It was my first NICU rotation as an intern and I still remember the first time I was asked to intubate a critically ill preterm infant. The attending looked at me, then at the monitors, and said quietly, “You’re going to do this. I’ll be right here.” His voice carried an assurance that steadied my hands. The intubation did not go perfectly, but he remained beside me, calm and unflinching. When the tube finally slid into place and the infant’s oxygen saturations began to rise, he smiled and said, “Good work. You stayed composed.” I walked out of that room feeling changed and inspired to be a neonatologist. What I had learned was not only a technical skill but the meaning of trust.

Years later, in my new role as interim program director, I sat across from our fellows as they described their experiences in training. One said they hesitated to speak during rounds for fear of being reprimanded. Another said that after performing a difficult procedure, they received no feedback at all. Others felt uncertain about how decisions were made about who would perform procedures or take leadership roles on rounds. As I listened, I began to realize how fragile trust can be within the training environment. Their words were not accusatory; they were expressions of disconnection. When I discuss with fellows and residents from other programs, I have observed similar concerns of lack of trust from both trainees and program directors.