Medical training with a “fixed” mindset: What could go wrong?

Who knew that your attitude could be such a major determinant in how much you can learn?

The basic idea of the “fixed” vs. “growth” mindset posited by Carol Dweck (great interview with Dr. Dweck here) is that we have a choice in how we perceive learning and intelligence. We can view the ability to learn as a “fixed” trait that you either have or don’t have, and so your ability to succeed in any new skill is based solely on your innate intelligence. Or, we can think of learning any new skill or concept as a process available to anyone who can access good teaching and is willing to work at it.

Based on my experiences during 13 years of medical training (and going…), I am not at all surprised that the original researchers found that children with a “growth” mindset were more likely to seek out challenging courses and projects, even later in life. Conversely, children with a “fixed” mindset were more likely to shy away from difficult coursework, for fear of not being able to pick up the new skill immediately and hence not living up to the expectation of being a “smart kid.”

Now here’s an experiment: I am currently training in a fellowship program run by a program director who is firmly in the “fixed” mindset camp.

Yep.

There are a number of ways that this has come up. Early in the year, he called me into his office to criticize my reports from weeks earlier. It was an odd way to receive feedback; I would have appreciated hearing about my errors at the time, and I happily would have fixed the reports then!

Later in the year, once months had passed and I had received fantastic teaching from the other attendings, he remarked that I was doing very well. He then commented: “Yeah, I never would have known, based on how you were doing in the beginning!”

Essentially, he felt that in the beginning of a year-long fellowship to learn a new skill, with a fairly steep learning curve, that performance in the beginning of the year was an indicator of our overall fixed “ability” to perform in this specialty. The rest of the attendings, on the other hand, seemed to understand that we all came in knowing next-to-nothing, and needed to work through hundreds of cases and receive teaching.

At one point, he actually spelled out his views on the universal truth of the “fixed” mindset. As with any other residency or fellowship, we take a yearly “in-training exam,” which is meant to identify topics in which our knowledge base is weak. It’s meant to guide our studying…not to judge our ability as physicians. So, Mansplaining Program Director (can you believe this is really all the same guy..ugh) remarked that I had done well on our annual in-training exam this year, but “I would expect for you to do even better, like greater than the 90th percentile! I mean, you have a PhD, so you’re smart!”

Sigh. I explained that my PhD research has absolutely no overlap whatsoever with the skills and procedures that we are performing in this fellowship. My ability to design experiments and write papers is a completely different skillset from what I’ve learned this year.

He wasn’t having it: “Nope! If you’re intelligent, you’re intelligent!”

There’s no reasoning with a “fixed” ability believer, I suppose.

It gets worse, though. He makes decisions on which residents to recruit based on their performance in various random grilling sessions during the beginning of their residency. He will pimp* them on various topics (not even related to our subspecialty), I’m guessing with his usual condescending tone, and so if they freeze up and get an answer wrong, he will see to it that this resident does not match with us for fellowship.

The consequence? In what he believes to be a random, unrelated stroke of bad luck, we had 3 fellowship spots go unfilled for next year.

Let that sink in. I will be taking extra call next year because of his woefully obstinate belief in the “fixed” mindset.

We need a consult from Dr. Dweck, STAT!!

Defiant Bitch, MD

* “Pimping” is a term used in medicine to refer to when attendings present questions to trainees (medical students, residents or fellows), and progressively ask harder/more obscure questions until the trainee doesn’t know the answer [or cries]. It can be done in a perfectly professional, friendly manner, but it is famous for being performed with a very aggressive and condescending tone.

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