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rapport
Dub,
I would say from my experience rapport isn't just a big thing, but rather, one of the biggest things. It does not matter how vast your knowledge base is, or how precise your clinical abilities are, if your patients do not trust you, because that means they will not listen to you. This applies to every level of patient care, from EMT all the way up to MD. I have the advantage of working both in an ED and on an ambulance, and I see rapport of all kinds being developed. The only thing I can say is the most basic form of rapport can be built in the first 30 seconds of your H&P, and once you loose it with a patient it pretty much doesn't come back. Until a patient decides to listen to you, and that you know what you're talking about, you're just a talking head in a white coat.
Where does rapport building skill come from? Experience. It is a clinical skill no different than IV access or intubating. It takes practice and it definitely diminishes over time if not used. You can learn the theory from a book, but you learn the skill from others more experienced than you.
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