Establishing trust as a resident

Trust is a key element to a successful residency experience. Trust between attendings and residents mediates participation and learning. Knowing you can trust senior residents to provide appropriate guidance is crucial to feeling supported during training.

Similarly, feeling trusted by your seniors can affect perception of your responsibilities, learning opportunities, and overall growth as a physician. This trust mediates opportunities to participate in patient care until you assume clinical independence.

You also need to earn patients’ trust.

So how, exactly, do you do all this?

Earning your team’s trust

Trust can be considered in terms of three basic components: competence, honesty, and benevolence. A fourth component, consistency, is often added. Let’s take a look at what these mean during residency.^[][]

Competence: During residency, your senior team members need to trust that you can handle the tasks assigned to you. You, in turn, need to be able to trust them to handle their own tasks.

Honesty: You need to trust your attendings and senior residents to tell what you need to know and be honest in their assessment of your abilities; you must do the same for those junior to you.

Benevolence: As a resident, you trust seniors to provide the guidance you’ll need to become a successful clinician, and to have your best interests at heart—not to just be using you for low-paid labor. Your juniors will place the same trust in you.

Consistency: As a resident, this means showing up on time and performing your duties to the best of your abilities every time, and expecting that those around you are doing the same.

The importance of these competencies, with a novel twist, comes across in a paper published in Academic Medicine, which identified three characteristics important for interns to display to earn the trust of their seniors:^[]

• Reliability

• Competence

• Propensity to make errors

Interns who were able to prioritize tasks, follow through on assignments, and ask for help were more trusted, because they were reliable. Interns who devised and implemented care plans, responded promptly to new and acute issues, and demonstrated knowledge were more trusted, because they displayed competence.

Finally, an important third aspect that built trust in interns was their propensity to make errors. Trust was not earned by not making errors, but by responding to feedback and reducing errors made over time.

With these characteristics, your team should be able to trust you.

Gaining patients' trust

Trust is the ability to rely on the character, ability, strength, knowledge, or truth of someone. It does not usually result from a single interaction but is instead built over time through repeated interactions that demonstrate trustworthiness.

In the patient-physician interaction, patients must trust you, their physician, to be doing what’s best for their health.^[] In medicine, this trust is often built through interactions that show you, the physician, to have technical competency as well as interpersonal attributes such as honesty and reliability.

You, in turn, must trust your patients to tell you what you need to know to care for them, and trust them to follow through on their care. You must also let them feel your trust in them, as that will improve cooperation in their care.

To help build trust between you and your patients, there are a few useful things to try:

• Communicate clearly, and often. Effective communication is the foundation for trust between you and patients. This includes talking to them about their treatment plan and actively listening, which you can demonstrate through paraphrasing, summarizing, clarifying, or reflecting on what they say. This shows you’ve heard them. Likewise, asking them to paraphrase, summarize, etc., what you’ve said, can help gauge their level of understanding.

• Empathize. Most patients respond better when they feel that you care. Just try not to become overwhelmed by their emotions or the situation yourself.

• Project calmness, even if you don’t feel it.

• Look them in the eye; don’t always be looking at your notes.

• Keep your word. Be clear about what you can and cannot do, and when you will and won’t be available to them.

But small efforts do make a difference, and gaining your patients’ trust will ultimately help you, and them, reach optimal outcomes.