Not sure? Uncomfortable? The popular advice is to just “fake it until you make it.” Since starting medical school, I have heard students repeat the phrase frequently as a way to grapple with novel and occasionally unsettling situations, as well as the extensive amount of knowledge we are expected to rapidly acquire and apply. When students are unsure how to interview a patient about personal details, how to precisely make the first incision into a cadaver, or how to assist in a surgery, the mantra is to “fake” your confidence. The belief is that if you “fake it” long enough, eventually you will “make it” — namely, gain confidence in your ability.
This ideology is initially attractive for the overwhelmed and flustered student. However, it is flawed. “Faking it until you make it” does not lead to confidence, as the saying implies. On the contrary, the mantra is dangerous and counteracts medical students’ ability to succeed as confident and accomplished physicians.
By definition, students are in the process of building a limited knowledge-base. Although this limitation is by no means a secret, many students feel shame and embarrassment when they do not know the answer to a question or are unsure of how to handle a particular situation — especially when under pressure. Instead of seeking an explanation, demonstration or clarification, students in these situations begin to conceal a lack of knowledge or a lack of confidence in their approach.
By instituting an ineffective strategy of “faking it to make it,” students do not acquire the information and skills they are missing. This is because learning doesn’t occur via osmosis, as the catchphrase implies. Gaps remain and expand as students progress through training. As a result of and contrary to the “fake it till you make it” mantra, compounded uncertainty — not confidence — develops. This is detrimental to medical students’ development, since it prevents them from constructively addressing gaps in their knowledge and developing founded confidence when providing patient care. And perhaps more importantly, students who “fake it” during training will no longer be able to “fake it” without compromising patient care due to the gaps in their education as attending physicians.
Preferable methods of overcoming uncertainty caused by knowledge gaps besides “faking it” exist for students and are practical. Trainees can research their questions, they can ask their peers, or they can ask their supervisors and mentors questions at appropriate times. Unfortunately there are barriers to these solutions, including limited time of both educators and students, and the grading process of clinical years. For these reasons, it is far too easy and attractive for medical students to conceal what they are not confident in as an attempt to save dignity.
To address these barriers, educators can set aside time each day for student questions, and even provide students opportunities to direct those questions towards someone not involved in the grading process. They can work with trainees to create environments where students can learn without fear of failure and concurrently apply their burgeoning skills to help ensure strong confidence when applied in a medical environment that requires the effective application of a complicated skill set and rich knowledge-base.
As a physician-in-training, identifying what you do not know and actively seeking to fill the gaps, not conceal them, is critical to “making it” as a successful, confident physician. Therefore, I challenge students: the next time your face gets hot and your brain spins through facts and procedures as you try to identify the correct answer or approach, do not think to yourself, “fake it till you make it.” Instead, consider the philosophy of, “if you desire to aspire, don’t be afraid to inquire.”