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After the Match

After the Match

Grit Will See You Through

Cook, Thomas MD

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doi: 10.1097/01.EEM.0000469326.99883.50

    The smartest person I ever met was my roommate in college. He never went to our physics class, blew off every lab, never studied, drank beer before tests, and still got the highest grade on the final exam. He double-majored at William & Mary in math and economics, but after graduation he ended up laying brick for his father's business, playing rugby, and going hunting with his “fat buddy from Texas.” I did not see him for a few years after college, but he showed up at my door unannounced the day after my mother suddenly died just to make sure I was OK. I loved that guy.

    Despite all his incredible attributes, however, he could not utilize them beyond a narrow scope of life in rural Virginia. My time with him in college was actually his second attempt at a bachelor's degree. He received an academic scholarship out of high school to attend the University of Virginia, but dropped out after a single year.

    All program directors wonder how an applicant will perform during residency but also whether he will be able to sustain himself over several decades practicing emergency medicine. We are showered with applications that contain stratospheric board scores and honor society memberships. We spend months strategizing over how to find the best people for the unique culture of our program, and then we spend weeks talking to anxious young men and women trying to figure out who will succeed and who might be a pain in the ass.

    This process is far from science. It is a bizarre game to find a quality that has no objective measurement. We want to find people who can take on grueling mental, physical, and emotional work caring for some of the most desperate and challenging people in society. Can they MacGyver solutions in the center of chaos and not lose their cool? Can they stay up all night, night after night, suffer from constant sleep disturbances, and not let the inevitable mood swings completely destroy their relationships with family and friends? Can they endure countless failures but realize that failure is not a permanent condition? Do they have the courage to look stupid after spending most of their lives being the smartest person in the room? Do they have grit?

    Angela Lee Duckworth's TED talk on the meaning of grit provides insight into this quality. ( From studying which military cadet at West Point will graduate to which rookie teacher at a tough inner-city grade school will last through his first year, she has found that grit — not IQ, interpersonal skills, or physical attractiveness — allows people to succeed. That mental toughness allows anyone to endure losing battles but to understand that failure is not permanent and go on to win wars. Many would argue that just getting through medical school is a demonstration of grit. But we all know that some of the most talented students in medical school avoid careers that require challenging patient care.

    One of our hospital vice presidents asked me for a favor many years ago. A friend of his had a son applying to our program who did not get an interview. He was a local guy who struggled with C grades during his first two years of medical school and had low USMLE scores. When we met with him, however, we were impressed. The day our selection committee gathered to compose our rank list for the next class, a guy from FedEx was waiting for us. He delivered an envelope to every single person in the room. Inside we all found the same thing: a letter from this applicant telling us he “really, really, really wanted” to train at our program.

    Three years later, he won every award we present to our graduating residents. After an extended tour in Iraq with the 10th Mountain Division from Fort Drum, NY, he settled into an idyllic life with his family in Charleston, SC. I love that guy, too.

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