Trainee growth vs. fixed mindset in clinical learning environments: enhancing, hindering and goldilocks factors

Doctors in training (trainees) have higher rates of burnout, anxiety and depression than other professionals. An important psychological tool to combat this crisis is promotion of a growth mindset, which increases resilience and improves mental health outcomes. How growth mindset might be promoted within the clinical learning environment is underexplored. This study aimed to explore the factors promoting a growth mindset versus fixed mindset in trainees from the perspective of the trainees.

This constructivist study employed a novel method of encouraging trainees' reflections on mindset adoption in the clinical learning environment. Trainees played Mindset, a tabletop simulation board game that included challenges encountered within training. This was followed by a facilitated debriefing, focusing on factors that promoted growth or fixed mindset adoption in the clinical learning environment. Debriefing transcripts were analysed using template analysis.

Three groups of oncology trainees and one group of medical education fellows participated (16 participants in total). Factors promoting growth mindset adoption included passion, collaboration, diverse career and role modelling. Factors promoting fixed mindset adoption included burnout and competition. Some factors, such as grit, previous success experience and singular training location promoted a fixed mindset when too much or too little were present, and promoted a growth mindset when they were in balance (the Goldilocks principle).

The importance of balance versus excess of certain factors, and the ubiquitous competitive culture in medicine promoting a fixed mindset, were compelling reflections. This study may aid invested parties to reflect on what factors they can upregulate and down regulate to optimise trainees' adoption of a growth mindset.