In a survey-based study published in the July 17, 2019 issue of The Journal of Bone & Joint Surgery, Samuelsen et al. made a hypothesis arising from a popularly held assumption about millennials: that orthopaedic residency applicants (predominantly millennials, with a mean age of 27.3) would have lower grit and self-control scores than attending orthopaedic surgeons (mean age of 51.3). The findings contradicted that hypothesis.
Surveys were completed by 655 (28%) of 2,342 attendings who received the questionnaire and by 455 (50.8%) of 895 orthopaedic residency applicants from the 2016-2017 resident match. The authors found that the residency applicants demonstrated higher mean grit scores (4.12 of 5.0) than the attending orthopaedic surgeons (4.03) (p <0.01). When compared to the general population, residency applicants and attendings scored in the 70th and 65th percentiles of grit, respectively.
The American Heritage Dictionary defines “grit” as “indomitable spirit” or “pluck.” In the medical literature, where “grit” has received a lot of attention lately, the concept is defined as “steadfast passion and perseverance for long-term goals, especially in the setting of hardship and setbacks.” However grit is defined, Samuelson et al. say it “has consistently been proven to be associated with success in…medical environments.”
Three other interesting findings:
- There were no significant differences in self-control or conscientiousness scores between the 2 groups.
- Both age and number of years in practice were positively correlated with self-control scores in the practicing-surgeon group.
- Among attending surgeons, the number of publications correlated with higher grit, self-control, and conscientiousness scores.
Samuelson et al. offer a possible explanation for the impressive grit scores among residency applicants: matching into orthopaedic residency has become increasingly competitive over the past several decades and “applicants to orthopaedic surgery…tend to represent the individuals at the top of their medical school classes.” Conversely, the authors suggest that grit, self-control, and conscientiousness scores could be used to identify applicants, residents, or junior staff “who are at risk for attrition during training or burnout in their careers.”
Having postulated that, however, the authors are quick to add that “it is unclear if [these findings] will be predictive of career success in the next generation of orthopaedists.”
Click here to see a 1-minute video commentary about these findings by Chad A. Krueger, MD, JBJS Deputy Editor for Social Media.
One thought on ““True Grit” Among Millennial Orthopaedists in Training”
Not a surprising result, but frankly a long bow to draw for a pretty contentious conclusion.
Like much questionnaire-based research, it’s a matter of what people say they will do versus what they actually do. Also, what one generation considers hard may very well be a walk in the park for another.
One of the hoped-for benefits of the 2003 ACGME mandated ‘shorter’ (but still very long) resident work hours was a reduction in medical errors as a result of fatigued residents, but there does not appear to be post-training differences in patient mortality, readmissions, or costs of care (https://www.bmj.com/content/366/bmj.l4134).
Some authors consider this finding a good thing, as shorter hours does not mean worse training. But where are the much-touted benefits to patient safety?
I don’t think grit is as easily measurable as some researchers think, and I suspect it would require a major catastrophe to prove who is right on this matter. Coping with regular attrition and avoiding helplessness from perceived hardship of modern life may not be the true test of resilience, particularly in the safety of a stable society.