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 GRIT Why 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 wellbeing? OVERVIEW OF STUDY DESIGN Participants: surgical residents across nine subspecialties at one academic center (N=141, 52 female; 85% response rate) Baseline Measure of Grit, Burnout, and Psychological Well-Being Repeat Measure of Grit, Burnout, and Psychological Well-Being 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 [email protected] REFERENCES 1Bergen, 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. 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