Grit in healthcare education and practice

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Published online: 7 January, TAPS 2020, 5(1), 1-2
DOI: https://doi.org/10.29060/TAPS.2020-5-1/EV5N1

What we eventually accomplish may depend more on passion and perseverance than on our innate talent.
—Angela Duckworth, Grit: The power of passion and perseverance, 2016 

There is now strong and compelling research evidence that individual grit (i.e. the combination of passion and perseverance of an individual for a given task—independent of the domain) is a better predictor of an individual’s potential for success in the future work environment (and, therefore, presumably one’s lifetime achievements as well) than just one’s innate talent. For example, cadets who gain admission into prestigious military institutions like West Point and the Army Special Operation Forces in the USA, are often selected from student cohorts with high scholastic achievements and excellent sportsmen: thus, acceptance into these prestigious institutions is highly competitive—requiring, both, intense physical endurance and high mental agility. However, in spite of such competitiveness, a small percentage of cadets selected often ‘drop-out’ prematurely from the training programme. The ‘dropouts’ often constitute an ‘economic waste’ to the organisation concerned, especially when candidates have been specially selected over many others with similar qualifications. The ability to predict such ‘potential dropouts’, even before the candidates undertake the training programme, will help in the selection of more suitable candidates for the training course, with consequent cost-savings to the organisation concerned. Moreover, if selected candidates are deemed “more suitable” for the training course, then it probably can also be assumed that such candidates will also perform well in their future work environment.

The “Grit Scale” was developed, designed and tested in several cohorts of individuals from different organisations (Duckworth, 2016). The grit scale is essentially a questionnaire designed to include “50% of statements” relating to “passion” and “50%” relating to “perseverance”. The Grit Scale is “… a test that, when taken honestly, measures the extent to which you approach life with grit” (Duckworth, 2016, p. 9); the total “grit score” will then determine how “gritty” an individual is and, therefore, an individual’s passion and perseverance for a given task. When the grit scale was tested in several cohorts of cadets who had gained admission into West Point, Grit turned out to be an astoundingly reliable predictor of who made it through and who did not. In fact, interestingly, it was found that “… stayers and leavers had indistinguishable Whole Candidate Scores [consisting of SAT scores, high school rank, leadership experience and athletic ability]”. The study clearly showed that “What matters is grit.” (Duckworth, 2016, p. 10)

Angela Duckworth (2016) was able to conclude, from the results of her studies in the military, education and business, that “Regardless of specific attributes and advantages that help someone succeed in each of these diverse domains of challenge, grit matters in all of them.” (p. 12)

USING ‘GRIT’ TO SELECT STUDENTS FOR ADMISSION INTO MEDICAL SCHOOL

Medical students often represent student cohorts with high scholastic achievements. Consequently, especially in the past, the selection of students for admission into medical school was based mainly on their scholastic achievements. However, such a practice was later found to be unsatisfactory and unreliable, as many graduates (the future medical practitioners) were often unable to deliver optimum healthcare to patients, and many were unable to cope with the rigours of the tasks ahead. This, of course, prompted medical authorities responsible for the selection of students for admission into medical school to expand the selection process through the inclusion of psychological tests such as the Multiple Mini Interviews (Eva, Macala, & Fleming, 2019).

In view of the high predictive value of ‘grit’ we would like to propose that all students, who aspire to become future medical practitioners, take the ‘grit test’ to first determine their individual grit scores and, therefore, their suitability for selection and admission into medical school. After all, the individual grit scores have been confirmed to be highly reliable predictors of the suitability of students for admission into an organisation’s training programme.

More recently, Thomas H. Lee, an experienced “clinician and health care leader”, and Angela L. Duckworth, a distinguished researcher on ‘grit’, have combined their expertise to write the article Organizational Grit in which the authors have highlighted,

contemporary perspectives on organizational and health care cultures [and] … the new model of grit in healthcare—exemplified by leading institutions like Mayo Clinic and Cleveland Clinic—passion for patient well-being and perseverance in the pursuit of that goal [i.e. Grit] become social norms at the individual, team, and institutional levels. (2018, para. 4)

DEVELOPING THE NEW MODEL OF GRIT IN HEALTHCARE

If a health care provider wishes to pursue and develop “the new model of grit in healthcare”, what approach should the organisation adopt? Based on the discussions of Lee and Duckworth (2018), the health care provider should ensure that all participants [i.e. all personnel within the system] “are committed to pursuing a shared high-level goal. Putting patients first is a common and effective objective.” A useful approach, therefore, is for the organisation to develop grit so that “Grit become social norms at the individual, team, and institutional levels” (Lee & Duckworth, 2018, para. 4) with “clear communication of [institutional] values by [the] leadership [within the organisation.]” (Duckworth, 2016, Chapter 12).

“For leaders, building a gritty culture begins with selecting and developing gritty individuals.” (Lee & Duckworth, 2018, para. 5)

Thus, a new model of grit in health care must ensure passion for patient well-being, and perseverance in the pursuit of that goal become social norms at the individual, team and institutional levels- as exemplified by leading institutions such as Mayo Clinic and Cleveland Clinic. Should healthcare organisations in Asia adopt the new model of grit in healthcare in view of the global paradigm shift from individual to team care of patients?

 

Dujeepa D. Samarasekera & Matthew C. E. Gwee
Centre for Medical Education (CenMED), NUS Yong Loo Lin School of Medicine,
National University Health System, Singapore

 

 

Duckworth, A. (2016). Grit: The power of passion and perseverance. United Kingdom: Ebury Publishing.

Eva, K. W., Macala, C., & Fleming, B. (2019). Twelve tips for constructing a multiple mini-interview. Medical Teacher, 41(5), 510-516. https://doi.org/10.1080/0142159X.2018.1429586

Lee, T. H. & Duckworth, A. L. (2018). Organizational grit. Retrieved from Harvard Business Review, https://hbr.org/2018/09/organizational-grit

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