On-Rounds Behaviors That Make Women Trainees Seem Less Confident

What subtle thing did you do on rounds this morning that made your male co-intern look decisive and made you look uncertain—even though you knew the case better?

That’s the trap here. It’s rarely about knowledge. It’s about behaviors that quietly signal “not confident” to attendings, seniors, and—worst of all—to yourself. And women in medicine get punished harder and faster for these signals.

The point of this isn’t to blame you. It’s to protect you from patterns I see derail talented women every single year.

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1. The “Soft Voice, Hard Work” Problem

You can do brilliant work and erase half of its impact with how you deliver it.

Common mistakes I see:

• Dropping your volume when challenged
• Speed-talking through your plan
• Ending sentences like you’re asking a question
• Letting others literally talk over your words

That last one? I’ve watched an intern pause mid-sentence because a male co-intern started talking—and she just ceded the floor. She knew the patient better. Guess who the attending wrote up as “confident and prepared”? Not her.

What this looks like on rounds

You say:
“Um, I think we could maybe start… like… 40 of Lasix?” (trailing off, quiet, upward intonation)

Your senior hears:

• Not sure
• Not ready to own the decision
• Needs someone else to sign off emotionally and clinically

Same content, different delivery:

You instead say:
“Given his weight gain, crackles, and JVP, I recommend 40 of IV Lasix now.”
Full stop. Neutral tone. No question mark.

Do not make the mistake of assuming people will “see past” your delivery. They won’t. Not in a busy hallway at 7 a.m. while 15 things are happening.

How to fix it without faking a different personality

You do not need to become loud or aggressive. You do need consistency.

Practice three things:

1. Volume: Aim slightly louder than feels natural. Hospital corridors swallow sound.
2. Speed: Slow the first sentence of every presentation—especially the one with your plan.
3. Intonation: Record yourself. If your plan sounds like a question, repeat it as a statement.

If you can only fix one thing this month, fix this. Soft voice + hedging language is one of the fastest ways women get tagged as “unsure,” even when they’re absolutely right.

Common Confidence-Undermining Behaviors on Rounds

Category	Value
[Hedging language](https://residencyadvisor.com/resources/women-in-medicine/subtle-behaviors-that-get-women-residents-unfairly-labeled-unprofessional)	85
Low volume	70
Ceding interruptions	65
Avoiding eye contact	60
Not stating a plan	75

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2. Hedging Language That Sounds “Polite” But Reads as Weak

This one is brutal because women get socialized into it. Then medicine punishes them for it.

Phrases that are killing your perceived confidence:

• “I’m not sure, but maybe…”
• “This might be a dumb question, but…”
• “I was just wondering if…”
• “So… I guess the plan is…”
• “Does that make sense?” right after a perfectly clear explanation

I’ve watched attendings visibly tune out after the second hedge. Not because they hate you, but because our brains associate hedging with “less reliable,” especially when it comes from women. Men often get interpreted as “thoughtful.” Women? “Unsure.”

Where it shows up the most

• Presenting your plan
• Answering a direct question
• Bringing up a concern or alternative
• Correcting someone about your patient

Here’s the mistake: You try to pre-defend yourself by softening everything. You think you’re being collaborative. It lands as you not believing your own words.

Language swaps that keep you respectful but firm

Do not say:
“I’m not sure, but maybe we could think about starting anticoagulation?”

Do say:
“I recommend we start anticoagulation today because…”

Do not say:
“I was just wondering if we should maybe get a CT?”

Do say:
“I’m concerned about X. I recommend we get a CT to evaluate for Y.”

You can still be open:
“If you disagree, I’d like to understand your reasoning.”
That’s confident. Not defensive.

If your mouth auto-loads “This is probably a stupid question, but—” you need to kill that habit immediately. Ask the question. Full sentence. No apology attached.

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3. The “I’ll Just Present the Data” Trap: Never Owning a Plan

Here’s a pattern I see constantly with women trainees: rock-solid data, weak or missing plan.

The script goes like this:

• Thorough HPI
• Impeccable labs, vitals, imaging
• Then: “So… that’s the update” or “That’s it for this patient”

No plan. No prioritization. You leave a vacuum—and someone else will fill it. Usually louder and more assertive. Often less prepared.

On a busy service, attendings don’t have time to drag the plan out of you. They just decide who thinks like a physician and who thinks like a scribe.

What it sounds like

Weak:

“Patient is still febrile, cultures are pending, WBC is slightly up. We’re continuing the same antibiotics.”

Confident:

“Patient remains febrile with rising WBC. I’m concerned our current regimen may not be adequate. I recommend we broaden antibiotics to X and obtain a CT abdomen to evaluate for source.”

See the difference? Same patient. But one version is “updating.” The other is “doctoring.”

Don’t make this mistake on rounds

Every patient. Every time. You must have:

1. One-line summary
2. Problem list
3. A primary plan for each major problem

Even if you’re not fully sure, you can lead with your best thinking:

“My plan is X for Y reason. If there’s a better option, I’d appreciate the teaching.”

That’s miles better than, “Um, I wasn’t really sure what we should do.”

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4. Body Language That Screams “Don’t Look at Me”

People underestimate how much nonverbal behavior shapes evaluations. Especially in a group setting like rounds.

Behaviors that make you look less confident even if your words are fine:

• Standing physically behind your co-resident or near the back of the group
• Folding your arms tightly or clinging to your clipboard/tablet
• Avoiding eye contact with the attending while you present
• Turning your body toward your note instead of the team
• Smiling or laughing when you’re challenged, even when nothing is funny

The “apologetic smile” is a classic. A woman presents an excellent plan. Attending pushes back, maybe a bit aggressively. She laughs awkwardly, looks down, and retracts. Later, a male resident offers the same idea more forcefully—and suddenly it’s “a good point.”

Fixing this without acting like someone you’re not

You don’t need theatrical gestures. You do need:

• To stand where you can be seen and heard, not buried in the back
• To face the person you’re talking to, especially for the plan
• To keep your hands relaxed at your sides or lightly holding your device—not white-knuckling it
• To let your face be neutral when challenged, not apologetic

A simple rule: when presenting, plant your feet, face the attending, and look up at least every few sentences. Glancing at notes is fine. Staring at notes the entire time reads as scared.

You’re not scared. You’re prepared. Make your posture match that.

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5. Letting Others Interrupt—and Staying Silent

This one makes me angrier than almost anything else because of how predictably it plays out.

Scenario I’ve seen dozens of times:

• Woman intern: starts presenting, gets halfway through key findings
• Senior or male co-intern: jumps in to “clarify” or “add something”
• She stops talking immediately. Smiles. Nods. Shrinks back.
• The rest of her plan never gets voiced.
• Later evaluation: “Lacks confidence in her assessments. Needs more leadership on rounds.”

See the absurdity?

Interruptions are common in medicine. But women get interrupted more and reclaim the floor less. That’s the piece you can control: taking your space back.

How to avoid the “steamrolled into silence” mistake

If someone jumps in mid-presentation:

• Pause. Let them finish their sentence.
• Then say, calmly and clearly: “I’ll finish the presentation and then we can come back to that point.”
• And you continue. Do not let your voice trail off.

If an attending asks the group a question about your patient and someone else answers before you even inhale, you can say:

“I have a thought on that as well—my concern is…”

You are not “being rude.” You’re actually doing your job.

The mistake is training everyone around you that you’ll back off the second they open their mouth.

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6. Over-Apologizing for Normal Things

Yes, medicine requires humility. No, it does not require you to apologize every 45 seconds.

I see women, especially interns, treat “existing” as a reason to apologize:

• “Sorry, I just have one question.”
• “Sorry, can we go back to bed 4 for a second?”
• “Sorry I’m so slow.” (When they’re not.)
• “Sorry, this might be stupid but—”

Each apology shaves off a little bit of how competent you look. And people remember the vibe more than the words.

There are times you absolutely should apologize:

• You missed something important that affected patient care
• You were late without warning the team
• You were rude or dismissive

Those are real. Apologize once. Then fix it.

But do not apologize for:

• Asking reasonable questions
• Clarifying orders
• Needing teaching as a trainee
• Not understanding something yet
• Needing a second to find a lab in the chart

A better script:

Instead of:
“Sorry, can you repeat that?”

Say:
“Can you repeat that? I want to make sure I understood.”

Instead of:
“Sorry I’m taking so long.”

Say:
“Thanks for your patience—this is still taking me a bit longer while I learn the system.”

Gratitude > apology. Most of the time.

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7. Disappearing When Things Get Uncomfortable

There’s a specific behavior pattern I see in women who are actually very strong clinically but get labeled “not confident”: they vanish when the room gets tense.

Examples:

• Attending grills someone about an error. You made part of that decision, but you let others speak and stay completely silent
• There’s disagreement on the plan for your patient. You know your stance, but you wait to see where the wind blows
• There’s a difficult family conversation, and you hang far in the back, neither speaking nor making your presence felt

What everyone else sees: withdrawal. Passivity. Timidity.

What’s often really happening: fear of being “too much,” or of attracting negative attention. Women know what happens to “bossy” or “argumentative” women in medicine. The backlash is real.

But the answer cannot be to vanish. That writes your story for you.

A better alternative

When tension rises:

• Take a breath. Do not rush into fixing the emotion in the room.
• If the case involves your patient, contribute at least one clear, grounded statement.
• If there was an error and you played a role, own your piece—briefly and clearly—then focus on the fix.

Example:

“I placed the order for X based on my understanding at the time. With new information, I agree we should have done Y. Going forward, for similar cases, I’ll make sure to check Z before ordering.”

That’s confident accountability. Not excuses, not silence.

The mistake is choosing invisibility to avoid discomfort. It protects you in the moment and costs you for months.

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8. Confusing “Nice” with “Professional”

I’ve watched women trainees contort themselves into “likable” at the expense of authority.

Behaviors that backfire:

• Laughing off disrespectful or dismissive comments from patients or staff
• Letting nurses, consultants, or even other students routinely bypass you and go to your male co-resident for decisions about your patients
• Doing emotional labor for the team—soothing everyone, defusing every conflict—while your own questions and ideas never get voiced

Being collegial is good. Being a doormat is not. Medicine will happily let you be the quiet, endlessly nice workhorse while someone else gets the “leader” label.

You want both: kind and clear. Warm and decisive. That’s possible.

On rounds, this might look like

Nurse looks past you and talks to your male co-intern about your patient. You stand there, smiling, holding the chart.

Better option:

“Natalie, since that’s my patient, run it by me and I’ll loop in the senior if we need to adjust the plan.”

Non-angry. Non-defensive. But very clear.

Or when a patient repeatedly calls you “sweetie” and your male colleagues “doctor”:

You can say, calmly:

“I’m your doctor this week. You can call me Dr. [Last Name] or [First Name].”

You don’t need to perform niceness at the cost of authority. That performance trains everyone to see you as less confident than you actually are.

Progression of Confidence-Undermining Behaviors

Step	Description
Step 1	Hedging language
Step 2	Soft voice
Step 3	No clear plan
Step 4	Ceding interruptions
Step 5	Seen as less confident
Step 6	Fewer opportunities

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9. Over-Preparing Content, Under-Preparing Delivery

This is the quiet sabotage almost every high-achieving woman in medicine commits at some point.

You spend hours:

• Pre-rounding thoroughly
• Reading primary literature
• Making detailed notes

You spend almost zero time:

• Practicing how you’ll actually say the plan
• Deciding which 2–3 points matter most for each patient
• Rehearsing pushback: “What will I say if the attending disagrees?”

So when you get asked a high-level question, you either:

• Dump all the data (and look scattered), or
• Freeze because someone cut across your internal script

The evaluation then says: “Hard worker, but lacks confidence in synthesizing and communicating plans.”

The mistake is thinking content is 100% of the game. On rounds, delivery is at least 40%.

A simple fix you can start tomorrow

For each complex patient, write—literally—one or two sentences with your recommendation. Then say them out loud once before rounds.

Example:

“Given her recurrent chest pain with dynamic troponins and high-risk features on history, I recommend urgent cardiology consult and plan for cath today.”

Then, in a separate line, jot a brief response to likely pushback:

“If cardiology says no cath today, I’ll clarify their risk assessment, confirm med optimization, and ask what specific changes would trigger cath.”

You’re not scripting a performance. You’re rehearsing confidence so that when the moment comes, your brain doesn’t dump everything on the floor.

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10. Letting One Attending’s Style Rewrite Your Personality

Here’s a subtle but dangerous mistake: you encounter one loud, hyper-aggressive attending. He rewards confrontation and swagger. So you decide that’s the only way to be seen as confident.

You start:

• Overcorrecting into aggression
• Picking fights to show you’re “not weak”
• Mimicking his sarcasm or dismissiveness

And suddenly you’re in a double bind: “too soft” for some, “too abrasive” for others. Women get slammed on both ends of that spectrum more than men, and you know it.

You do not need to become a caricature of the loudest person you rotate with.

Your job is to find a version of confident that’s sustainable and authentic:

• Clear voice
• Direct language
• Owned plan
• Respectful but not submissive under pressure

Adapt your style slightly to different attendings? Sure. Completely abandon your core way of communicating? No. That’s how people burn out or start hating themselves.

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Quick Reference: Behaviors That Quietly Undercut You

You want a short list of the biggest mistakes to watch for? Here:

Mistake	Better Replacement
Hedging every statement	State plan, then invite input
Speaking too softly	Slightly louder, slower, neutral tone
Presenting data without a plan	Always end each problem with a clear plan
Letting interruptions stand	Calmly reclaim the floor and finish
Over-apologizing	Use gratitude and direct requests instead

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FAQ (Exactly 3 Questions)

1. What if I genuinely do not know the answer—won’t acting confident be dishonest?
You do not need to fake knowledge. Confidence is not pretending to know everything; it’s owning what you know and what you don’t. Say, “I don’t know the exact number, but I believe the range is X–Y. I’ll look it up after rounds.” That reads far more confident than panicked hedging or rambling guesses. The mistake is equating confidence with omniscience.

2. How do I handle an attending who clearly favors louder male trainees?
Do not try to out-yell them. Instead, make your contributions precise and reproducible. After rounds, you can also send a brief, structured follow-up (one or two lines) to your attending about a key patient you were managing: “For Mr. X, I reviewed Y and adjusted Z accordingly.” That builds a written record of your leadership. Also, ask for targeted feedback: “I’d like to show more leadership on rounds. What’s one thing you think I should change?” Force them to articulate something specific instead of relying on vibe.

3. I’m worried that speaking up more will make me seem “difficult.” Should I just wait until I’m more senior?
Waiting is the mistake. If you train people now that you’ll stay in the background, that reputation will follow you into senior years. You do not need to become combative. You need to consistently claim ownership of your patients, your plans, and your questions. The residents and attendings who actually respect competence will see it. The few who punish any assertive woman? They’ll criticize you either way. Do not build your entire personality around avoiding their disapproval.

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Key Takeaways

1. Your knowledge is not the main problem; how you deliver it on rounds is.
2. Drop the reflex hedging, over-apologizing, and disappearing when interrupted or challenged.
3. Every patient, every day: clear voice, clear plan, and the guts to finish your sentence.