Performance advantages for grit and optimism.

BACKGROUND:Unsustainable surgeon burnout rates and moral imperatives for performance improvement suggest an urgent need to understand and apply rationales and methods for cultivating grit and optimism in surgery. DATA SOURCES:Embase, MEDLINE, and PubMed articles. CONCLUSIONS:Passivity in response to negative events is the default human response, but the presence of control activates the prefrontal cortex-the brain region controlling executive function-promoting effort toward solutions. Challenges, failures, and traumatic events perceived as inescapable, permanent, pervasive, and irreparable lead to debility and attrition; grit and optimism shift the human response toward growth, strength, and improved performance. Methods for realizing these advantages include maintaining positivity, pursuing major challenges that match personal skills, engaging in deliberate practice to improve skills, persisting in hard work, and pursuing higher meaning and purpose in work and life. Grit and optimism are difficult to teach; selecting gritty, optimistic surgical residency applicants may also be effective.