Developing Grit in Medicine

By: Lauren Lin (c2022)

Grit, a term coined by psychologist Dr. Angela Duckworth, is the passion and perseverance people have for their long-term goals. Individuals with grit are strivers. They have an enduring sense of interest and dedication for what they do, as well as the willingness to keep fighting for it even after encountering setbacks and obstacles. 

I first heard the term “grit” a few years back and immediately knew that I wanted to be “gritty” (yes, that’s the actual term for it!). However, actively learning about and working on becoming gritty was placed on the backburner for me up until the end of 2019. I was four months into medical school, and I had the realization that more than ever, I needed grit. Who better to turn to than Duckworth herself? 

I picked up a copy of her book, Grit: The Power of Passion and Perseverance, for some self-improvement holiday reading, and here is what I took away from it. Before I continue, I would highly recommend that you read this book yourself because it will likely affect you differently, and ideas that I didn’t end up including here might have been the most important to you. 

One: Why Do You Want to be Gritty? 

Two components of grit are passion and perseverance. A common misconception is that passion for goals is an intense, almost all-consuming commitment. Duckworth and the high achievers she interviewed describe passion as a consistent dedication over time. A person who seems to give 100% of effort on five different projects in a year may not actually be demonstrating grit. Rather, a gritty person is someone who remains devoted to the same goal for years. Duckworth uses the analogy of passion being a compass that you need to create and modify until it’s just right before you can use it as a guide for the road ahead.  Perseverance, on the other hand, is the determination to continue working towards a goal and bouncing back even after setbacks. Passion and perseverance are subtly different concepts but work closely together. 

Although grit sounded appealing right away, I still needed some more convincing for why I should dedicate time and effort to cultivating it. It took me three steps to fully buy into the idea of grit. 

First, I found it important to recognize what may be making us resistant to giving grit the spotlight: we’re drawn to the idea of natural talent. When asked, people tend to say that they value being hardworking more than being intelligent or naturally talented. Studies have found that we actually have an implicit bias that works the opposite way. When presented with someone who is a “natural” with innate talent and someone else who is a “striver” with experience and a history of persistence, people rated the “natural” as more successful and hirable.

Second, it’s hard to deny the wealth of evidence that grit matters when it comes to determining how close people get to accomplishing their goals and how well they do it. Duckworth researched a variety of groups, from students competing in a national spelling bee, to employees working in retail, to cadets training to become Green Berets. Overall, she found that people who had more grit were higher achievers and more likely to stay committed to their goals. In fact, grit seemed to be a better predictor for behavioural outcomes compared to other more traditional measures like SAT scores or GPA. To make things even better, gritty people have also been found to be more optimistic, happy, and satisfied with their lives. 

Third (but definitely not least), Duckworth’s theory on the psychology of achievement made all the pieces fit together for me. The theory can be summarized in two equations: 

talent x effort = skill 

skill x effort = achievement 

Talent is defined as the rate your skills improve when you apply effort. Achievement happens when you use your skills. As you can see, someone’s natural talent still plays a role in achievement. However, effort is included in the theory twice because not only does it develop skills but also determine how much people apply their skills. Therefore, talent and effort work together to lead to achievements, but effort seems to count more. 

Two: Why Grit in Medicine? 

Medicine is tough. Since coming to McMaster, I can’t remember how many times I’ve been told that our training will continue to get harder. If you’re like me and already finding pre-clerkship challenging, it’s easy to feel intimidated and worried about how to move forward. How do we maintain passion and perseverance towards our goals when there seems to be a long list of potential future hardships, stressors, and obstacles? Is grit the answer?

It seems that many people are asking these same questions. A simple Google search yielded blog posts, articles, and even some podcast episodes on grit in medicine. Studies have found that high levels of grit are associated with lower physician burnout, greater physician engagement, life satisfaction, and happiness. Therefore, I wasn’t surprised to see that there is also a rise in people advocating for the use of grit for medical school admissions as a predictor of medical school success

Three: How Gritty Are You Now? 

You may be eager to know how to get grittier, but there’s one more thing to do: find out where you’re starting from. In Duckworth’s research, she uses a 10-item questionnaire called the Grit Scale to measure grit, including its passion and perseverance parts. You can go to her website here to measure your own grit. The results will also tell you what percentile you rank compared to American adults in a recent study. 

The Grit Scale tries to capture your grit levels at this moment in time and is subject to change, especially if you work at it. Don’t be discouraged if you turned out to be less gritty than you imagined – the fun part is that you can become grittier. 

Three: How Do You Develop Grit? 

A large portion of the book outlines strategies on how to grow grit, and I’ve tried my best to highlight the major concepts. However, since which aspects of grit people want to develop will differ, I’ll once again emphasize that you’ll get the most out of reading the whole book! 

Passion and Perseverance Towards… What Goals? 

Dedicating passion and perseverance towards poorly thought-out goals is not effective. Before aiming towards a goal, a good first step is to figure out what goals you have. Goals are not created equal. Duckworth divides goals into low-level, mid-level, and top-level. Low-level goals are a means to an end, such as finishing your tutorial prep or making sure you arrive at the hospital on time. Mid-level goals (and there can be multiple layers of mid-level goals) connect low-level goals with your top-level, more abstract, but most important goals. Top-level goals are your ultimate goals or life philosophy. For example, if your top-level goal was to use your medical career to advocate for underserved patient populations, you may have mid-level goals that include things like “be a good communicator,” and low-level goals like “journal today” or “sign up to speak at an event.” 

To help you figure out your goals, I have some key pieces of information to consider. First, avoid the common fallacies that people fall into when setting goals. These include “positive fantasizing,” which involves having top-level goals without the mid-level or low-level goals that help you work up to them, as well as the opposite problem of having many mid-level or low-level goals without a top-level goal to unify and organize them. Second, I learned that your life philosophy doesn’t necessarily have to be career related. An example Duckworth includes is Jeff Gettleman, who is an admired Pulitzer-prize winning journalist. When interviewed, Gettleman said his passion was to “live and work in East Africa,” and that journalism was a career that helped him achieve his ultimate goal. Third, Duckworth recommends having one professional top-level goal but writes that people often have multiple top-level goals for various aspects of their life. To ensure that you have the time and energy to achieve your goals, you can try to unify your top-level goals and pare down mid-level and low-level goals. Additionally, if a low-level goal didn’t work out, don’t hesitate to revise it or scrap it and start again. 

One exercise you can do for goal setting comes from Warren Buffet, the highly successful billionaire American businessman who runs Berkshire Hathaway. Duckworth writes that his supposed method of prioritizing goals starts with jotting down 25 career goals. Then, you circle the five most important goals. Lastly, you consider the 20 goals that didn’t make it into your top five and try your best to avoid spending more energy on them. When doing this activity, think about whether any of your goals can be slotted under one overarching goal. If so, then you can better focus on what you should strive towards. 

The Four Tenets of Grit 

Duckworth came up with four assets of gritty people that counteract the four main reasons why people quit. 

  1. Interest vs. feeling bored: intrinsic enjoyment of what you do decreases the tendency to stop something because you’re bored.
  2. Practice vs. feeling like your efforts don’t matter: consistent and challenging practice helps you achieve mastery.
  3. Purpose vs. feeling like the goal isn’t important: knowing that your work matters helps sustain your commitment. 
  4. Hope vs. feeling like you can’t do it: hope is needed throughout the entire process of working towards your goals. It is there when things are hard, and you start to doubt yourself. 

Building Interest

There are three stages of creating a long-lasting passion – discovery, development, and deepening. Discovering your interest is most likely not going to feel like being struck by lightning. Interest takes time to find, and most people don’t realize when they have first encountered their lifelong passion until later. Checking in with yourself after one horizontal or during your first day of a clerkship rotation to see whether you’ve found “the one” is too early. To start, you can consider what you care about, think about frequently, and don’t like. Once you have a general idea of what you may be interested in, you need to experiment by interacting with the outside world. You can’t find your interest through even the deepest of introspection because the world is unpredictable, nor can you will yourself into liking something. Don’t be scared to try things and eliminate them if you don’t like them. 

When you’ve found something you want to look into more, it’s time to develop your interest. Overall, development is a process of exposing yourself to the interest repeatedly and increasing your knowledge and expertise. You can do so by asking questions, finding the answers, then asking more questions. Finding a mentor can also help you. At this stage, those around you can provide you with the information, stimulation, and encouragement that is required to like something increasingly.

If you’ve been doing something for a while, then it may be time to deepen your interest. People like novelty, which is why some of us find ourselves giving up on what we have been working on for a long time. Deepening interests involves growing an appreciation for complexities and nuances that only experts who love the field can understand. For example, think about watching sports. For those who know little about it, the game can start to feel boring or repetitive. However, people who understand the sport well are excited by each action because they’re able to see novelty in the subtle differences in execution. 

Practise Smarter and Harder

Gritty people seem to be driven to constantly improve above and beyond their current level of ability. On top of that, they’re able to resist plateaus in their improvement by engaging in deliberate practice

Here are the basics of how you do deliberate practice: 

  1. Find a clearly outlined stretch goal. A stretch goal focuses on mastering one specific aspect of your performance that you feel is a weakness.
  2. Strive towards your stretch goal. 
  3. Get feedback and reflect on how your initial attempts at practising went. Then, modify how you’re going about your goal and repeat. 
  4. Repeat steps 2 and 3 until you’ve reached your stretch goal. 
  5. Find a new stretch goal and go through the process again. 

Deliberate practice is meant to require more effort and be less enjoyable than other types of practice. However, it’s the best at elevating your ability. 

No, gritty people are not constantly miserable and struggling through deliberate practice. First, there are strategies to make it more manageable and enjoyable. Duckworth suggests making deliberate practice a habit. Creating a ritual out of doing deliberate practice can make it more automatic. For example, you can schedule your deliberate practice to happen at about the same time and same location. That way, you reduce the amount of effort put into deciding when and where you should do it. Additionally, you can change the way you perceive deliberate practice. Embracing a challenge rather than fearing it and having no judgement when you’re practising can turn deliberate practice into something less stressful and negative. Draw inspiration from kids learning how to walk – they’re always tumbling, but instead of feeling shame, they get up and try again. 

Second, gritty people practice more and experience more “flow.” Flow describes a state of intense concentration when you’re performing at high levels while feeling like it’s effortless. While deliberate practice is carefully planned and motivating by helping you get better, flow is spontaneous and intrinsically rewarding. Practice sets you up to do better, and flow is the feeling you get when you’re achieving your best.

Cultivating Purpose

People usually begin with a self-oriented interest (i.e. do I like it?), progress to practising, then use their work to support the well-being of others. We’re naturally motivated to connect with other people. Those who enjoy their work and recognize how their work helps others are more likely to find meaning in what they do. Although it seems straightforward how medicine can benefit others, it’s important to reflect on how it does so for you personally. 

There are three ways to build purpose (defined as the “intention to contribute to the well-being of others”): 

1. Think of how what you’re doing now contributes to society. 

Reflecting on what you’re currently doing and how it’s related to society increases engagement, resulting in being motivated to work harder. 

2. Think of ways you can change what you’re doing now to increase your work’s connection to your core values. 

You don’t need to dramatically change what you’re doing now, but there are small ways you can make your work more meaningful and enjoyable. You can add, delegate, and customize things so that they better match your personal goals. 

3. Be inspired by a role model who has purpose. 

Some questions from Stanford psychologist Bill Damon’s research you can ask yourself include “Imagine yourself fifteen years from now. What do you think will be most important to you then?” and “Can you think of someone whose life inspires you to be a better person? Who? Why?”

Keeping Hope

Grit depends on hope, which Duckworth describes as an expectation that what we do can better our future. You may have heard of the term learned helplessness before, which refers to when people acquire the idea that they’re powerless in their situation. Learned helplessness is associated with many negative outcomes, such as symptoms of depression, difficulty concentrating, and poor sleep. However, it turns out that you can train yourself to believe the opposite, termed learned optimism. Learned optimism is closely tied with the idea of resilience and an “I won’t give up” attitude. 

When something bad happens, optimists are more likely to attribute it to a temporary, specific cause, such as “I didn’t manage my time properly.” On the other hand, pessimists are more likely to connect it to permanent and more general reasons, such as “I never get things right.” Optimists are generally happier, healthier, and more devoted to their jobs. 

Duckworth has three recommendations for teaching yourself how to be hopeful. 

1. Rethink intelligence and talent. 

Intelligence and skills can be developed. Research shows that IQ scores can increase and that there are changes in brain structure as people grow. You can steadily shift your perspective on intelligence and talent from a fixed mindset (i.e. I’m born with a certain level of intelligence and talent that can’t be changed) to a growth mindset (i.e. I can significantly change my intelligence and ability). A growth mindset helps you believe that you can do better, rather than thinking that you’re incapable of doing something whenever you hit a roadblock. 

2. Use optimistic self-talk.

You can modify the way you speak to yourself. When you encounter a setback, you may have pessimistic self-talk (e.g. “I’m such an idiot! I’ll never get this.”) or optimistic self-talk (e.g. “I’m not going to give up! I can figure this out.”). The second, more optimistic, way of speaking to yourself is associated with having higher resilience, as well as less anxiety and depression. Although it’s possible to move towards optimistic self-talk, it can be difficult, especially if you’re someone who uses lots of pessimistic self-talk. Duckworth writes that if you see yourself as an “extreme pessimist”, it’s worth getting cognitive behavioural therapy, which can target self-talk. I would like to also add that there are many cognitive behavioural therapy worksheets and books written by mental health professionals that are available. 

3. Ask for help. 

When things get tough, it’s good to reach out to others. People around you can be a source of comfort, they can be your cheerleaders, and they may be able to offer ideas on how to overcome adversities. Gritty people have the strength to get up after being knocked down, but they rarely do it alone. 

The Role of Your Environment 

As you may have suspected, there’s another critical piece to developing grit: others. It starts early on when children learn about grit from their caregivers. Children imitate adults, especially those close to them. Supportive parents with high expectations for their children (termed “authoritative,” or as Duckworth prefers, “wise” parents) who also model gritty behaviour tend to raise gritty children. It’s not only parents who influence children. Teachers, coaches, and other leaders who are warm and supportive but also push children to achieve their best have long-lasting impacts on children too. 

Longstanding extracurriculars and hobbies can play a huge role in developing grit. They are good opportunities to work on grit because they’re enjoyable and challenging. The commitment and follow-through learned in extracurriculars are transferable to other aspects of life, including academics and career. By learning that hard work can be rewarding, people tend to strive more. Therefore, extracurriculars provide more value than we may think.  

What about the culture you’re part of? Duckworth writes that to become grittier, you should join a gritty culture. If you surround yourself with people who seek to constantly improve themselves and push you to do the same, you’ll follow this philosophy and eventually integrate this culture as part of your personal identity. The culture around you and your identity then work together to determine your behaviour, which can be particularly important when you’re confronted by challenges.

Duckworth writes about a culture that models the perseverance component of grit: the Finnish. There’s a concept called sisu in Finland, which refers to an inner strength that allows people to keep working at something even when others quit. There are two lessons that Duckworth writes that we can borrow from sisu: 

  1. Have a personal identity as someone who can overcome extreme hardships. Remind yourself that you have what you need to succeed and that you’re someone who pushes past setbacks. 
  2. Feel like you have an internal source of energy that allows you to chip away at challenges. Sometimes, you may think you have no strength left, but reaching deep and slowly chipping away at something can yield accomplishments you thought were impossible. 

The last thought I’ll leave you with is the idea of the “social multiplier” effect for grit. Essentially, one person’s grit inspires another person, who then inspires another person, and it goes on. Having a network of people who are willing to work hard and committed to evolving pushes each person to new heights. As we’re taking steps towards a life in medicine, I think it’s comforting and motivating to realize that we have so many people to rely on and that we, in turn, contribute to others’ development. 

One thought on “Developing Grit in Medicine

  1. This is an amazing book! I just finished it a couple weeks ago. Still have to write my review but will link to you! Great job explaining the material!

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