Qualitative identification of mindset in general surgery trainees and faculty in the United States

Growth mindset, the viewpoint that ability and intellect are dynamic and can be improved upon with dedication and feedback, has been associated with increased resiliency and academic success. Prior research suggests that many surgeons have a fixed mindset, viewing personal attributes as static entities. There is a paucity of literature exploring how mindset is perceived and/or applied in a surgery-specific context. This study sought to identify mindset characteristics of surgical trainees and faculty at general surgery residency programs in the United States. As part of the SECOND Trial, semi-structured interviews about wellness were conducted with surgical faculty, residents, and staff. Programs were selected based on their performance on the SECOND Trial survey (e.g., exemplary wellness scores), notable wellness initiatives identified on the SECOND Trial Program Director survey, and/or identification by wellness experts. Transcripts were coded deductively using the SECOND Trial conceptual model. Transcripts that had been coded with the Individual Mediating Factors domain, which focuses on individual residents’ skills in dealing with difficult situations, were selected for further deductive coding, applying fixed and growth mindset frameworks. Coding was performed by dyads with differences in coding discussed until consensus was reached. After the transcripts were coded, narrative data were deconstructed and thematic analysis was performed inductively identifying wider emergent themes and subthemes. 393 interviews and focus groups were conducted at 15 general surgery residency programs. 201 transcripts were coded for Individual Mediating Factors. In 35 of these transcripts, examples of mindset were identified through additional coding and reconciliation. Sub-themes from fixed mindset data include: perfection or bust, sabotage for success, old habits die hard, and hiding from emotion. In growth mindset, the following sub-themes emerged: opportunity from failure, lifelong learning, and flexibility and open-mindedness. Additionally, broader sub-themes on mindset fluidity were identified: the ability to shift mindset and how the departmental environment plays a critical role in cultivating mindset. Surgeons provided examples demonstrating how fixed and growth mindset characteristics appear in surgical training programs. Growth mindset themes described a positive educational and working environment, while fixed mindset often hindered performance and camaraderie. Benefits to individuals and programs were noted when mindset shifts (from fixed to growth) occurred. Thus, teaching growth mindset may improve professional development, learning opportunities, and workplace collegiality. Department of surgery leaders have an opportunity to facilitate environments that support and propagate growth mindset.