us consider a hypothetical tweet from a female doctor to her colleague describing a recent patient: ‘Just saw an 18-year-old unmarried G5P0, with Chlamydia, herpes, and gonorrhea. Disgusting!’ This tweet would have contravened a few of Wilkinsons (2009) so-called ‘behaviors inherent to good medical professionalism.’ This doctor should have had “respect for her patients’ diversity” and shouldn’t have been so judgmental (in this case, about the patients alleged sexual promiscuity and lifestyle). She also should have upheld patient confidentiality (as although the patient’s name wasn’t tweeted, the descriptors used about her obstetric and sexual histories would surely have made her easily identifiable amongst her friends and family who might have come across this tweet). The doctor should have, in my opinion, had better regard for professional boundaries and exercised greater judgment and discretion.

Defining unprofessionalism online and policing it has been challenging. However, with the increase in awareness of such occurrences, regulatory bodies have published various documents in an attempt to regulate physician’s activities on social media sites. The General Medical Council (GMC) has attempted to do exactly this with its paper. It warns against the blurring of boundaries between ones public and private lives and advices that privacy on these sites cannot be guaranteed. Furthermore, it stresses that physicians must be careful with regards to patient confidentiality, elaborating that although one piece of information may not breach confidentiality by itself, together, a few may certainly do so.

In summary, physicians must be cognizant of patient confidentiality and privacy and monitor their Internet presence to ensure that information posted is both accurate and appropriate. With regards to interaction with patients through social media, again, this interaction should fall within the boundaries of established professional norms. If a physician feels that such an interaction transgresses such norms, he/she should report the matter to the relevant authorities. Finally, it is imperative that physicians realize that inappropriate online interactions may have a negative impact on their reputations and that of their institutions, career advancements, and, perhaps most damning, may serve to undermine public trust in the medical profession as a whole.

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