Surgery requires the ability to perform under pressure and recover from setbacks.  Mental toughness is a construct that helps individuals deal with such stressful situations.  It is well established in sports psychology; however, there is a paucity of studies measuring mental toughness in surgeons.  The purpose of this study was to quantify mental toughness in surgical residents and staff. 

The Mental Toughness Index (MTI) is a validated tool to measure eight facets of mental toughness. A survey containing the MTI was distributed among general surgery residents and staff.  Responses were recorded using a 7-point Likert scale standardized to a percentage of positive (0% for Likert 1, 100% for Likert 7).

There were 83 participants (56 residents, 27 staff) from three Canadian academic institutions.  Average age of residents and staff was 29±5 and 42±8 respectively.  Residents had a significantly lower percentage positive in all facets of mental toughness: self-belief (83.4% vs. 91.5%, p<0.001), attention regulation (78.1% vs. 89.5% p<0.001), emotion regulation (71.9% vs. 87.8% p<0.01), success mindset (87.2% vs. 94.2% p<0.001), context knowledge (75.0% vs. 88.9%, p<0.001), buoyancy (79.5% vs. 90.5%, p<0.001), optimism (77.0% vs. 86.8%, p<0.01) and capacity to deal with adversity (76.8% vs. 84.7%, p<0.05). 36% of residents and 56% of staff reported using specific techniques to deal with stressful situations, the most common being deep breathing, visualization and organization.  87% of residents and 63% of staff were interested in developing additional techniques for mental toughness.

To our knowledge, this is the first study to quantify and compare mental toughness between residents and staff general surgeons.  Residents scored lower in all measured facets of mental toughness than staff.  Both groups expressed a desire to further develop mental toughness. Furthermore, participants identified specific techniques may be useful in developing mental toughness.  Additional research is required to assess the effectiveness of these techniques.

Mental Toughness in Surgeons: How do we measure up?