Commentary on Impersonating an Imposter: Minority Students and the Burden of Microaggressions.

With her untamed baby curls and swept-up braids, this tired Black medical student is seen removing a thin mask at the end of the day. Through this scene, my classmate Nile Harris’ photograph relays how the unique experience of microaggressions in underrepresented minority (URM) medical students leads to a heightened sense of an already commonplace imposter syndrome in medicine. Over the past few years, the public discourse on speech has created 2 camps. One places great stock in how words shape not only a figurative societal climate but real-life manifestations of racism, sexism, and classism. The second adopts a view in which words should essentially not be taken so seriously. Chosen with intention, the photo’s black and white palette represents the stark contrast between the 2 worldviews. With each debate over public figures’ discussion of current events or ideologies, the 2 camps grow in their refusal to entertain the other’s views. Microaggressions have found themselves in the crossfire between how the 2 camps view the importance of speech. Defined as commonplace behavioral, environmental, or verbal choices that denigrate or express prejudicial slights and insults toward any group, particularly minorities,1 microagressions can be intentional or unintentional. In the photograph, the nature of the material the student removes from her face serves as a twofold reference. It denotes the mask of imposter syndrome that many students, majority and minority, feel as they integrate into the world of medicine. Less evident, though, is the way that the thin, almost invisible material of her mask symbolizes the nature of microaggressions as they contribute to a minority student’s sense of imposter-hood: hardly noticeable to an outsider but a burden to remove for the recipient. When introduced to microaggressions, often through accusation, people are pushed to pick a camp. For some, it is a call to more carefully navigate their expression of gut reactions to minority coworkers, classmates, and students. However, many see microaggressions as the product of a hypersensitive culture looking to further polarize groups and deem harmless statements racist. This combined photograph and commentary aim to denote the gravity of microaggressions by presenting them in the context of the established phenomenon of imposter syndrome. This phenomenon is not unique to URM medical students, but we write and photograph to suggest its experience may be worse in the underrepresented due to the persistent presence of microaggressions in their academic environments. Feeling inadequate and undeserving is a nearly inevitable tenet of this medical school plague of imposter syndrome. Roughly half of all medical students experience imposter syndrome.2 Associated with higher burnout indices and psychological despair,2 it is damaging. Through understanding how microaggressions fuel this hallmark struggle with imposter syndrome, perhaps we can be less concerned with staving off an accusation of racism and look more deeply into prevention. When roughly 9% of physicians are URMs in a country where they constitute 31% of the population,3 the world of medicine serves as a fertile ground for the expression of microaggressions. The minorities who make it to medical school are accustomed to slights such as being ignorantly applauded for pursuing higher education by filling a diversity quota instead of being recognized as valuable members of an academic community. These continued microaggressions, though, are compounded by the newfound intensity of imposter syndrome inherent in the prestige of medicine. Both microaggressions and imposter syndrome diminish confidence. By experiencing both, minority students are demeaned and isolated in a distinctly damaging way. The racial and social isolation this breeds is represented in the photograph by the way the subject’s black braids contrast with the white coat and wall that surround her. Her hair choice embodies the otherness of feeling both outnumbered and undervalued as a medical student of color. Furthermore, this uniquely destructive combination of imposter syndrome and microaggressions robs URM students of the confidence needed to assume their role as physicians. This is a task that proves difficult for even those well represented in medicine; the faceless subject in the picture emphasizes the stalled formation of an identity as a physician. Microaggressions are committed by well-meaning individuals. Sometimes, they are the product of an excitement about the field’s increasing diversity. But intent and impact are not synonymous. Ideally, the willingness to change could be rooted in an understanding of how microaggressions detrimentally shape the identities of future minority doctors. Those of the dominant culture in medicine must challenge themselves when working with minority medical students. This challenge may come in the form of pausing to ask yourself, “Would I make this comment to a nonminority colleague?” Or more importantly, in the event that you are seen as the perpetrator of a microaggression, be ready to listen, regardless of your camp.