Understanding mindset theory in surgical education

This study contains three goals toward understanding mindset theory in surgical education: understanding surgical faculty mindset, understanding surgical resident mindset and its relationship to behavior, and the relationship of mindset and behavior to challenging surgical task performance.

The department of surgery faculty and residents at a single, university-based institution were surveyed. Mindsets were assessed with a modified version of the Implicit Theories of Intelligence Scale. Resident behavior and beliefs were evaluated using a novel series of questions. Junior surgical residents from a single, university-based institution were recruited for the task performance assessment. Task performance was measured by a unique curriculum of nine tasks on the SimNow robotic simulator. Surveys were distributed via Qualtrics. Data were analyzed with STATA.

The faculty survey achieved a response rate of 53% (53/100). 89% of faculty endorsed a growth mindset toward surgical skill. The resident survey achieved a response rate of 38% (46/121). 89% of respondents endorsed beliefs consistent with a growth mindset orientation. 78% of respondents had a behavior score with a growth-mindset orientation. Ordinary least squares regression demonstrated a significant, positive association between resident mindset score and behavior score (β = 0.31, p = 0.001), indicating that as residents more strongly endorsed beliefs consistent with the malleability of surgical skill, they were more likely to self-report actions and behaviors consistent with a growth-mindset orientation.

Sixteen residents participated in the task performance assessment. 100% of the residents endorsed a growth mindset toward surgical skill and 87.5% of residents had a behavior score with a growth-mindset orientation. The behavior score was significantly lower than the mindset score (p < 0.001). Importance of improving surgical skill and level of skill practice after failure (questions 5 and 9) were the most discriminating between participants. The most difficult tasks (8 and 9) were the most discriminating between participants. There was no significant relationship between average total task score and mindset score (p = 0.48). There was a significant, positive relationship between importance of improving surgical skill and task 8 score (p = 0.017, y = 17.7x–2.6) and task 8 score and level of practice after failure (p = 0.05, y = 15.3x + 15.2).

The majority of faculty and residents indicated a growth mindset toward surgical skill. However, there was a discrepancy between the extent of resident growth mindset endorsement and the actual reported behaviors. This suggests that the residents may hold somewhat aspirational beliefs regarding mindset, and that the surgical training environment may require a more specialized mindset assessment tool. We identified a significant, positive relationship between mindset score and self-reported behaviors. We found the most discriminating behavior questions to be related to certain task performance metrics, suggesting that there is a positive relationship between behaviors with a growth-mindset orientation and task performance.