Original Article

Grit Does Not Predict Burnout among First-Year Internal Medicine Residents

Authors: Andrew J. Klein, MD, MS, Thomas Grau, MD, Carla L. Spagnoletti, MD, MS, Scott D. Rothenberger, PhD, Kathryn Berlacher, MD, MS

Abstract

Objectives: Grit, defined as passion and perseverance for long-term goals, has been associated with the avoidance of burnout among residents in a number of specialties. We aimed to evaluate the relationship between grit and burnout among first-year Internal Medicine residents.

Methods: During the 2018–2019 academic year, the authors recruited 75 first-year Internal Medicine residents within a large academic program to complete the Short Grit Scale (Grit-S) and the Maslach Burnout Inventory General Survey (MBI-GS) at baseline and after 6 and 12 months. The primary outcome was the association between baseline Grit-S and MBI-GS scores within the domains of emotional exhaustion (EE) or cynicism (CYN) over time using linear mixed models. Secondary outcomes included the association between grit and high burnout at 6 or 12 months, grit and persistently high burnout, and the association of baseline high burnout with later high scores at 6 and 12 months using logistic regression models and trends in grit over time using repeated-measures analysis of variance.

Results: A total of 53 of 75 (71%) first-year residents completed the Grit-S and MBI-GS at baseline and at least one other time point. There was no association between grit and EE (P = 0.44) or CYN (P = 0.61) burnout domain scores. High baseline EE and high baseline CYN significantly increased the odds of later high burnout scores within each domain (EE odds ratio 9.66, 95% confidence interval 1.16–80.83; CYN odds ratio 13.37, 95% confidence interval 1.52–117.75). Grit scores and professional efficacy scores remained stable throughout the year (P = 0.15 and 0.46, respectively), while EE and CYN significantly increased (both P < 0.01).

Conclusions: In this single-center study, grit was not associated with burnout among first-year Internal Medicine residents; however, our findings highlight the value of baseline burnout scores in helping to identify first-year residents who may be at higher risk of later burnout.
Posted in: Mental Health43

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Shanafelt TD, Bradley KA, Wipf JE, et al. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med 2002;136:358–367.
 
2. Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med 2012;172:1377–1385.
 
3. Ripp J, Babyatsky M, Fallar R, et al. The incidence and predictors of job burnout in first-year internal medicine residents: a five-institution study. Acad Med 2011;86:1304–1310.
 
4. West CP, Huschka MM, Novotny PJ, et al. Association of perceived medical errors. JAMA 2006;296:1071–1078.
 
5. Shanafelt TD, Noseworthy JH. Executive leadership and physician wellbeing: nine organizational strategies to promote engagement and reduce burnout. Mayo Clin Proc 2017;92:129–146.
 
6. Epstein RM, Krasner MS. Physician resilience: what it means, why it matters, and how to promote it. Acad Med 2013;88:301–303.
 
7. Sood A, Prasad K, Schroeder D, et al. Stress management and resilience training among department of medicine faculty: a pilot randomized clinical trial. J Gen Intern Med 2011;26:858–861.
 
8. Chaukos D, Chad-Friedman E, Mehta DH, et al. SMART-R: a prospective cohort study of a resilience curriculum for residents by residents. Acad Psychiatry 2018;42:78–83.
 
9. Bird A-N, Martinchek M, Pincavage AT. A curriculum to enhance resilience in internal medicine interns. J Grad Med Educ 2017;9:600–604.
 
10. Duckworth AL, Quinn PD. Development and validation of the short grit scale (grit-s). J Pers Assess 2009;91:166–174.
 
11. Cross TM. The Gritty: grit and non-traditional doctoral student success. J Educ Online 2014;11:1–30.
 
12. Miller-Matero LR, Martinez S, MacLean L, et al. Grit : a predictor of medical student performance. Educ Health (Abingdon) 2018;31:109–113.
 
13. Shih AF, Maroongroge S. The importance of grit in medical training. J Grad Med Educ 2017;9:399.
 
14. Salles A, Cohen GL, Mueller CM. The relationship between grit and resident well-being. Am J Surg 2014;207:251–254.
 
15. Dam A, Perera T, Jones M, et al. The relationship between grit, burnout, and well-being in emergency medicine residents. AEM Educ Train 2019;3:14–19.
 
16. Maslach C, Jackson SE. Maslach Burnout Inventory Manual, 4th Edition. https://www.mindgarden.com/maslach-burnout-inventory-mbi/685-mbi-manual.html. Published 1986.
 
17. National Academies of Sciences, Engineering, and Medicine. Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being. Washington, DC: The National Academies Press; 2019.
 
18. Leiter MP, Maslach C. Latent burnout profiles: a new approach to understanding the burnout experience. Burn Res 2016;3:89–100.
 
19. Johnson TP, Wislar JS. Response rates and nonresponse errors in surveys. JAMA 2012;307:1805–1806.
 
20. Campbell J, Prochazka AV, Yamashita T, et al. Predictors of persistent burnout in internal medicine residents: a prospective cohort study. Acad Med 2010;85:1630–1634.
 
21. Accreditation Council for Graduate Medical Education. ACGME common program requirements (residency). https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/CPRResidency2020.pdf. Accessed May 30, 2020.