0:09

Hello. And welcome back to doctor informed.

0:11

You're listening to DI two episode

0:13

seven. This is a podcast brought to you

0:16

by the BMJ and sponsored by Medical

0:18

Protection. Doctor informed

0:20

is primarily for those doctors working in hospitals,

0:23

taking you beyond medical knowledge and

0:25

talking about all those things that you need know

0:27

be a doctor, but which don't involve

0:29

medicine. I'm Clara

0:31

Munro, a general surgical registrar in

0:34

the northeast of England, and I work as a freelance

0:36

clinical editor at the BMJ. In

0:39

our new season of doctor informed, we will

0:41

be discussing topics relevant to hospital

0:43

dot Those often not covered formally

0:46

in teaching, which can and

0:48

today I hope will inspire some debate

0:50

amongst doctors. Today,

0:52

we will be talking about grit, what

0:54

it is, how it relates to medicine,

0:57

and whether we should be considering using

0:59

grit score worrying when recruiting doctors,

1:01

either to medical school or to specialty.

1:04

The definition of grit was developed by Angela

1:06

Duckworth, an and psychologists and

1:08

researcher. Grit refers to

1:11

the combination of passion and perseverance

1:13

for long term and meaningful goals. It

1:16

is the ability to persist at something you

1:18

feel passionate about even when

1:20

doing so can seem hard. Both

1:22

in the UK and right around the world right

1:24

now. Many doctors are choosing to leave the profession.

1:27

In the wake of the pandemic, we are seeing more

1:29

and more reports of poor well-being amongst

1:31

healthcare professionals with burnout high.

1:34

What can grit tell us about this? Do

1:36

we all just need more grit? Or even

1:38

the grittiest people limited when faced with a

1:40

pandemic? Waiting lists or failing health

1:43

systems. Can understanding grit

1:45

help support clinicians better? I'm

1:53

thrilled today to be joined by our panel

1:55

and our ex but joining us

1:57

is Simone

1:58

Batching, a neurosurgeon working

2:00

in Brooklyn, New York, who has researched

2:02

extensively on this subject. Thank

2:05

you, Clara. I've been here

2:07

for about sixteen years now.

2:09

And as a female neurosurgeon,

2:12

I am in great minority

2:14

here in the United States where about seven

2:17

percent of neurosurgeons at

2:19

this point are female. I

2:22

had the distinct pleasure many years

2:25

ago now to seeing Angela Duckworth

2:27

talk about grit in person.

2:30

And at that point, Afterwards,

2:32

I was thinking what

2:35

I had been through through my

2:37

training as a medical

2:40

student and then as a resident in

2:42

neurosurgery, and even

2:44

as an attending as years went on. And

2:47

then what all of us as

2:49

physicians have to go through to get to where

2:51

we are and started to think about

2:53

the question of grit and medicine, my

2:57

focus was also looking at written

2:59

gender. And so I called

3:01

up Professor Duckworth and I

3:03

said, you know, what do you think?

3:05

And she had never been able to

3:07

find a difference really meaningfully between

3:10

men and women in even the most difficult

3:12

fields, but sent me on my and has

3:14

given me great advice and

3:17

had a lot of meaningful conversations with

3:19

her about grit and medicine since then.

3:22

So I did publish a paper several

3:25

years ago now looking at written surgeons.

3:27

The punch line really being that there

3:29

was no difference in gender between

3:33

men and women's surgeons. This is amongst

3:36

about eleven hundred surveys.

3:39

The interesting point and I think we can probably

3:41

dig into it a little more later of what

3:43

we did see was that While

3:46

there was a correlation with burnout, and

3:48

think that's something that's been documented and

3:50

discussed in the past, interestingly, women

3:54

had the same grit

3:56

scores as men, but higher burnout

3:59

rates. And so I think when you're thinking

4:01

about medicine and burnout as you talk about

4:03

in the introduction. It's interesting

4:06

to think about, you know, it's not

4:08

grid alone, but what else could it be

4:11

And, you know, we had our own hypotheses

4:13

of what those things might be that were also

4:15

protective or predictive

4:18

of a burnout that we can dig into

4:20

later. Well, I can't

4:22

wait to talk about this. And I'm

4:24

really pleased to be joined by the rest of our

4:26

panel today. We have some familiar

4:28

faces. We're joined again by

4:30

DeKlin. DeKlin, would you like to remind

4:33

our listeners about yourself?

4:35

Yes. Hi. And Dechlema

4:37

Murphy, a current academic ophthalmology

4:39

training up in the north

4:41

of England. Find this topic

4:43

absolutely fascinating. And I think particularly around,

4:45

you know, the the concerns with

4:47

the NHS and the the workforce problems as

4:50

well that we're having So

4:52

I'm really really interested and really excited

4:54

to have a discussion about

4:55

it. And after a bit of a break,

4:57

I am thrilled Ayesha is back with us

4:59

on the podcast. Ayesha for days

5:01

of our listeners who have not been with us

5:03

from the

5:04

beginning, shocking. Would you like

5:06

to reintroduce yourself? Yeah.

5:08

Sure. Thanks, Clara, and thanks for having me again.

5:10

So, hi, everyone. My name is Ayesha Ashmore.

5:13

I am an awesome guy in New Jersey in the East

5:15

Midlands. And super

5:17

interested in this topic as well. It's caused

5:20

lots of contentious

5:22

arguments in my household. So I'm

5:25

I'm interested to where this discussion

5:27

takes us. Excellent.

5:34

Those who have listened to the first few

5:36

episodes of our next series. We'll know

5:38

that we like to get ourselves warmed up

5:41

by discussing what people are talking

5:43

about on the wards or what has been in the

5:45

news recently. I can't take

5:47

credit for this one, but one of our other panelists

5:49

drew my attention to this story of Daymar

5:52

Hamlin, a defensive back

5:54

who plays for the NFL American

5:56

football team Buffalo Bills. In

5:59

a high profile match up against the Cincinnati

6:01

Bangers, the young player

6:03

born in nineteen ninety eight, makes

6:06

you feel very old. Collapse on the

6:08

pitch whilst playing having had a

6:10

cardiac

6:10

arrest. Did anyone else see

6:12

this story? Does anyone else read about this?

6:15

Yeah. I saw it. And III

6:18

don't It was it was interesting to

6:20

see all of the kind of coverage around

6:22

it because you know, there was this

6:24

whole thing about heart attacks and cardiac arrest

6:26

again. And there's so much

6:28

like misinformation even on reputable

6:31

news sites. I think something even

6:33

I think on the BBC, I think I saw something

6:36

which was factually incorrect and

6:39

it just and it brought back all of the

6:41

stuff about, you know, footballers in

6:44

in the in the last few years. What what was his name

6:46

again? Christian Erickson, and

6:48

all of all of what happened

6:50

with him and it was just fascinating to

6:52

see that actually there's still

6:55

no learning from from

6:57

a kind of generalistic perspective about medical

6:59

conditions and diseases. Do you think

7:01

that has a big impact on

7:04

public perception? I think so

7:06

because especially how

7:10

people perceive what

7:12

these kind of medical conditions are and what

7:14

may relate to them. So I think we were talking

7:16

about anti vaxes and

7:19

how they think that this might be related to

7:21

the COVID vaccine. And that's why we're seeing so

7:23

many young professionals

7:25

and athletes collapsing everywhere.

7:29

So nothing has changed. Yeah.

7:32

I thought it was really interesting as well. Like,

7:35

you know, I'm looking at the the

7:37

tweet, so one in the Georgia

7:39

congresswomen Marjorie Taylor Green

7:41

tweeted. Before the COVID

7:44

vaccines, we didn't see athletes dropping dead on

7:46

the playing field like we do now at time to investigate

7:48

the COVID vaccines. That tweet

7:50

has been viewed around, well,

7:53

over a million times a day for the

7:55

last three days since it went up,

7:58

which shocks me that people were, you know,

8:00

we're still getting this level of of misinformation.

8:03

Decking you're a football fan. What do you think

8:05

about this?

8:06

First of all, I'm not a football fan. What? I'm

8:10

an I'm an American football

8:11

fan. It's every

8:12

time Hey. So this is an American football fan. It was

8:14

am however a a basketball fan

8:16

even though I'm about five seven. So

8:19

I have some interest in the spot. Yes.

8:21

And I think it's really interesting. think there's

8:23

there's couple of things. I think, firstly,

8:25

if you know, the classic discrepancy

8:28

between cardiac arrest and and

8:30

heart attack. You know, that's been going on

8:32

forever. And clearly, we're not doing something well

8:34

enough to inform public. I've always

8:36

of the opinion that, you know, the general public aren't

8:38

stupid. We're perhaps

8:40

just not com communicating that well enough

8:42

to them. So I think the last part

8:44

of the thing, we're actually we as, like, you know,

8:46

medical professional have to take some responsibility, as

8:49

well as the journalists also have to

8:52

in terms of how they actually are communicating

8:55

with the public because it's a very basic

8:57

concept and refuse to

8:59

believe that the public aren't able to understand

9:01

that. So I think, yeah, that's one interesting

9:04

thing. And then you have the other

9:06

side of thing, the misinformation. Where,

9:09

you know, clearly, there are groups who

9:12

are knowingly, you know, attributing

9:14

these things to COVID,

9:17

for example, And then you have the public

9:19

who, again, I feel aren't

9:22

stupid, but perhaps

9:24

haven't been kind of

9:26

educated in how to critically

9:28

appraise information. And again, I think in

9:30

in some ways that's kind of our responsibility

9:33

as medical professionals always just educated as

9:35

full stop. So it's really interesting

9:37

and these things pop up every single time. There's

9:39

something, you know, in the news about a health

9:41

relate a health related thing to any celebrity

9:44

I think Rod Gilbert is in is in

9:46

the news at the moment with his prostate cancer and

9:49

there's a lot of kind of

9:51

lack of understanding about that as well. So

9:54

Yeah. I mean, I just kinda looked at it and I was like, well,

9:56

we really need to start educating people better

9:58

and the medias that we use to educate

10:00

people need to be aligned with

10:03

what, you know, helps people to understand things.

10:06

But, yeah, the whole misinformation side of

10:08

thing as well is just I I don't

10:10

know how I don't know how it's a a

10:11

problem, sadly. I think there's quite a

10:14

lot to do with us as medical professionals. There's

10:16

been like this massive push to go

10:18

jargon free. But there hasn't been

10:20

like a kind of quality control for the

10:22

jargon free language that we use. So

10:24

I think because there isn't this kind of standard,

10:27

on how to use nonmedical language. We

10:29

ourselves as medics may be getting

10:31

it wrong when we're describing

10:33

things, not using medical

10:35

language. And then that's being propagated. Yeah.

10:38

And I think similarly with kind of like

10:40

the explosion of Twitter, I think people are also

10:42

using medical language, but inappropriately. So,

10:45

you know, don't have not the qualifications, but

10:47

haven't been educated in that field and are

10:49

thrown about these terms, which, you know, very

10:51

much sounds like they haven't lived in there. Understanding,

10:54

but but really don't. So it's very difficult

10:56

for the general public to be able to, you know, decide,

10:58

you know, what

11:00

what, you know, what what the truth is. If

11:03

people start using sports terms, I would have

11:05

no idea if they were accurate or not. I'm gonna

11:07

be completely honest. Interestingly,

11:10

this is a sort of a side, but stemming

11:12

from what you've said, Dachen, when

11:15

you guys write letters to patients

11:17

after clinics, do you write it to the patient,

11:19

or do you write it to their general

11:22

practitioner, their family doctor, with

11:24

the patient copied

11:25

in. It

11:26

depends on the consultant you're working for.

11:28

Doesn't it? That's how I don't know.

11:31

I I always wrote to the patient. Yeah.

11:33

I mean, I didn't really care what who the consultant

11:35

was. And I To

11:37

be to be honest, Adam, it's such a rebel.

11:40

But yeah, I think it's There

11:43

was a time when I was about fourteen and

11:45

I remember, girl, my dad had an 0GD.

11:47

This is very off topic. So I don't

11:50

I'm an ophthalmologist now. I can't remember what's a sulfur

11:52

electrode it, you know.

11:54

I don't know if they DI a a thing down the throat.

11:56

It anyway. You know this girl.

11:58

I can't attest of the Golar. Okay.

12:00

Yeah. Exactly that. And

12:02

it was just when Nikita

12:04

explained his result. It was

12:07

so terribly explained to him

12:09

that he had absolutely no idea. And

12:11

maybe I was a bit older. Maybe I was like seventeen

12:13

and eighteen. might have just started school, but I remember,

12:16

like, being like, can you please explain that again? Because

12:18

that makes absolutely no sense. think that's

12:20

always stuck in the back of my mind of, like,

12:22

you actually have to be able to communicate

12:24

what the hell is and honor these people. So

12:27

even if the consultant wanted XYZ

12:29

put

12:29

in, I would also add on, you know, this

12:31

is what it means in real terms. Yeah. But

12:34

I

12:34

think may maybe that's just me where, you

12:36

know, I do try to be patient focused there, can

12:38

be.

12:39

No. I was I actually found out the other day that is

12:41

the NHS standard now to write

12:43

your letter. We should all be writing

12:45

the letters to the patients in

12:47

jargon free way to summarize the exportation,

12:50

which I've always tried to DI but

12:52

a bit like Eurasia. Sometimes my boss is

12:54

like, why are you doing that? Write it to their GP, you

12:56

know. Is there a standard someone in

12:58

the US? Do DI write letters

13:00

to patients or do you write it to the family doctor?

13:03

So with the electronic medical record,

13:06

it's a little bit of a pre populated

13:08

situation, which I'm sure is similar. And

13:11

our letter is do go to the primary to

13:13

the referring doctors. Mhmm.

13:16

And they

13:18

are available on the portal. For

13:22

the patients to log in to.

13:24

And then they the patients will get a separate

13:27

patient summary at the time. That's

13:29

written more that skips a

13:31

lot of the details and is more

13:33

of an action plan diagnosis

13:35

focus. That they

13:38

would get at the time

13:40

of a visit. That's how

13:42

I quite like that. I think that's quite a good model

13:44

because yeah, the criticism from

13:47

consultants, maybe this is what they said to you, A.

13:49

Show us, I've been referred this patient,

13:51

so I'm going to write to the doctor. You

13:53

know, in doctor language that,

13:56

you know, to the person that's referred them. But sometimes,

13:58

I think when these patients get copied in and there's

14:00

all these, you know, declan as doctor

14:02

and he does even know what DI

14:04

means. So How can we How

14:07

can we expect people to get a number?

14:09

I'm just in awe of this

14:11

online portal and here I am with my little

14:13

dictaphone. Recording

14:15

tape.

14:17

We are about thirty years behind, I think.

14:20

Well, it's a

14:21

diff it's a difficult thing to do though, isn't it,

14:23

I think? And it's also hard because

14:25

you you do need to use specific

14:27

terms to communicate to other

14:29

physicians.

14:32

And, I mean, simplifying some of them

14:35

succinctly is is not it's not easy. I

14:37

mean, I remember doing a couple of things for the BMJ

14:39

and trying to write for, you know, even from, like, an

14:41

ophthalmology perspective, trying

14:43

to write for a general doctor is

14:45

is difficult. So it's pretty

14:47

challenging with the time constraints and stuff that you have

14:50

as well. It's not to to actually be able to do that.

14:52

And in medical school, we're not told how to

14:54

write when, you know, and

14:57

it's a skill that really does take training.

15:00

So, yeah, to tangy one. Well,

15:02

interesting stuff. Now

15:04

we are all warmed up in our discussion. I

15:07

am keen that move on to the nitty

15:09

gritty of our

15:10

topic. Sorry, dad, Jake, that.

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future. Okay. Back

16:09

to the show. Simone our

16:11

experts say, I want to start with you.

16:13

Could you tell us a little bit more about

16:15

what is grit and what grit

16:18

isn't?

16:19

I think great use summarized great in

16:21

your introduction. It is the passion

16:24

and perseverance really for

16:26

long periods of time and often without

16:29

you know, the positive reinforcement or

16:31

feedback that we might seek

16:34

as individuals when pursuing

16:36

something

16:36

difficult. You know, so

16:38

it really has nothing to do with the

16:40

talent or with

16:42

luck or with our

16:44

intentions or our wishes.

16:47

It's more of, you know, our

16:50

ability to continue on

16:52

a goal and a path making progress

16:54

over

16:55

time. And is

16:57

this something that you I mean, you mentioned

16:59

how you got into talking

17:02

or thinking about grit and

17:05

that you went to see one of Professor

17:07

Angela Duckworth lectures. Is

17:10

grit something that you now

17:12

use when you think about yourself

17:15

or you think about your trainees or that your colleagues

17:17

that you work

17:18

with. It's So honestly,

17:20

I think more about it with my children a

17:22

lot of the time. And

17:25

how I can instill, you know,

17:27

grit in them I think one

17:30

of the things when we think about grid is we

17:32

automatically think it's just a part of

17:34

us or not, but like many things in

17:36

our personality, it is mutable. And

17:39

there is a lot of evidence that grit changes

17:42

over time. We know that older people

17:44

have more grit than younger people, for instance,

17:46

that's you know, been well documented over

17:48

the years. So I think

17:50

about it when you think about

17:53

studying it and who the proper compares

17:55

person is. Right? So, you know, you talk

17:57

about your trainees and your colleagues and you

17:59

think about grit. And is your comparison,

18:02

your store neighbor who isn't in medicine,

18:04

or is your comparison, your other colleagues,

18:06

or earn medicine, are the

18:08

other people within your own specialty?

18:11

So I think about it like that. And

18:13

I think about it when it relates to burnout,

18:16

but I certainly don't think about it

18:18

as far as screening

18:20

for people for any type of positions.

18:24

Mhmm. think that's interesting that

18:26

you mentioned that grit is something

18:28

that you know, you have or you haven't got

18:30

grit. Because my I think my immediate assumption

18:33

was this is testing for something that is,

18:35

you know, part of your personality, but But

18:37

what I'm I'm hearing from you is that actually

18:39

grit is something that you can almost train

18:42

into

18:42

people. Is that is that what you think?

18:44

I do think it is something that people can

18:47

get better at. And I think you also have to think

18:49

of when it's time to quit something.

18:51

Right? I mean, if you're pursuing a

18:53

goal and you know, we're

18:55

all successful doctors here,

18:57

but there was a point where we gave

18:59

something up something else up

19:02

in our lives so that we could make

19:04

that decision to go into medicine. Right?

19:06

So whether it was

19:08

sports or another academic career that

19:10

you may have been interested in and

19:12

working towards, we all do have

19:15

to know when to pull back and

19:17

to change course. Yeah.

19:20

Grid is absolutely something that

19:22

can change over time. Angela's

19:25

book, she talks about how

19:27

she makes her kids do one hard

19:30

thing every day. And

19:33

that's how she thought about instilling

19:36

grit in someone. I think

19:39

there's a lot of connections obviously between

19:41

grid and things like Carol

19:44

Dwight's, you know, growth mindset, that

19:47

she and others have talked about

19:49

at length and, you know, instilling in children

19:52

in school. And they're very

19:54

similar. Right? With these social science

19:57

abstract DI. And

20:00

I do think that they're changeable, and I do

20:02

think we can do things to fortify

20:05

our grit or

20:06

to, you know, try to modify it.

20:09

I saw Asia and Daclyn

20:11

nodding along when he said that

20:14

you know, having grit is what we say about knowing

20:16

when to give up. And I

20:19

do wanna come back to that because I think that that's such

20:21

an important point especially at the moment and

20:23

in the context that we're talking about this.

20:25

But just going really into the basics,

20:27

we're talking about grit here as a sort of an abstract

20:30

ep7. Is there a measure of grit? Can we measure

20:32

grit in people? And if so, how do we

20:34

do that?

20:35

So there was a, you know, professor earth

20:38

is really well known for having developed

20:40

the grid scale that takes

20:42

about three minutes and it's available online.

20:44

Anyone take it and you can get

20:46

your instant score as a feedback. Of

20:49

course, as with any of these

20:51

social science scales, you

20:54

have to understand the

20:56

drawbacks of them. The grid scale

20:58

was really developed for research. It wasn't

21:00

developed as a screening tool. You

21:03

know, the feeling is, of course, you know, we're

21:05

all science based. If you can't measure

21:07

it, it's very, very hard to talk about it.

21:10

We'd like to put numbers and values on

21:12

things, and this is another way we can

21:14

put a number or a value to

21:17

a a personality trader, an idea

21:19

but you can think about it. We're

21:22

more as people than what a piece of paper tells

21:24

us. Right? And it's great

21:26

for self reflection. It's great for research.

21:29

It may even be great for screening people

21:32

who might be predisposed to burn

21:34

out or, you know, think

21:36

about how we can make people DI as

21:38

a way to protect them from burnout,

21:41

but it's very hard to

21:43

use one of these subjective measurements

21:45

to screen people for job

21:48

applications or trainees into

21:50

medicine or anything else because

21:53

it is subjective. And

21:55

also, I think because it's

21:58

pretty easy for many people

22:00

to give dishonest

22:02

answers. Right? You know, you have to really

22:05

be willing to be honest with yourself to measure

22:07

lot of these traits. So when

22:09

it's that easy to fake, you shouldn't

22:11

be using it to screen people

22:13

for a job position or

22:15

a career

22:16

goal. So we can't use

22:18

the score to tease the grittiest people,

22:20

but does give us an idea when

22:23

we're researching or targeting people

22:25

for help. Understood. Ayesha,

22:28

I saw you nodding when Simone

22:30

mentioned about grit or

22:33

saving about. When to give ep7? You

22:35

had to give up on something in the

22:37

past because of medicine.

22:39

God, where where do we start with that crushing

22:42

flower? Have

22:44

you ever done something really hard? And just had

22:46

to think, do you know what Ayesha can't

22:48

do this? Just gonna have to pop this in the bin.

22:51

Well, it's funny that you mentioned that because

22:54

I did my great school today. DI think

22:56

my husband's doing my grits his grit

22:58

score. And we both did it

23:00

without, like, knowing about grit,

23:03

and then we compared our results. And your

23:05

husband is a general surgeon? Vascular

23:07

surgeon. Vascular surgeon apologies. And

23:09

my score was higher than

23:11

his,

23:11

which

23:12

is called main this is what's

23:14

called the tension in our household today.

23:16

We're gonna have a divorce on our hands. Well,

23:18

maybe. Yeah. Because

23:22

he says that actually, like

23:25

like he said someone, you can fake it, aren't

23:27

you? And I think that my personal

23:30

kind of life and grade school is

23:32

very different to my medical life and grade school.

23:34

So in my personal life, I can't have

23:36

a hobby for more than one second. Whereas

23:39

in a professional life, I will

23:41

spend three years trying to get a paper published

23:43

if if that's what what's needed. So

23:45

and it's so funny because in one in

23:48

one aspect of my personality, I'll just give

23:50

up DI. And

23:52

in another way, won't. And and so my husband

23:54

was was raging at the

23:56

fact that he's gone through this difficult process

24:00

of getting a vascular surgery number. And

24:02

has persevered for, like, his entire life

24:04

to get there, and I've gone to my Rick's school.

24:06

We DI

24:09

you think he has a higher grade score in his personal

24:12

life?

24:13

Yeah. Definitely. That's interesting. That's

24:15

really interesting, isn't it? How about you, Dachshund? I'm

24:17

assuming you haven't done your grade score? It's

24:19

alright. I didn't DI either. I She's just

24:21

now made it kind of standard as a framework

24:23

for this podcast. Yeah.

24:25

I I did have about a five second

24:27

brief look at what the grit score was. But

24:30

no, I haven't done that. I

24:32

feel like you can you can have grit score

24:34

to an extent, but there's many, many other

24:36

factors which are also contrarian.

24:39

So I'm probably going to be leaving medicine

24:41

pretty soon. And, you know,

24:43

I haven't done my great skill, but I'd argue it's

24:46

pretty damn high. Yeah. And, you

24:48

know, tend to persevere, whatever. But,

24:51

yeah, it's it's a it's a difficult one

24:53

because, yeah, I think it's it's also

24:55

knowing I think it's recognized

24:57

in, you know, your own your

25:00

own mental health and stuff as well and

25:02

and whether whether it's with with

25:04

it in the the broad context of your

25:06

life, really. Also, I guess, I didn't

25:08

quite understand when you're saying you,

25:10

you know, you can use your grip score to know

25:13

when to quit. Am I interpreting that right?

25:15

As in, you know, some of the high grit score

25:17

can persevere

25:19

through challenges and achieve you

25:22

know, highly kind of alongside

25:25

those challenges. But I guess, where where does it

25:27

come into play when you're then thinking about

25:29

using it to

25:30

quick? Simone, if you don't mind me asking.

25:33

Of course. I I don't think you can use it like

25:35

that. I think that, like, any personality

25:37

trait, some of your greatest strengths can also

25:40

be your greatest misses. Right? So if you dig in

25:42

your heels and you're going for something that's

25:45

just not working out, you you still need to

25:47

have the self recognition of when to quit.

25:49

I don't think Grit score has anything to do with that.

25:51

I just think that there

25:53

are times when grit isn't

25:56

the be all end all. For

25:58

your, you know, long term goals. And

26:01

do you perhaps think people with the highest script

26:03

scores? Do you kind of find the

26:06

find the challenge in too quick because

26:08

you can sometimes go

26:10

for too much, which just just

26:12

kind of reflecting when, you know, people get

26:14

in a kind of very competitive specialties. Which

26:17

I feel pretty much all of us are in

26:20

that sometimes it can be a lack of

26:22

the recognition of

26:24

other contributing factors and people persevere

26:26

regardless? It's

26:28

a great question, Jacquelyn. And I think

26:30

it just speaks to how there's

26:33

not one thing that we can use

26:35

to make decisions or determine who we

26:37

are as people or how we act. Yeah.

26:39

Do I think that the DI

26:42

people don't know when to quit. I I

26:44

don't think that's generally

26:45

true.

26:46

I don't know that there's ever been any evidence

26:49

to show that people with really high grit scores

26:51

don't know when to make

26:53

the decision to move on, but I

26:55

do know that all of us in life have made

26:58

that decision to give up on

27:00

things no matter how greedy we are.

27:02

Right? We've all made

27:04

choices to give

27:06

something up. And I think as Ayesha

27:09

clearly pointed out, she's really gritty in her

27:11

medical life and maybe

27:13

in her personal hobbies. You

27:15

know, she's just not as gritty. And maybe

27:18

her husband is you know, a little bit

27:20

more balanced or different has a different

27:22

approach. And I think that that's probably true for all

27:24

of us, which takes me back

27:26

to, you know, it depends what your says, you

27:28

know, what exactly are you talking about and

27:31

who are you comparing yourself against.

27:37

One of my questions, which I think you've sort

27:39

of asked that Jacklyn was, is there

27:42

such a thing as being too

27:45

gritty? Like, is it is it

27:47

something that we, you know, we see

27:49

as being good, you know, grit is good, it

27:51

helps you stick at things. But also, can

27:53

it get you stuck in a job that you

27:56

hate or a specialty that you hate because

27:58

you

27:58

think, well, I've said I'm gonna carry on doing

28:00

this, so I'm gonna dig my heels and,

28:02

you know, does it equate to stubbornness? mean,

28:05

I don't think it's the same thing as stubbornness. I

28:08

think it's different. I don't know

28:10

the there's a correlation

28:12

between stubbornness and grit. There is a correlation

28:14

between grit and success,

28:17

which is very hard to define, but

28:19

there have been attempts to study

28:22

that. And there is

28:24

a high correlation, but it's

28:26

not the only factor. There

28:28

certainly are gritty people that can end

28:30

up not being successful. Is it

28:32

because they end up too DI? And they're stubborn?

28:34

And don't know when to quit? That's a great hypothesis

28:37

about maybe why those

28:39

that percentage of people doesn't end up,

28:41

you know, quote unquote, successful. Well,

28:45

I guess when I was thinking about this topic,

28:47

When I first saw grit, I thought, oh,

28:50

tough and stubborn. Those are the words that I equated

28:52

it to you. And then I think the more I've read about it, the

28:54

more I've understood that maybe does there's many

28:56

more facets to it. But I think

28:58

almost, you know,

29:01

I know that you're saying that grit score

29:03

in the in the sense that you've looked

29:06

at it in the past and the the score

29:08

that professor Duckworth developed

29:11

isn't for selection.

29:13

But I was thinking that actually, you know,

29:15

all the things that any of us do

29:17

to get into medical school kind

29:20

of proves the grittiness already. I mean, medical

29:22

school is already sort of a great

29:24

test in itself. It's like, can you jump through

29:26

all of these hoops? To prove

29:28

that actually you wanna stick at something when it's hard,

29:30

you know, when all of your friends are going out, getting

29:32

drunk and you were having to wake up at nine AM the next

29:34

morning to go to a lecture. Does that actually

29:37

prove that you have some perseverance or are committed

29:39

to something? So actually, you know,

29:42

are we kind of selecting for grit already?

29:45

And then those that are relatively

29:47

successful, all of these other factors

29:49

are coming into play, Oh, a

29:51

hundred percent. We're preselected in

29:53

medicine, of course. I mean, there's

29:56

no doubt that we've become a preselected

29:58

crowd, which is why studying grit and medicine

30:01

becomes challenging in and of itself because

30:03

you're taking people that already do

30:05

have very, very high levels

30:07

of grit, and you're trying to compare them to

30:09

each other. And there's such nuanced

30:11

conversations about, you know,

30:14

do different specialties have different

30:16

grid. I mean, it's really hard to compare

30:18

when you're at such a

30:20

high level at the

30:22

beginning point. And I think that, you

30:25

know, this scale was just used to try

30:27

to study it and give a

30:29

scientific measurement to

30:32

a trait that is otherwise hard

30:35

to define. So when I was

30:37

doing my background

30:39

reading about you, And I know

30:41

that you've touched on this earlier, but I noticed

30:43

that you're involved in a subject which is very close

30:45

to my heart, which is women in surgery. And

30:47

one of my first thoughts was is

30:50

grit gendered, which I know pertains

30:52

to the research that you did. One of

30:54

the things I wondered is do you men

30:56

generally have more grit than women.

30:58

And historically is this where there are more

31:00

men in sort of successful or

31:02

inverted commas high powered professions. Or

31:05

is this less about grit and more

31:07

about sort of pre existing patriarchal structures

31:09

or something else

31:10

entirely? I think a lot about female surgeons.

31:13

And I we can talk about we

31:15

could talk about female surgeons for hours.

31:18

But our study, not that it's the

31:20

end to the story, but

31:22

really demonstrated that within surgeons,

31:24

at least, and there's

31:27

been other studies that have mimicked these findings

31:29

in residents and in medical other

31:31

medical specialties, the men and

31:33

women have the same grit

31:35

scores. They're not significantly different.

31:38

I think that the point in

31:40

me doing the study was that maybe

31:44

not so much or hopefully

31:46

less so now than when went into training,

31:48

but certainly when I interviewed for

31:50

residences, I was

31:53

inappropriately asked many times

31:55

if I was enough enough to

31:57

do neurosurgery. And I think

31:59

that while tough and grit

32:02

are not exact, synonyms.

32:05

There are nuanced differences. I

32:08

do think that there is a

32:10

preconceived no in

32:14

the society here in the US

32:16

and probably globally given the numbers

32:19

are similar. For female surgeons

32:21

around the globe that

32:24

women are lacking some kind

32:27

of whether you call it

32:29

grit or toughness or ability

32:32

you know, be successful in

32:34

a surgical residency in a surgical

32:36

career. Hopefully, the data,

32:38

you know, we have shows that that's

32:40

not the case. Women are just as gritty

32:42

as men. So I don't

32:44

think it has anything to do with that.

32:47

I think also that, interestingly,

32:51

what we saw and I know that the data

32:53

prove it out and many other places is is that

32:55

burnout in women in medicine

32:57

is and surgery specifically is

32:59

much higher than in

33:02

men. And if your grits the

33:04

same, but your burnout and the rates at which

33:06

you're leaving your career or higher, you

33:08

know, that becomes a much more interesting

33:11

question. Question and is it that

33:13

women are more likely to report burnout

33:16

than men, which is possible, you know,

33:18

certainly there are gender and cultural

33:20

differences about who reports, what kind of

33:22

symptoms. And then second

33:24

of all, if if grit is

33:26

the same, then what else

33:30

is protective of burnout? Because

33:32

if we can figure out how

33:34

to protect people against burnout,

33:36

then we can screen them and hopefully

33:39

change things before, you

33:42

know, burnout occurs instead of way

33:44

game for it. We kind of

33:46

hypothesized some kind of success.

33:49

However, you define that, might be protective,

33:52

but we don't have any answers. Yeah.

33:54

I'd be curious to see if anyone else has ideas

33:56

of what they think might be protective of

33:59

burnout

34:00

besides grit. As far as personality

34:02

traits. I

34:03

was gonna ask you Ayesha because you

34:06

work in Ep7 and Guinee, and

34:08

I feel like whenever people talk about women not

34:10

being tough. Somebody just has to say childbirth.

34:13

I'm I'm sure that you have tons of experience of

34:16

that. Do you have any thoughts on,

34:18

you know, if women are as girthy as

34:20

men, why is it that

34:23

women report more

34:24

burnout? Or what could we do to protect

34:27

people that report more burnout? It's

34:30

interesting because, like, Obzengai in the UK

34:32

has one of the highest attrition rates Mhmm.

34:34

-- within the special within different

34:37

specialties. And one of the

34:39

reasons for it is burnout. Normally,

34:42

secondary to like litigation and things

34:44

because there's in

34:46

obstetrics in particular particular, you

34:49

get quite a lot of incidents which

34:52

end up litigation. And

34:55

I don't know if there's any evidence

34:57

to what I was saying here, but one of the

34:59

protective factors for myself

35:02

and the people I work with within

35:04

my own training program is having

35:07

peers and and

35:09

peer support. And be

35:12

able to reflect amongst

35:15

our group that actually these

35:17

are normal things to happen within

35:19

training. And and

35:22

to be able to almost have kind of an

35:24

echo chamber and

35:26

be able to bend a bit and

35:28

but then also take take

35:30

some constructive steps as to

35:32

actually, is there anything that I could have gone better? Is

35:34

that it's true reflection really? And then

35:37

to be able to take it forward knowing that, actually,

35:39

it's not just me. And I

35:41

think it's actually helped a lot of

35:43

people get through difficult parts

35:45

of trading, particularly when things

35:47

have gone really badly wrong. And which

35:49

is the nature of Opsgenie. That

35:51

would certainly lend to your hypothesis.

35:54

Wouldn't it to mean that if you've got fewer women

35:56

in a specialty and those women

35:58

have a higher rate of burnout if

36:01

they've got less peer support or less,

36:03

you know, a gas

36:05

fist and peer support in the sense

36:07

that people that look like them or people that are

36:09

are like them, perhaps

36:11

perhaps that's that's the reason. Decathlon

36:14

is somebody who's in the process of

36:16

leaving the NHS and has had a

36:18

degree of of burnout, but

36:20

is obviously incredibly gritty.

36:24

Is there anything you think that

36:26

that might have have been a protective

36:29

factor for you? I I mean,

36:31

I think what I use this is is amazing.

36:33

I think ophthalmology and academia in itself

36:35

are both incredibly isolating. And there's

36:37

so few people who are doing the same thing

36:40

that you're doing that. It's it's very, very

36:42

challenging to actually get somebody that understands

36:45

what you're going through. You know, you can't

36:47

speak to consultants because

36:50

they're typically big big dog professors

36:52

on their own who, you know, can't quite relate

36:55

to those challenges anymore. You can't speak

36:57

to your peers because, you know,

36:59

you're basically doing two jobs and

37:01

trying to achieve the same clinically as them at the

37:03

same time. Can't speak to allied

37:05

healthcare professionals because they're just, like, reset

37:07

it to why waste your time doing that. So

37:10

I actually think that I think that's an an

37:12

absolutely huge one. No. Yeah.

37:15

So I think that probably would have helped

37:17

me. But I I mean, ultimately, it's

37:19

it's the whole system, which is the reason why I am

37:21

leaving. But but yeah, I think

37:23

what Ayesha said would probably be the key

37:26

thing that probably would have helped

37:28

me stay in a little bit

37:29

longer. I

37:31

also think there's a, like, a massive, like, mentoring

37:33

that Yeah. Like -- Yeah.

37:36

-- back in the day, which is what I hear from my

37:38

consultants all the time, you would have, like,

37:40

someone who, you know, a senior person

37:42

who would kind of take you under their wing, you

37:44

know, would support you through trading and

37:48

and kind of prevent all of these issues

37:50

from arising or not arising, but

37:53

having an effect as an effect

37:55

as it may be doing now. And I

37:57

think there's just a complete lack

37:59

of mentoring within our training

38:01

programs nowadays. I wouldn't I wouldn't know

38:03

who to turn to from the consultant wanted

38:05

go to. And for that level of support?

38:08

Yeah. Absolutely. And I mean,

38:10

I personally feel like almost the opposite. I

38:13

mean, I remember raising a few concerns

38:15

about different things and you feel quite

38:18

isolated as a junior because, you know, you

38:20

you rotated quite frequently so the consultants

38:22

aren't in my in my

38:24

personal opinion don't appear as

38:28

invested in you as they may be in the rest

38:30

of the team, not they have spend the time with.

38:32

So it's a very isolated position to be as

38:34

a junior doctor, I think, at the moment now.

38:36

Because the consultants have a pretty rubbish job

38:39

generally as it is. They're

38:41

trying to, you know, keep everything great

38:43

in the whole team. And then you have the, you

38:45

know, s h who well, F1SH who's

38:48

and registras who are doing a hell

38:50

of a lot of the groundwork, but really

38:52

don't know where to turn. So I I do

38:54

think that's a a major major factor.

39:00

Simone, you talked about grit

39:03

not being this kind of unchanged

39:06

entity that somebody just possesses

39:08

or doesn't possess, that it changes it

39:10

with time and place,

39:13

I imagine, and job. And

39:15

we talked about things you can do to increase

39:17

somebody's grit. But conversely, are

39:19

there things that you have seen or

39:21

you've you know, come across

39:24

that reduce somebody's

39:25

grit, either in the short term or the long

39:28

term. Do you mean more like circumstance

39:31

that might occur or a

39:33

personality,

39:34

another personality trait that comes into

39:36

play that tempers it Yeah.

39:39

I mean, I guess we've talked a lot about the former,

39:41

and I think we all know what circumstances will

39:44

erode our own grit or I'd like think we have an

39:46

DI. But, yeah, I suppose the the

39:48

the latter, like, from a personality point

39:50

of view or, you know, for instance, you

39:52

talked about You talked

39:54

about most most of the evidence

39:57

points towards that as people get older,

39:59

their grit improves. Conversely,

40:01

is there any you kind of like overarching

40:04

life event or personality trait that

40:06

reduces somebody's

40:07

grit. I think that the

40:09

interaction is probably difficult to

40:12

measure or to, you know, say

40:14

that this one thing takes credit

40:17

for it. You know, the relationship

40:19

between things like resilience, success,

40:22

grid and burnout are interesting.

40:27

Certainly, we've seen correlations. The question

40:29

is, is there a causation there.

40:31

Right? Always careful as doctors

40:34

and scientists is thinking about is

40:36

correlation the same as causation. And

40:39

so I I do wonder if, you know,

40:42

burnout separate from your grit can

40:44

then in a flywheel

40:46

kind of circle back and impact level

40:49

of grit. So if you do have a certain level of

40:51

burnout, does that then impact

40:53

your willingness to persevere and

40:55

persist on this goal for

40:57

a long time? If

41:00

you don't have success, does that

41:02

come back and tell you that your grid

41:04

should go down? I don't know of anything that

41:06

shows that. I tend to

41:08

think that if you're if it's

41:10

time to quit something or something's

41:12

not going right, you need other personality traits

41:15

that come that will tell you that

41:18

this is more stubbornness than grit, and it's

41:20

time to move on to something

41:22

else. So I think it's a self

41:23

awareness. So maybe it's

41:25

that, you know, that you're a mindfulness almost

41:28

that you need that can counteract

41:30

when the grid is not your friend anymore.

41:34

I'm really glad that you brought up the word resilience

41:36

because it's a

41:38

word that's come on this podcast loads. We've had

41:40

a load of discussion about it. And one

41:43

of the studies that I came across when I was

41:45

reading this, which I will link in

41:47

the show nights. And this is

41:49

a twenty seventeen study by

41:51

Laura Halladay, Abigail Walker, Selivig,

41:54

John Hynsen, John suggested

41:57

that grit could be used to sort of target

41:59

for one of the better term, individuals who

42:01

need more support. And that could be

42:03

done in the form of resilience

42:05

training. And I know, as

42:07

I say, that that's a bit of trigger word for some

42:10

of us on this podcast. But

42:12

taking aside what people think about resilience

42:14

training and how it can be sort of weaponized

42:18

as an intervention. What do people

42:20

think about using these grips scores

42:22

as as a way of sort of helping

42:24

people by by supporting them

42:26

better, I suppose. I I mean, I'd

42:28

be interested in hearing what people as

42:31

Chinese you know, earlier on in their

42:33

career feel because I

42:35

do think that if we're going to use it as

42:37

a screening in the aims

42:40

of helping and not as

42:42

a way to weed certain people

42:44

out. You know, there has to be obviously

42:46

the same kind of privacy that you get

42:49

from any other medical examination

42:53

or data that people get. So there has

42:55

to be obviously section and a privacy

42:57

issue with the data. And then

43:00

if we think about as an institution

43:02

or a health service that we're going to

43:04

help to build people, protect

43:07

them against burnout or build resilience or

43:10

grit. Then there has to be before you

43:12

actually screen for that, there has to be a program

43:14

in place that is

43:16

going to be, you know, proven

43:18

to be beneficial. Because if we're gonna use

43:20

it to, then we have to be able to help them. Right?

43:23

We can't just get this data and say,

43:25

boy, you might be a risk for burnout or

43:27

or, you know, who You need to work on something.

43:30

You know, so I think you need to have a plan in

43:32

place first.

43:33

Yeah. But I'd be interested to hear

43:35

what some of the other folks think

43:37

on the panel about whether

43:39

that's even a good idea or if that's

43:42

kind of crossing a line for

43:43

them. I'm not sure, you know, because

43:46

it always feels like you're setting

43:48

up like a two tier system based

43:51

on a score so that some people

43:53

get some support, which can either be seen

43:55

as they're getting lots of extra help. Or

43:58

it could be seen as, oh, you're not good enough

44:00

so you're getting extra help. And

44:02

then, like, the rest. And

44:05

I I think it does the opposite of leveling

44:07

the playing field. I think it makes it

44:09

completely uneven. And I don't I don't think

44:11

I would like that as a

44:12

trainee? No. I mean, you wouldn't

44:14

you you wouldn't like it

44:15

if you were in the like no grit group

44:18

or the low grit group. Would you I don't

44:20

I don't know. I don't think I'd like it. Any

44:22

any of those groups to be honest, because you can

44:24

argue like each each group

44:26

has its own

44:27

benefit. Stating.

44:28

Mhmm. What do you think, Daqlyn?

44:30

Yeah. I mean, you you may have to admit. I honestly

44:32

thought that might be a good DI. As

44:36

as long as, like Simone said, there's

44:38

an actual, you know,

44:41

reasonable evidence based plan.

44:44

For those who are struggling because anyone at least,

44:46

you know, showing that they're at least trying to care about

44:49

us and, you know, trying

44:51

to quantify in that? And is there a way

44:53

to find those who are most at risk? But,

44:56

like, you just said that will come with a million challenges.

44:59

And I think yeah, there

45:01

would be conflict between different

45:03

trainees, different, like, healthcare professionals,

45:06

why the doctors get in there, but we're not, we're doing

45:09

Eximal hours than that if that's the

45:11

case. think it would be difficult to

45:13

roll out. But,

45:15

I mean, generally, it would be nice

45:17

to see that as an organization, the

45:19

NHS are trying to use some sort of

45:21

evidence to intervene to those

45:23

who may be most at

45:25

risk. As we've kind of already talked

45:27

about, it's not just about your grit score,

45:29

but it's it's your personality as

45:31

a whole. So you could how can you,

45:33

you know, stratify risk based on

45:36

just a great

45:36

school.

45:37

Yeah. I mean, they may well add additional things

45:39

in, I I guess, to make it a bit

45:41

more.

45:42

Yeah. A bit more thorough.

45:45

I'm curious. Would you be in

45:47

favor then of having if

45:49

there was a proven training or

45:51

program that could build things like

45:54

written resilience. Would you be interested

45:57

in having it then available on just

46:00

if you want it, you can go and do it

46:02

basis or a mandatory everybody

46:06

has to go and do this because that important

46:09

for us. And so there is no

46:11

two tiered system

46:12

between the haves and the haves knots. No.

46:16

I was just gonna say we've we've discussed resilience

46:18

resilience training we have in the

46:20

NHS. And I imagine that there is, you

46:23

know, something similar in a

46:25

lot of other places. And I think

46:27

that the criticism, certainly

46:29

from people that I've spoken to you, on this

46:31

podcast or off this podcast, And I

46:33

think I heard someone say recently, resilience

46:36

training in the way that we have it at the

46:38

moment, particularly with the NHS

46:40

being in situation it is is asking

46:42

a person to run into a burning building,

46:45

waiting for them to catch fire, and then once they've

46:47

caught fire, bringing them out and saying, here's how

46:49

you can put the fire out. But by the way, now you have

46:51

to get back in the building again. And that's why

46:53

a lot of people feel, actually, we're not fit

46:56

fixing the systemic problems that

46:58

have created, you know, that

47:00

have meant that person is now on we

47:02

are just fixing the individual and making

47:04

it an, you know, an individual problem when

47:06

actually a lot of this is systems based.

47:08

So I can totally see why the idea of this

47:11

resilience training comes from and

47:13

that there is a lot of good in it. But

47:15

I think I can always say see

47:17

the other the frustration when there's a systems

47:20

based problem. And somebody

47:22

saying, you know, I don't think a trading program's

47:24

gonna sort this out. I

47:27

guess my my final crash question

47:29

was gonna be whether we call it

47:31

grit or whether we call it

47:33

resilience or whether we call it

47:35

toughness or stubbornness, whatever the name

47:38

is for it, is actually

47:40

one of the issues that a lot

47:42

of healthcare systems, whether that public

47:44

or private, have relied on

47:47

any healthcare practitioners'

47:50

grittiness for too

47:53

long. And actually, we're getting kind

47:55

of to the end of people's gritty tethers.

47:57

Now when it comes

47:59

to, you know, wide scale

48:01

burnout and and germany

48:04

poor well-being and people leaving the professions?

48:06

Yes. Absolutely. I mean, there's there's

48:08

no different factors that come in, you know, economic.

48:11

You know, we we aren't getting paid as much we

48:13

want to learn. We can't afford to to

48:15

live on the salaries that we're on. And then

48:18

you go and you have increasing amount of challenges

48:21

at work and you feel devalued

48:23

in our role. You

48:25

could argue it's less respected and

48:28

whether it be by the public or not. So I think there's

48:30

an accumulation of all of those. And I

48:32

mean, for me anyway, you know, having been

48:34

someone who I would probably say is fairly

48:36

gritty, throw medical school in the

48:38

early part of my career at the

48:40

end of my tether. And there

48:43

are other alternative, which which

48:45

give you a better better work like balancing

48:48

and you need focus on your own. Well-being.

48:51

So yeah, I I completely agree.

48:53

I'm very much the teller of my

48:55

grit. Simeon, you said something right

48:57

at the beginning, which I just wanted to

48:59

circle back to to sort of, you know, come

49:01

full circle, say to speak, is One of in

49:03

your definition of grit, one of the things that

49:06

you said was that

49:08

it's the being able to continue even

49:10

when you're not getting that validation,

49:13

you know, somebody saying, well, don't you keep going?

49:16

And I actually wondered if maybe that

49:19

is one of those protective factors that

49:21

we were talking about from burnout is actually

49:24

somebody saying to you, you've done a good job, keep

49:26

going, you know, in whatever format comes

49:28

public or or personal. I don't know

49:30

if that's something that you you think

49:32

protects you Ayesha

49:35

from from feeling burnt out. Definitely.

49:38

I mean, so

49:42

funny story, but as

49:44

at the beginning of my training, every

49:46

cesarean section I went to. I fainted

49:49

in. Every one of them. I

49:51

spent most of that year lying on the floor

49:54

on labor ward. But

49:57

the thing that got me through that year

49:59

was my peers and my consultants being

50:01

like, look, it's fine. You're gonna get over

50:04

this. You're, like, don't

50:06

don't let this, like, completely destroy

50:08

you because it was. Yeah. Because I was like,

50:10

god, how am I ever gonna do specialty. Like,

50:12

I have to be able to stay upright. And

50:16

it it was it was then saying, you're doing

50:18

a good job. You know, you're good at

50:20

every every other part of your job. This

50:22

is just a little hiccup. You'll get through it. And

50:25

eventually, I did. But

50:28

yeah, definitely think that was something

50:30

that kept me in training and

50:32

managed and kept me going

50:35

through to

50:36

SD five now. Even

50:39

even when all these systems base things, even

50:41

when the house is on fire. That's that's

50:43

still keeps you

50:44

going. It's pretty interesting. Grid

50:46

is not the BL end all. There are other

50:48

things that are very important to us as

50:50

physicians and as people And

50:54

while we are already self selected

50:56

as a pretty gritty crowd, obviously,

51:00

things like integrity on this

51:02

see, you know, hardworking, tolerance,

51:05

kindness. These are all

51:07

important factors for being

51:10

a good citizen, good human being, and

51:12

certainly good physician as well. And

51:15

I think making any overreaching

51:18

statements that grid is, you know, the most

51:20

important thing that we

51:22

look for is saying

51:24

too much. It happens to be the topic we're

51:26

talking about today, but I I, you know, I don't

51:29

want anyone to walk away thinking

51:31

it's the only personality

51:34

trait that should be looked at or cared

51:36

about or

51:38

thought about when we think about who we are

51:40

and what's protective of our own personal

51:43

you know, burnout and whether it's grid

51:45

or a combination of things. And

51:47

I think that both

51:50

Ayesha and Deckelen have made really good

51:52

points that for things that are protective

51:54

are having potentially mentors and

51:56

peers. And those are things

51:59

that, you know, are very hard to measure we

52:02

had toyed with the idea of success. So

52:05

I think that there's this obviously

52:07

is multifactorial.

52:08

It's not really easy to pick out one

52:10

thing. And I

52:13

think we each as individuals will

52:15

need to do our own self exploration about

52:18

what it is that, you know, we think

52:20

makes us grittier or

52:22

less DI or will protect us against

52:24

burnout because it's probably a little

52:26

bit different for everyone.

52:28

I think that's a really good note, probably

52:31

the most positive note. To leave

52:33

this podcast on, say thank

52:35

you so much for joining us

52:37

for this episode. And

52:43

thank you for listening to doctor informed. That's

52:46

all we have time for today. We're

52:48

really keen to hear from our listeners. For

52:50

ideas of future discussions and reflections

52:52

on the topics we've discussed today, please

52:55

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