Occupational Therapist Imposter Syndrome: Not a Bad Thing

On social media and even in studies of other healthcare workers, imposter syndrome often comes up as a subject. This is common for new grads who are first practicing as occupational therapists, for those who change settings, or even those who may have several years of experience under them. The word imposter has negative connotation associated with it – a fake, a fraud, someone who is deceptive. In Adam Grant’s book, “Think Again”, he makes a very good point about how imposter syndrome is not a bad thing at all. Many will tell you to break out of this thinking cycle and how to overcome feeling like an imposter. Even I thought felt like this myself and wanted to find out how to not feel like an imposter and more like my peers who were confident in their abilities. After some thought, here’s why I think it’s actually a healthy thing to experience as a new grad.

The Two Opposite Syndromes

Grant contrasts Imposter Syndrome to Armchair Quarterback Syndrome. One way to think of both phenomenons is our competence and confidence. When you are a new grad with imposter syndrome, what would your competence and confidence levels be? With imposter syndrome, your competence is likely high and your confidence is actually low. This is how Grant defines imposter syndrome (IS) in his book. The opposite, low competence and high confidence is when you have armchair quarterback syndrome – someone who watches a sports game on TV in their armchair who is very vocal and thinks they know more than the coach.

High OT Competence

After all, you had to prove yourself with a series of tests: OT school, group projects, capstone project, fieldwork, NBCOT exam. Unless you cheated your way through becoming an occupational therapist, I would argue that you are fairly competent. It’s natural to have low confidence in any practice as a student and new practitioner. A systematic review in 2020 says imposter syndrome can vary widely from 9% to as high as 82% across various studies as indicated by the Clance Imposter Phenomenon Scale and the Harvey Impostor Phenomenon Scale.[1]Bravata, D. M., Madhusudhan, D. K., Boroff, M., & Cokley, K. O. (2020). Commentary: Prevalence, predictors, and treatment of imposter syndrome: A systematic review. Journal of Mental Health & … Reference List Imposter syndrome is often higher among women compared to men.

Modified from “Think Again” by Adam Grant (2021).

The Opposite

Given the two syndromes, which would you rather be? The armchair quarterback reminds me of someone who ‘fakes it until they make it’ as they have low competency and high confidence. As a healthcare worker, this can be even more dangerous. Someone who is overconfident in their abilities may be prone to making mistakes that could cause more harm. The best scenario is that they improve – due to luck. The worst-case scenario is they may get injured, condition exacerbates, or even lead to death.

Take PPE and COVID-19 for example. In the early days of the alpha or even delta variant, the disease was much more deadly compared to omicron.[2]Duong, D. (2021). Alpha, Beta, Delta, Gamma: What’s important to know about SARS-CoV-2 variants of concern?. If an OT is overconfident in their abilities to don PPE before seeing a patient who is positive for COVID-19, they may not don it correctly and cross-contaminate others and spread the virus. Now take someone with imposter syndrome – they are competent but unsure. As such, they would likely question their donning procedure, take their time, or even ask a team member for guidance. This would likely lead to a lower risk of cross-infection compared to the OT with armchair quarterback syndrome (AQS). Compared to spectating a sport, an OT with AQS is much more dangerous than an OT with IS.

The Benefits of OTs with Imposter Syndrome

  • Humility and humbleness
  • Willingness to learn
  • Scientific mindset
  • More careful
  • Evidence-based practice
  • Seeks help and mentorship
  • Makes fewer mistakes
  • Learns from mistakes

Someone with AQS would have the opposite of these characteristics and traits. We all know how this can be dangerous in healthcare as occupational therapists work with the sick and injured in settings such as acute care in the ICU or other units with high patient acuity. Even in lower acuity settings, continued poor practice can lead to harm. And one of our main practice principles as occupational therapists is to do no harm.

Forever An Imposter?

So does this mean that given the two syndromes, the ideal mindset is to feel like an imposter for the beginning or even rest of your occupational therapy career? Given the two syndromes, yes IS is better than AQS, but according to Grant, the sweet spot is in the middle – somewhere between having AQS and IS. Just like anything else in life, finding a balance between the extremes is often the way to be, and this is true when you are feeling like an imposter. Grant calls this sweet spot the confident humility zone. As you gain competency and confidence, you progress from being a novice and more towards confident humility. However, if you become an overly-one thing or another, you risk falling into the AQS or IS category.

Discussion

So it’s okay to feel like an imposter, especially when you first start out as an occupational therapist. I would say it is even natural as we all want to help others and do good for our society. While this may be dependent on your task at hand, responsibility, experience, and own personality, the willingness to reflect back and learn is an important part of growth as a practitioner.

Is it always bad to ‘fake it until you make it’? Not necessarily. I think it is situationally dependent. However, if you sense that the risk may be higher – beneficence vs. maleficence, right? Then faking it will not do you, your patient, and the team any good. So I say, embrace feeling like an imposter as you are completely not alone. Other nurses, therapists, technicians, even doctors go through this and feel like an imposter at some point!

If I was a patient, I would rather see an OT with imposter syndrome than one with Armchair quarterback syndrome.

Those with IS have very good quality traits that make us good OT practitioners. It keeps us on our toes. It prevents us from being overly confident. It makes us lifelong learners. In the world of healthcare, it is not like you graduate from OT school with all the knowledge you need for the rest of your career. Even an OT with years of experience should continue to learn through practice and continued education because society will continue to evolve, people and their occupations and habits will change, science will have new evidence, technology will make our lives different, beliefs change, attitudes change – everything changes. An OT that practices today likely has a different approach and knowledge base than one who practiced 20 years ago.

I would guess that as you continue to practice and gain more confidence, you will feel less like an imposter. You may still feel like one, but your OT practice is probably on a higher level than someone with armchair quarterback syndrome. It’s okay to be wrong or not know everything. Those who grow as occupational therapy practitioners are the ones who choose to do with our mistakes or gap in knowledge that matter.

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References

References
1 Bravata, D. M., Madhusudhan, D. K., Boroff, M., & Cokley, K. O. (2020). Commentary: Prevalence, predictors, and treatment of imposter syndrome: A systematic review. Journal of Mental Health & Clinical Psychology, 4(3).
2 Duong, D. (2021). Alpha, Beta, Delta, Gamma: What’s important to know about SARS-CoV-2 variants of concern?.
Jeff is a licensed occupational therapist and lead content creator for OT Dude. He covers all things occupational therapy as well as other topics including healthcare, wellness, mental health, technology, science, sociology, and philosophy. Buy me a Coffee on Venmo.