Dr. Jonathan Weinkle talks with UCLA surgery resident Dr. Phifer Nicholson about his Journal of Pediatric Surgery paper reframing “imposter syndrome.” They explore why labeling near-universal self-doubt as pathology harms physicians, especially women and minorities, and how treating it instead as humility and honest self-assessment can build healthier training cultures.
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What if the relentless self-doubt felt by high-achieving physicians is not a personal pathology or “syndrome,” but a near-universal signal of humility in a demanding profession that constantly pushes people to the edge of their competence?
In this episode, Dr. Jonathan Weinkle speaks with Dr. Phifer Nicholson, a UCLA surgery resident, Duke School of Medicine graduate, and Theology, Medicine, and Culture Initiative alum. With colleagues Drs. Mary Brandt and Holland Kaplan, Nicholson co-authored a paper arguing that medicalizing the imposter phenomenon pathologizes an experience reported by 70–80 percent of trainees and attendings, highest of all in surgery, and shifts responsibility onto individuals rather than toxic systems.
They reframe these feelings as a potentially virtuous acknowledgment of human limits, especially acute for women, physicians of color, and those lower in medical hierarchies. Drawing on mentor stories, morbidity-and-mortality culture, and Jewish concepts of teshuvah, Moses, and Zusha of Hanipol, the conversation shows how naming doubt honestly, in community, can replace isolation with growth and safer care for everyone.
Top 3 Takeaways
About the Show:
Healing People, Not Patients explores ways to enhance medical practice by infusing it with compassion, humanity, and a deeper sense of purpose, aiming to help healthcare professionals rediscover the "soul" of their work. Framed around the four questions of the Passover Seder, it probes how to transform medicine for the better, promoting an empathetic and supportive approach that empowers patients to create meaningful, sober lives, while drawing on Jewish teachings about community and friendship.
"Our theme song, 'Room for the Soul,' is available on Bandcamp at https://jonathanweinkle.bandcamp.com/track/room-for-the-soul."
About the Guest:
Dr. Phifer Nicholson is a general surgery resident at UCLA and a graduate of Duke University School of Medicine and its Theology, Medicine, and Culture Initiative. With Drs. Mary Brandt and Holland Kaplan he co-authored a paper in the Journal of Pediatric Surgery reframing imposter syndrome as a near-universal phenomenon rather than a pathology, advocating for humility, community, and systemic change in surgical training.
About the Host:
Dr. Jonathan Weinkle is an internist and pediatrician who practices primary care at a community health center in Pittsburgh. He strives to be a "nice Jewish doctor" focused on patient-centered healthcare, emphasizing effective communication and holistic well-being.
He teaches the courses, “Death and the Healthcare Professions” and “Healing and Humanity” at the University of Pittsburgh, authored the books Healing People, Not Patients and Illness to Exodus, and runs ‘Healers Who Listen’, where he blogs on healing and Jewish tradition. Once an aspiring rabbi, he now integrates faith and medicine to support other physicians and his own patients.
🌐 Website: healerswholisten.com
🔗 LinkedIn: linkedin.com/in/jonathan-weinkle-3440032a
📸 Instagram: @HealersWhoListen
📘 Facebook: @JonathanWeinkle
[00:00:00] Hollywood and Broadway love a good stick it to the establishment story, especially one where an unlikely hero wins a game no one wanted to let them play in the first place. 42, for example, or the song Me and the Sky from the musical Come From Away. Each tells the story of someone breaking a barrier while people defending that barrier try to break them.
We know the ending. Jackie Robinson becomes the first Black Major League Baseball player in the modern era. Beverly Bass becomes the first female airline captain in American Airlines history. But for every Robinson or Bass, there are countless people for whom twice as good is never enough, as the title of a recent MedPage Today editorial puts it.
Dr. Onyekachi Otugo describes the challenges of being a Black physician, and especially for physician leaders in academia. She puts it like this: When there are that few of you on a faculty, you don't get to be just an academic. You're a case study, and everyone is waiting to see [00:01:00] what you prove and if you're worthy.
Otugo contends that for underrepresented minorities, the pioneers aren't the heroes that a movie might make them out to be, breaking barriers to universal acclaim. They are conversation pieces, good publicity for the institution, and convenient victims when something goes wrong. They often take the fall for institutional misconduct and their public, quote, "failures" set back other hires by supposedly proving that they were, quote, "in over their heads".
The pattern Otugo describes is one of many deeply ingrained patterns that feeds into what is popularly called imposter syndrome, a feeling even among people who are indeed twice as good that they are not enough, that they are frauds just waiting for someone to discover the truth about them and cause their whole house of cards to collapse, even when the cards they hold are essentially a royal flush of the best training, the sharpest skills, and the highest accolades anyone could ask for.
It's a clear reason why minority physicians, women physicians, and others [00:02:00] who've traditionally not had a seat at the doctor's table in the cafeteria or a membership to the medical society suffer disproportionately from this debilitating self-image of not belonging. But systemic bias is only one reason people experience imposter syndrome.
Otherwise, how do you explain that more than seventy percent of trainees and young attendings endorse some level of imposter syndrome during their formative years? That's not just systemic racism or sexism, it's systemic toxicity. My guest today is a resident in general surgery, the specialty with the highest reported rate of imposter syndrome at a whopping seventy-six percent.
Dr. Pfeiffer Nicholson is a surgery resident at UCLA, a graduate of Duke University School of Medicine, and of their Theology, Medicine, and Culture Initiative. Together with his colleagues, Doctors Mary Brandt and Holland Kaplan from Baylor University, Pfeiffer recently published a paper in the Journal of Pediatric Surgery looking at how we have almost made imposter syndrome seem like an illness and the aspiring doctors who experience it like patients.[00:03:00]
He and I discuss how that can make the person suffering seem like the problem instead of placing the locus of illness where it belongs, in a system that makes competent, deserving, intelligent people feel like they have no place there. In the end, Pfeiffer and his colleagues suggest there are much healthier ways to look at this experience of self-doubt and ways to help each other through it that will make all of us better doctors to everyone's benefit
[00:00:00]
Thanks so much for joining us this afternoon. I have with me today, Pfeiffer Nicholson. Pfeiffer is a surgery
resident at UCLA, and we met a few months ago at the Conference on Medicine and Religion, where I meet all of my best guests. And the reason that I invited Pfeiffer on today was to talk about a paper that he co-authored with Mary Brandt and... Holland Kaplan about a very hot topic these days, which is imposter syndrome.
And it was published in the Journal of Pediatric Surgery, which is where Pfeiffer hopes to end up professionally as well. Pfeiffer, thanks so much for joining me today.
It's a pleasure to be here. Thank you for having me.
So in the paper you presented at the conference, you and your colleagues tried to reframe imposter syndrome.
The classic description that we're all used to is this high-achieving person who has clear success in their career and can't internalize it. you've included Pauline Clance, who was one of the co-discoverers or co-descriptors of this imposter phenomenon back in the late '70s, and she [00:01:00] describes this experience of relentless self-doubt.
But you took this and recast the situation to something more humble and human. So explain that new framework to us.
Absolutely. Yeah. I appreciate that question. Yeah, Dr. Clance's early work is the kind of fundamental work in this world of kind of imposterism, the imposter phenomenon.
And again, just kind of to reiterate what you said, she basically proposed three criteria to define this experience, this phenomenon. One, it occurs in high-achieving individuals who, two, have documented success, but three, are unable to internalize that success. So there's a real sense of folks who have reached a certain level of achievement and attainment, but because of some sort of framework either within their minds or within the world around them, are unable to be able to hold onto that and internalize and kind of assume that professional identity.
This-- the problem that we identified is that there's [00:02:00] this imposter phenomenon that she initially talked about, and then other early, authors and researchers started to reframe it as a kind of perceived fraudulence. But in the kind of like 2000s, 2010s, the word imposter syndrome became the label that was used, and it has since, become rocketed up in popularity and in use and in publication, across many disciplines in particularly in the medical field.
And the problem that we identify with the conceptualization of this imposter phenomenon as a syndrome is that it risks medicalizing And pathologizing something that is so pervasive, you know, 70 to 80% of physicians and surgeons say that they experience these types of feelings. And to then name that and label that as a, a pathology, and to medicalize it and to use medical language of [00:03:00] prevalence, etiology, diagnosis, treatment I think ends up diminishing the experience itself over-medicalizing the experience and then, taking away from what could be a virtuous turn that we could have when we approach these types of feelings and have these types of experiences.
Yeah.
So let me try and digest this for a second. So first of all, I think we all know that person where we hear them downgrading their expertise and worrying that like, "Oh, I'm just never gonna make it in this field." And I'm like and we're like: What are you, nuts? You're like the most brilliant person I know.
You're so accomplished. And it's like we're watching two different movies of their life, and I'm seeing the Oscar-winning version, and they're seeing what got left on the cutting room floor. that's the first part. So I can certainly recognize that. I won't name the people who are running through my head, but there's dozens of people that I've known in my life.
But I agree with you. Like, I trained in the early aughts. I finished med school in 2004, [00:04:00] graduated residency in 2008. I don't think I ever heard this term. But in the last 10 years, a lot of which I've spent in this space about sort of talking about ways to practice medicine better and teaching and writing and now podcasting you can't turn around without bumping into the term imposter syndrome.
So I can readily appreciate what you're talking about. I wanna offer a medical analogy and see if I'm on the right track with this. You know, I remember in med school hearing somebody say, so when we talk about... And they did, one for each of the, traditional genders.
talking about fibrocystic breast disease in women doesn't make sense-.. when somewhere between 40% and 90% of women who are post-menopausal experience this. By the same ... talking about prostatic hypertrophy in men when 70% to 90% of men over 60 have an enlarged prostate also doesn't make sense to call that a disease.
So this is, it sounds like fundamental, especially as you said in surgery, but really throughout the medical profession. Am I on the right track [00:05:00] there?
Absolutely. And it's important to note that it's Not an actual diagnosis, actually. So, you know, if you look at the DSM or you look at any of the kind of like, you know, official documents and ways of- Mm
kind of understanding, framing, categorizing, diagnosing, and treating any sort of mental state or mental disorder, it's not even in the books. ... it's not a part of a diagnostic framework. And again, by taking up medicalized language. in an experience that, again, I agree with you wholeheartedly, is so pervasive so almost universal problematic both by the way of kind of defining it as a disease state or as a syndromic state.
And then also leaves the onus on the individual or on the physician- ... per se, potentially, to address that, when of course, within the community of physicians, I think that this is something that we can address together. But there's no pill to address it.
There's no you know, specific, therapeutic technique that has been studied to address it. And I think it's much more important to kind of, reframe it and understand it as it [00:06:00] actually is, as a near universal experience which is then something that we can start to talk about more thoughtfully as a community to both address- Yeah
the individual factors as well as the very real systemic factors. And again, it's important to name that the imposterism as a phenomenon is disproportionately experienced by women, by people from minoritized populations, folks of color at transition periods in, training when students are given more responsibility or when residents move up in their training or junior faculty.
These types of feelings are disproportionately experienced in those who are comparatively or relatively disprivileged within, a hierarchical system like medicine- and in particular surgery.
Yeah. S- okay, so if we're rebranding and you were in charge of the rebrand, what would you call it instead?
And then talk to us a little bit about the approaches that you and your colleagues are suggesting that we take to this phenomenon.
Absolutely, yeah. So I wish that I had [00:07:00] some like really witty, you know relabeling of it. we really take up some of the more traditional frameworks.
I think the two ways that we take it up is either labeling it as the imposter phenomenon. Basically labeling it more as an experience and localizing it in its subjectivity. and also I think that word phenomenon also captures the kind of collective and the sheer number of people who experience it.
and then there are other articles in literature that use the word imposterism. It's kind of a word that's made up, but it's this, this kind of also this sense of either imposter syndrome or I am experiencing imposterism in my work, in my job, in my profession, in my day-to-day life.
So I think that those are the kind of reframings that we suggest and kind of put forward in our paper. And I would not claim those to be in- original in their own sense. It's more of kind of trying to pull back and to, pull apart and pull away from the medicalizing language and move more towards a more descriptive language of the subjectivity of the experience itself .
Got it. Okay. So [00:08:00] once we've slightly renamed it, What's the thought pattern you're trying to achieve instead to sort of supplant that feeling of- Yeah ... I don't see the success. I can't see myself as being good at what I'm doing. Somebody's gonna find out about me eventually. What do you replace that with?
So the replacement, is to normalize the experience. And to understand and to kind of invite those in the broader community and us as individuals to say this is actually part and parcel of what it means to be a high-achieving individual in a high-achieving field, oftentimes working and operating at the edge of your comfort zone.
If you're in that type of profession, in medicine across all specialtiesI'm speaking as a physician, I'm speaking toward, you know, kind of the audience of physicians, but this can be translated, I think, to many other professions. But, my wife, she's a pastor and she feels
and deals with these types of [00:09:00] experiences constantly in her role as a pastor. that these moments of self-doubt they're normal, they're near universal, and they actually might just be what we would argue is a potentially virtuous response to acknowledging that you're running up against your limits.
That you- are a creature, that you are a trainee, that you are someone who is being thrown into a difficult situation, into difficult circumstances that you're unfamiliar with, and of course you're gonna feel inadequate. That's part of the process. And in fact- ... it sounds a lot more like
you're being humble, that you are having humility, that you have actually a real honest self-assessment of who you are and acknowledge that you're running up against your limits. So we argue that instead of, pathologizing this, to actually reframe it as a near universal
experience, a very common experience, that actually is a signal [00:10:00] of your admission and your acknowledgement of your limited-ness as a practitioner as a human, and you're actually demonstrating humility, a proper virtuous response to a challenging circumstance- Yeah ... a new situation. And it then gives you language that we would argue to start to have conversations with each other about this experience in a more productive way.
Yeah, and I love that you particularly lean on humility. I think it's important at this juncture to bring out this idea that humility and humiliation are not the same thing. Absolutely ... you mentioned your wife being a pastor. What, which denomination?
Methodist Church, yeah
Soas you know from interacting before, I come from a Jewish background and- ... as my listeners know, one of the concepts that I'm really into in Judaism I had a guest on that talked about this as a framework for her work as a psychologist, is the Musar tradition, which is a virtue ethics-based tradition of these different character traits , and humility is always the first one you [00:11:00] learn.
Yeah.
But humility gets framed as this sort of continuum where at one end of the humility spectrum you have arrogance, which obviously is not where you wanna live on that spectrum. And at the other end of the spectrum you have humiliation or self-abasement, self-deprecation, which is also not- Yes
where you wanna live, and that's where the imposter phenomenon hangs out. And in between- Yes ... that you oscillate between these... It's almost like the foci of an ellipse between humility, meaning recognizing your limitations, and confidence, which is recognizing your strengths, and flowing back and forth between those two points knowing that the other one is always there somewhere.
I think that's a beautiful conceptualization. And I can think about, at least from my own experiences as a surgical resident, the most dangerous surgeon is the one who's never wrong.
The most dangerous resident is the one who is always right, who even when they are proven to be wrong or have made a mistake, [00:12:00] will either deflect or will not own their mistakes or assume responsibility or even are obstinate in saying that, "You know, I was right the whole time," even when things clearly went the other way.
That's a conversation I have a lot with my co-residents, with folks in surgery that those are the scariest, and it's thank goodness it's rare to run into those types of people. But they're exactly... Imposterism and the imposter phenomenon Folks who are on the spectrum, that you said of kind of humiliation versus arrogance
So we're kind of hanging out in this imposter syndrome, imposterism is on the far end. And then on the kind of- the arrogant aspect of it. You would much rather err, I would say, towards self-deprecation and, you know, self-effacement, as opposed to being arrogant in this field.
And I think that that's what we're trying to get at, is that these feelings are you gesturing towards the fact that you are reaching a limit. That you are butting up against the edges of your [00:13:00] knowledge, the edges of your experience. And my goodness, I experience this on a daily basis, literally on a daily basis in my work, where I'm doing things I've never done before.
I'm addressing disease states I've never addressed before. I'm spending time in an operating room being corrected constantly on the things that I'm doing well and the things that I need to improve on. And so there's this constant sense of that if I was approaching my job, of course, with this sense of you know, I'm God's gift to surgery and I can do no wrong, I would be dangerous and no one would wanna work with me.
But then on the flip side, of course, if I am stuck in a feeling of inadequacy, you can't get there either. That said, I think these feelings, being near universal, are markers of people gesturing and having the kind of moral intuition that they are, again, reaching limit, and that's normal.
And then I think that, when I speak and then again, I'm speaking to my own, kind of world and experience in surgery, we're [00:14:00] getting much better at talking about these experiences, about senior faculty being candid about mistakes that they've made, bad outcomes they've had times they've gotten sued, what have you.
And that's a really huge shift because it normalizes these encounters that when you first experience them, it makes you wanna pull back, and it makes you wanna retreat and it makes you feel small. And so I think again, If we're able to collectively say these feelings are you butting up and scratching up against limits, and it's actually indicative of yourself grasping towards a virtuous kind of hold on humility, we can affirm the feelings or, you know, we can at least name the feelings and and hold the feelings and then affirm the individual finding themselves at a really actually good spot that we can then work towards a more productive, real robust sense of humility altogether, where we can actually have a self-forgetfulness
a kind of, trust in [00:15:00] your ability and then a kind of leaning on other people to be able to help fill your gaps where you have them.
I love that. If you could just, give us a few examples of conversations that you've had that tend in this new sort of more humble, more virtue-forming direction.
Like some things that have happened in your training that you're like, "Okay this is what we need."
Oh, absolutely. Yeah. I mean, a few that come to mind I'll speak first, and more very directly to the senior author on this paper, Dr. Mary Brandt. She is an emeritus pediatric surgery faculty who has now pursued training
She went to divinity school and her new vocation is to heal the healers. This is what she wants to do and what she is doing. and she has become a friend and a confidant and a mentor who I can go to with my feelings of frustration, my feelings of burnout or of alienation, and she very candidly will lean into those conversations, can [00:16:00] draw from a, a wealth of ex- personal experiences and share those with me.
so she's become someone who very meaningfully and through her life's work is embodying this different response. I have other mentors here at UCLA, folks within the pediatric surgery department here, at Duke University where I went, that again have become friends who I can kind of go to with bad outcomes or things that I feel ashamed of.
I had a near miss on a case a few months ago, and the faculty that I was working with you know, he could tell that I was rattled by what had happened and he paused for a moment and said, "It's okay," "Things are fine." You know, "We need to, like, gather ourselves and focus on the rest of the case."
Then we debriefed it afterwards. He was very affirming of mebasically affirming my, fear and my understanding of the gravity of the near miss that we had ... and then said that's exactly what you should feel, and now you need to, like, internalize that and keep going forward.
You know, and then he was very- gentle and kind in addressing that. I'm gonna keep [00:17:00] going. Just got a couple more examples.
In the field of surgery, again, I'm kind of speaking from my own community Ryan Antiel, he's one of my mentors from Duke University.
He runs and has founded a project called Projecting the Good Surgeon. it's a curriculum that explicitly addresses the malformation that happens within surgical training. And he has become a confidant, a mentor, and a friend, I've read the book cover to cover.
We're gonna try to get it off the ground here at UCLA in the coming year just to stimulate and kind of- invite conversation with both senior fac- senior faculty and among residents. And then out of the blue, we had a new faculty come in, to UCLA, named Raul Rosenthal, who hosted a session a few months ago on medical malpractice and getting sued.
Something very simple, but he talked- Right ... about his experiences with running up against, legal issues and addressing and, conveying mistakes to patients. And then a lot of our faculty that we know and love and respect who are excellent consummate surgeons stood up and relayed stories from their career.
It's [00:18:00] all a way of, bringing out of silence kind of experiences that people often suffer alone in and- universalizing them 'cause they're near universal normalizing them, and then, creating spaces of conversation where we can kind of pursue the good together. So those kind of went on a little bit of a monologue there, but I'm really grateful that I have been privy to a number of communities and people, in my early career that have modeled a really wonderful response to this.
That's incredible. interestingly, a book that I was reading for religious reasons, not for professional reasons
by Rabbi Danya Ruttenberg called, ... "On Repentance and Repair," where she's discussing the process in Judaism called teshuvah, of making amends for things you've done wrong... it's a very well spelled out process. and she's going back to a model that comes from Moses Maimonides, so it's, you know, close to 1,000 years old.
Yep. But one of the models that she looked at was the University of Michigan's, institution-wide effort to name and apologize [00:19:00] for medical errors. And that's been going on for 20 years , and they've reduced the number of times that doctors that work for that health system have been sued, I think well over 50%, because we understand that lawsuits happen when people don't have the humility to say, "Hey, something went wrong." Yeah. Yeah ... "And I'm really sorry that it went wrong, and we're gonna find out why it went wrong. and if we can fix it for you, we will. And if we can at least fix it for the next person that's in your situation," that's what a lot of people wanna hear, right?
They wanna know that This won't happen to anybody else.
And I almost think that the desire to clam up and not talk about this doesn't necessarily come from the doctor. A lot of us wanna go apologize to somebody because we feel horrible, and risk management is telling us not to.
But it-
Yeah, exactly. Right.
So in point of fact if it's internal, it's because we're afraid that if we admit it, then everyone will know we were a fraud all along, that we didn't [00:20:00] belong.
Yeah. Absolutely. There's been a really, decent amount of work recently in kind of thinking, and we gesture towards this in our paper, thinking about morbidity and mortality.
it's a cultural- institution within surgery. I do M&M every single week.
for the non-physicians in the audience m&M is your worst nightmare. The little candies with the colorful shells on them.
it is a conference where all the residents and med students and attendings in a department get together, and one of them has to get up and tell the story of how they screwed up, and then everybody else- Yeah ... in the room tells them why it was their fault.
Absolutely. More or less. 100%. Yep, 100%.
a colleague and a friend of mine from Duke University, I spent some time in dedicated theological study at Duke's Theology, Medicine, and Culture Initiative. And a friend of mine who was a few years ahead of me named Danielle Ellis, she's now a surgical resident at Massachusetts General Hospital.
She wrote a really great article comparing and kind of likening M&M to the practice of confession within the tr- the Christian tradition. that there's an acknowledgement of a [00:21:00] mistake, of a wrong and then there's a real... and then I believe that she draws the connection to, Charles Bosk's work, who was a, an early anthropologist at University of Chicago who embedded himself in a surgical department, who wrote a book called "Forgive and Remember,"
based off of his experiences, where M&M is this time that someone gets up in front of the group, exam- the classic, you know, The traditional experience of it was kind of this name and blame or name and shame experience. Right. the formation that is at its heart should be happening at its best is it's an admission of something that went wrong a claiming of personal responsibility.
there was an M&M that was presented and, the point of the questioning that the person was going under was it a stitch that you threw or was it a stitch that someone else threw that failed?
Okay. And the person said, the answer was, "I have to believe it was my stitch. I have to believe it was my stitch."
And that's what the [00:22:00] point of M&M is to form surgeons. At its best, it's to form surgeons to assume responsibility, learn from errors. And then, there's a recent wonderful article written by, Hannah Phelps and, Badr Shakshir, a group out of U Chicago and WashU, that talk about the importance of forgiving oneself and one another, and then coming together to replace a sense of hopelessness with the determination to be better in the future.
So I think that we're kind of grasping towards and gesturing towards again the inherent feelings and experiences and kind of like fundamental, affective changes that will come upon us when we're entering into high-intensity, high-stress, high-achieving professions like medicine.
And then trying to think, again, cast this conversation not in a pathologizing way, but reframing it as let's become more virtuous. let's grasp towards the good together.
Awesome.
I think that this is a [00:23:00] fantastic framework. I imagine that you can push back as hard as you want, but there are still gonna be some folks who internally feel like, "Nope, that's great for most people, but I really feel like I don't belong here." And what I'm really worried about is that there's still gonna be people in leadership who are the ones, you know, running those classic M&M conferences where it's blame and shame or- other types of kind of the the more toxic training situations that might actually just say to you, "You know what, Pfeiffer? thanks for that, but some people really just aren't cut out for this job." How do you respond?
And that's all, I think that
There is something to be said we have to have honest evaluation and- the experience itself is fundamentally that it, this is someone who is objectively achieving on all measures- or on the key measures, but then is failing to internalize that. This is, of course, not a conversation of someone who is not meeting core competencies
And again, in my experience, if I [00:24:00] was a surgical resident and I was unsafe in my decision-making, unsafe in my technical work, unsafe in the things that- I would want to know about that. and I would want to Yeah ... have that be corrected and addressed. And if I am so unsafe as to not be safe for patient care, then maybe there is the reality that I would be better fit and suited for another profession.
So I think that there is important room for that, and we have to, say this isn't like a everyone should get through to the finish line if they're objectively failing. So one little quip that I'll add. So for the first person that you said, the kind of the person who says
"Yeah, that's all well and good, but I'm actually bad. I'm actually not good." Again, this is then the person who is objectively, their program director says you're in good standing." Their, ... colleagues say, "I trust you. You're good at your job." You know, they're actually good. I was in medical school, and I was, stressed out about an exam, and, I was, you know, I [00:25:00] was worried I was not gonna do well. And my buddy, who was also in my same program at Duke in the theology medicine program he was a couple years ahead of me, he looked at me and said, "You know what, Pfeiffer?
You're not that special." And I was like, what do you mean by that?" And he was like you're probably not... You're not the best medical student there's ever been, you're not the worst medical student that's ever been." He said, "You're probably gonna do just fine, just like everybody else." And I was like, "Oh.
Oh that's nice. I am not that special." And so I think that was just kind of a funny quip- ... but it does get to it, is that imposterism is really someone saying that, "I am exceptionally bad. I exceptionally don't belong. I am an exception," when they're really not. They absolutely belong.
Now, I think this is a nice segue into a conversation around the broader systems and the disproportionate experience of imposterism and the role of those in leadership and those in positions of power to see that, to name [00:26:00] it and to work to address that. I mean, again, I think I've mentioned this earlier in our conversation, that women, folks of color, folks of minoritized populations, folks lower on the hierarchy totem pole folks from less prestigious institutions, all of those types of people- Yeah
experience this more than those who are not. That's very well-studied and very well-documented. And so there has to be I believe, I think it's important for especially those of us who have relative power, relative privilege, have leadership positions, to understand that, name that, and work to dismantle and address and mitigate the broader systemic things to diversify medicine, to bring people from all backgrounds in that reflects the nature of our patient population.
for someone to say, "I'm the first X or Y to do this," if you're less of an imposter if other people have done it before, and other people who look like you are doing it right now. So there are very important broader [00:27:00] systemic changes and workshops and tools and hiring practices that can also help address the imposter phenomenon and that broader set of experiences.
So part of what you're saying is that some of this isn't really a self-assessment of someone's skills in isolation. It is a walking into a room and looking around and saying, I kinda stick out like a sore thumb here."
Yeah. I'm not sure if you've ever encountered, the work of a researcher named Will Bynum.
He's a family medicine doc at Duke University. and he does work on shame. And on my first week of medical school at Duke, I remember this slide. He put it up and, oh, man, It was a very colorful slide. I think there were fish on it, and it was like the fish were all looking around, and I think it's drawing from- Mm
the really wonderful, convocation speech at Kenyon College. The David Foster Wallace. David Foster Wallace. I was like, I was like the Odyssey, David Foster Wallace. his whole work, body of work, that there's the fish who are looking around, you know.
David Foster Wallace was talking about, you know, this is water and you can't seem to understand the world that you're swimming in. What Dr.- Mm ... Bynum did is he [00:28:00] kind of employed that and then had these fish basically saying, "I'm the worst. How did that person know that?
How did this person know that? I didn't know the answer to that question. How did he, how did she in the corner know that and I didn't? I must be the worst student here." And then he basically overlaid a bunch of other fish who were all s- thinking the same thing. And that's not just, like, a nice idea.
That's studied. It's very well-studied, very well-documented that all of us are internally thinking that we're inadequate, all of us. Mm. And this is an imposter phenomenon. I think the experience and the process of kind of feeling shame in medicine is very much linked closely to imposterism
and imposter phenomenon. And again, that was basically him telling us, "You're not that special. Like, everybody else in the room is feeling the same thing that you do." Mm ... and you may think that you're the only one who didn't know that question, and then all of a sudden you're gonna answer something someday, and someone else on the other side of the room is gonna think, "Oh my gosh I didn't know that," "they must be so much smarter than me." Dr. Bynum's very important work on [00:29:00] shame our work here on in- the imposter phenomenon I think that's all kind of... We're taking up a similar task towards a very similar- Mm
goal of creating more vulnerability creating more honesty and more candid conversation and a more hospitable community for those of us in the professions.
Got it. So as you're creating this, you know, there are people that are sort of heading to the point that you're at, med students, pre-meds, even high school students who are thinking about going into medicine.
And a lot of them are under the same... Under sort of equivalent pressures for their level of study, right? The high school student who's like, "I have to get As in physics and chemistry or I won't get into the right college," or the college student who's like, "If I get a B in orgo, it's the end of my career."
Yeah ... you know, the med student who's looking at if their score is even 1.2 low on the step one, they're not gonna make it into the residency of their choice. Yeah ... those pressures are there all along the continuum.
if you could talk to 15-year-old Fifer or 20-year-old Fifer and say, [00:30:00] "Hey, think about it this way instead." Like, if you could just talk to yourself at that point, what might you have said?
Yeah. Lovely. I use it all the time now. you're not that special. I think it's a really great line. I think it's very funny, very sweet to basically say at the end of the day I think that at every stage, and an attending of mine here at, UCLA, a surgical oncologist named Mark Ergas, mentor of mine, he basically just said, like, he was like, at the beginning of residency, we sat down.
We had a nice meeting. I was walking away, and then he was like: "Hey, hey, hey, wait, come back." And he just said, he's like: "If you are just honest and work hard-
...
You're gonna be just fine." He's just like: "Everything's gonna be okay. Just be honest and work hard."
And Of course, that may be a little bit rosy, and of course that is with someone who's kind of, I'm already in a surgical residency. I've kind of made it this far. I think to be able to acknowledge that we can control what we can control, namely the effort that we put in the building of [00:31:00] relationships and community around us.
I would say that none of this work can be done in isolation. It always has to be done in community. So whether that's a community of co-professionals, whether that's a community of friends, whether that's a community of pre-meds, although the pre-med culture is pretty stressful. I'm stressed out. I found a lot of my community outside of the pre-med community.
I was a religion major and- Yeah ... and came back to it late. But find people that you trust who have gone before you who are behind you, who are with you, that you can express these feelings to, 'cause they're near universal. I can literally just, on a board, you know, put a tally mark of every time I felt like I wasn't good enough.
And then I can look back and say: "Wow," like, "I, I've gotten this far. I'm really grateful." And a lot of the fears and worries of a current moment look funny in hindsight or look small in hindsight. And so I think that Vulnerability, honesty, hard work and then a kind of candor [00:32:00] about your limitations and leaning on other people to be able to fill in those gaps.
Those are skills that are gonna be useful whether you're aspiring, whether you're right in the trenches, or whatever field that you're going to go into. I think that regardless of that, I think if you can inhabit those types of practices, I think you'll probably be successful in whatever you do, whether that's medicine, surgery, or something completely different.
It's kind of a broad brushstroke- Great ... but I think that's probably what I would say to myself.
I think that's great advice andI'll test drive that for you and see how it works.
Best of luck to him. Honestly, the season of the pre-med undergrad
I would say one of, if not the most difficult hurdles to overcome. And I think that med school is hard, residency is hard, life is hard, but that season is very hard.
And so I am not envious of him being in it, and I'm sure he's gonna do very well.
Thanks. I appreciate that. Try though we [00:33:00] might, we obviously are getting a late start and there's some people that are already on the path to feeling features of the imposter phenomenon, and it might feel difficult or impossible to admit that to anybody.
And therefore they can't ask for help because if you don't admit that you have a feeling, you can't get somebody to help you with it. So for people who are having trouble formulating the question, saying the words out loud, what can we say to somebody who maybe we sense that there's something going on even though they haven't told us, to help them start seeing themselves in a different light, a more forgiving light, even if they don't come right out and say, "Yeah, I'm feeling like an imposter"?
Yeah. I think that my first move Like now that I'm squarely in the middle of my surgical residency training, so I am a third-year resident, so I'm sometimes a junior resident, sometimes a senior resident. We're like the classic middle children at the residency.
and I am now- You want everybody to be happy. Exactly. You're trying and you're [00:34:00] doing every kind of job. And I'm now in the position of like leading teams and having junior residents. And, my first move and this is of course, I think you were asking more in the sense like someone who's more senior or more kind of wizened
or more, maybe has lacked the vocabulary for many years to be able to articulate these experiences or hasn't had the experience of having someone... all this to say is I think I would just start with my own experience and... start with vulnerability about- things that I felt.
And I think that as opposed to kind of trying to ask the perfect question to elicit something from someone usually the best move is to start with vulnerability and say, "Man, I've really felt like I don't belong sometimes. I've really felt like I have been a screw-up," and there have been seasons of my residency training
And I'll tell consult, you know, when I was a consult [00:35:00] resident I missed something a great example of this, and this is very surgery specific, but one of our chief residents told one of my colleagues, he said, "There will be a time where you're the on-call resident overnight.
You take a consult, you see them, you staff them, and then the next morning the team comes in and they take the patient emergently to the operating room right away." And he said, "When that happens, just know we've all had that experience. That's something that's universal." And so I think that's of course someone who's more senior speaking to someone who's more junior, but he's basically saying like in no uncertain terms, "I had that happen to me and I felt awful 'cause I felt like I missed something.
I felt like I was not a good resident. I felt like I-" had failed and not met the mark." And I think that in every situation, if you're feeling like someone's struggling with this type of stuff, my first move is to always just tell stories about ways that I felt similarly, about mistakes that I've made- Yeah
about ways that I felt inadequate. and that usually people will meet you in kind if they're at a place where they're ready to talk about it, and sometimes [00:36:00] people aren't, and that's just where they're at.
what I hear you describing is modeling where you're Giving somebody permission to speak in a certain way or behave in a certain way 'cause you've done it.
And I think it- 100% ... it can work laterally or it can work, senior to junior. It's a little hard to get somebody who's your senior to open up to you in that situation. Probably wouldn't be appropriate, but it does help to sort of lay a groundwork. I'm at a different point in my career than you are.
I'm a chief medical officer of a small to medium-sized health center, so I have- Yeah ... people that work for me, and I have colleagues around me that, I think that's a posture I can certainly take, and I've taken it with my students before. I've taken it with with newer, newer colleagues where, something goes wrong, like, this happened.
I've been there. I've done that." Yeah. "I did that wrong."
Yeah. "
I did it wrong more than once. Now I'm doing it right." So yeah. Yeah. I love that modeling idea. So what's the next step in this project? you mentioned Dr. Brandt's name, and I realized I had [00:37:00] heard her interviewed earlier this year on Tyler Johnson's podcast,
on Doctor's Art. Loved that interview. and I know Ryan Anteel, and I know of Will Bynum through Emily Silverman's podcast, "The Nocturnist." So- is the water we swim in. I happen to be really fond of this water. It's exactly the right temperature for me.
Yeah.
But where is your work going next other than, you know, doing a lot more surgical cases 'cause you're a third-year resident?
Yeah. It's a great question. Thank you for asking it. the big priority right now is, I feel like my imagination is pretty narrow and pretty focused on, the kinda day-to-day clinical work and training.
Dr. Brandt, and I are continuing to collaborate on a few projects. I'm actually working on a project right now with Ryan Anteel. We're hopefully planning to develop consensus decision-making tools for infants with trisomy 13 and 18. ... vulnerable population high-risk and complex population that surgeons have a real dearth of contribution in regards to which surgeries we ought and ought not to offer.
It's not necessarily related to humility. [00:38:00] my hope and goal is to continue, and the imposterism, is to continue to do work at this intersection. and then, I think that, Taking up and continuing to work with the Good Surgeon Initiative at UCLA is kind of a next step to at least, within this vein and this strain of having us have a better conversation around these, again, near universal feelings.
and given I'm a surgery resident, I'm starting with my own people first, and we'll do it within the surgeons and then hopefully have it spill over-
into other worlds as well. So yeah, those are the kind of trajectories that we're on. a lot of dreaming and then also a lot of keeping my head above water at this point too in, in the residency continuum.
For sure. And I wish you continued success in doing so. so we will certainly link to the Good Surgeon program in the show notes so that people can read a little bit more about it. And, I hope that we continue to cross paths, whether it's at CMR or in some other point of our career again.
Pfeiffer, thank you so much for being on today.
Jonathan, it's a pleasure. I think we're swimming in the same waters, so I think we're gonna be [00:39:00] seeing a lot of each other, and I look forward to seeing you and collaborating more in the future
[00:00:00] Pfeiffer's stories from his training make it clear that even the all-time greats have self-doubt. Fortunately, he's been blessed to work with role models who are willing to name and claim that self-doubt publicly and not bury it. One advantage of studying Jewish text is that I got that model early on.
When God calls on Moshe in the desert at the burning bush, Moshe says, "Send someone else. I'm not a good speaker. The people won't believe me. Pharaoh won't listen to me." Moshe is an outsider everywhere he goes. The Egyptians know he's an Israelite. To the Midianites and to his own people, he's, quote, "that Egyptian man."
He even names his son Gershom, meaning I was a stranger there, or possibly even outcast. Especially scary for our time when imposter phenomenon often leads to death by suicide, see Otuga's article that I quoted in the cold open, Moshe even asks God to strike him down rather than carry the burden of leadership [00:01:00] any longer And this from the person who was so exalted that we learn elsewhere that he spoke to God face to face like a friend.
Indeed, if Moshe had this much doubt, how could any of the rest of us be expected to get through life without it? And we're not even expected to live up to that standard. The great Hasidic master, Zusha of Hanipol, as he lay dying, shared with his students what scared him about death. He said, "I'm not worried that God will ask me, 'Zusha, why were you not like Moshe?
Why were you not like Avraham?' If God asks me that, I will answer, 'Master of the universe, you did not make me Moshe or Avraham. How should I be like them?' I am worried that God will ask me, 'Zusha, why were you not like Zusha?' And to that, I will have no answer." That story is a classic one to tell at this time of year.
This episode is airing right during the ten days of repentance between Rosh Hashanah and Yom Kippur, when Jews around the world are engaged in the soul-searching, [00:02:00] self-evaluation, and repentance called in Hebrew, Teshuvah, return. As I said to Pfeiffer during the interview, he and his colleagues have developed a framework that's very much like Teshuvah.
It creates space to name the problem and own it, and to do the hard work of learning how to do better, not in shame, but in love, in the company of colleagues who expect us to always be putting in our full, honest effort rather than expecting impossible perfection. I think a framework like this can create space to approach other problems in the system, to allow us to be transparent with patients when something goes wrong, understanding that saying, "I made a mistake," is not the same thing as saying, "I am not worthy of being your doctor."
It gives us room to grow rather than deflect and defend. It gives us a voice, even when that voice is not the voice of authority or certainty. I chose the word voice because that's how Nkechi Otuga put it in her article. [00:03:00] "As a trainee, I was made to feel as if I didn't have a voice," she says. She correctly identified that a patient returning pale and unconscious from surgery was hemorrhaging internally, but was made to leave the room for speaking up before other physicians on the team confirmed she had been exactly right.
Speaking not just of herself, but of the broader experience of Black physicians, especially the lonely few in leadership roles, she remarked, "We believe our degrees protect us, that each accolade confers a little more protection in rooms where we are the only one. But no credential can protect you in a space that treats you as a guest it didn't invite."
I'm hopeful that a shift such as the one Feifer and his colleagues describe can help change this experience and empower physicians of all backgrounds, especially those who historically been pushed back or pushed out altogether, to stand up and own that they are in formation, not being held to some Moshe-level standard that none of us can meet.
I'm reminded of my own chair of medicine when I was a third-year [00:04:00] med student at Pitt. Dr. Mark Zeidel did a session for every cohort of students on internal medicine, where he screened the ER episode, "Love's Labor Lost," and then shared his own story of being in over his head. It was the first night on call as an intern on an ICU rotation.
The day attending was signing out to the night team, and the nighttime person remarked, "There's a lot of really unstable patients on this list." The day attending smiled and said, "I'm sure this fine intern has things well under control." To which young Dr. Zeidel replied, "I most certainly do not. It isn't safe to leave this in my own hands, and I expect someone will be here to guide me and teach me."
It was a tremendous display of chutzpah, one which our culture of fear and deference, the medical culture, not the Jewish culture, beats out of most people, especially those who might feel that they are, quote, "guests who weren't invited". Feifer spoke about the most dangerous residents being the ones who believe that they are never wrong.
The ones who know they're [00:05:00] wrong and are too afraid to say it out loud are also a danger to themselves and to others and it's not their fault. They're being set up to fail by a culture that says, "Figure it out yourself, and if you can't, you didn't really belong here in the first place." What if we had a culture that expects people to speak up like that, to own their fear, to admit their limits, and to ask for help?
To believe that it's normal to not know everything the day you walk in the door, to not have all the answers just because your white coat now comes all the way down to your thighs. That's a teshuvah culture, a caring culture, a safer space, not only for doctors but for the people who put their lives in our hands.
The end goal of the teshuvah process in Judaism is always the wish we give ourselves and each other in this season, may you be inscribed for a good year in the book of life. Let's get to work on this new culture, and may it lead to all of us, those providing the care and those receiving it, being inscribed together in the book of [00:06:00] life