Balancing Grit and Quit: Strategies to Prevent Burnout in Medical Students

Burnout among medical students and healthcare workers has reached alarming levels (Frajerman et al. 2019; Tan et al. 2022). Characterized by emotional exhaustion, cynicism, and reduced personal accomplishment, burnout not only jeopardizes students' mental health but also impairs academic performance and patient care (Dyrbye et al. 2019; Ilic et al. 2024). As the demands of medical education continue to intensify, effective strategies such as exercise and sleeping hygiene need to be explored to counter the risk of burnout (Boyd et al. 2023). This editorial examines the interplay between two seemingly opposing approaches, namely grit and quit. It proposes a nuanced framework for fostering student well-being and success.

Grit, defined as passion and perseverance for long-term goals (Duckworth et al. 2007), has been widely touted as a predictor of success in various domains including medicine and surgery (Huo et al. 2022; Miller-Matero et al. 2018; Ursua et al. 2021). Gritty individuals demonstrate resilience, maintain focus in the face of setbacks, and work persistently towards their objectives (Fillmore 2015). A longitudinal study showed that grit protects medical students from burnout (Jumat et al. 2020). However, an overemphasis on grit can lead to the “fallacy of sunk costs”, where students persist in unproductive or detrimental pursuits, neglecting their well-being (Arkes and Blumer 1985; Isenberg et al. 2020).

Conversely, strategic quitting entails disengagement from commitments that no longer align with one's goals or values (Wrosch et al. 2003). It requires self-awareness, prudent decision-making, and the courage to let go of burdensome obligations (Banatvala and Doyal 1998). While quitting often carries negative connotations, research suggests that the ability to abandon unattainable goals is associated with better psychological adjustment and physical health (Wrosch et al. 2003). As Morgan (2021) puts it, “Less grit more quit” has its benefits (Morgan 2021). The following Table 1 summarizes selected references that reveal how grit and quit could prevent burnout.

References results of research Grit to avoid burnout Quit to avoid burnout (Ursua et al. 2021) Grit matters. Efforts count twice in one's achievement X (Wiskin et al. 2018). To grit or not beyond context? There will be times when students need to say “No” X (Harolds 2021). A toxic learning environment could contribute to burnout. NA NA (Boyd et al. 2023). Stress could induce burnout. Self-care measures such as exercise and sleep hygiene are needed. NA NA (Blanchard et al. 2021). Emotional intelligence matters in preventing burnout. NA NA (Isenberg et al. 2020). The grit scale could be related to personality measures (e.g., empathy) X NA (Brateanu et al. 2020; Miller-Matero et al. 2018). Grit helps medical students' performance. X NA (Huo et al. 2022). Grit helps surgical residents avoid burnout. X NA (Abd Elwahab et al. 2022; Lee et al. 2023). Increasing grit levels is needed for different specialties and work grades to avoid burnout X NA.

To prevent burnout effectively, medical students must learn to navigate the delicate balance between grit and quit. This requires them to assess their goals, motivations, and stressors regularly, and to make informed decisions about when to persist and when to disengage. For example, a student juggling competing demands from clinical rotations, co-curricular activities, and personal obligations can show grit and strive to persevere by optimizing their time management and seeking support. Recognizing early signs of becoming overwhelmed and proactively seeking help, while selectively choosing what to continue and what to step away from, can be prudent. Strategic quitting involves making deliberate choices to prioritize well-being and prevent burnout. By following this strategy, students can allocate their energy and focus to the most meaningful and productive endeavors, potentially leading to improved quality of effort and outcomes. This approach ultimately fosters the resilience needed for long-term success in medicine.

Getting the balance right requires not only individual effort but also institutional support. Medical schools must foster a culture that values student well-being, provides accessible mental health resources, and offers mentorship to guide students in navigating challenges. Educators should incorporate teachings on resilience, self-care, and adaptive goal setting into the curriculum. Furthermore, policies that allow for flexible training pathways and accommodations for needs can empower students to make healthy decisions without fear of stigma or penalty. Lastly, different specialties, sexes, and job grades appear to need/show more grit than quit (Abd Elwahab et al. 2022; Lee et al. 2023). In summary, more literature suggested that grit could prevail over quitting than vice versa in preventing burnout. Nonetheless, we still believe that preventing burnout among medical students necessitates a multi-faceted approach encompassing emotional intelligence (Blanchard et al. 2021), personal resilience, adaptability, and institutional support.

Practical tips for Medical Students (1) Seek mentorship: Connect with mentors who can provide guidance, support, and perspective. (2) Set SMART goals: Specific, Measurable, Attainable, Relevant, and Time-bound. (3) Prioritize self-care: Integrate activities that promote physical and mental health into daily routines (Boyd et al. 2023). (4) Practice mindfulness: Engage in mindfulness practices to enhance self-awareness and stress management. (5) Learn to say “No”: Develop the space to decline additional responsibilities that could lead to overcommitment and burnout (Kalkat 2024). (6) Utilize campus resources: Take advantage of counseling, academic support, and wellness programs offered by the institution.

How Framework should be used (Figure 1).

Proposed framework to bring about cultural change (Figure 2).

Preventing burnout among medical and surgical students necessitates a nuanced approach that balances grit and quit. By equipping students with the skills to persevere through challenges while also knowing when to step back, we can foster resilience and well-being. However, the onus does not rest solely on individual students; medical schools must actively cultivate a supportive environment that prioritizes student welfare. Ultimately, by striking this delicate balance, we can empower future physicians and surgeons to thrive both personally and professionally, ensuring the delivery of compassionate, high-quality patient care.

The authors have no affiliations or financial involvement with any commercial organization with a direct financial interest in the subject or materials discussed in the manuscript.