Professionalism in residency: Managing interpersonal relationships during this journey

Residency is a unique time in the life of a physician. It is a level beyond that of medical school, but it remains a provisional ‘in-training’ period. There are greater responsibilities, but there remains a tolerance for mistakes. Sort of like the ‘teenage years’ of medical education—you’re not quite ‘grown up’ just yet.

During this awkward time of transition, it is well-known that the journey to replace the pure theoretics and black/white textbook print of medical school with the messiness, shades of gray, and bodily fluids of clinical practice is completed. But as this happens, an equally important transformation is co-occurring. While professionalism and relationship-building are both important during the medical school years, postgraduate training presents a more significant opportunity to apply and develop these skills in the real-world setting.

As a medical student, you tend to be transient, your interactions with peers, staff and faculty lasting only as long as the class or rotation before you move on to the next thing. As a resident, you are truly a (semi) permanent fixture of your program. As a result, you will interact with physicians and allied health staff of all levels in a professional capacity over a long period of time. More importantly, you will forge battle-hardened relationships with your co-residents, some of whom you may spend more time with during a busy week than your own family.

As the name “residency” implies, the boundaries between work and personal life often blur considerably. That’s why learning to navigate the waters of professionalism and learning how to create healthy interpersonal relationships with your staff and co-residents are such vital skills.

Here are three core competencies to focus on developing during residency that will set you apart in your program and your career.

Cultivate honesty/integrity and keep your promises

When you begin residency, your only real assets are your work ethic and your integrity. You can show enthusiasm and excitement to make a good first impression, but that will quickly fade if you don’t back it up with the demonstrated ability to keep your promises and commitments. A friend and mentor recently told me that if you build a reputation for being someone who always does the right thing and can be counted on to deliver on their obligations, every door will be open to you. You’ve probably heard that before.

The really hard part about following that advice isn’t choosing to do the right thing and keep your commitments—it’s knowing when to ask for help when you don’t feel up to the task. Attempting to tackle a challenge you are not suited for on your own can lead to failure, frustration and really bad outcomes. Assuming that there are no bad actors here and everyone’s goal is to be their best, the times when we fall short are when we get overwhelmed or outclassed. Know how and when to ask for help, and do not leave a colleague or junior resident who asks you for help out in the cold.

Additionally, and this could be an article all its own, the other really tough thing to learn here is what size your plate really is—how not to over-promise or over-commit yourself. To be honest, this is probably what I struggle with the most. In the words of a different friend and mentor, “once you say yes, more opportunities appear.” In other words, “when it rains, it pours.”

When you’re starting out in residency, there is a strong drive to dive in feet first and do as much as possible. If you say yes too many times, you may find yourself stressed, over-worked, and miserable. The disappointment you might give someone by turning down an opportunity pales in comparison to the negative outcomes of not following through on an obligation. Try to cultivate an understanding of your limits and work on setting healthy boundaries.

Avoid the gossip trails

When you get into a very close-knit group such as a residency program, it can feel natural and tempting to be somewhat judgmental, or to speak about people as you might in a much more informal setting. This can be especially evident when a person’s performance or how they manage patients can be so emotionally charged due to the consequences of poor decisions. Additionally, there may be an atmosphere of competition among your peers that lends tension to your interactions, as everyone you know might be a rival for a chief resident or fellowship spot.

When you get wind of something juicy, like a secret or misstep, it can be easy to want to share it. In the same manner, those late nights in the workroom might seem like the perfect time to say something behind another resident’s back. You might open up about private struggles and place trust in someone who doesn’t have your best interests at heart.

When residency gets difficult, we rely on our co-residents as backup and professional support.

You never know when something you said will come back to bite you or affect the team relationship dynamic. Don’t spread gossip, and treat others with respect. Your colleagues will respect you for it.

Emotional capital

Several years ago, I learned about the concept of “emotional capital”, and it stuck in my mind.

Emotional capital might also be termed “relationship banking.” It requires you to go out of your way to do favors and help out others in order to make “emotional bank deposits” so that in the future, when you need something, others will be happier to return the favor. While it may seem impersonal to use banking as the metaphor for this, the reason it works conceptually is that these favors, good deeds and acts of friendliness actually gain interest that compounds over time.

Thinking of emotional bank deposits as purely transactional is missing the big picture. When you consistently do good things for other people, you communicate that you are a person people want to work with and for. This can add up to a sense of goodwill and loyalty that far exceeds any individual action in value. That becomes closer to the concept of emotional capital, a large endowment of positivity you can reinvest to accomplish bigger things.

Helping others not only helps yourself, it also feels good. Being the person who is consistently bringing positive actions and behavior to your residency program will also make your time in residency more enjoyable. Strive to develop emotional capital with everyone in the hospital and your contacts in the larger profession. You never know when somebody else will come through for you in a tight spot. Forging these types of beneficial relationships throughout residency can help guide you as you become more confident over time and are able to pass along the same knowledge and more in the future.

Related reading:

How to make mistakes and recover from them as a resident

Five more unique electives for residency