One way to train gritty doctors: Don't allow them to quit

What is grit?

In an article in The Guardian, Angela Duckworth, a psychologist often called the guru of grit, defined it as the commitment to finish what you start, to rise from setbacks, to want to improve and succeed, and to undertake sustained and sometimes unpleasant practice in order to do so.

She said in a paper that grit is perseverance and passion for long-term goals.

I think we’d all agree we would want our doctors, particularly our surgeons, to have grit.

That sounds great, but how do we find people who possess grit? This is especially important in surgery because attrition rates in general surgery residency programs have been about 20 percent for many years.

In 2014, I blogged about a paper that used grit levels, measured by a brief survey — the Short Form Grit Scale (SFGS), to predict who might drop out of surgical training programs. However the authors did not find that low grit made a significant difference because attrition rates in the programs studied were lower than expected.

A recent study published ahead of print in the American Journal of Surgery used the SFGS to identify potential residency dropouts and found that residents with less grit thought about leaving their program more frequently, but the numbers were again too small to show a significant difference in resident attrition. Those with higher grit levels had a better sense of well-being which is nice.

One of the problems in trying to measure grit is that the grit scale is fairly easy to “game.” For example, in response to the statement “I am a hard worker,” how many surgical residents would describe themselves as “not like me at all”? In fact, if you can’t get a high score on the SFGS, you not only short on grit, you are also lacking common sense and should not be licensed to care for sick patients.

It’s hard to measure grit, so why can’t we just teach it?

The Guardian story said Duckworth’s father often disparaged her, and she reacted by trying harder to prove him wrong.

In today’s world, can you imagine teaching a resident to persevere by using disparaging remarks? I don’t think so.

From the Guardian: “To avoid some of the mistakes of her own upbringing, Duckworth teaches her children grit. With her husband, Jason, she has developed ‘the Hard Thing rule.’ Each family member must choose a discipline — for Jason and Duckworth their work, for the girls an interest — and apply themselves to it. No one may quit until the activity has run its course.”

That’s one way to cut down on resident attrition rates. Simply do not allow them to quit.

Problem solved.