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Original Investigation
June 30, 2021

National Evaluation of Surgical Resident Grit and the Association With Wellness Outcomes

Author Affiliations
  • 1Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
  • 2Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
  • 3American College of Surgeons, Chicago, Illinois
  • 4Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
  • 5Division of Pediatric Surgery, Ann and Robert H. Lurie Children’s Hospital, Chicago, Illinois
  • 6Department of Surgery, Virginia Tech Carilion School of Medicine, Roanoke
  • 7Department of Surgery, Indiana University School of Medicine, Indianapolis
  • 8Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison
JAMA Surg. Published online June 30, 2021. doi:10.1001/jamasurg.2021.2378
Key Points

Question  What is the association between general surgery resident grit and burnout, thoughts of attrition, and suicidal thoughts?

Findings  In this national survey study of 7464 general surgery residents, grit scores varied significantly among residents and residency programs. Residents with higher grit scores were 47% less likely to experience burnout, 39% less likely to have thoughts of attrition, and 42% less likely to report suicidal thoughts.

Meaning  The results of this survey study suggest that, among all US general surgery residents, there was an inverse association between grit and burnout, thoughts of attrition, and suicidal thoughts.


Importance  Grit, defined as perseverance and passion for long-term goals, is predictive of success and performance even among high-achieving individuals. Previous studies examining the effect of grit on attrition and wellness during surgical residency are limited by low response rates or single-institution analyses.

Objectives  To characterize grit among US general surgery residents and examine the association between resident grit and wellness outcomes.

Design, Setting, and Participants  A cross-sectional national survey study of 7464 clinically active general surgery residents in the US was administered in conjunction with the 2018 American Board of Surgery In-Training Examination and assessed grit, burnout, thoughts of attrition, and suicidal thoughts during the previous year. Multivariable logistic regression models were constructed to assess the association of grit with resident burnout, thoughts of attrition, and suicidal thoughts. Statistical analyses were performed from June 1 to August 15, 2019.

Exposures  Grit was measured using the 8-item Short Grit Scale (scores range from 1 [not at all gritty] to 5 [extremely gritty]).

Main Outcomes and Measures  The primary outcome was burnout. Secondary outcomes were thoughts of attrition and suicidal thoughts within the past year.

Results  Among 7464 residents (7413 [99.3%] responded; 4469 men [60.2%]) from 262 general surgery residency programs, individual grit scores ranged from 1.13 to 5.00 points (mean [SD], 3.69 [0.58] points). Mean (SD) grit scores were significantly higher in women (3.72 [0.56] points), in residents in postgraduate training year 4 or 5 (3.72 [0.58] points), and in residents who were married (3.72 [0.57] points; all P ≤ .001), although the absolute magnitude of the differences was small. In adjusted analyses, residents with higher grit scores were significantly less likely to report duty hour violations (odds ratio [OR], 0.85; 95% CI, 0.77-0.93), dissatisfaction with becoming a surgeon (OR, 0.53; 95% CI, 0.48-0.59), burnout (OR, 0.53; 95% CI, 0.49-0.58), thoughts of attrition (OR, 0.61; 95% CI, 0.55-0.67), and suicidal thoughts (OR, 0.58; 95% CI, 0.47-0.71). Grit scores were not associated with American Board of Surgery In-Training Examination performance. For individual residency programs, mean program-level grit scores ranged from 3.18 to 4.09 points (mean [SD], 3.69 [0.13] points).

Conclusions and Relevance  In this national survey evaluation, higher grit scores were associated with a lower likelihood of burnout, thoughts of attrition, and suicidal thoughts among general surgery residents. Given that surgical resident grit scores are generally high and much remains unknown about how to employ grit measurement, grit is likely not an effective screening instrument to select residents; instead, institutions should ensure an organizational culture that promotes and supports trainees across this elevated range of grit scores.

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