For every job, though, the No.1 thing we look for is general cognitive ability, and it’s not IQ. It’s learning ability. It’s the ability to process on the fly. It’s the ability to pull together disparate bits of information.

Finding the right people is important of a successful organization. It’s particularly important for an organization whose net revenue in 2013 was approximately $58.7 billion and, as of April 2014, controls about 88.2% of the world’s search engines: Google. Some may think such a wildly successful, dynamic, and progressive company would scour the top ranks of the best schools and premier companies for their very smartest, the intellectual crème de la crème. But, in fact, that’s not necessarily the case. Laszlo Bock, senior vice president of people operations for Google, said in an interview with the New York Times that, “G.P.A.’s are worthless as a criteria for hiring, and test scores are worthless. … We found that they don’t predict anything.” So, if quantitative markers of intelligence aren’t high on the list of desired traits, what are? According to Laszlo, “one is grit.”[i]

This statement reminded me of a brilliant blog post by Dr. John Greenwood on iTeachEM, called The Importance of Grit. So, what is Grit? Well, in short John describes it as a non-cognitive skill that is really about a person’s commitment to long-term success and achieving certain goals despite adversity. Furthermore, one of the defining characteristics of grit is one’s ability to experience failure, bounce back, and learn from his or her mistakes. I talked with John about the topic and posted our conversation here.

One of the leaders in the field of grit research is Dr. Angela Duckworth, from the University of Pennsylvania. Duckworth has explored a variety of characteristics that predict success. Her research suggests that in many circumstances grit correlates more strongly with success than IQ or other characteristics[ii]. Specifically, she has demonstrated that “grittier” teachers outperformed and had longer retention than their colleagues in difficult, low-income school districts[iii]. Furthermore, grit accounted for significant variance in success outcomes in a host of other areas: educational attainment, grade point averages among Ivy League undergraduate students, retention in classes at the United States Military Academy at West Point, and even winning the National Spelling Bee[iv]^,[v]. In fact, Duckworth has even developed a validated tool for measuring grit (the Short Grit Scale) and is currently exploring ways to teach, foster, and develop grit with other researchers at Stanford University[vi]^,[vii].

Dr. Angela Duckwork’s TED Talk: The Key to Success? Grit

After reflecting on my career in military special operations, in the corporate world, in civilian critical care transport, and now finishing my first year of medical school, grit seems to be a common thread that separates great performers from the rest of the pack. In my humble opinion, I would submit that it’s one of three very important things besides intelligence:

GRIT – the ability to focus on long-term goal, recover from failure, embrace criticism and generally thrive in the face of adversity over a lifetime on the steady climb to success.

MENTAL TOUGHNESS – the ability to perform under acutely stressful circumstances, to fight through difficult moments, to persevere and even excel through individual trials and tribulations (Something Scott discusses in Toughness Part I).

MOTIVATION – the fire burns deep inside and drives an individual forward toward their goal, the psychological construct that describes why a person is willing to endure hardships and work tirelessly to be successful.

Medicine and its various subspecialties are, I would submit, somewhat unique. So, does grit really apply to medicine? According to John Greenwood, it absolutely does:

Grit matters in medicine. Grit is a critical non-cognitive skill for physicians, especially those in emergency medicine, critical care, and other high-stress specialties. Resuscitations, and even careers for that matter, don’t always go according to plan – but we need to teach our students how to learn from their failures so they succeed and adapt the next time they are faced with a similar challenge[viii].

To this end, I can also relate my recent personal experience. Looking back at my first year of basic clinical science education, I can attest that grit seems to be important to succeed. I have watched as some very intelligent students, with elite academic pedigrees have failed. In so doing, I find it interesting how their first instinct is usually to blame the professor, the class material, or the test format. Their very image of themselves seems to have been shaken to the core and they continue to struggle. Yet there are others, many of whom do not have the same glowing list of scholarly accolades, that fail and see it as a challenge. They accept their shortcomings, acknowledge their mistakes, and work tirelessly to improve on the next exam. I sincerely admire this latter group. They demonstrate serious grit.

It is worth mentioning that intelligence, without a doubt, plays an important role in medicine, just as it has demonstrated to be an important ingredient to succeed in many other areas[ix]^,[x]. After all, standardized tests, such at the MCAT, and grades are at least somewhat predictive of performance on the U.S. Medical Licensure Examination[xi],[xii]. However, the question remains to what degree is this true? As psychologists have described various forms of intelligence, which ones are most important in medicine?[xiii] Finally, beyond USMLE scores, what are legitimate methods for quantifying success in emergency medicine and critical care? For now, the debate about how to best select candidates to entering the medical field rages on.

Based on limited personal experiences, review of the literature, and conversations with a host of physicians, I can only conclude that becoming a great resuscitationist is fundamentally reliant on a balance of intelligence, grit, and a host of other attributes. Therefore, I pose the following to the EMCrit audience: where does this equilibrium exist? I’m interested to hear the thoughts of professionals from around the world that deal with critically ill and injured patients. To what degree do you believe these variables are important and how do you select or cultivate individuals with an ideal balance?

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References

[i] Friedman, T. L. (2014). How to Get a Job at Google. The New York Times. Retrieved from http://www.nytimes.com/2014/02/23/opinion/sunday/friedman-how-to-get-a-job-at-google.html

[ii] Duckworth, A. L. (2006). Intelligence is not enough: Non -IQ predictors of achievement. Dissertations Available from ProQuest, 1–128.

[iii] Robertson-Kraft, C., & Duckworth, A. L. (2014). True Grit: Trait-level Perseverance and Passion for Long-term Goals Predicts Effectiveness and Retention among Novice Teachers. Teachers College Record (1970), 116(3).

[iv] Duckworth, A. L., Peterson, C., Matthews, M. D., & Kelly, D. R. (2007). Grit: Perseverance and passion for long-term goals. Journal of Personality and Social Psychology, 92(6), 1087–1101.

[v] Duckworth, A. L., Kirby, T. A., Tsukayama, E., Berstein, H., & Ericsson, K. A. (2011). Deliberate Practice Spells Success Why Grittier Competitors Triumph at the National Spelling Bee. Social Psychological and Personality Science, 2(2), 174–181.

[vi] Duckworth, A.L. (2013). True Grit – Association for Psychological Science. Retrieved from http://www.psychologicalscience.org/index.php/publications/observer/2013/april-13/true-grit.html?utm_source=socialmedia&utm_medium=sociallinks&utm_campaign=twitter

[vii] Duckworth, A. L., & Quinn, P. D. (2009). Development and Validation of the Short Grit Scale (Grit–S). Journal of Personality Assessment, 91(2), 166–174.

[viii] Greenwood, J. (2014). The Importance of GRIT. iTeachEM. Retrieved from http://iteachem.net/2014/09/value-grit/

[ix] Gottfredson, L. S. (1997). Why g matters: The complexity of everyday life. Intelligence, 24(1), 79–132.

[x] Neisser, U., Boodoo, G., Bouchard Jr., T. J., Wade, A., Brody, N., Ceci, S. J., … Urbina, S. (1996). Intelligence: Knowns and unknowns. American Psychologist, 51(2), 77–101.

[xi] Ogunyemi, D., & Taylor-Harris, D. S. (2005). Factors that correlate with the U.S. Medical Licensure Examination Step-2 scores in a diverse medical student population. Journal of the National Medical Association, 97(9), 1258–1262.

[xii] Koenig, J. A., Sireci, S. G., and Wiley, A. (1998). Evaluating the Predictive Validity of MCAT Scores across Div…?: Academic Medicine. Retrieved May 17, 2015, from http://journals.lww.com/academicmedicine/Fulltext/1998/10000/Evaluating_the_Predictive_Validity_of_MCAT_Scores.21.aspx

[xiii] Brown, P. C., III, H. L. R., & McDaniel, M. A. (2014). Make It Stick: The Science of Successful Learning. Cambridge, Massachusetts: Belknap Press.

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Mike Lauria

Regular Contributor at EMCrit.org

Medical Student, Dartmouth Geisel School of Medicine
Critical Care/Flight Paramedic, Dartmouth-Hitchcock Advanced Response Team (DHART)

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Latest posts by Mike Lauria (see all)

• EHPR Part 5: Using Mental Practice and Visualization Exercises by Mike Lauria - February 21, 2017
• Situation Awareness in Resuscitation Part 2: A Force of Habit - November 4, 2016
• Situation Awareness in Resuscitation by Mike Lauria - October 21, 2016