First impressions last forever.  As cliché as this may sound, its truth is undeniable.  You only have one chance to make a first impression.  Judgments will be made about you in the first four to eight seconds of interacting with someone.

As a young physician, resident or fellow, it is crucial to understand that your ability to make a good first impression is just as important as your ability to make a good diagnosis.  Patients, colleagues, and industry peers will form opinions about you before you speak a word or have an opportunity to impress them with your technical acumen.  When interacting with patients, it is imperative that you are quickly able to establish yourself as a person who is trustworthy, credible, and competent.  The way that you interact with your colleagues and superiors will either enhance or detract from your technical abilities.  When attending conferences or community events, the impression you give those with whom you meet will not only be a reflection of you, but also of your practice, place of employment, and overall profession.

There are many factors that are a part of making a positive first impression how you introduce yourself, how you shake hands, your body language, your ability to carry on a conversation, your ability to introduce others, your ability to use names appropriately, and how you dress.  All of these things contribute to your total “professional package”.  With practice, you can hone and master skills that will ensure your “professional package” is one that leaves a positive and memorable first impression.

Forms of Address
Failure to show respect to those you meet is one of the most common mistakes a young physician can make.  Never assume that individuals wish to be addressed on a first name basis. To do so implies familiarity, which is not always appreciated.  This is especially important when meeting people who hold a higher rank or authority than you.  Always use an honorifi c, such as “Dr.”, “Mr.”, or “Professor”, until you have been specifi cally invited to use a fi rst name.  For example, when a resident, Paul, is introduced to his superior, Andrew Smith, he should address his superior as “Dr. Smith” until he has been invited to address him as “Andrew”.  When in doubt, err on the side of formality.

It is important to note that you should never give yourself an honorific.  For example, you should introduce yourself as “Andrew Smith”, as opposed to “Dr. Smith”.  Further, in the case of women professionals, the appropriate honorific, regardless of marital status, is “Ms.” unless the female holds an honorific that supersedes “Ms.” such as “Dr.” or “Professor”.

The Basics of Professional Introductions
It sounds like a simple task, but one that very few physicians have mastered the art of making a professional introduction.  Research shows that Americans generally expect four things when meeting or greeting someone:
1. Stand up.  First and foremost, in a professional environment, it is essential that both men and women stand for all introductions.  Remaining seated may be seen as a lack of respect for the person whom you are meeting or as a lack of professionalism.
2. Smile & Make Eye Contact.  The words you speak will be interpreted by the nonverbal gestures that accompany them.  A smile puts others at ease and is one of the most effective nonverbal gestures for people to communicate acceptance to others.  Making direct eye contact with the person whom you are meeting establishes trustworthiness, builds rapport, and communicates your enthusiasm and interest in meeting the person.
3. Make a Proper and Professional Introduction.
Introducing Yourself
When introducing yourself to another person, be sure to clearly state both your first and last name.  Savvy professionals should use a self-introduction as an opportunity to share information such as your profession, field specialty, place of work, etc.  Attaching this additional information to your name provides fuel for starting a conversation.

Introducing Others When it comes to introducing others, the most important rule is to just do it.  Too often, physicians fail to introduce people because they are uncomfortable, have forgotten a name, or are unsure of how to make a proper introduction. It is always better to attempt to make an introduction than to ignore the opportunity.

Who’s First?
In professional situations, introductions are based on rank and authority; therefore, you should show deference to the highest-ranking person.  In other words, people of lesser authority are introduced to people of greater authority.  A fail-safe way to ensure that you adhere to this point of protocol is to say the name of the highest-ranking person first. For example, “ Dr. Alexander (Program Director), I’d like to introduce Dr. Bowman (resident).”

Provide Additional Information
A savvy introducer is someone who knows to provide information about each person involved in the introduction.  For example, you should always give a person’s title (i.e. Chief of Staff, CEO) and explain how you know them as you make the introduction.  It is also appropriate to help facilitate an easy and comfortable conversation between the individuals by giving information that can serve as a jumping off point for continued conversation.

Keep the Introduction Balanced
When making introductions, it is helpful to think of a scale that must remain in balance.  If you use an honorific when referring to one person, you should use an honorific when referring to the other person as well.  The use of titles, and first/last names should also be kept “in balance” when making introductions.

Responding to Introductions
How you respond to being introduced by others is just as important as how you make an introduction.  At a minimum, respond by saying “Hello” and repeating the name of the person to whom you have just been introduced.  “Hello, Dr. Jones.”

4. Offer a Firm Handshake.  A handshake leaves a lasting impression, and in a professional arena, it is the only appropriate form of physical contact.  Your handshake reveals your feelings, motivations, personality, and attitude.  It is important to make sure that your handshake is sending the right message to those you meet.  A good handshake:
• Is firm, but not overbearing.  A firm handshake is representative of a person who is confi dent, capable of
making decisions, takes risks, and is interested in the person whom they are meeting.
• Uses a “web-to-web” grip.  When extending your hand, keep your fingers together and your thumb up.  Slide the web of your hand all the way to the web of the other person’s hand.
• Is not cold or clammy.  To avoid a wet or cold handshake, hold your drink in your left hand at social functions so that your right hand will be free for handshaking.
• Is made squarely facing the person.  Turning your body away from a person while shaking hands can be interpreted as a lack of confi dence or uneasiness.  Squarely face the person and make direct eye contact as you shake hands.
• Takes only two to three pumps. It is not necessary to continue the “pumping” motion as the introduction continues.  After two to three pumps, take the initiative to drop your hand and continue the introduction or conversation.
• Is initiated by anyone.  Professional protocol is gender neutral, so either a male or a female may be the first person to extend their hand for a handshake.

The Name Game
The ability to remember names is an outstanding asset.  It takes practice and concentration.  Physicians who make an effort to hone this skill will quickly realize its impact and power. The most common reason for not remembering a person’s name is the failure to focus on the moment of introduction.  Often, you are already planning what you will say next and fail to even hear the name of the person you have just met.  To help you avoid making this mistake, concentrate on hearing the name and then immediately repeat it back to the person by saying, “a pleasure to meet you, Dr. Neal.”  It is also helpful to use the person’s name throughout your conversation.  Not only do people enjoy hearing their names, the repetition will help to engrave the person’s name in your memory.

Despite your best efforts, there will inevitably be times when you simply cannot recall a person’s name.  If you find yourself in this situation, simply ask the person to help you with your recollection and make light of the situation. You might say, “It’s been one of those days and I’m having trouble recalling your name.”  Forgetting a person’s name is never an excuse to ignore someone or to fail to make an introduction. People inwardly wince when their name is mispronounced.

It is always better to ask someone to help you with the pronunciation rather than attempt it on your own and risk botching it.  If a person introduces himself and you do not clearly understand the pronunciation of his name, immediately ask him to clarify the pronunciation.  The individual will appreciate your attention to this detail.  This is especially
true when you are interacting with individuals from diverse ethnic backgrounds.

Body Language
Body Language is such an important part of your overall image that entire books have been dedicated to the subject. In fact, research shows that 90 percent of first impressions
are based on nonverbal signs such as body language.  Body language is comprised of your posture, facial expressions, and hand gestures.  If you are unaware of body language
and its impact, you can often contradict your words by your nonverbal signals.  For example, if you say you are prepared and confident for a meeting, but walk into the room with
your head down and fidget through the duration of the meeting, you will send a message that you are unsure of yourself.  Knowing how to use nonverbal signals effectively will enhance your image and allow you to present yourself as someone who is in control and confident.

Positive Body Language
• Leaning forward and maintaining good eye contact while conversing demonstrates attentiveness and interest.
• Keeping your arms open and at your side signals openness and trustworthiness.
• Standing up straight and keeping your head parallel to the ground conveys confi dence.
• Nodding in acknowledgement during a conversation shows that you are actively listening.
• Using your hands to make small gestures while talking indicates confi dence, honesty and outgoingness.

Negative Body Language
• Fidgeting, playing with items in your pocket, rocking from one foot to the other, and looking around the room signals restlessness, inattentiveness, and nervousness.
• Keeping your arms crossed or keeping your hands in your pockets indicates defensiveness or may signal that you are hiding something.
• Looking at the ground while speaking conveys a lack of confidence or uneasiness in what you are saying.
• A fixed, unfocused stare signals that your mind has wandered and that you are not paying attention.
• Standing further away from a person that approximately 18 inches conveys mistrust or nervousness.

Dress for Success
How you look is just as important in establishing a positive image as how you move, interact, and converse.  In your professional life, you will be required to dress differently for different occasions.  Whether it is hospital scrubs, an interview suit, or office casual wear, what you wear speaks volumes about you.  Think of your clothing as your “visual resume”. Every practice, hospital or healthcare provider will have a standard dress code.  It is always appropriate to dress one step above what is expected for someone at your level.   If you are unsure of how to dress, observing how your superiors dress will provide you with general guidelines in determining your own wardrobe. When attending any event, it is always better to overdress than underdress and to err on the side of conservatism.

The following are general guidelines to help familiarize you with specific categories of dress.  However, if you are ever uncertain as to how you should dress for a specific event,
do not hesitate to ask the host or someone familiar with the event for clarification.

Professional or Career Wear for Women 
• Professional wear typically indicates either a traditional skirt suit or a pant suit.  The length of the skirt should fall just above or just below the knee.  The appropriate
length for pants is measured such that the bottom of the pant hits the point where your shoe meets the heel.
• When buying career clothes, invest in quality fabrics and colors that are multi-seasonal.  Good multi-seasonal fabrics include wool blends, gabardines, and silks.
• Choose suits that in conservative colors such a black, navy, of dark gray.  You can add a touch of color through your accessories.
• Open toed shoes are not appropriate for professional wear.  Choose leather pumps or slingbacks that are dark in color.
• Bare legs are not appropriate for professional wear. Choose hosiery in neutral, natural shades.
• Avoid wearing glitter in jewelry or fabrics.  Such items should be reserved for formal affairs.
• Jewelry should be small and quiet and made of metals such as gold or silver. Beaded jewelry and other fashion type jewelry should be reserved for business casual days.

Professional or Career Wear for Men
• Professional attire for men consists of a well-made, tailored, conservative suit in a dark color (black, navy or gray).  Brown suits are generally reserved for more casual
• When buying clothes, invest in quality fabrics that are multi-seasonal.  Wool blends and wool gabardine is always appropriate.
• White dress shirts are most professional, followed by pale blue.  Patterned shirts are generally considered more casual than solid colors.
• The appropriate length for pants is measured such that the bottom of the pant hits the point where your shoe meets the heel.
• Shirt cuff should extend about an inch below the sleeve of the jacket.
• The fit of your shirt at the neck is the most important.  It should be snug around your neck, but not too tight that it is restrictive.
• Short-sleeved dress shirts are never appropriate for professional wear.
• Black dress loafers or oxfords are appropriate for any dark colored suit.  Brown shoes should be reserved for more casual events.
• Your socks should be dark in color (black, navy, or dark gray) and should be long enough to cover your leg when you sit down or cross you leg.
• It is appropriate to pair a conservative suit with a bright colored or patterned silk tie.
• If you are a tall man, make sure to buy ties that are extra long to ensure that they hang in the appropriate place.

Business Casual in General
In general, “business casual” is a term that will have very different interpretations depending on your type of work as well as the particular dress code of your workplace.  The
business casual category of dressing has great range and can include a great variety of clothing.  The most important thing to remember about business casual dress is to strive
to dress towards the upper end of the spectrum of options. Too often, professionals are too blasé in their business casual selections and can unknowingly send a message of unprofessionalism simply by the casualness of their dress.

Business Casual for Women:
• The dressiest interpretation of “business casual” is a jacket paired with either a skirt or a dress pant.  The jacket is the most powerful piece of clothing for women.  It commands respect and authority; therefore, women who wish to be taken very seriously will choose jackets as part of their standard business casual wardrobe.
• In business casual environments, jackets do not need to match the bottoms.  Consider wearing a “column of color” under a jacket.  For example, a black dress slack paired
with a black knit shell and a colored or patterned jacket is a very high-level business casual look.
• More moderate interpretations of “business casual” include twinset sweaters or tailored blouses paired with a skirt or dress pant.  A convenient way to dress down a twin-
set is by removing the cardigan part of the twinset, buttoning it, and draping it over your shoulders with the button side facing your back.
• In general, solid colored shirts are more professional than patterned shirts.
• Skirt lengths should be either right above or right below the knee.
• Pants should be full length, meaning the back of the pant should hit the point where your shoe meets the heel.  Pants that are any shorter in length than this should be
reserved for weekend wear.
• When wearing a pant suit, it is not necessary to wear hose with your shoes.
• When wearing socks with your pants, match your sock to the color of the pant.
• Sleeveless tops and dresses are not appropriate.
• Unless specifically allowed by your employer, avoid wearing the following:
– Shorts
– Denim
– Plunging necklines
– Tight clothes
– Showing your midriff
– Open toed shoes
– Bare legs
– Capri pants

Business Casual for Men:
• The dressiest and highest level interpretation of “business casual” is to wear a wool gabardine dress pant with a long sleeve solid colored dress shirt and blazer or sport coat.  To dress up this basic ensemble, add a tie.  To dress it down, remove the jacket or wear a dress shirt with a small pattern.
• A moderate interpretation of “business casual” is to wear a wool gabardine dress pant with a solid colored sport shirt or one with a small geometric pattern.  A silk or
cotton knit shirt, either with or without a collar, can also be paired with the wool gabardine pant. You may consider replacing the wool gabardine pant with a silk pant and pair it
with a silk shirt. A good example of this type of dress is the “Tommy Bahama” line of clothing.
• The lowest level interpretation of business casual is to wear a khaki pant with a knit polo style shirt.  Many men immediately jump to this lowest level of business casual
dressing without realizing that there are other ways in which to give a more professional appearance, even in a business casual environment.
• Unless specifi cally allowed by your employer, men should refrain from wearing shoes without socks.
• When wearing a shirt without a collar, make sure that your white undershirt does not show.

Formal or Black Tie for Women:
• For “black tie” events, fl oor-length, short, or three-quarter length evening gowns are all acceptable.
• Accessories should include evening sandals or pumps, an evening bag made of a dressy fabric such as silk, satin, velvet or brocade material, and appropriate jewelry
such as pearls or glittery pieces (in general two pieces of jewelry is enough).
• In cold climates, accessorize with a long silk or crepe sheath or a dressy jacket made of silk, crepe or satin.
• For “black tie optional” events or cocktail parties, wear a short dress or evening suit made of a dressy fabric
such as silk or crepe.  Use dressy accessories such as glittery earrings or a silk evening bag.
• Pant suits, no matter how dressy, are inappropriate for black tie events, but are acceptable at cocktail parties.
• Full-skirted ball gowns are usually reserved for white tie affairs.

Formal or Black Tie for Men:
• The best choice is a classic black dinner suit (tuxedo) accompanied with a crisp white dress shirt, black tie, black socks and black shined shoes.
• A white or patterned silk handkerchief may be tucked into a dinner jacket’s upper left pocket.
• Accessorize with a pair of personalized or studded cufflinks.
• Never wear a brocaded, satin, or patterned dinner jacket.

About the Author:

Wesley D. Millican, MBA, CEO and Physician Talent Officer of CareerPhysician Advisors, LP, and CareerPhysician, LLC, provides comprehensive talent solutions for academic children’s hospitals, colleges of medicine and academic medical centers across the nation. He possesses a longstanding passion for career development of all young physicians and serves as a go to career resource for training program directors and their residents and fellows. In continuing his commitment to the “future of medicine”, Mr. Millican speaks nationally at residency and fellowship programs. His Launch Your Career® Series is a proven resource for today’s residents and fellows and has served as a go to resource for program directors over the last 15 years.