After spending nearly every single waking moment in the classroom for two years of medical school, thousands of 3rd year medical students will be walking into the hospital for the very first time this summer. Some students will start out on general surgery scrubbing into cases while others will be rounding on the peds ward. Regardless of the service, there are universal behaviors that absolutely impact one’s ability to gain credibility and trust with colleagues, hospital staff, and attendings.

After countless experiences working with medical students and residents, I have come to believe that it is entirely possible for one to establish nearly immediate credibility with hospital staff. It is often said that first impressions are made within the first seven seconds of meeting someone. Every month, medical students start new rotations on new services with new hospital staff, nursing, administration, and other medical students. Needless to say, there are a lot of first impressions being made. Although making a great first impression is important, it’s only the first step to establishing lasting trust and credibility.

Before we get started, let’s take a minute to review the core components of credibility, which are defined by Dr. Steven R. Covey as 1) Integrity, 2) Intent, 3) Capabilities and 4) Results. Together, integrity and intent make up one’s character, while capabilities and results make up one’s level of competence. Both character and competence are essential for building trust with the entire spectrum of individuals with whom students interact with in the hospital — everyone from attendings to patients. To build lasting trust and establish your credibility, you will need to demonstrate each of these components. If even one is lacking, credibility is damaged and once it’s gone, it’s hard to regain.

Here are some real life examples. First, let’s look at a student who has strong values, is punctual, works hard, but has multiple failures on Step 1/ Level 1. This student may embody the first three components described above, but lacks the results needed to demonstrate mastery of essential medical principles. How about the student who has high board scores but is caught leaving early or making up physical exam findings when he/ she clearly did not evaluate the patient? Credibility is damaged in both of these scenarios.

 

Below are 10 behaviors that will maximize your credibility and gain trust on rotations:

Behavior #1: Demonstrate respect…always!

This goes for anyone and everyone you may encounter during your rotations. If you want to be respected, you will have to demonstrate respect, even if you feel discounted by nurses at times or other hospital staff that may view you as unimportant to the team. At some point on your rotations, you will likely feel discounted and/ or a non-essential part of the service. The truth is…you are. You are there to learn and to help out when called upon. If their service cannot fully run without you, then something is direly wrong. Even if you find your attendings or fellow residents talking down to someone, be mindful of the importance of demonstrating respect at all times.

Behavior #2: Come Prepared

Students who come prepared stand out in the wards. They know their patients and are able to answer questions when pimped, not because they are necessarily smarter, but because they put the extra time into reading about their patients and their disease processes.

Behavior #3: Admit Wrongs

If for any reason, ever, you mess up, be sure to admit your wrongs. For example, if you mistakenly report lab values based on inaccurate recollection, let your team know about the mistake. We all make mistakes, but those who cover them up damage their capacity to build trust with others.

Behavior #4: Avoid Commentary

When you are on a service, you will find numerous opportunities to participate in gossip and add commentary when relaying patient information. Furthermore, you may hear others behaving in this way. For example, calling a patient a “drug-seeker” is something you should absolutely avoid when reporting a patient. Stick to the facts and avoid commentary at all costs when interacting with hospital staff. This will pay dividends in the way you are viewed and treated.

Behavior #5: Talk Straight

If there ever is a time when you forget to do something such as see a patient or pull up lab values, be careful not to skirt around the issue. By straight-talking, even when you fear that people won’t like what you have to say, you will build credibility. This is especially important with patients. Students often confuse being sensitive with talking around issues. It is a learned skill to be able to communicate directly and with empathy.

Behavior #6: Be Accountable

Days in the hospital can be long…very long. It’s easy for medical students to get lost for hours at a time. Make sure if you leave the floor, someone on the team knows where you are. Most services will not require you to wear a pager. Tell someone if you are going to be off the floor and especially let someone know when you are leaving for the day. The last thing you want to happen is for your team to be looking for you when you are out of the hospital. Don’t take the risk.

Behavior #7: Be Teachable

This is often an issue with some of the highest-performing students. The truth is, if you are an extremely high performer, you may actually possess a level of medical knowledge even above that of the residents and staff about you. No matter how high your board scores are though, you still have a lot to learn in clinical medicine. Be teachable. Avoid coming across as someone who is arrogant and a know-it-all. Your team is volunteering their time to train you. Make sure you embrace their wisdom and experience treating patients.

Behavior #8: Get Better

Establishing competence with various procedures, etc. takes time. You will try things for the first time throughout your medical career. Although you may struggle with certain procedures or with certain concepts, keep practicing and get better. For example, most students cannot tie good knots when they show up in the operating room for the first time. That’s okay. The key is to practice and develop the skill set over time.

Behavior #9: Practice Humility

What does it mean to be humble? If you can’t answer that question, perhaps you should spend some time reading on this topic. Demonstrating humility is one of the most important human elements for a physician to embody.

Behavior #10: Ask for Feedback

So often in my experience working with students, they fail to ask for feedback. Don’t let your clerkship grade be the first time you receive feedback from your attending. Typically, I recommend to students that they select residents and attendings for feedback at three points in their rotation….after the first week, midway, and at the end. Asking for feedback will force your attendings to starting thinking about you as a student who is on their service and trying to get better. Specifically ask what improvements you can make and if you are lucky enough to get a thoughtful response, focus on these areas. If you never ask for feedback, how will you ever assess where you can get better?

 

In conclusion, it’s a good rule of thumb to make sure you are always adding to the service you are rotating under. Establishing credibility and trust with house staff is absolutely essential for having the best rotation possible. You’ll learn more, build better relationships, and find your rotations to be more rewarding if you can follow these principles.

 

This post was authored by Joshua Courtney, DO, Founder and Chief Medical Officer of TrueLearn, Inc.

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