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?
Other Posts by Mike
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.
Mike Lauria
University of New Mexico Health Sciences Center
Former US Air Force Pararescue and Critical Care/Flight Paramedic
Latest posts by Mike Lauria (see all)
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[…] this is from EMCrit, a blog about emergency medicine. But the article is excellent and of interest to all, including those who have nothing whatever to do with the […]
thanks Mike for the thoughtful post I guess I read “Grit” as “Resilience” I must say its one of the priority qualities I look for when recruiting new Flying Doctors. Two of our best recent recruits are both ex Aussie military and it clearly shows. They just arent phased by anything. The Aussie Navy elite UDT clearance operators talk about finding the”Grey man” in their selection process ( bit sexist but no female has ever made UDT selection) The Grey man is someone who doesnt stand out as excellent in any single quality but is just solid across all fields and doesnt give up. Anyway as you know I am reluctant to overly promote military concepts and paradigms into medical process and selection so I am not going to overstate the importance of resilience. Clearly some doctors are more resilient than others and as you have seen in 1st yr med school, its not all about knowing the most nor being the smartest. To be honest I dont think its a quality you can train folks in. like UDT selection, you find those who have it and those who dont. thats where I think its utility in medicine is lost.… Read more »
The term, “grey man” is use quite a bit differently in my roamings. It is skill, competence, lethality without any of the flash. The grey man blends in and won’t be picked out from a crowd (and therefore doesn’t become a target). He or she wears unnoticeable clothing rather than tactical gear. No visible weapons, no bumper stickers, no molle-laden bags, etc. Basically the opposite of a mall-ninja; who has all the right gear and none of the skills.
In the EMS world, the latter would be stroker/wanna-be who has a med kit with every conceivable item (often as expensive as possible) with no actual medical skills and knowledge. And of course in Dunning Kruger-fashion they are often quite arrogant re: all the “jobs” they have done. The opposite is the veteran with 20 years of experience, beaten up scope hanging off her belt, who can handle anything and is so confident that arrogance is completely superfluous.
Be weird if they use this term entirely differently down under.
s
Scott, thanks for feedback
I think Grey man concept is same down under from what you write.
Doesnt stand out during selection but is last one standing at end of selection.
in my Flying Doctor recruitment process, I see it like the ones with the flashiest looking CVs and who talk big during interview.
they dont last
its the quiet ones who listen more than talk. dont stand out from the crowd as exceptional.
Throw them into a MCI or remote trauma, they thrive.
thats counterintuitive to medical culture. typically we look for the smartest, most confident. that doesnt always cut it out here.
but thats whole point of Mike’s post I believe.
who has grit and who doesnt and why does it matter
I had to double check my facts
first female navy clearance diver in 2013
http://www.smh.com.au/federal-politics/political-news/navy-salutes-first-woman-clearance-diver-20130312-2fyho.html
Mike,
Fantastic post, brother! I see some Duckworth psych literature in my future. Regarding your question of what attributes are most important in becoming a great resuscitationist, I’d posit:
1. Grit
2. Genuine empathy
3. Interpersonal communication skill
4. Intelligence / medical knowledge base
5. Efficiency
Empathy is the toughest to teach. Grit is teachable to a degree, but the only way to learn it is to surround yourself with a bunch of gritty SOBs.
Reading your post, it struck me that your definition of grit is pretty similar to Collins’ definition of Level 5 Leadership.
Carpe diem,
Bill
Awesome. Thanks so much, Bill. This offers great insight. I’ll have to check out Collin’s definition of “Level 5 Leadership”. I don’t believe that I’m familiar with this.
Thanks
The reference is a book by Jim Collins, “Good to Great.” Best business / leadership book I ever read, because it’s completely evidence-based, not just conjecture.
Finally got around to reading “Good to Great.” Thanks for the recommendation, Bill.
It is great to see people explore how the mind works in our specialty. I would offer though a counterpoint to some of your observations. Terms such as “grit” and “mental toughness” belie an underlying sense of struggle with what we do. “To fight through difficult moments” suggests that there is an underlying conflict in taking care of people that must be won. I think coming at it from this perspective has some serious draw backs. Not every case we see is a resuscitation. In my practice I see about 5% critical care, the rest deals with the daily human toil of illness and disease and all the psychological underpinnings that come with those cases. When the ED is full and people are waiting and 3 ambulances are coming in, I would submit that “fighting through” the situation may not be the best mental mindset for these moments. The situation you find yourself in at work, is the situation. It isn’t anything else but what it is. Struggling against it will lead to more stress, not less. And more importantly, struggling will likely not lead to clear cognition because you will be focused on what you want the situation to… Read more »
Hey Sid, Thank you so much for bringing up that point. You know, I never quite looked at the language from that perspective. Although I have generally been discussing these ideas within the context of resuscitation of the critically ill and injured, I guess I didn’t really look at the connotation of the words from that perspective. What a beautiful and interesting way to approach the idea. I was rock climbing with a friend one day and he said, “Quit trying to fight your way up! Relax and yield to rock. It’s your friend, not your enemy.” Your observation made me think of that day. It also reminds me of various eastern art forms that stress “blending” with your opponent or your opponent’s energy. Perhaps more pragmatic philosophies of work or management suggest reduction of conflict and struggle, letting somethings go, relaxing, and exercising constructive strategies for problem solving and teamwork. Is this latter idea more along the lines of what you are talking about? I think we are talking about the same issues from different angles. But I feel as though what you have pointed out about the language I use is, in deed, important. Thank you very much… Read more »
Mike, Letting things go is really important in what we do. You can’t let everything go and shouldn’t but taking in the current situation without judgement and ego can be essential. On occasion, I have to deal with conflict events involving physicians. When I talk with the physicians involved, it is inevitable that the situation surrounding the outburst was stress laden. That stress is usually sparked by fear. A discussion on fear is a totally separate topic but I think it does come into play when you think about the most effective mindset when working in the ED. You cannot be adaptable and malleable to a situation if you are being controlled by things like fear. I think your medical school colleagues you referenced who struggle with their test results, are struggling with fear. The ones that shrug it off, accept their shortcomings….they are seeing things as they are and moving on. I realize this all sort of sounds like “lets make a drum circle” and if you knew me you’d realize I am pretty far from that kind of personality. Twelve years into private practice though, I am starting to get handle on the dynamics of what makes you… Read more »
Excellent post and comments. To me Grit is not so much approaching every situation as if it is a fight or a struggle, but having the metacognitive abilities to see when your mind and body are leading you into that mode of operation. That recognition allows you to take control of your thoughts and emotions, which in turn helps you control your physiology and get to that place that Sid is talking about where you are malleable, aware, and able to use your energy to the best effect. Being in “fight or flight” mode with multiple patients a shift is draining, and it spills into relationships with partners, consultants, nurses, and even into home life.
I suspect people with grit have a better handle on their endogenous epinephrine drip and metacognition than the average person allowing them to see past, present, and future more clearly.
Phil Goebel MD
Hey Phil,
Excellent point about avoiding the “fight or flight” overload and extension into inappropriate areas of your life…like home. Thanks for commenting.
-Mike
Mike Firstly let me say I am really impressed with all of your postings and guest lectures, as your former profession is very close to me as I am a former BLM Smokejumper about 5-10% of our population were ex-SF operators. I can say with great pride and enthusiasm that my mentor, roll model and friend was a former Cpt. with a SF Mountain Team. Eric taught me more about GRIT than I thought I could ever know. He was one of the most humble, quiet professionals that I had ever worked wtih as many of the postings have stated nothing flashy or overly exaggerated about the man but when it came time to jump out of the plane into a wildland fire situation there wasn’t anybody calmer or more put together than Eric. I spent my first year jumping with Eric observing, and more importantly listening to his knowledge and advice on our profession. He once told me before rookie training began in Fairbanks AK ” Just keep calm, quiet, and in the middle and you will perform beyond what your body says it can” This to me created all the GRIT I would need to survive those proceeding… Read more »
Hey Dustin,
Thanks for commenting. I have the utmost respect for smokejumpers and the entirety of the wildland fire service. You guys truly understand grit.
You know, this is something that I go back and forth on constantly. I think you’re right. On one extreme of the spectrum, some people simply don’t have grit. On the other hand, others seem to naturally develop it and it shines through guiding them through their lives and careers. However, it seems there are a thousand shades of gray. So, I agree, it can be nurtured, developed, and perhaps trained. The question is, in my mind, to what extent?
Take care. Fly safe.
-Mike
Mike Thanks for the insightful relpy. I am in agreement with you on the back and forth off are people just natural born operators, doctors, or flight clinitions? After all it is easy to acknowledge those who are just naturally talented and the have the skills, and personality to own these high end positions. However the most rewarding moments in my career either as a Smokejumper and as Flight Nurse has been to take on that person who has the GRIT and just does not know it and push, and polish them to a high level, I feel there is no greater gift especially in medicine than to give back what was once given to you. I also feel strongly that in our profession that there is a imperative need to have an idoctrination prior to being ” let through the gates ” if you will. There are a lot of highly qualified people out there who look great on paper, and are well spoken in an oral board, however this is just half the of the process these candidates need to go through a shared hardship and challenge as a team to in not so many words PROVE that… Read more »
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