Helping trainees grow by nurturing mindset, motivation, and grit: a developmental framework for medical education

The dual goals of medical training are to ensure that trainees can demonstrate the performance required to move on to the next phase of their training while, at the same time, shaping "non-ability" outcomes that should support lifelong learning and improve performance over time. Yet, the data on performance after completion of training suggests that we are not consistently meeting our second goal. Here, the authors consider non-ability outcomes as a composite of three overlapping attributes: mindset; motivation; and grit, and use the term "growth attributes" to describe this composite outcome. Since learning experiences typically involve at least one teacher, they view the impact of learning experiences on outcomes as a person x person x context (P x P x C) interaction. They review relevant literatures on the impact of growth attributes on future learning and use the P x C x C framework to discuss potential strategies to enhance one or more growth attributes in medical trainees. The authors predict that changes to the learning context that promote educational safety and trainee autonomy should support growth attributes. Similarly, the interaction between trainee and teacher is likely to cultivate growth attributes when the teacher balances support of the trainee with an appropriate level of challenge, provides growth-promoting feedback, and models growth attributes. In addition to potentially improving life-long learning and future clinical performance, growth attributes may bring additional benefits to trainees and physicians in the form of enhanced well-being and reduced risk of burnout. Consequently, growth attributes can be viewed as a surrogate for important long-term outcomes. The authors end by proposing future steps for exploring the role of growth attributes in medical training, starting with a validity evaluation of tools to assess growth attributes followed by studies to evaluate strategies to nurture growth attributes in medical trainees.