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Dr. Lockwood, Editor-in-Chief, is Dean of the Morsani College of Medicine and Senior Vice President of USF Health, University of South Florida, Tampa. He can be reached at DrLockwood@ubm.com.
Ob/gyns have the mental make-up to thrive in medicine but success requires tenacity
As I approach my ninth year as a medical school dean (can that really be true?) there are many things that keep me up at night. But first and foremost is the fundamental question of how to help my students, residents, fellows, faculty and affiliated community physicians keep up with the accelerating pace of new medical information. Next year it’s estimated that medical knowledge will double every 73 days (it was every 20 years when I was a medical student).1
Pulitzer Prize-winning author Tom Friedman, has argued that the accelerating rate of technological change has already exceeded the ability of humans to adapt.2 Nowhere is the rate of acceleration greater than in medicine. Many factors contribute to physician burnout, including burdensome regulations, arcane billing rules and the insatiable demands of electronic charting, but I think the greatest challenge to our mental wellbeing is keeping up with the thousands of new articles published monthly, the plethora of new drugs being approved every year, and rapid proliferation of new genetic tests.
So how can we keep up? First, we need to learn to be curators of medical information rather than repositories of such knowledge. Medical school curricula are quickly evolving from memorization of “facts” to clinical reasoning using curated up-to-date data. Medical students are also being taught that they must become lifelong learners because much of what they are taught in medical school may be out of date in a few years. The same applies to residents, fellows, faculty and community physicians. What does it take to be a lifelong learner without burning out? I would contend it takes the same personality trait that got you into medicine in the first place: grit.
What is grit?
I was pondering questions about preventing burnout and promoting lifelong learning while attending this fall’s Association of American Medical Colleges’ annual meeting when I serendipitously walked into a lecture by Dr. Angela Duckworth. She is a Professor of Psychology at the University of Pennsylvania and a 2013 Mac-Arthur “Genius” awardee. An expert on the science of achievement, she has focused much of her professional career on studying what makes successful people successful. Dr. Duckworth’s seminal contribution to this question is that they are simply grittier than less successful people. I know that sounds pretty simplistic but there is a compelling body of qualitative and quantitative data to support her thesis. Dr. Duckworth is a very engaging and dynamic speaker, as you can discern from viewing her TED Talk on grit: . As I looked about the packed audience, it dawned on me that, by definition, the physicians all around me were gritty or they wouldn’t be there and grit might just be the key to maintaining the discipline of lifelong learning while avoiding burnout.
When I got home, I read Dr. Duckworth’s book, Grit: The Power of Passion and Perseverance, which is part autobiography, part biography, and part an exceedingly readable psychology text.3 She describes various people, from Navy Seals and Olympic swimmers to Spelling Bee champions and kids who survived impoverished neighborhoods and broken families to excel scholastically. They all share one characteristic: grit.
Grit can be defined as passion and perseverance to achieve long-term goals. It requires certain building blocks, the first of which is curiosity to explore a variety of interests before settling on the one most compelling. Next comes a desire to master that interest completely. Initial novelty is soon replaced by deep appreciation of the nuances of a given field or discipline but mastery requires deliberate practice. The latter consists of pushing oneself to continuously improve, to overcome weaknesses through intense concentration and honest feedback, and to meet progressive stretch goals. Long periods of effortful, deliberate practice lead to exhilarating moments of effortless flow and peak performance which drive an ever more intense desire for mastery.
Physicians are gritty
Physicians (and especially ob/gyns) should relate to all these characteristics. Think how hard you worked in your pre-med years. First, you discovered you might want to be a physician because you loved science and wanted to help your fellow man. This was followed by intense study, shadowing, summer research projects and the pursuit of perfection on assignments. Think of the elation you felt when you were finally accepted to medical school. Then the process started all over again-mastering fundamental science and the rudiments of physical exams and clinical reasoning, followed by exposure to different clinical disciplines. Next your interest was piqued during your ob/gyn clerkship and after weighing your options, you committed yourself to our wonderful profession. Can you remember the exhilaration of the Match? And then the process started all over yet again. Recall how you learned to perform pelvic exams, ultrasounds, and episiotomies, and then mastered progressively more challenging aspects of surgery. Remember how you constantly sought to perfect your skills and how they progressively improved during your 4 years-with further refinements if you did a fellowship and/or then in practice.
But gritty exemplars exhibit more than interest and practice, they have purpose. It is that higher purpose that builds resilience in the face of adversity and exhaustion. There is abundant data that grittier people are more optimistic than their non-gritty peers. This optimism helps gritty individuals view setbacks as temporary. Gritty individuals exude hopefulness and eschew learned helplessness. In fact, they are statistically happier. While you could debate whether all this is “chicken or egg,” there is evidence that being optimistic and happy allows you to be grittier, but that being gritty makes you more optimistic and happy-in other words, there is a virtuous cyclicity to grit.
Using grit to crush burnout
Gritty individuals tend to seek out and thrive in gritty cultures and follow gritty leaders. These cultures and leaders tend to be both demanding and supportive. If you find yourself being led by someone who is supportive without being demanding, you are in a permissive culture without progress or excellence. Being in a demanding but not supportive setting creates a harsh, relentlessly hostile environment that no one can thrive in or long tolerate. Being in a milieu that is neither supportive nor demanding creates apathy and ennui. But being both demanding and supportive is what sets great parents, teachers, coaches, managers, leaders and physicians apart and it is the ideal setting for gritty individuals! Great mentors know just how far to push trainees; to demand excellence through deliberative practice without intimidation and fear. If we can practice in such an environment, we will thrive. If we can ourselves practice such “wise parenting” with our patients, we can achieve better outcomes. If we practice it with our staff, trainees, and colleagues, we will not only create a culture of excellence, we can combat the insidious ingredients of burnout: emotional exhaustion, doubt, cynicism, and pessimism. More to the point, if we can maintain our grittiness, we will not only pursue lifelong learning, we will take pleasure in the process and it will make us grittier.
We live in an era of accelerating change, and of astonishingly rapid expansion of medical knowledge. To keep pace we must all be lifelong learners. But while this relentless pace of change is generating extra-ordinary advances in health care it also breeds burnout. Fortunately, all of us have the impetus for lifelong learning and the antidote to burnout hardwired into our personalities: grit. Without grit we would never have gotten into medical school, never matched into a residency program and never mastered the many skills required to be great ob/gyns. But to continue to thrive, we need to stay gritty by maintaining a keen interest in our field, and constantly strive to be better clinicians through deliberate practice (i.e., lifelong learning). This may involve reading Contemporary OB/GYN and other journals, participating in the American Board of Obstetrics and Gynecology’s Maintenance of Certification program, perfecting surgical and sonographic skills and engaging in continuous quality improvement in our practices. Finally, we need to always keep in mind our higher purpose: caring for the gynecological and obstetrical health of women in a safe, efficient and effective manner.