ABSTRACT
Background
Grit, resilience and a growth mindset are traits that help health professional students respond positively and adapt to the challenges of the clinical learning environment. The aim of this study was to determine if a 5‐week education‐based intervention can enhance grit, resilience and a growth mindset in physiotherapy students on clinical placement.
Methods
In this single group intervention study, physiotherapy students participated in a 5‐week group‐based, online educational intervention for 1 h per week during their first clinical placement. Grit, resilience, mindset type and academic tenacity (a combined measure of these traits) were measured using validated tools pre‐ and post‐intervention. Differences in scores were analysed using Wilcoxon signed‐rank tests.
Results
One hundred and forty‐three students (62% female) completed the intervention, and 70 (64% female) completed measures at both baseline and follow‐up. No changes in outcome measures were seen across the overall participant cohort post‐intervention. However, students with a fixed or undecided mindset at baseline significantly improved mindset type (p = 0.043 and p = 0.035) and those with low academic tenacity at baseline had significantly higher levels following intervention (p = < 0.001).
Conclusion
Tailored interventions that target grit, resilience and a growth mindset hold promise for enhancing growth mindset, academic tenacity and possibly grit in students with low baseline levels of these traits. Further research is needed on how best to match interventions to students' baseline traits, ultimately fostering adaptable health professionals capable of excelling in complex, high‐pressure clinical environments.
1. Introduction
Grit, resilience and a growth mindset are personal traits that assist health professional students to adapt positively to common stressors experienced throughout their studies to optimise success [1, 2]. High levels of grit, resilience and/or possessing a growth mindset are associated with higher academic achievement and positive psychological well‐being in health professional students [3, 4]. Further, preliminary research suggests that resilience can be improved with targeted interventions for health professional students, but which interventions are most effective is not yet clear [5]. It is also not clear if grit and/or mindset type can be fostered with interventions for health professional students [5].
Health professional students are likely to face stressors throughout their education, including academic pressures, family expectations and interpersonal challenges as well as challenges with new experiences associated with clinical learning and managing ill patients. Studies have demonstrated that health professional students have higher rates of distress and sustained stress, causing mental and physical exhaustion compared to their age‐matched peers [6, 7]. Whereas low to moderate stress may enhance learning, excessive stress is thought to impair learning, negatively impacting students' well‐being and academic performance [8].
Grit, resilience and a growth mindset are personal traits that underpin one's ability to counteract the negative aspects of stress to adapt to learning challenges [9, 10, 11]. Grit has been defined as perseverance and passion towards longer‐term goals despite episodes of failure, setbacks and adversity [10]. Resilience is commonly defined as one's ability to regain mental health and ‘bounce back’ after negative experiences, with contemporary definitions describing it as a dynamic process that occurs in response to challenges [9]. A growth mindset is the personal belief that abilities and intelligence can be developed through effort, learning and perseverance [11]. In contrast, a fixed mindset is the belief that our abilities and intelligence are innate and unchangeable, potentially leading individuals to avoid challenges and give up more easily [12]. Therefore, the development or fostering of these attributes in health professional students is important as a mechanism that may counteract the negative effects of stress.
Like many health professions, experiential learning in the real‐world clinical environment is the cornerstone of physiotherapy education, providing experiences that require students to draw on emotional, physical and cognitive attributes [13]. Although the development of clinical skills is paramount, students will also be confronted with unique patients and/or complex situations that may be challenging and overwhelming, for example, distressed families, unpredictability of the clinical environment or critically ill patients [14]. Students with low levels of grit or resilience or a fixed mindset may be vulnerable to maladaptive responses to common stressors during clinical placements, which may negatively affect their learning. Preliminary research has demonstrated that physiotherapy students with low levels of grit are twice as likely to fail a clinical placement compared to students with moderate or high grit [3]. By incorporating interventions to enhance these traits during critical periods, there may be an opportunity to assist students to overcome the challenges associated with clinical learning and develop into adaptable health professionals.
Research supports the idea that resilience is an attribute that can be developed in health professional students [1, 3]. A recent systematic review reported that targeted interventions, including education programmes, yoga, mindfulness and deep breathing activities, for health professional students (mainly nursing and medical students) improved resilience by a moderate amount in 13 studies with 990 participants [pooled standardised mean difference (SMD) 0.74, 95% confidence interval (CI) 0.03–1.46] [5]. Interventions of more than one session appeared to have the greatest effect (pooled SMD 0.97, 95% CI 0.08–1.85) [5]. Grit and growth‐mindset interventions (including specific education in grit and mindset) improved grit (pooled SMD 0.48, 95% CI −0.05–1.00, n = 2) and growth mindset (pooled SMD 0.25, 95% CI −0.18–0.68, n = 2) by a small, non‐significant amount only [5], and require further investigation.
Two trials included in this review examined physiotherapy students specifically. One study implemented an 8‐h resilience curriculum programme [15], whereas the other delivered 11 1‐h online modules to increase empathy and work engagement in physiotherapy students [16]. Mejia‐Downs [15] reported significantly greater increases in resilience (p = 0.03) in the intervention group compared to the control group. Mueller et al. [16] reported significantly greater increases in empathy (p = 0.02) and work engagement (p = 0.04) but not grit (p = 0.24) between the two groups over time. Further research is needed to understand the best mode and timing of interventions to help students transition into the clinical environment. Furthermore, although there is limited grit and/or growth‐mindset interventional research in health professional students, evidence suggests these traits are malleable with targeted interventions in line with improvements seen in school‐aged children [17, 18]. Finally, emerging evidence suggests interventions might be more effective when targeted towards students with low levels of resilience [19], grit [20] or a fixed mindset [17].
Previous research has examined grit, resilience and mindset type separately; however, these three traits have overlapping theoretical constructs [21, 22]. A new tool, the Bolton Uni Stride Scale (BUSS), provides a comprehensive evaluation of these three inter‐related traits in a single measure defined as ‘academic tenacity’ [22]. Academic tenacity is a broad concept that encompasses grit, resilience and growth mindset as well as well‐being and self‐efficacy to describe the perseverance and determination students show in overcoming challenges and maintaining effort towards their academic goals despite obstacles [22]. Subsequently, considering grit, resilience and mindset type together when designing interventions for health professional students may lead to greater benefits.
Therefore, the aim of this research was first to explore the effect of a 5‐week targeted intervention on improving grit, resilience, mindset type and/or academic tenacity concurrently in physiotherapy students as they transitioned into the clinical learning environment. A secondary aim was to explore the effect of the intervention on students sub‐grouped by baseline levels of these traits.
2. Methods
2.1. Study Design
This single group pre‐ and post‐intervention study was conducted from July to December 2022. Ethics approval was gained from the University Human Research Ethics Committee (HEC22153).
2.2. Participants and Recruitment
A convenience sample of physiotherapy students in their penultimate year of study was invited to participate. The students were eligible to participate if they were enrolled in the first clinical placement subject of their course during the recruitment period.
Students were provided with information about the study via email and during an introductory class. Students who wished to participate then provided informed consent through the electronic survey. A total of 180 eligible physiotherapy students were invited to participate in the programme and 155 consented (86% recruitment). Students were aged between 20 and 30 years old, 62% were female, and one in four reported having a mental health condition (Table 1). Overall, just under a third of students had low resilience (n = 47), low academic tenacity (n = 50) or a fixed or undecided mindset about intelligence (n = 40), and one in seven had low grit (n = 22) (Table 2).
TABLE 1.
Participant sociodemographic and non‐cognitive factors at baseline.
| Characteristic | Total population (n = 155) | Paired sample (n = 70) |
|---|---|---|
| Gender | ||
| Male, n (%) | 58 (37) | 25 (36) |
| Female, n (%) | 96 (62) | 45 (64) |
| Non‐binary, fluid, queer, n (%) | 1 (1) | 0 (0) |
| Age, mean (SD, range) | 22 (3, 20–39) | 22 (3, 20–39) |
| Course | ||
| Postgraduate (masters), n (%) | 50 (32) | 27 (38) |
| Undergraduate, n (%) | 105 (68) | 43 (62) |
| Campus | ||
| Metropolitan, n (%) | 118 (76) | 60 (85) |
| Regional, n (%) | 37 (24) | 10 (15) |
| Disability, n (%) | 8 (5) | 3 (4) |
| Diagnosed mental health condition, n (%) | 43 (28) | 14 (20) |
| International student, n (%) | 6 (4) | 4 (6) |
TABLE 2.
Participant baseline measures and categories.
| Categories, n (%) | ||||||
|---|---|---|---|---|---|---|
| N = 155 | Min | Max | Mean (SD) | Low | Moderate/normal | High |
| GritS | 2.38 | 4.75 | 3.55 (0.51) | 22 (14.2%) | 122 (78.7%) | 11 (7.1%) |
| BRS | 1.67 | 4.67 | 3.24 (0.64) | 47 (30.3%) | 102 (65.8%) | 6 (3.9%) |
| BUSS | 30 | 58 | 43.22 (5.06) | 50 (32.3%) | N/A | 105 (67.7%) |
| Fixed | Undecided | Growth | ||||
| DMI‐i | 2 | 6 | 4.39 (0.83) | 14 (9%) | 26 (16.8%) | 115 (74.2%) |
Abbreviations: BRS = Brief Resilience Scale, BUSS = Bolton Uni Stride Scale, DMI‐i = Dweck Mindset Instrument‐Intelligence, Grit‐S = Short Grit Scale.
2.3. Intervention and Setting
The study was conducted at an Australian university that offered entry‐level physiotherapy programmes at two campuses: one metropolitan and one regional campus. Students participated in the intervention during their first 5‐week clinical placement subject. During this subject, students were placed in healthcare organisations in metropolitan, regional and rural areas, both within the state and interstate. Therefore, the intervention was designed to align with the existing subject and support students' transition from university to workplace learning.
The intervention comprised one 60‐min workshop per week for the 5 weeks of the students' first clinical placement. The learning goals and content aimed to improve students' grit, resilience and a growth mindset during their first clinical placement (Table 3).
TABLE 3.
Intervention themes and content.
| Workshop and theme | Content |
|---|---|
| Week 1 | Lecture content: Defining grit, resilience and mindset‐types |
| Introduction to grit, resilience and mindset | Small group discussion: How can these concepts be applied in the clinical environment? Week one common challenge, thoughts and feelings on placement—can you identify growth versus fixed mindset moments? Re‐framing thoughts |
| Week 2 | Lecture content: Understanding resilience, the role of ‘some’ discomfort/stress in learning, signs of distress and where/when to seek help on placement |
| Resilience | Small group discussion: Week 2 common areas of ‘discomfort’ on placement—developing awareness of triggers, stress versus distress and when to seek support? |
| Week 3 | Lecture content: Receiving and responding to feedback through a fixed versus growth‐mindset lens and tackling fear of failure on placement |
| Mindset | Small group discussion: Week three common worries on assessment, fear of failure and re‐defining success on placement through a growth mindset |
| Week 4 | Lecture content: Digging deep and getting gritty—defining passion and short and long‐term goals to enhance perseverance |
| Grit | Small group discussion: Identifying your short‐ and long‐term goals and remembering your ‘why’ when things get tough on placement. Examples of grit role modelled by our patients and supervisors |
| Week 5 | Lecture content: Grit, resilience and mindset types are not linear—the importance of awareness, self‐reflection, re‐framing and re‐defining ‘success’ for lifelong learning |
| Reflections on success and growth | Small group discussion: Celebrating your growth from Weeks 1 to 5 of placement, reflections on common challenges and strategies to applying key grit, resilience and growth mindset lessons to your next placement |
2.4. Content
The workshop content was derived from previous educational interventions targeting health professional students that reported positive outcomes for grit [20], resilience [15] or growth mindset [23]. In line with these studies, our workshops incorporated a lecture component to define each concept, followed by practical learning activities such as self‐reflection, role‐playing and case‐based scenarios to apply the information to their current clinical placement learning experiences. Specific activities included identifying and reframing negative thoughts for a growth mindset, recognising stress and implementing self‐care strategies for resilience and identifying personal motivations and setting goals for grit (Table 3) [15, 20, 23]. Teaching staff facilitated discussion on common stressors experienced by physiotherapy students, informed by research [14] and tutor expertise. See Table 3 for further details.
2.5. Educational Theory
Workshops were informed by, and designed using, principles of effective learning [24], further enriched by co‐designing content with industry partners (Eastern Health, Northern Health, Alfred Health and the Royal Melbourne Hospital) and incorporating feedback from previous students. A key component of workshops was creating a ‘safe container’ [25] where students felt supported to engage, speak freely and have access to complementary resources. Workshops were designed to include peer learning opportunities and Gibbs' cycle of reflection activities to encourage interactivity and reflection [26].
2.6. Delivery
Considering students were geographically dispersed during the intervention period, the workshops were delivered synchronously online. Workshops were delivered by tutors employed by the university, who were physiotherapists with either experience supporting students on clinical placements or who were recent physiotherapist graduates, providing real‐life reflections on their experiences for students. Tutors did not supervise or assess the participants and were trained by academic lecturers to facilitate the programme and followed tutor guides for consistency.
Clinical supervisors (physiotherapists directly supervising and assessing students on placements) were informed of the tutorial programme and provided students with time and an appropriate place to participate in the weekly online workshops during placement hours. Workshops were group‐based, with 40–60 students per group. Groups were facilitated by up to five tutors at a time. In each workshop, lecture content was presented to the large group, followed by interactive activities and reflections in small breakout groups (10–12 students per tutor) with learning activities designed to promote discussion and sharing of placement experiences (Table 3).
2.7. Measures
Participants completed electronic, self‐administered validated surveys that were collected and managed using REDCap electronic data capture tools [27] at two time points: pre‐intervention (baseline) and immediately post‐intervention. Demographic information collected included age, gender, campus, degree enrolment and factors related to university success including diagnosed mental health conditions and disabilities to describe our sample. The Short Grit Scale (Grit‐S) was used to measure perseverance and passion towards long‐term goals (i.e., grit), and the Brief Resilience Scale (BRS) measured participants' ability to bounce back or recover from stress (i.e., resilience). The Dweck Mindset Instrument—Intelligence (DMI‐I) was used to measure participants' beliefs about the malleability of intelligence (i.e., fixed or growth mindset), and the Boston Stride Uni Scale (BUSS) was used to measure academic tenacity. Further details of these measures and their psychometric properties are described in Table 4.
TABLE 4.
Outcome measures.
| Tool | Items | Scoring | Categories | Tool development | Psychometric properties |
|---|---|---|---|---|---|
| Short Grit Scale (Grit‐S) | 8 items on a 5‐point Likert scale | Scores are averaged to obtain a maximum score between 1 (not at all gritty) and 5 (extremely gritty) |
1–2.99: low grit 3–4.3: normal grit 4.31–5: high grit |
Designed to measure perseverance and passion for long‐term goals as a more concise version of the original Grit Scale (Grit‐O) [10] | High internal consistency, strong test–retest reliability and good predictive, construct and convergent validity when measured against other commonly utilised tools of Grit‐O and Big 5 Personality in university students [28] |
| The Brief Resilience Scale (BRS) | 6 items on a 5‐point Likert scale | Scores are averaged to obtain a score between 1 (lowest resilience) and 5 (highest resilience) |
1–2.99: low resilience 3–4.3: normal resilience 4.31–5: high resilience |
Developed to measure an individual's ability to bounce back or recover from stress [29] | Excellent internal consistency, strong re‐test reliability and good construct, convergent and predictive validity when measured against other resilience scales in university students [30] |
| Dweck Mindset Instrument Intelligence (DMI‐i) | 8 items on a 6‐point Likert scale | Scores are averaged to give a score between 1 (fixed mindset) and 6 (growth mindset). |
1–3 fixed trait 3.1–3.9 undecided 4–6 malleable (growth) trait |
Often referred to as Implicit Theories of Intelligence Scale designed to measure an individual's beliefs about the malleability of intelligence [31] | Good internal reliability strong retest reliability in school aged children [32] |
| Bolton Stride Uni Scale (BUSS) | 12 items on a 5‐point Likert scale | Scores are averaged (theoretical range 12–60) with a higher global score reflecting greater academic tenacity |
20–40: low academic tenacity 41–57: high academic tenacity |
Designed to measure a combination of personal characteristics grit, resilience, mindset, self‐efficacy, and mental well‐being referred to as ‘academic tenacity’ [22] | Good internal consistency among university students across 25 countries, good convergent validity against grit, mental well‐being and self‐efficacy scales [22] |
2.8. Statistical Analysis
Data analysis was conducted using IBM SPSS Statistics (Version 27). Descriptive statistics were calculated for the sample using means and standard deviations when data were normally distributed. Students were stratified into baseline levels of grit, resilience, mindset type and academic tenacity based on pre‐specified cut‐offs (Table 4). Due to the abnormal distribution of data, the difference between matched pre‐ and post‐intervention scores for grit, resilience, mindset type and academic tenacity was analysed through Wilcoxon signed‐rank tests. A sample size of 90 was required to detect a small increase (effect size 0.3) in post‐intervention grit with 95% CI and 80% power [20].
3. Results
Twelve of the initially recruited 155 students did not progress to their first clinical placement or withdrew early from their placement and hence did not participate in the intervention. Of the remaining 143 students, 82% (n = 117) attended all five workshops and the remainder attended four workshops. A total of 70 (49%) of eligible students completed post‐intervention surveys and are included in the analysis (Figure 1).
FIGURE 1.
Flow of participants through the study.
3.1. Effect of Intervention on the Whole Sample
When considering the whole sample (n = 70), grit, resilience, mindset type and academic tenacity did not significantly change from baseline to post‐intervention (Table 5).
TABLE 5.
Paired sample tests change pre‐ and post‐intervention.
| Baseline median (Q1—Q3), n | Post‐intervention median (Q1—Q3), n | Related‐samples Wilcoxon signed‐rank test statistic (two‐sided p) | |
|---|---|---|---|
| Resilience (BRS) | |||
| All BRS | 3.40 (2.83–3.83), 70 | 3.33 (2.83–3.67), 70 | 762 (p = 0.467) |
| High | 4.42 (4.33–4.41), 2 | 4.42 (3.83–4.42), 2 | 1.5 (p = 1.00) |
| Moderate | 3.50 (3.33–3.83), 48 | 3.50 (3.17–3.67), 48 | 260 (p = 0.109) |
| Low | 2.50 (2.33–2.79), 20 | 2.59 (2.21–3.00), 20 | 104 (p = 0.420) |
| Grit (Grit‐S) | |||
| All Grit | 3.60 (3.34–3.90), 70 | 3.75 (3.38–3.91), 70 | 1255 (p = 0.150) |
| High | 4.38 (4.37–4.41), 6 | 4.13 (3.94–4.28), 6 | 0 (p = 0.027)* |
| Moderate | 3.60 (3.38–3.88), 59 | 3.75 (3.38–3.88), 59 | 911 (p = 0.83) |
| Low | 2.75 (2.56–2.81), 5 | 3.13 (2.57–3.38), 5 | 14 (p = 0.080) |
| Mindset (DMI‐i) | |||
| All DMI‐i | 4.50 (4.00–4.88), 70 | 4.5 (4.00–5.00), 70 | 1011 (p = 0.524) |
| Growth mindset | 4.63 (4.38–4.90), 55 | 4.63 (4.13–5.00), 55 | 465 (p = 0.294) |
| Undecided | 3.75 (3.50–3.88), 9 | 4.50 (3.63–4.82), 9 | 33 (p = 0.035)* |
| Fixed mindset | 3.00 (2.47–3.00), 6 | 3.25 (2.60–4.16), 6 | 15 (p = 0.043)* |
| Academic tenacity (BUSS) | |||
| All BUSS | 43.50 (40.00–46.00), 70 | 43.50 (41.75–46.00), 70 | 1026 (p = 0.111) |
| High | 45.00 (43.00–47.25), 50 | 44.50 (43.00–47.25), 50 | 364 (p = 0.715) |
| Low | 38.00 (37.00–40.00), 20 | 41.00 (39.25–42.00), 20 | 161 (p = < 0.001)* |
Abbreviations: BRS = Brief Resilience Scale, BUSS = Bolton Uni Stride Scale, DMI‐i = Dweck Mindset Instrument‐Intelligence, Grit‐S = Short Grit Scale.
p < 0.05.
3.2. Effect of Intervention on Participants by Baseline Levels of Traits
3.2.1. Mindset Type
Students with a fixed mindset (n = 6, median mindset score 3.00/5) or an undecided mindset type (n = 9, median mindset score 3.75/5) at baseline significantly improved their mindset type. The fixed mindset group shifted to the ‘undecided’ category (median 3.25) and the undecided mindset group shifted to the ‘growth’ category (median 4.50) with a median value difference of 0.43 (p = 0.043) and 0.75 (p = 0.035) points, respectively, post‐intervention (Table 5). The mindset‐type score remained largely unchanged for students with a growth mindset at baseline.
3.2.2. Academic Tenacity
Students with low academic tenacity at baseline (n = 20, median academic tenacity 38/60) significantly improved their academic tenacity post‐intervention and on average moved to the ‘high academic tenacity’ category, with median values differing by 3 points (p = < 0.001) (Table 5). Academic tenacity score remained largely unchanged for students with high academic tenacity at baseline.
3.2.3. Grit
Students with low grit at baseline (n = 5, median grit 2.75/5) trended most positively to improved grit post‐intervention, with median grit levels moving up a category into ‘moderate’ (median grit 3.13/5) post‐intervention, but this did not reach statistical significance (p = 0.08) (Table 5). Students with high grit at baseline had a negative shift in their grit level post‐intervention (p = 0.027) but remained within the high grit category.
3.2.4. Resilience
Following the intervention, the total resilience score for students with low, moderate or high grit at baseline did not significantly change (Table 5).
4. Discussion
This study found no significant changes in grit, resilience or mindset type in the overall sample of physiotherapy students following a tailored 5‐week education‐based intervention on their first clinical placement. However, students with a fixed or undecided mindset at baseline significantly improved, shifting towards a growth mindset, and those with lower baseline levels of academic tenacity significantly improved their academic tenacity post‐intervention. Students with lower grit at baseline demonstrated small positive changes in grit; however, no changes in resilience were seen post‐intervention when compared with initial baseline levels. This suggests that interventions may need to be tailored and targeted to suit students' baseline levels of grit, resilience and/or mindset type to enhance improvements in these traits.
There are many possible explanations for the findings, but they may suggest that interventions are most effective when tailored to students' baseline level of grit, resilience and/or mindset type. Previous research supports this finding that interventions to increase grit [20] or resilience [19] may be more effective in students with lower baseline levels of these traits. Whereas students with low levels of any one of these three traits may be at higher risk of poorer academic and psychological well‐being outcomes [2, 3, 4], university educators should consider programmatic approaches to optimise outcomes for all students in the transition to clinical placements. Future research should focus on developing tailored interventions that address the specific needs of students with lower levels of grit, resilience and/or a fixed mindset while simultaneously understanding how to harness and enhance the strengths of those with moderate and higher levels. Future research must also consider practical implications of how to best evaluate students' baseline levels of grit, resilience and/or mindset before determining which interventions they should receive.
The BUSS tool utilised in this study evaluates grit, resilience and mindset together as a measure of the ability to persevere and overcome challenges in learning [22]. Further research is warranted to determine its potential as a reliable assessment and evaluation tool as it may reduce survey fatigue by replacing multiple outcome measures of related constructs. Educators may also consider the optimal timing of evaluations and interventions. Interventions delivered during critical times could provide students with the necessary tools and support to cope with increased stress and demand. However, the stress of placements may also limit the extent to which students fully engage with and benefit from interventions and may be a potential reason for the limited improvement of this participant group. Future research could therefore consider the timing of interventions and explore if different timings could yield greater improvements.
Tailored interventions to support effective learning and positive coping strategies on placements may also need to consider other individual student factors. For example, one in four students in our study reported a diagnosed mental health condition. Previous research highlights that this group and other groups such as international students, those students with a disability or culturally and/or LGBTI diverse students may face other or additional complexities and challenges that impact academic success and wellbeing [3]. Hence, university educators, clinical supervisors and support staff need to consider the unique challenges and personal circumstances of individual students. Practical implications for university educators include contemplating a cohort‐wide approach to encourage all students to reflect on their challenges before clinical placements. Educators may work with academic counselling and university support services to increase awareness of existing student services and collaborate with these services to provide additional or targeted training.
Although we acknowledge that both the timing of the intervention and the inclusion of participants with varying baseline levels may have influenced the findings, other design‐related factors could also have contributed to the weak results. Many elements of the intervention were grounded in evidence‐based practice and supported by pedagogical theory. For example, research suggests that multi‐session programmes incorporating an educational component are associated with positive outcomes [5]. However, the absence of supervised practice sessions for learners to apply newly acquired strategies may have limited the intervention's effectiveness. Additionally, although the programme spanned 5 weeks, it is possible that a longer duration was necessary to elicit significant improvements in resilience and grit. Nevertheless, this timeframe is comparable to other studies involving physical therapy students that have reported more favourable outcomes [15, 16].
Students with a fixed or undecided mindset at baseline significantly improved their mindset towards the growth spectrum following our intervention. Incorporating grit and resilience concepts into the intervention design may have enhanced the significant improvements in mindset type and subsequently academic tenacity. Our intervention aimed to foster resilience and grit by integrating growth mindset principles, such as reframing maladaptive thoughts, addressing fear of failure and emphasising the importance of the learning process over assessment outcomes [12]. Conversely, we also incorporated grit education and strategies like goal setting and time management [10] to foster resilience and a growth mindset as well as resilience education and strategies focused on recognising stress, practising self‐care and seeking support [33]. Promisingly, the significant improvement in academic tenacity via the BUSS tool that measures grit, resilience and mindset shows that the intervention may have significantly improved these three traits or, conversely, that BUSS findings were bolstered by growth mindset effects. Designing interventions that address these interconnected constructs may help students positively adapt under pressure, particularly during clinical placements, to shape future health professionals ready to thrive in complex clinical environments.
The significant improvement in academic tenacity via the BUSS tool that measures grit, resilience and mindset shows that the intervention may have significantly improved these three traits.
Exploring whether improvements in grit, resilience, mindset or academic tenacity lead to better academic performance or improvement in well‐being outcomes was beyond the scope of this study. However, understanding the impact on academic performance and well‐being is an important area for future research. Resilience interventions have been shown to positively decrease perceived stress levels in health professional students; however, we have a limited understanding on how improvements in grit and mindset affect well‐being [5]. Interestingly, our study did show a significant improvement in academic tenacity via the BUSS, which incorporates not only grit, resilience and mindset but also perceived stress and self‐efficacy. Hence, improvements in the BUSS indicate a potential reduction in perceived stress from our intervention. Future research should also consider the shared responsibility of developing grit, resilience and mindset not just at an individual level but also across educators and within the broader organisational context. Incorporating a multifactorial approach that includes building these traits in students and perhaps educators and considering the impact of organisational resilience in universities and clinical settings may lead to more effective outcomes.
A key limitation of this study was the low completion rate of post‐intervention measures potentially influencing the findings due to low power. Results for grit and resilience outcomes may have been stronger had the study been fully powered as per sample size calculations. The timing of the intervention during a stressful placement period potentially impacted students' post‐intervention survey completion rates, taken on the final day of clinical placement. The intervention was also specific to physiotherapy students, indicating the potential need for similar targeted approaches in different health professional student populations. To build on this study's findings, future research may consider including a control group, adopting a longitudinal design and assessing if improvements in grit, resilience and mindset translate to better academic outcomes and/or a decrease in perceived stress. A control group would help isolate the intervention effect compared to natural development and provide clearer evidence of its impact. Longitudinal studies would allow researchers to track changes over time, offering insights into the sustainability of the intervention's effects. One might assume that the challenge of clinical placement alone may be a catalyst to develop one's grit or resilience, as reported in a longitudinal study of pharmacy students where grit improved by a small but significant amount over time with no intervention [34].
In conclusion, although the intervention did not significantly alter the grit, resilience, mindset type or academic tenacity for the whole sample, benefits for students with a fixed or undecided mindset or lower levels of grit or academic tenacity at baseline were found. Tailored interventions that target these traits together, in both design and evaluation, hold promise for enhancing student outcomes. This study provides evidence to generate a deeper conversation and further research possibilities around which personal traits to focus on, how to best assess for those and how to design effective tailored interventions to help develop grit, resilience and a growth mindset in all students as they transition to clinical learning in the workplace.
Author Contributions
Marlena Calo: conceptualization, data curation, formal analysis, methodology, project administration, resources, writing – original draft, writing – review and editing. Belinda Judd: supervision, conceptualization, data curation, formal analysis, methodology, writing – review and editing. Lucy Chipchase: formal analysis, writing – review and editing. Madeline Hannington: investigation, resources, writing – review and editing. Allison Hillbig: investigation, resources, writing – review and editing. Carolyn Taylor: resources, writing – review and editing. Casey Peiris: supervision, conceptualization, data curation, formal analysis, methodology, project administration, writing – review and editing.
Conflicts of Interest
The authors declare no conflicts of interest.
Acknowledgements
The authors have nothing to report. Open access publishing facilitated by La Trobe University, as part of the Wiley ‐ La Trobe University agreement via the Council of Australian University Librarians.
Funding: The authors received no specific funding for this work.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.