|ORIGINAL RESEARCH ARTICLE
|Year : 2018 | Volume
| Issue : 2 | Page : 109-113
Grit: A predictor of medical student performance
Lisa Renee Miller-Matero1, Sarah Martinez1, Lisa MacLean2, Kathleen Yaremchuk3, Alvin B Ko3
1 Department of Behavioral Health, Henry Ford Health System, Detroit, Michigan, USA
2 Department of Medical Education, School of Medicine, Wayne State University, Detroit, Michigan, USA
3 Department of Otolaryngology, Henry Ford Health System, Detroit, Michigan, USA
|Date of Web Publication||30-Nov-2018|
Lisa Renee Miller-Matero
Henry Ford Hospital, 2799 West, Grand Boulevard, Detroit, MI 48202
Source of Support: None, Conflict of Interest: None
Background: Several predictors of medical school performance have been identified, yet more research is needed to select applicants who will perform well. Grit is a personality trait that is described as persevering through difficult tasks. Although it is hypothesized that this type of trait would be high in a medical student population, this has not been studied. The purpose of this study was to examine grit among medical students and to explore whether grit-predicted performance in medical school. Methods: There were 131 graduating medical students who completed a questionnaire in May 2014 on grit as well as demographic questions and involvement in other activities in medical school. Data on test scores, years in medical school, and class ranking were obtained from the medical school. Results: The average grit score among 130 medical students was high (mean = 4.01, standard deviation = 0.42). Those who completed the program in 4 years had higher grit scores than those who completed in 5 years (P = 0.01). Grit was related to medical school performance including clinical knowledge scores (P = 0.02). There was also a difference between the highest and lowest class rank (P = 0.03). Discussion: Medical students have high levels of trait-like perseverance and it appears that those with higher levels of grit are more likely to perform better in medical school.
Keywords: Academic performance, grit, personality trait, tertiary education
|How to cite this article:|
Miller-Matero LR, Martinez S, MacLean L, Yaremchuk K, Ko AB. Grit: A predictor of medical student performance. Educ Health 2018;31:109-13
| Background|| |
Previous research has examined the predictors of medical school performance in determining success during medical school.,,,,, Specifically, scores on the Medical College Admission Test (MCAT), which is a problem-solving and knowledge-based exam used as a factor in evaluating applications for medical school admissions and undergraduate academic performance, have been repeatedly found to be predictive of medical school performance. MCAT scores and undergraduate performance have been shown to be related to grades in medical school, United States Medical Licensing Examination (USMLE) Step scores, and board certification exam performance.,,,,, However, there has been a need to find better predictors to improve the selection of applicants for medical schools. Researchers have started to consider noncognitive variables impacting medical school performance. For example, the nonacademic criteria associated with the medical school application, such as the personal statement and interview, as well as personality factors including conscientiousness, extroversion, and empathy., These noncognitive factors appear to add incremental validity in predicting performance in addition to academic measures such as MCAT scores and grade point average (GPA)., Given the small number of studies examining noncognitive factors as predictors of medical school performance, a survey was conducted to evaluate the impact of grit, a personality trait of perseverance, as a noncognitive trait that could possibly predict medical school performance.
Grit is defined as a personality trait that measures “perseverance and passion for long-term goals.” Grit has been measured in several different cohorts including West Point cadets, participants in the National Spelling Bee, and Ivy League undergraduates. Higher levels of grit have been associated with educational attainment, successful outcomes, and have predicted achievement beyond a person's ability. It would be reasonable to assume that medical students have high levels of grit, given the highly competitive process involved in applying, matriculating, and completing medical school. Because grit has been successful in predicting performance in other cohorts; grit may be useful in predicting success in medical students. Of the research that has examined demographic differences, age was positively correlated with grit; however, there were no differences in grit scores based on race, or gender. There has been little research that has evaluated whether there are demographic differences in grit scores, and this has not been evaluated among medical students where there may be differences that are not found in other samples. Therefore, we wanted to explore whether there were any relationships among demographic variables (e.g., age, gender, and race) and grit scores among medical students. The purpose of this study was to evaluate the average level of grit among graduating medical students and determine if grit scores were associated with academic success in medical school.
| Methods|| |
The graduating medical students (n = 309) from a medical school were eligible for the study. Of these, 130 (42.1%) students completed the survey.
Participants were asked questions regarding demographics, research experience, and if they were a member of the Alpha Omega Alpha (AOA) honor medical society. As an indicator of research experience, we grouped students into whether they had presentations and whether they had publications. These were separated because publications often require more time and work, which may require higher levels of grit.
Grit was measured with a 12-item survey. The items are scored on a 5-point scale from 1 (not at all like me) to 5 (very much like me). An average score was obtained across the 12 items with higher scores indicating a higher level of grit. This measure has adequate reliability with an internal consistency of alpha = 0.85. There was also adequate internal consistency of this measure within the current sample (alpha = 0.76).
This study was approved by the Institutional Review Boards at two institutions; one institution was the medical school where the data were collected, and the other was a local health system where some members of the research team are employed. Recruitment was done by convenience and graduating medical students were asked to participate in this study when they picked up their regalia for their graduation ceremony in May 2014. Participants were provided with an informed consent document prior to their participation. They completed the questions described above, which took approximately 5–10 min.
Data were obtained from the medical school regarding the participants' results of USMLE Step 1, Step 2CK, and Step 2CS, and class rank to determine whether grit can predict academic performance in medical school. The USMLE Steps are required for medical licensure in the United States. USMLE Step 1 is the first part and it assesses students' abilities to apply important concepts of the sciences (i.e., anatomy, behavioral sciences, pathology, biochemistry, physiology, genetics, and epidemiology) to the practice of medicine. The second part is the USMLE Step 2CK, which assesses the students' ability to apply medical knowledge to a variety of clinical situations. The USMLE Step 2CS assesses the students' abilities to interact with a patient. The examination is comprised of several encounters with standardized patients and examinees are expected to conduct a thorough patient evaluation. Students' performance on Step 1 and Step 2CK are based on a three digit score. For Step 2CS, students were placed into two groups based on performance: (1) passing on the first try prior to residency match day and (2) did not pass on the first try or had not taken it by match day. USMLE performance is important for medical students as the results are among the top ways that residency programs evaluate applicants. Preparation for these exams often requires a high level of time commitment. In addition to the USMLE, students were classified based on class rank from the medical school. Class rank is determined by both academic performance and clinical performance and allows residency programs to see where a student may fall in comparison to their classmates. The top students were ranked as exceptional, followed by outstanding, excellent, very good, and good. See [Table 1] for a description of each of these ranks.
Analyses were conducted using SPSS 20 (IBM Corp. Armonk, NY, USA). Descriptive statistics were calculated to determine the difference in average grit scores across student characteristics. Participants were divided into “yes” and “no” groups based on whether they had research presentations at conferences or research publications. Independent samples t-tests were conducted to determine the differences between grit and student characteristics (gender and race) and academic outcomes (research activity and Step 2 CS status). Due to unequal variances, a Welch's t-test was used to determine the differences between grit and if a student was an AOA member. The Mann–Whitney U-test nonparametric test was conducted when a group had <15 participants (years for school completion, class rank). For class rank, because of the five groups and smaller sample size within the groups, the highest and lowest class ranks were compared for differences in grit to maximize power. Pearson's correlation was used to determine if there was a relationship between grit and age, as well as grit and academic performance measures (Step 1 and Step 2 CK scores).
| Results|| |
Of the 130 medical students who participated in this study, 71 (54.6%) students were male and 59 (45.4%) students were female. Most of them completed the program in 4 years (92.3%, n = 120) and the others completed the program in 5 years (7.7%, n = 10). Average age was 27.19 (standard deviation [SD] = 2.12). The majority identified as White (n = 98; 75.4%), 24 (18.5%) who identified as Asian, 3 (2.3%) who identified as Black, 3 (2.3%) who identified as multiracial (2.3%), 1 (.8%) who identified as American Indian/Alaskan Native, and 1 (.8%) who identified as other. The students who participated in this study were similar to the entire graduating class in terms of age, gender, and race. There were also no differences between participants and nonparticipants among the variables used to assess academic success, including USMLE Step 1, Step 2CK, Step 2CS, class rank, years to complete medical school, and whether or not they were AOA members (P > 0.05).
Grit and participant characteristics
Grit scores ranged from 3.08 to 4.92 with an average score of 4.01 (SD = 0.42). No significant differences were found between males and females, yet females tend to have a slightly higher average score [Table 2]. There was a statistically significant difference between Whites and non-Whites [Table 2]. There was not a significant relationship between age and grit score [Table 2].
|Table 2: Grit, participant characteristics, and medical student performance|
Click here to view
Grit related to medical student performance
Students who completed the program in 4 years had higher grit scores than those who completed the program in 5 years [Table 2]. There were no statistically significant differences between grit scores and Step 1 scores; however, statistically significant differences were detected between grit scores and Step 2CK scores [Table 2]. Those who had passed Step 2CS tend to have higher grit scores [Table 2].
Students with an exceptional class rank had higher grit scores than those at the lowest class rank [Table 2]. There were not significant relationships between grit and whether the participants had presentations or publications or were an AOA member [Table 2].
| Discussion|| |
Outcomes indicate that medical students have high levels of grit. The average grit score in this medical student sample was 4.01, which may be higher than the averages found in other samples studied, including West Point cadets, Ivy League undergraduates, and participants in the National Spelling Bee, where average scores ranged from 3.46 to 3.78. It is not surprising that medical students would have high levels of grit since they have already completed and excelled in an undergraduate education, achieved high performance on their Medical College Administration Test (MCAT), and matriculated to medical school. These students likely entered medical school with a higher than average grit score and previous research suggested that individuals with higher levels of grit tend to have higher levels of education.
Students who identified as White had significantly higher grit scores than non-Whites. This was unexpected given that previous research has not found a difference in grit scores based on race., However, other research has found that personality traits may differ between race and that certain characteristics could be related to academic performance. This suggests that the relationship between race and grit may be affected by other intervening variables not measured in this study. In addition, females tend to have higher grit scores than males. There may be something unique about being a medical student that increases the grit scores of these groups. In the USA, women accounted for just under 32% of physicians, so it is possible that female medical students need higher levels of grit to break through a male-dominated profession. Alternatively, it is possible that there are cultural differences regarding perseverance and those identifying as White and female may tend to be higher in grit when compared to those who are male and non-White in the general population. There was not a statistically significant difference between age and grit score. This could have been due to the restriction of range for both grit and age, especially given that previous research found that those who are older tend to have higher grit scores than those who are younger.
In the current study, there were statistically significant differences between grit and medical student performance. First, students completing the program in 4 years had higher grit scores than students completing the program in 5 years. Second, those in the highest class ranking had higher grit scores than those in the lowest class ranking. In addition, there was a positive relationship between grit score and Step 2CK scores, suggesting that those with higher grit scores have higher Step 2CK scores. Although not statistically significant, a relationship between grit and performance on the Step 2CS trended toward significance. It was hypothesized that grit would predict medical student performance because previous research has found that grit is predictive of future achievement. Furthermore, grit was not related to USMLE Step 1 scores, which assesses basic medical knowledge, but was related to the Step 2 CK scores, which assesses the clinical application of the basic knowledge. It is possible that this difference was found because grit is a better predictor of clinical knowledge and proficiency as opposed to basic science. Many students in medical school may be able to learn and memorize information easily, which may not need the same level of perseverance. Alternatively, a high level of perseverance may be needed when working directly with clinical scenarios because the students need to apply their knowledge which is often more challenging and requires more practice than memorizing information. Therefore, personality factors such as grit may predict who will be more successful when providing direct patient care as measured by the licensure examination.
It is possible that knowing the grit scores of medical school applicants could prevent attrition and burnout. Previous research in medical resident samples found that those with lower levels of grit were more likely to consider leaving their residency program were more likely to report burnout during residency and had lower levels of psychological well-being. Results from this study suggested that students with higher grit scores were more likely to complete the program in 4 years rather than 5 years. It is possible that low grit scores can be used by medical schools to help to predict which applicants may not be able to persevere through the end of medical school or may take additional years to complete the program. Therefore, grit may not only predict some measures of academic performance, it may also predict other important outcomes as well.
Knowing that a personality variable such as grit may predict medical student outcomes, medical schools may want to consider evaluating noncognitive variables during the application process. Previous research has suggested that noncognitive variables can offer information that could assist in predicting outcomes beyond MCAT scores and undergraduate GPA., Looking at noncognitive factors in other areas of the application, such as the personal statement, letters of recommendation, and the interview, has been successful at predicting medical student performance.
Although this is the first study to look at grit in a sample of medical students, there are several limitations. First, there was a 42.4% response rate for this study. However, when compared to demographics of the entire graduating class, as well as across the United States, the sample was similar suggesting that it is likely representative. In addition, some variables (e.g., race, AOA membership, Step2CS, years in school) had large differences in the size of the groups which could affect power. It is possible that statistical significance could have been achieved if there was a larger sample size, especially given that small to medium effect sizes were found with some of these variables (e.g., age, gender, research experience, and AOA membership). It may have also been difficult to find statistical significance with some of the variables because of the restricted range of grit, in which the majority of the sample scored highly. Therefore, future research should replicate this with a larger sample size. Finally, because grit was measured at the end of medical school, it is possible that grit scores could have changed during medical school. This is thought to be unlikely, though, given that grit is a personality trait and traits are expected to be consistent over time. Yet, even if grit scores increased as students persevered throughout medical school, differences in medical school performance were still found at the end of the medical school training.
| Conclusion|| |
It appears that medical students have high levels of trait-like perseverance and it is possible that those with higher levels of grit are more likely to perform better in medical school. Future research should examine whether grit scores change throughout medical school, if grit predicts other areas of medical school performance, and whether these results extend to performance in residency and as practicing physicians. Future research could also examine whether grit scores are related to better academic performance in other graduate programs.
Thank you to Patrick Bridge, Ph.D., for his assistance with preparing and proofreading this manuscript.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Donnon T, Paolucci EO, Violato C. The predictive validity of the MCAT for medical school performance and medical board licensing examinations: A meta-analysis of the published research. Acad Med 2007;82:100-6.
Dunleavy DM, Kroopnick MH, Dowd KW, Searcy CA, Zhao X. The predictive validity of the MCAT exam in relation to academic performance through medical school: A national cohort study of 2001-2004 matriculants. Acad Med 2013;88:666-71.
Haight SJ, Chibnall JT, Schindler DL, Slavin SJ. Associations of medical student personality and health/wellness characteristics with their medical school performance across the curriculum. Acad Med 2012;87:476-85.
Peskun C, Detsky A, Shandling M. Effectiveness of medical school admissions criteria in predicting residency ranking four years later. Med Educ 2007;41:57-64.
Veloski JJ, Callahan CA, Xu G, Hojat M, Nash DB. Prediction of students' performances on licensing examinations using age, race, sex, undergraduate GPAs, and MCAT scores. Acad Med 2000;75 10 Suppl: S28-30.
White CB, Dey EL, Fantone JC. Analysis of factors that predict clinical performance in medical school. Adv Health Sci Educ Theory Pract 2009;14:455-64.
Ferguson E, Sanders A, O'Hehir F, James D. Predictive validity of personal statements and the role of the five-factor model of personality in relation to medical training. J Occup Organ Psychol 2000;73:321-44.
Hojat M, Robeson M, Damjanov I, Veloski JJ, Glaser K, Gonnella JS. Students' psychosocial characteristics as predictors of academic performance in medical school. Acad Med 1993;68:635-7.
Duckworth AL, Peterson C, Matthews MD, Kelly DR. Grit: Perseverance and passion for long-term goals. J Pers Soc Psychol 2007;92:1087-101.
Hill PL, Burrow AL, Bronk KC. Persevering with positivity and purpose: An examination of purpose commitment and positive affect as predictors of grit. J Happiness Stud 2014;17: 257-269.
Bowman NA, Hill PL, Denson N, Bronkema R. Keep on truckin'or stay the course? Exploring grit dimensions as differential predictors of educational achievement, satisfaction, and intentions. Soc Psychol Personal Sci 2015;6:639-645.
Duckworth AL, Quinn PD. Development and validation of the short grit scale (grit-s). J Pers Assess 2009;91:166-74.
United States Medical Licensing Exam. Available from: http//www.usmle.org
. [Last accessed on 2016 Sep 27].
Steele-Johnson D, Leas K. Importance of race, gender, and personality in predicting academic performance. J Appl Soc Psychol 2013;43:1736-44.
Burkhart RA, Tholey RM, Guinto D, Yeo CJ, Chojnacki KA. Grit: A marker of residents at risk for attrition? Surgery 2014;155:1014-22.
Salles A, Cohen GL, Mueller CM. The relationship between grit and resident well-being. Am J Surg 2014;207:251-4.
FACTS: Applicants, Matriculants, Enrollment, Graduates, MD/PhD, and Residency Applicants Data; 2014. Available from: https://www.aamc.org/data/facts/
. [Last accessed on 2015 Mar 18].
[Table 1], [Table 2]