GRIT: A MARKER OF ATTRITION?

ARGHAVAN SALLES, GEOFFREY L. COHEN, & CLAUDIA MUELLER

ASSOCIATION FOR SURGICAL EDUCATION

APRIL 23, 2013

The authors have nothing to disclose

OVERVIEW

Background

Research Design

Methods

Results

Conclusions

Limitations

Background

Research Design

Methods

Results

Conclusions

Limitations

INTRODUCTION

Residency is challenging

Attrition in general surgery is ~20%1-4

Attrition is costly to both individuals and programs2

GRITWhy might people of similar intelligence achieve different outcomes?

Grit is a measure of perseverance and passion for long-term goals5

“Whereas disappointment or boredom signals to others that it is time to change trajectory and cut losses, the gritty individual stays the course.”

“. . .individuals high in grit deliberately set for themselves extremely long-term objectives and do not swerve from them—even in the absence of positive feedback.”

GRIT

Controlling for intelligence, grit is an independent predictor of achievement

Grit and IQ are not positively correlated

Those with higher grit attain higher educational outcomes and have fewer career changes

We examined the relationship between perseverance and attrition in a longitudinal study

Background

Research Design

Methods

Results

Conclusions

Limitations

RESEARCH QUESTION

Is there a relationship between grit and attrition?

-Does grit predict burnout?

-Does grit predict psychological well-being?

OVERVIEW OF STUDY DESIGN

Participants: surgical residents across nine sub-specialties at one academic center (N=141, 52 female; 85% response rate)

Background

Research Design

Methods

Results

Conclusions

Limitations

DATA COLLECTION

Participation was voluntary

Residents were surveyed during mandatory educational meetings

Residents who were not present were emailed a survey link

Residents were surveyed again 6 months later

MEASURES

Short Grit Scale6

“Setbacks don’t discourage me.”

“I often set a goal but later choose to pursue a different one.”

Maslach Burnout Inventory7

“I feel emotionally drained from my work.”

“I feel used up at the end of the workday.”

Psychological Well-Being8

“How often were you bothered by illness, bodily disorder, aches, pains?” “I woke up feeling fresh and rested during the past month.”

Background

Research Design

Methods

Results

Conclusions

Limitations

RESULTS

Grit was stable within the timeframe of this study,

(r=0.71, p<.01)

Grit was predictive of burnout (B=-0.63, p<.01)

RESULTS*p<.01

*p<.01

*p<.01

RESULTS

Grit was predictive of general psychological well-being (B=0.58, p<.01)

Background

Research Design

Methods

Results

Conclusions

Limitations

CONCLUSIONS

Grit is stable, at least over a short time

Those with more grit tend to have better psychological well-being as measured by the Maslach Burnout Inventory and the Dupuy General Psychological Well-Being Scale

Grit may serve as a proxy measure for burnout and psychological well-being

Assessing residents’ grit may identify those who might benefit from counseling or other social support

Background

Research Design

Methods

Results

Conclusions

Limitations

LIMITATIONS/FUTURE DIRECTIONS

This is only a correlational study and was only performed at one institution

The timeframe was too short to assess attrition itself

Qualitative data would help in understanding factors that lead to attrition

Consider administering the grit survey to residency candidates

ACKNOWLEDGEMENTS

This research was funded by the following:

• National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health

• Stanford University School of Education

• Stanford University Vice Provost for Graduate Education

• Clayman Institute for Gender Research

arghavan@stanford.edu

REFERENCES1Bergen, P.C., Turnage, R.H., & Carrico, C.J. (1998). Gender-related attrition in a general surgery

training program. Journal of Surgical Research, 77, 59-62.

2Longo, W.E., Seashore, J., Duffy, A., Udelsman R. (2009). Attrition of categoric general surgery residents: Results of a 20-year audit. The American Journal of Surgery, 197, 774-778.

3Yeo, H., Viola, K., Berg, D., Lin, Z., Nunez-Smith, M., Cammann, C., . . . & Curry, L.A. (2009). Attitudes, training experiences, and professional expectations of US general surgery residents: A national survey. Journal of the American Medical Association, 302(12), 1301-1308.

4Yeo, H., Bucholz, E., Sosa, J.A., Curry, L., Lewis, F.R., Jones, A.T., . . . & Bell, R.H. (2010). A national study of attrition in general surgery training: Which residents leave and where do they go? Annals of Surgery, 252(3), 529-536.

5Duckworth, A.L., Peterson, C., Matthews, M.D., & Kelly, D.R. (2007). Grit: Perseverance and passion for long-term goals. Journal of Personality and Social Psychology, 9, 1087-1101.

6Duckworth, A.L, & Quinn, P.D. (2009). Development and validation of the Short Grit Scale (Grit-S). Journal of Personality Assessment, 91, 166-174.

7Maslach, C., & Jackson, S. E. (1996). Maslach Burnout Inventory–Human Services Survey (MBI–HSS). In C.Maslach, S. E. Jackson, &M. P. Leiter, MBI manual (3rd ed.). Mountain View, CA: CPP, Inc.

8Dupuy, H.J. (1984). The psychological general well-being (PGWB) index. In N.K. Wenger, M.E. Mattson, C.D. Furburg, & J. Elinson (Eds.), Assessment of quality of life in clinical trials of cardiovascular therapies (pp. 170-183). Le Jacq Publishing.