Dealing with high expectations, homesickness and self-doubt. International student Itisha Adukia reflects.

I recently had a call with my mum – the only way to keep in touch with my parents as an international student – when she asked how placement had been, whether I went grocery shopping, whether I got to bleed any patients recently. She told me how proud my aunt was of me. How proud everyone was that I was the first in the family to go to medical school. 

Meanwhile, all I could think about was how much work I had to catch up on. Not only that, but I didn’t feel prepared for my exams at all and I didn’t know where to start.

But telling my mum that would only worry her, so I avoided the topic entirely and thanked her (and my aunt).

I couldn’t stop thinking about that conversation for weeks afterwards. It felt like I wasn’t doing enough, at least according to my parents’ expectations. 

On a pedestal

Medical students are often put on a pedestal before they’ve even started medical school. Whether it’s family and friends asking about your achievements and studies, or the high expectations set by schools and tutors – from the moment you enrol you’re immediately signing onto being assessed at a specific standard, not only professionally but academically. 

So what happens when you don’t feel able to meet these expectations? How does it affect our self-esteem and ability to study, work and interact with colleagues and patients? 

We often deal with feelings of self-doubt and insecurity as medical students, also known as ‘imposter syndrome’ – which is especially common among high-achieving people such as doctors and medical students. These emotions can take up most of our daily lives and have a negative impact on our mental health. 

I’m no stranger to the negative thought spiral. As an international student and the ‘first person in the family to go to medical school’, these emotions are constant. There are expectations that we’re expected to live up to but there’s also an aspect of wanting to do the best for yourself.

I try to identify my feelings and ask why I feel the way I do. Is it fact? Am I terrible at this, or am I still just learning?

Living so far away from home also takes its toll. I can’t speak for all international students, but homesickness certainly plays a major part in my ability to work and study. I feel like I should be at home and the fact that my parents have sent me to university in another country almost seems ridiculous because of how far I am from my family. 

But I know that, if anything, being so far away on your own just shows how capable you can be and that your true achievements can lie outside of the academic world. 

Rising self-doubt

Being in fourth year also comes with its own challenges. You’re no longer under the supervision of junior doctors like you were in third year. You’re now expected to speak to patients on your own. At first, it feels fine, until patients start presenting with the ‘weird and wonderful’. Suddenly, you forget the basics. SOCRATES has flown out your head and you can no longer remember how to take a history. 

Feeling incompetent and incapable, your self-doubt rises, and you begin speaking to less patients on the chance they might present in similar ways that you don’t fully understand yet. Instead, you bury yourself in books and videos just to cover all the things you’ve seen that day – no matter how useful (or not) they are to your final exams. 

In the end, I realised it’s not about knowing the ‘weird and wonderful’ – as the junior doctor on the ward once told me. I realised that I needed to visualise where I was and where I want to be to stop doubting my own abilities.

Acess MCQs with Synap

Step by step

To combat my insecurities, I drew out a calendar of weeks I had left until exams and started filling out the boxes with the topics I needed to cover. All it took was an A4 sheet, which now hangs at arm’s length from me whenever I’m sitting at my desk. Not only does it let me know that I am, in fact, not running out of time – it also makes learning all the conditions much more achievable. 

Imposter syndrome is more common than it sounds and can affect even the brightest and happiest of minds. There are many things we can do as medics to battle self-doubt. I try to identify my feelings and ask why I feel the way I do. Is it fact? Am I terrible at this, or am I still just learning? I then try to recognise my successes and maybe write down my achievements and compliments from peers so I can remember the positives – not just the negatives.

No one is perfect – not even the consultant – and these feelings won’t last forever. Rather than holding you back, let it motivate you to be the best version of you there is.

MDU advice

Medico-legal adviser Dr Ellie Mein shares advice on dealing with self-doubt.

It may be reassuring for new and training doctors to realise that feelings of inadequacy are common despite how confident their peers might appear – also known as ‘imposter syndrome’.

Those that suffer with imposter syndrome often deal with ongoing feelings of self-doubt or inferiority. It can be more common among high-achieving women and previous studies have shown that around one-third of a sample of doctors and medical students are affected by it.

Recognising these feelings and talking to trusted colleagues can help as they will be able to relate to your concerns and reassure you.

Here are a few things to keep in mind when battling with imposter syndrome.

  • Recognise and celebrate your successes. It helps to keep a record of positive feedback or appreciation from colleagues, supervisors and patients.
  • Try to avoid constantly comparing yourself to others. We all have our own individual strengths and weaknesses. What feels natural to you may not for someone else – and vice versa – but that doesn’t take away from your own successes.
  • Reflect on incidents where things haven’t gone to plan but don’t be too hard on yourself. Reflection is a key part of clinical practice and an ethical duty. It can also help with your professional development. However, be conscious that everyone makes mistakes.

This page was correct at publication on 24/05/2022. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.