Embracing the Growth Mindset as a Physician

I have heard Dr. Carol Dweck's book Mindset referenced many times over the past few years. I thought I knew the difference between a fixed mindset and a growth mindset, and I thought I had the latter. But recently, I slowly read the book and it basically blew my mind. Every page now has underlining. I most definitely do not have a growth mindset in many areas. It has been eye opening to discover this, and to learn all the ways in which actively developing a growth mindset can open one up to a fuller, more engaged life.

https://www.barnesandnoble.com/w/mindset-carol-s-dweck/1100167257ean=9780345472328

Definitions of Fixed vs Growth Mindsets

The fixed mindset believes that your qualities are set. It believes each person is given a certain amount of athletic ability, intelligence, personality, character, musical talent, or people skills. People with fixed mindsets have a need to prove repeatedly that they are capable or talented in their designated areas. The fixed mindset is exemplified in these statements: "he's just a natural athlete, he doesn't even have to work at it, she has the ear for music, he has good hands, he's a natural people person, etc." It feels great to be bestowed with these compliments as a child or young adult, and these qualities then become part of one's identity. It is common for people to start pursuing things they are told they are naturally good at. This is what drives many people to become athletes, musicians, or physicians. The downside to being told that you are a "natural" or "just have it in you" or that it "comes easy for you", however, can be a feeling of total devastation when confronted with your first inevitable failure. If your identity is being the smart one, who are you if you get a C in an advanced class? If your identity is that of a natural musician, who are you if you don't get in to a top music school? If you have spent all of your formative years racking up awards in baseball with minimal effort, who are you when you get to college and get repeatedly struck out? The emotional consequences of this reckoning can be devastating. People tend to want to quit as soon as they are not flawless, or it requires an increase in effort beyond what they expected. They question all of their choices, feel like utter failures, never admit they need help, and suffer from significant imposter syndrome.

The growth mindset, on the other hand, believes that your qualities are things you can grow and develop through effort, strategy, and help from others. The growth mindset believes the hand you are dealt in life is only the starting point. People with a growth mindset are optimistic that they have a much larger potential with the help of dedicated effort, sustained interest, training, and coachability. They are not afraid to say they don't know something or to ask for help. They take learning into their own hands, not relying simply on what they perceive was naturally given them. They view setbacks or failures as information and opportunities to adjust or learn. They appear to have a less fragile ego by asking for input, advice, help, and expertise at work, school, and home. They have more freedom to pursue what they truly enjoy. They feel that a good relationship or a good path in life is one where you are challenged to grow. The fixed mindset values outcomes. The growth mindset values the work, regardless of the outcome.

The Fixed Mindset in Medicine

"Nowhere is the anxiety of being dethroned more palpable than in pre-med classes," Dr. Dweck writes on page 60 of Mindset. I can certainly relate to this, and I will even take it a step further. After digesting this book, I believe the field of medicine actually selects for and promotes a fixed mindset. From high school or college on, students, trainees, and physicians are judged on their outcomes - grades, board scores, diagnoses made, revenue generated, number of surgeries performed, patient satisfaction scores. The system selects for good test takers. The sheer volume of work and information makes it laughable to think about deep learning or pursuing what strikes your curiosity. There is always much more to learn, and more patients waiting. Quick judgment is necessary when it comes to medical decision making and patient care. Procedural and surgical specialties want trainees with "good hands," and screening questions in residency interviews often ask about hobbies involving dexterity. The stakes are high and time is scarce, so training a surgical resident who really struggles with dexterity is not ideal.

Training in medicine necessitates certain characteristics. But as we come around the dark side of the moon after training and our early years in medicine, we can start to do things a little differently. We can actively work towards a growth mindset.

The Growth Mindset in Medicine

A growth mindset can help us enjoy our work more as physicians. How can we work towards this? Normalize being human. No one can know everything. Admit when you don't know, and ask for help. Collaborate. Communicate. Get over that one low grade, bad score, or undesirable match. Those were simply setbacks to be used as learning opportunities for growth. Get over the past statements made about your apparent abilities, or lack thereof. I'm guessing that almost every one of us at some point in medical training was made to believe we just didn't naturally have what it takes. Forgive those people and their fixed mindsets. Embrace being a lifelong learner. Involve yourself in one "deep learning" topic per day or week in clinic. Embrace effort and growth. Don't get frustrated with your job and relationships because they challenge you, instead value them for just that very reason. Adjust your clinic or surgical schedule slightly to reflect more of what interests you or sparks your curiosity.

A growth mindset can help us be better teachers. How can we do this? Don't be quick to judge when it comes to a student's, resident's, or employee's initial performance or perceived knowledge. Give them room and encouragement to develop. Actively teach and invest in your people. Praise their growth and improvements. Appreciate their efforts. There are many examples of groups of individuals doing amazing things as an organization, given growth-minded leadership.

A growth mindset can help us be better parents. The three keys to encouraging a growth mindset in children is to 1) Praise the process rather than just the outcome, 2) treat setbacks as opportunities to learn and grow, and 3) focus on deep understanding rather than surface memorization for a test or result. Share, normalize, and encourage discussion of setbacks, frustrations, and failures. Encourage their genuine interests, rather than what you feel they are good at. Value and praise effort. Reward perseverence and determination, not just "natural" ability. Compliment their creative process, hard work, and kind actions rather than their fixed traits (such as being artistic, smart, or good with people).

The examples in Dr. Dweck's book are many and are impressive. She describes a second grade teacher taking children who were considered impossible to teach and having them reading and discussing Shakespeare within the year. She shows the simple artwork of people at the start of a drawing course, and the amazingly advanced artwork of those same people a mere five days later. She describes athletes, musicians, and CEOs in terms of their fixed vs growth mindsets. I would encourage anyone to read this book or listen to her talks, but I think my physician colleagues in particular can greatly benefit from applying this life-altering mindset shift.