Summary

Increased grit scores are strongly associated with increased rates of orthopaedic research productivity in United States and Canadian orthopaedic residents.

Abstract

Grit is defined as trait-level perseverance and the ability to sustain passion for long-term goals. It is strongly associated with resilience, hardiness, and mental toughness. Prior studies show grit to be a positive predictive factor for nursing, pharmacy, and medical student performance with increased grit relating to improved clinical performance, decreased burnout rates, and improved residency match rates. To date, no studies have investigated the relationship between grit and scholarly activity in the form of research productivity. Scholarly activity in resident education is a core component of training due to its ability to promote critical thinking and an improved understanding of pathophysiology and treatment modalities. Methods available to predict scholarly activity of orthopaedic residents are currently lacking. Personal characteristics such as grit provide a measurable trait that could be used to measure an applicant’s ability to handle the rigors of orthopaedic residency schedules while also predicting scholarly output. This study measured grit and scholarly productivity using an online survey reviewed by the American Academy of Orthopaedic Surgeons (AAOS) and distributed to AAOS resident members in the United States and Canada. The survey collected demographic data and outcomes such as number of peer-reviewed publications, number of conference presentations, number of lead or first author publications, number of published book chapters contributed to, and number of manuscripts produced. This survey was complemented by the Short-Grit questionnaire, a 12-question validated assessment of grit. The maximum grit score was 5 (extremely gritty) and the minimum score was 1 (not gritty). Cohorts were grouped as high grit (score > 4.0) vs low grit (score < 3.9). Chi-squared tests were used to determine which factors were independently associated with metrics of research productivity. All findings were considered significant at P<0.05 (two-sided). 399 residents were included in the study from a pool of 4,832 (response rate of 8.3%). The mean grit score was 3.8 ± 0.5 with a range of 1.75 – 5.0. Residents in the high grit score cohort were more likely to have 10+ peer-reviewed publications (P<0.001), to have contributed to 10+ presentations (P<0.001), and were more likely to be the lead author or first presenter for 7+ projects/publications (P<0.001) when compared to residents in the low grit score cohort. Limitations of this study include possible recall bias from survey participants as survey responses relied on self-reporting research activity, and the arbitrary grit thresholds incorporated into the cohort design. These results suggest that a higher grit score is strongly associated with scholarly productivity among orthopaedic surgery residents. Due to the value of resident research and its association with resident engagement within the orthopaedic field, this points to grit as a possible positive predictor of orthopaedic resident performance. This study presents grit as a possible tool that may predict such attributes and act in tandem with typical evaluation methods to create more well-rounded analysis of residents and residency applicants.