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• W3154339998 abstract "The year before starting medical school, I worked in the vascular surgery laboratory at the University of North Carolina at Chapel Hill. The laboratory was under the direction of Dr George Johnson, Jr, the 11th President of the Southern Association for Vascular Surgery (SAVS). Bauer Sumpio, MD, PhD, and a SAVS member, was the vascular surgery fellow and was directly responsible for hiring me. I am grateful to Bauer to this day for teaching me the joy of being a surgeon scientist. I was also influenced by Drs Willis Wagner, Fuad Ramadan, and Albert J. Banes during this critical and nascent period of my learning what constitutes a surgeon scientist. As a direct result of my work in the vascular surgery laboratory, I received a podium talk at the 13th annual meeting of the SAVS. I vividly remember a few items from that meeting. First, I was allowed to leave my second-year medical school pathology block in January and fly to Key West, Florida. It was warm and, therefore, I explored much of Key West, including Hemingway's house with all the cats with syndactyly. Second, I performed my first oral presentation. I remember my discussant was Dr Joseph P. Archie, Jr, the 24th President of the SAVS. Although I was justifiably nervous, Dr Archie was gentle with his questions, even though he had a reputation as a tough discussant. I came away from my first SAVS meeting knowing that I wanted to be a vascular surgeon, but also proud that I was from the South, where many prominent vascular surgeons have originated. Thanks to the many members of the SAVS who have served as mentors and friends. The list of close personal friends, mentors, and confidants in the SAVS I have is too long to list; however, I need to acknowledge Drs Ali AbuRahma, Sam Money, Bruce Perler, Tom Huber, Chip Sternbergh, Spence Taylor, Rick Endean, Julie Freischlag, and Will Jordan. Growing up in a small town in North Carolina, there really was not much to do except for play sports, join the Scouts, go to church, and try to do well enough in school to “get out” of the small town. This is not a knock against small towns, because they have likely afforded a biologic protection during the COVID-19 (coronavirus disease 2019) pandemic. Perhaps we all should be dispersing to small towns! One of the many joys of growing up in a small town in the 1960s and 1970s was going to summertime matinees at the Rockingham Movie Theatre. Better known as the “Rock,” this family-owned business was a massive single-screen theater the likes of which no longer exist. There were double seats at the end of every other row where you could sit snugly with your girlfriend, the floor was so sticky from all the spilled soda you could barely walk to your seat, and the bathrooms, which were upstairs and remote, were scary! One of the classics that we saw at the “Rock” was “True Grit,” John Wayne's 1969 Oscar-winning performance in which he played a bigger-than-life, whiskey drinking, U.S. Marshall with a patch over his left eye.1WikipediaTrue Grit (1969 film).https://en.wikipedia.org/wiki/True_Grit_(1969_film)Date accessed: November 16, 2020Google Scholar Growing up in the 1960s, I am sure many of us thought our own Dads were like John Wayne. My Dad, Rivers, was 6 ft 3 in. and somewhat reminded me of John Wayne, bigger than life with a swagger. “True Grit” is also the story of a young woman named Mattie Ross, played by Kim Darby, who loses her father when he gets killed by the outlaw Tom Chaney. Determined to see him hang, she discovers that Tom has fled to Indian Territory, where only a U.S. Marshall can get him. A Marshall who has true grit is required to vanquish, not only Chaney, but also his group of notorious bandits, played by Robert Duvall and Dennis Hopper. Mattie finds the toughest Marshall in the West, the one-eyed Reuben J. Rooster Cogburn, and hires him to go after the bad guys. Rooster soon pairs with a young Texas sheriff named La Boeuf, played by Glen Campbell, who also is looking for Chaney. In what I consider the best movie scene ever, Mattie and La Boeuf witness the final shootout from a distance between the four bad guys on one side and Rooster by himself on the other side. The exchange between John Wayne and Robert Duvall is a classic. Cogburn begins by warning the four bad guys to “stand clear, and you won't get hurt.” Robert Duvall then asks, “What's your intention? You think one on four is fair?” Rooster yells back across the meadow, “I mean to kill you in 1 minute Ned, or see you hanged in Fort Smith at Judge Parker's convenience.” Duvall in response says that “seems like bold talk for a one-eyed fat man.” Then, with complete conviction and a little foul language, Rooster charges the four bad guys with guns blazing. Viewing all this from afar, Mattie Ross says in shear excitement, “No grit. Rooster Cogburn, not much.” So what about this narrative reminds me of almost every vascular surgeon I know? Well, in addition to the occasional bad language and whiskey drinking, vascular surgeons take on patients when the odds of success are stacked against themselves on a daily basis. For example, when attempting to repair a ruptured thoracoabdominal aortic aneurysm in the setting of multiple comorbidities, does it seem like you are taking on four bad guys at once? We, that is, vascular surgeons, arm ourselves with a local therapy to treat a systemic disease! We take on the most difficult operations even when patients are still performing self-injurious practices, such as cigarette smoking. Armed with a scalpel, some wires, some grafts or stents, we are willing to show “True Grit,” and, against all odds, take on diseases that have no true cure! Surgeons in other specialties resist or lament contentions that many cancer resections are palliative, although many surgical diseases have high rates of recidivism. As vascular surgeons, we rage on against vascular disease no matter the odds. We stand at the ready for our patients no matter the etiology of the disease or how inevitable a poor outcome might be. In part of my preparation for this address, I watched a number of Dr Angela Duckworth's video talks as she is widely credited with defining and studying grit. Although I run the risk of exposing my own implicit biases, Dr Duckworth, through her TED (technology, entertainment, design) talks,2Duckworth A.L. TED talk. Grit: the power of passion and perseverance.https://www.ted.com/talks/angela_lee_duckworth_grit_the_power_of_passion_and_perseverance?language=enDate accessed: November 16, 2020Google Scholar, 3Duckworth A.L. TED talk. True grit: can perseverance be taught?.https://www.youtube.com/watch?v=qaeFnxSfSC4Date accessed: November 16, 2020Google Scholar, 4Duckworth A.L. Talks at Google.https://www.youtube.com/watch?v=W-ONEAcBeTkDate accessed: November 16, 2020Google Scholar, 5Fessler L. Quartz at work: the nitty gritty. “You’re no genius”: her father’s shutdowns made Angela Duckworth a world expert on grit.https://qz.com/work/1233940/angela-duckworth-explains-grit-is-the-key-to-success-and-self-confidenceDate accessed: November 16, 2020Google Scholar redirected my thoughts about which movie character had demonstrated true grit in the movie by the same name. Although Rooster Cogburn is often credited as showing true grit because he did the job he was paid to do, is he really the “grit” defining character in the movie? The answer is a resounding no. Dr Duckworth suggests that Mattie Ross, the orphan who hires the Marshall to go into Indian territory and then goes with him, is actually the character demonstrating grit. Mattie remains focused on the long-term gain of avenging her own father's death at great peril to her own life. She stays on task and has a sustained passion to avenge her father's murder. She has the greater purpose. Although much of this address was penned during the March and April throes of COVID-19 and preceding the #med-bikini event in vascular surgery,6Shapiro N. Viral #MedBikini response to controversial manuscript leads editor to retract article.https://www.forbes.com/sites/ninashapiro/2020/07/25/viral-medbikini-response-to-controversial-manuscript-leads-editor-to-retract-article/?sh=3af66321f47dDate accessed: November 16, 2020Google Scholar I could not let this Presidential opportunity go by without highlighting three female vascular surgeons who, much like Mattie Ross, have persevered through different career paths to be world famous and outstanding vascular surgeons. They have, through the experience of becoming a vascular surgeon, redefined true grit for me. I intentionally chose three women from different parts of my life who represent a mentor, a contemporary, and someone who I have mentored. These three women represent a cross-section of the many women who have inspired me. They were kind enough to share their personal stories with me on how grit was critical to their success. When I went to medical school in 1976, 42% of the class were women at [an] average age of 27 years. At that time, only 10% of medical students nationally were women. Norma Wagoner, PhD, was the admissions dean and she made it happen at Rush. The increased number of women gave us all a feeling of belonging. Probably one of the reasons that I loved surgery, which I did first to get it out of the way as I wanted to be a pediatrician, was that my intern was Roseanne Krinski. For me, this seemed normal. When I interviewed for surgery residency, I was the only woman interviewing at most every place I went. UCLA had a woman chief resident, Marjorie Fine, so it looked feasible. As an intern at UCLA, there were only three women interns, one went into plastics and one went into anesthesia. They called us by each other's names, many times I was Debbie or Barb. If I was doing something good, I corrected them. If I wasn't, I did not! I was the only woman faculty member at my first job at UCSD and my second job at UCLA. I was one of two women faculty members at my third job. I was the only woman division chief in the country when I went back to be division chief at UCLA. I was the fourth woman to be a department chair of surgery in the country, when I took the job at Hopkins. I was the first woman president of the Association of VA Surgeons, Society for Vascular Surgery, and the Society of Surgical Chairs.Learning to speak out, despite being the only female in the room, was an art I learned early. Expressing that other opinion in a way that others would listen was my super power. I once asked Haile Debas if he thought people asked him to interview because he was black and if so what did he do about it? Haile was one of my faculty members at the West LA VA when I was an intern and resident at UCLA. He said probably yes, but always accept and say something brilliant, so that the next time they ask you, they remember that you were brilliant and they ask you because of that! So, despite who is around you, I have learned to speak up and be as brilliant as I can be. My story suggests that I strengthened my grit as the numbers of female (vascular) surgeons increased! The characteristic to which I most attribute my success as a vascular surgeon is grit. I was determined to be a surgeon from the age of 5, and was told early and often that I could or should not pursue surgery. As a child in the early ’70s, all of the surgeons on TV (and nearly all in real life) were men, and, honestly, a woman as a surgeon was not socially acknowledged. I was oblivious to that, and could never understand why, when I told people I was going to be a surgeon they would reply, “You mean a nurse.” As a medical student, a fellow male medical student told me out loud, in public, and in all seriousness, that women couldn't be surgeons. During training I was treated to all sorts of what would now be called (and frankly was then) inappropriate behavior. As a young attending, I was told after a particularly difficult thoracoabdominal aneurysm patient died that perhaps I shouldn't be doing those “difficult” cases. I've gotten the verbal “pat on the head” more times than I can remember. My patients frequently call me by my first name without invitation, and I am asked on nearly a weekly basis if I am going to be doing the surgery as I consent patients. It takes grit and determination to experience these things and continue to fully believe that I am meant to be a surgeon, and that I am a good one.These experiences are not things I think about much, and I certainly don't dwell on them. I don't waste my time and energy getting angry; I don't have enough of either. I simply answer each situation as best I can, and calmly get on with my career. I think that is the secret to success. Don't allow these things to distract you from your goal. Just keep going. Frankly, I'd love to meet that fourth year medical student who told me I couldn't be a surgeon now. I moved a lot, every 9 to 24 months, growing up due to my father's profession/career advancement. This was hard. My parents divorced as I was entering high school, which was also hard. I was consistently the tall, awkward new kid; therefore, I was bullied and didn't have a ton of friends. That was isolating. Much of my family can be described as hard-working blue collar people. My father has been professionally, profoundly successful and now serves as president of a major company. That said, he comes from very humble beginnings and was committed to making a “bigger life” for his family for more opportunity. He served in the Navy, and my grandfather served in the Army. I'm really proud of them and I credit my own work ethic and grit to my father's influence. I have constant gratitude (and guilt) for my opportunity/privilege in this regard (this is clarified with each deployment). I always knew I wanted to serve. I commissioned in the United States Army Reserve as an intern—I had my son the year I graduated fellowship, went to officer basic training the following year, my first deployment was in 2015 (and they've been every 2 years like clockwork since). The first was forward, the next will be far forward. I've learned a lot in the Army and a lot about myself. I've learned how to be stronger and have gained a lot of self-confidence by successfully overcoming challenges that would have wiped “the old me out.” I am grateful for these experiences. I'm also not immune to micro- and macro-aggressions (and other frank mistreatment), and while I chose to focus my energy on things that I have control over, I would be remiss to suggest these latter events weren't formative for me.I try very hard to focus on optimism and gratitude (hunt the good stuff). I do best with a regimented schedule. I tend to be conflict avoidant (when it comes to personal matters), unless a “vulnerable” has been wronged, at which time I have no problem advocating for justice. Finally, I am trying to listen actively more, and learn, and help where I can by maintaining my focus on people. All three of these personal vignettes define grit. They were shared with me by friends who agreed to have their stories told, centering primarily on personality traits, including grit, that allowed them to attain success. Their stories are inspiring for sure but are likely similar to the stories many female and male vascular surgeons can tell. What did I learn from these three amazing vascular surgeon's vignettes? Namely, we all have a story to tell and it is rarely easy. Although clearly some have experienced more difficulties than have others because of gender, racial, environmental, and/or privilege barriers, once we are vascular surgeons, we are obligated to pay it forward. For the success of the specialty, we are obligated to learn how to make it better for our trainees and future vascular surgeons. The questions I wanted to ask and at least partially answer in this address are: (1) who does grit (or a lack of it) affect in vascular surgery, (2) are our patients or the disease processes we treat affected by grit, and, finally, (3) do vascular surgeons need grit to be successful? Little has been written specifically about grit and vascular surgery. However, if you do not believe grit is important in vascular surgery, I would ask you to think about what happens when we lose a patient in the operating room, despite performing admirably with excellent technique and judgment. What prepares us for this awful situation, and, more importantly, how do we cope with it? Academic failures, such as not receiving a promotion, or failure to sustain oneself in the private practice setting, can also lead to debility and attrition. Believing that grit is critical in vascular surgery, one should ask: are we equipped with the right personality traits and emotional tools to confront bad outcomes and burnout? If not, can we teach or learn grit in vascular surgery? To better understand the role grit plays in vascular surgery, we first must define it. A lot has been written about grit in social and behavioral science, but literally nothing has been written about grit and vascular surgery (a literature search I performed in October 2020). Drs Dawn Coleman, Mal Shehan, Sam Money, and others, on the Society for Vascular Surgery well-being task force are on a quest to combat burnout and prioritize well-being. Dr Coleman has written specifically about resilience, a component of grit, in vascular surgery trainees.7Audo C.O. Coleman D.M. Prioritizing personal well-being during vascular surgery training.Semin Vasc Surg. 2019; 32: 23-26Crossref PubMed Scopus (3) Google Scholar So what is grit? Webster's Dictionary defines grit as “unyielding courage in the face of hardship or danger.”8Pulos N. Shin A.Y. What is surgical grit?.Tech Hand Up Extrem Surg. 2017; 21: 29Crossref PubMed Scopus (1) Google Scholar Grit as a personality trait has been best defined by Dr Angela Duckworth, who has dedicated her career to defining, studying, and teaching grit. Starting in 2007, after working for a prominent consulting firm, teaching in the public schools, and winning a MacArthur Award, Dr Duckworth returned to graduate school to better understand grit.9Samora J.B. Ficke J.R. Mehta S. Weber K. True grit in leadership: 2018 AOA critical issues symposium addressing grit, sex inequality, and underrepresented minorities in orthopaedics.J Bone Joint Surg. 2019; 101: e45Crossref PubMed Scopus (6) Google Scholar,10Duckworth A.L. Peterson C. Matthews M.D. Kelly D.R. Grit: perseverance and passion for long-term goals.J Pers Soc Psychol. 2007; 92: 1087-1101Crossref PubMed Scopus (2446) Google Scholar She defines grit as a “perseverance and passion for long-term goals.”10Duckworth A.L. Peterson C. Matthews M.D. Kelly D.R. Grit: perseverance and passion for long-term goals.J Pers Soc Psychol. 2007; 92: 1087-1101Crossref PubMed Scopus (2446) Google Scholar She originally described grit as “guts, resilience, initiative, and tenacity.” Dr Duckworth has studied grit in multiple areas (eg, athletics, education, military training, science, business) as a personality characteristic that allows people to persevere despite adversity11Duckworth A. Grit: the power of passion and perseverance.1st ed. Scribner, New York, NY2016Google Scholar (Table I).11Duckworth A. Grit: the power of passion and perseverance.1st ed. Scribner, New York, NY2016Google Scholar, 12Duckworth A.L. Quinn P.D. Development and validation of the short grit scale (Grit-S).J Pers Assess. 2009; 91: 166-174Crossref PubMed Scopus (1215) Google Scholar, 13Isenberg G. Brown A.M. DeSantis J. Veloski J. Hojat M. The relationship between grit and selective personality measures in medical students.Int J Med Educ. 2020; 11: 25-30Crossref PubMed Scopus (6) Google Scholar, 14Vela J.C. Lu M.T.P. Lenz A.S. Hinojosa K. Positive psychology and familial factors as predictors of Latina/o students’ psychological grit.Hisp J Behav Sci. 2015; 37: 287-303Crossref Scopus (37) Google Scholar, 15Hill P.L. Burrow A.L. Bronk K.C. Persevering with positivity and purpose: an examination of purpose commitment and positive affect as predictors of grit.J Happiness Stud. 2016; 17: 257-269Crossref Scopus (105) Google Scholar, 16Muenks K. Wigfield A. Yang J.S. O’Neal C.R. How true is grit? Assessing its relations to high school and college students’ personality characteristics, self-regulation, engagement, and achievement.J Educ Psychol. 2017; 109: 599-620Crossref Scopus (158) Google Scholar, 17Halliday L. Walker A. Vig S. Hines J. Brecknell J. Grit and burnout in UK doctors: a cross-sectional study across specialties and states of training.Postgrad Med J. 2017; 93: 389-394Crossref PubMed Scopus (59) Google Scholar In an era in which we have been inundated with articles about burnout, workforce shortages, and implicit bias, in a recent scoping review written by a young faculty member at the University of Florida, Loftus et al18Loftus T.J. Filiberto A. Rosenthal M.D. Arnaoutakis G. Sarosi Jr., G. Dimick J.B. et al.Performance advantages for grit and optimism.Am J Surg. 2020; 220: 10-18Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar suggested that building and strengthening our own grit and optimism can serve as a method to prevent burnout and also actively improve performance. I set out to explore whether we can learn from the social and natural sciences to cultivate grit to improve performance and diminish burnout in vascular surgery.Table IPersonality characteristics associated with increased grit1. Agile2. Adaptable3. Conscientious4. Committed5. Empathetic6. Engaged7. Growth oriented8. Intense9. Initiator10. Mentally tough11. Optimistic12. Purposeful13. Resilient14. Self-control15. Self-esteem16. Self-regulation17. SocialData from Duckworth et al,10Duckworth A.L. Peterson C. Matthews M.D. Kelly D.R. Grit: perseverance and passion for long-term goals.J Pers Soc Psychol. 2007; 92: 1087-1101Crossref PubMed Scopus (2446) Google Scholar, 11Duckworth A. Grit: the power of passion and perseverance.1st ed. Scribner, New York, NY2016Google Scholar, 12Duckworth A.L. Quinn P.D. Development and validation of the short grit scale (Grit-S).J Pers Assess. 2009; 91: 166-174Crossref PubMed Scopus (1215) Google Scholar Isenberg et al,13Isenberg G. Brown A.M. DeSantis J. Veloski J. Hojat M. The relationship between grit and selective personality measures in medical students.Int J Med Educ. 2020; 11: 25-30Crossref PubMed Scopus (6) Google Scholar Vela et al,14Vela J.C. Lu M.T.P. Lenz A.S. Hinojosa K. Positive psychology and familial factors as predictors of Latina/o students’ psychological grit.Hisp J Behav Sci. 2015; 37: 287-303Crossref Scopus (37) Google Scholar Hill et al,15Hill P.L. Burrow A.L. Bronk K.C. Persevering with positivity and purpose: an examination of purpose commitment and positive affect as predictors of grit.J Happiness Stud. 2016; 17: 257-269Crossref Scopus (105) Google Scholar Muenks et al,16Muenks K. Wigfield A. Yang J.S. O’Neal C.R. How true is grit? Assessing its relations to high school and college students’ personality characteristics, self-regulation, engagement, and achievement.J Educ Psychol. 2017; 109: 599-620Crossref Scopus (158) Google Scholar and Halliday et al.17Halliday L. Walker A. Vig S. Hines J. Brecknell J. Grit and burnout in UK doctors: a cross-sectional study across specialties and states of training.Postgrad Med J. 2017; 93: 389-394Crossref PubMed Scopus (59) Google Scholar Open table in a new tab Data from Duckworth et al,10Duckworth A.L. Peterson C. Matthews M.D. Kelly D.R. Grit: perseverance and passion for long-term goals.J Pers Soc Psychol. 2007; 92: 1087-1101Crossref PubMed Scopus (2446) Google Scholar, 11Duckworth A. Grit: the power of passion and perseverance.1st ed. Scribner, New York, NY2016Google Scholar, 12Duckworth A.L. Quinn P.D. Development and validation of the short grit scale (Grit-S).J Pers Assess. 2009; 91: 166-174Crossref PubMed Scopus (1215) Google Scholar Isenberg et al,13Isenberg G. Brown A.M. DeSantis J. Veloski J. Hojat M. The relationship between grit and selective personality measures in medical students.Int J Med Educ. 2020; 11: 25-30Crossref PubMed Scopus (6) Google Scholar Vela et al,14Vela J.C. Lu M.T.P. Lenz A.S. Hinojosa K. Positive psychology and familial factors as predictors of Latina/o students’ psychological grit.Hisp J Behav Sci. 2015; 37: 287-303Crossref Scopus (37) Google Scholar Hill et al,15Hill P.L. Burrow A.L. Bronk K.C. Persevering with positivity and purpose: an examination of purpose commitment and positive affect as predictors of grit.J Happiness Stud. 2016; 17: 257-269Crossref Scopus (105) Google Scholar Muenks et al,16Muenks K. Wigfield A. Yang J.S. O’Neal C.R. How true is grit? Assessing its relations to high school and college students’ personality characteristics, self-regulation, engagement, and achievement.J Educ Psychol. 2017; 109: 599-620Crossref Scopus (158) Google Scholar and Halliday et al.17Halliday L. Walker A. Vig S. Hines J. Brecknell J. Grit and burnout in UK doctors: a cross-sectional study across specialties and states of training.Postgrad Med J. 2017; 93: 389-394Crossref PubMed Scopus (59) Google Scholar The medical literature has suggested that trainees, in particular, are especially susceptible to early attrition after stress. The inability to appropriately respond to stress occurs during medical school as students shift from the preclinical to clinical phases. During this critical early transition period, third-year medical students experience an erosion in empathy as they become more involved in direct patient care activities.19Hojat M. Vergare M.J. Maxwell K. Brainard G. Herrine S.K. Isenberg G. et al.The devil is in the third year: a longitudinal study of erosion of empathy in medical school.Acad Med. 2009; 84: 1182-1191Crossref PubMed Scopus (871) Google Scholar This continues into residency, with as many as 18% of residents quitting general surgery residency after a stressful event.20Khoushhal Z. Hussain M.A. Greco E. Mamadi M. Verma S. Rostein O. et al.Prevalence and causes of attrition among surgical residents: a systematic review and meta-analysis.JAMA Surg. 2017; 152: 265-267Crossref PubMed Scopus (132) Google Scholar Two studies linking increased attrition with low grit scores in surgery residency suggest that we, in vascular surgery, who now have primary residency programs, must learn how to both test for—but more importantly—teach grit to combat the high attrition rates among trainees. Focusing on improving trainees' grit levels will also lead to greater well-being and lower rates of depression and burnout.21Salles A. Lin D. Liebert C. Esquivel M. Lau J.N. Greco R.S. et al.Grit as a predictor of risk of attrition in surgical residency.Am J Surg. 2017; 213: 288-291Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar,22Salles A. Cohen G.L. Mueller C.M. The relationship between grit and resident well-being.Am J Surg. 2014; 207: 251-254Abstract Full Text Full Text PDF PubMed Scopus (147) Google Scholar Isenberg et al13Isenberg G. Brown A.M. DeSantis J. Veloski J. Hojat M. The relationship between grit and selective personality measures in medical students.Int J Med Educ. 2020; 11: 25-30Crossref PubMed Scopus (6) Google Scholar examined 241 medical students and documented that students with higher grit scores were more likely to be empathetic and have greater self-esteem. In addition, those students with higher grit scores displayed lower levels of aggression and hostility and were less impulsive.13Isenberg G. Brown A.M. DeSantis J. Veloski J. Hojat M. The relationship between grit and selective personality measures in medical students.Int J Med Educ. 2020; 11: 25-30Crossref PubMed Scopus (6) Google Scholar Come on vascular surgeons, even orthopedic surgeons test for grit and attempt to improve grit among their trainees!23Kurian E.B. Desai V.S. Turner N.S. Grawe B.M. Kelly A.M. Krych A.J. et al.Is grit the new fit?—assessing non-cognitive variables in orthopedic surgery trainees.J Surg Educ. 2019; 76: 924-930Crossref PubMed Scopus (10) Google Scholar,24Samora J.B. Ficke J.R. Mehta S. Weber K. True grit in leadership.J Bone Joint Surg Am. 2019; 101: e45Crossref PubMed Scopus (3) Google Scholar Although most of the literature has focused on trainees, data are also available to suggest that attending surgeons will have greater levels of grit than trainees or general practice physicians. In a multicenter sectional questionnaire from the United Kingdom, the investigators characterized the relationship between grit and burnout in attending doctors in an attempt to establish whether differences exist between specialties and trainees.17Halliday L. Walker A. Vig S. Hines J. Brecknell J. Grit and burnout in UK doctors: a cross-sectional study across specialties and states of training.Postgrad Med J. 2017; 93: 389-394Crossref PubMed Scopus (59) Google Scholar The study found a weak negative correlation between grit and burnout in doctors (r = −0.243; P < .001) with consultants (ie, attending surgeons) having higher grit scores, lower burnout scores, lower disengagement, and less exhaustion compared with trainees. These investigators suggested that interventions to improve grit through resilience training should be examined.17Halliday L. Walker A. Vig S. Hines J. Brecknell J. Grit and burnout in UK doctors: a cross-sectional study across specialties and states of training.Postgrad Med J. 2017; 93: 389-394Crossref PubMed Scopus (59) Google Scholar As clinicians, we attempt to understand and improve vascular surgery patient outcomes using multiple, well-defined risk factors known to affect long-term outcomes along the continuum of care. Chronologically, we have divided these known risk factors into preoperative, intraoperative, and postoperative periods. Although most reports have focused on nominal risk factors, such as age, gender, and so forth, f" @default.
• W3154339998 created "2021-04-26" @default.
• W3154339998 creator A5058111361 @default.
• W3154339998 date "2021-05-01" @default.
• W3154339998 modified "2023-10-17" @default.
• W3154339998 title "Grit matters in vascular surgery" @default.
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