Why mindset matters for junior doctors

I am bookended by survivors.

My father is a Holocaust survivor; he was in Auschwitz in 1944 when he was 16 years old. My daughter is a tsunami survivor; she was 4 years old in 2004 when the tsunami hit her village in Thailand, leaving her an orphan.

They are both incredibly resilient people and I am honoured to be my father’s daughter and my daughter’s mother.

They have been the inspiration behind my work with medical students and junior doctors, to help build their resilience.

Even in the best hospital work culture, those first years are filled with challenges and setbacks. Mistakes can be very costly both to patients and the young clinician. But there are relatively simple strategies to help young doctors manage these challenges – and they start with mindset.

Surviving the unthinkable

My father does a great deal of public speaking about his Holocaust experiences and I am on faculty at Melbourne Business School (MBS), so we decided to develop a session together on resilience for business leaders. I can’t fly my father to Australia from Florida every time I teach resilience, but I show videos of him talking about the coping strategies he used in the camps.

Remarkably, these strategies are very consistent with what research tells us are ways to cope – garnering social support, helping others, having a goal and breaking it down into manageable steps, and having flexibility in how you see the difficult situation you are in.

My father always had a buddy in the camps and they helped each other out whenever possible. He had the goal of getting back home to his mother and two sisters, and he broke that goal down into smaller milestones – when he woke up in the morning he was determined to get through the day’s slave labour, when he went to sleep at night he was determined to wake up again in the morning.

He employed flexible thinking by telling himself that if he dies, then the Nazis win. If he survives, then he wins. And he wanted to win.

All of this helped my father to survive, and to make it home to his mother and sisters. He also had a lot of luck. You could be very strong and resilient in a Nazi concentration camp, but unless you also had a lot of random probability falling in your favour, it was impossible to survive.

Our MBA students and executive education participants at MBS have found this to be a very moving session, and now I also teach resilience to medical students as well as senior clinicians.

Healthcare is a high-stakes environment – clinicians must frequently make life and death decisions, and mistakes can be catastrophic.

Resilience for healthcare workers is necessary on a daily basis, but until recently these skills haven’t been formally taught.

The importance of a ‘growth mindset’

A key aspect of resilience that resonates with both students and practitioners is the concept of the ‘growth mindset’.

Research conducted by social psychologist Carol Dweck and colleagues shows that our implicit assumptions about the origins of abilities such as intelligence and talent have a powerful impact on how we view setbacks.

Those with a ‘fixed mindset’ believe that ability is genetic and static, and setbacks indicate a lack of ability. Those with a growth mindset view ability as acquired through effort, practice and learning; setbacks represent an opportunity for development and improvement.

When those with a fixed mindset fail at a task, they experience self-doubt and negative emotions, and they will avoid new challenges that might lead to mishaps or to being seen as incompetent.

In contrast, those with a growth mindset rebound better from failure, are motivated to improve, and accept new challenges in order to build their competence.

Building resilience in junior doctors

I have written, with colleagues, about the importance of encouraging a growth mindset in medical students, junior doctors, and even experienced clinicians.

By the time a student arrives in medical school, they have likely spent years as the best student in the class. Family, friends and teachers have praised them repeatedly for being smart, intelligent, and gifted.

This type of praise encourages a fixed mindset, with the student believing that people either “have it” or they don’t, and their prior experience has told them that they do have it. Being smart and top of the class has become a core part of their identity and self-esteem.

Now they find themselves in a classroom with hundreds of peers who were also top performers. Half of these students are going to end up in the bottom half of the class grade wise – most of them for the first time.

For those with a fixed mindset this can be a massive blow and feel as if a core piece of identity has been stripped away. Those with a growth mindset aren’t out celebrating when they get a low score on an exam, but they aren’t torn apart either. They see their performance as an indication that they have to stretch to meet their challenges, and they need to ramp up their efforts.

As important as a growth mindset can be in medical school, it matters even more once young doctors begin to practice. In Australia doctors have been found to have higher rates of psychological distress and attempted suicide than many other professions, and this difference is particularly striking for young doctors.

I am concerned that some of this distress may be due to having a fixed mindset when dealing with setbacks and mistakes.

To address this, we have been incorporating growth mindset and resilience training into the Melbourne Medical School curriculum, and we are conducting research into what interventions have a long-lasting, positive impact on our students.

We are also advocating for cultural shifts in our hospitals, so that setbacks and mistakes are handled as a learning opportunity, and as part of the process of becoming a competent and trustworthy clinician. This could ultimately lead to greater patient safety.

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