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Surgical residents who saw themselves as especially passionate about personal goals and willing to do whatever it takes to achieve them were less likely to show burnout, researchers found.

With virtually all U.S. surgical residents in 2018 participating in a survey, those showing the highest levels of these personality features -- a.k.a. "grit" -- were markedly less likely than those with lower scores to report dissatisfaction with surgery as a career or to have considered quitting or committing suicide, according to Karl Bilimoria, MD, MS, of Northwestern University in Chicago, and colleagues.

So residency programs could screen internship candidates for these characteristics as a way to fight burnout in their trainees, right? Whoa, not so fast there, cowboy.

"Grit is likely not an effective screening instrument to select residents; instead, institutions should ensure an organizational culture that promotes and supports trainees," Bilimoria's group wrote in .

And, in an , the journal's clinical education editor warned that grit assessment may have a "dark side" with overtly negative consequences.

"Specifically, individuals high in the grit-perseverance subscale tend to hold themselves and others to unrealistically high standards," wrote Pamela Lipsett, MD, MHPE, of Johns Hopkins University in Baltimore.

She, too, argued that burnout prevention begins with residency and hospital culture, not with the residents themselves.

Why the disconnect between the study's findings and these conclusions?

First some background. The survey was piggybacked on the American Board of Surgery's In-Training Examination in 2018, and as such was completed by nearly every prospective surgeon then in training (7,413 participants, for a 99.3% response rate). Along with items assessing attitudes toward their training, the survey included the Short Grit Scale that asks respondents to agree or disagree on a Likert scale with eight statements about themselves. These responses were summed into an overall grit score ranging from 1 to 5.

Scores averaged 3.69 (SD 0.58) in the cohort. Each 1-point increase in scores was associated in multivariable analysis with the following odds ratios for adverse endpoints:

• Burnout symptoms: 0.53 (95% CI 0.49-0.58)
• Thoughts of quitting residency: 0.61 (95% CI 0.55-0.67)
• Thoughts of suicide: 0.58 (95% CI 0.47-0.71)
• Dissatisfaction with duty hour regulations: 0.69 (95% CI 0.63-0.76)
• Dissatisfaction with time for rest: 0.72 (95% CI 0.65-0.79)

But for Bilimoria and colleagues, as well as Lipsett, the high average score indicated that most residents are plenty gritty, detracting from the instrument's utility as a screening tool for residency candidates.

Moreover, despite this overall high grit level, nearly 40% of respondents reported burnout symptoms, which the study authors and Lipsett took to mean that grit is not especially effective in preventing burnout.

Bilimoria's group also noted that grit, as defined by perseverance and passion about goals, is not a fixed innate trait, but rather can be taught and inculcated to a considerable extent.

"The formation of an organizational culture that supports grit development may effectively mitigate burnout and promote wellness despite the immutable challenges facing health care professionals," they wrote.

Lipsett, however, was more skeptical about grit assessment having any use in surgical training. Perseverance and goal passion are distinct constructs that don't always align completely, she wrote, and evidence is lacking that interventions to increase grit will, in fact, have any impact on burnout or suicidal ideation.

"[D]esigning interventions to increase or improve composite grit scores may in fact have unintended consequences," Lipsett warned.

And, she scoffed at the notion that grit measurement could aid in the residency matching process: "Rather than simply selecting grittier residents, we must make changes in our culture and how we approach training our residents."

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