Reflections on The Growth Mindset in Dance and Medical Education by Dr Filomar C. Tariao

Part III of a 3-part series

The first time I encountered the term Growth Mindset (GM) was in an email from our Human Resources encouraging us to join seminars. I ignored the mail as the activities clashed with my classes. Fast forward to the time my Science of Learning group decided to take on GM as a presentation topic, and I realised that my ignorance of it may have been fortuitous, because now I can look at Carol Dweck’s theory with fresh eyes. Coming from both an artistic and scientific background where the rigour of practice is tradition, I felt doubtful of the applicability of GM in my own domains. In dance, auditions are a way of life. Rejection, together with self-judgment are daily fare.1,2 One of the dancers in a performing arts medicine seminar, was asked how she dealt with rejection. She answered she just expected to get rejected every time, so she would not get disappointed. This way, she can be pleasantly surprised when she does get accepted. In medicine, high stakes exams and audits are common fare. They are supposedly to prepare clinicians for life-and-death situations in the hospitals. One can argue the only way to produce such professionals is through unwavering regiment.

I beg to differ now. As I go through the GM literature, I surmise that it is precisely the nature of these 2 professions that lend themselves well to a GM intervention.

Conservatory training focuses on virtuosity,3 while Ballet has a perfect aesthetic ideal: turned-out legs longer than the torso, narrow waist, long arm spans.4,5,6,7 Dancers can either perform skills well during a show or the critics will have a field day. Demonstrating ability is a performer’s bread and butter.

My teachers were considered old-school. A couple of them had sticks to slap our ankles with if our feet were not pointed enough. Starting dance at 21, I had difficulty fitting in with my rower’s body. I recall a lecturer commenting in front of class that the left side of my body was bigger than my right (from the back, my right would appear bigger). Of course! Being a previous athlete, I rowed on the right side of the boat, I thought, suddenly very self-conscious of my appearance and performance.

As an instrument, a dancer’s body is constantly under scrutiny. Unsurprisingly, a 2012 article concludes body dysmorphia to be more prevalent among dancers compared to the normal population.8 No wonder only 10 percent of arts graduates continue to become working artists.9

The institution of medicine is no different. The constant pressures to accumulate knowledge and skill to promote life or prevent death can inadvertently take its toll on anyone’s psyche. Consequently, prevalence rates of psychiatric disorders are much higher in the medical profession than in the general population.10,11,12 This information reminds me of a time I was on 24-hour duty at the paediatric wards. That night, there were 50 patients, 48 hospital beds, 2 stretchers, myself, and only 2 nurses. My shift partner fell ill and the hospital did not have enough beds or staff to accommodate any more patients. There was one adolescent leukaemic patient who needed immediate transfusion and medication. He was admitted because he was also a bone-marrow transplant candidate. Concurrently, all our seniors were in the neonatal and intensive care units to oversee emergency cases. Suddenly, a power surge caused the lights to flicker continuously, triggering a seizure on a patient. Simultaneously, our afebrile and chatty dengue patient, Jenjen (not her real name) started to bleed through the nose and ears, while our leukaemic adolescent’s blood pressure (BP) went spiralling down. One nurse attended to the seizure, while I asked the other to refer Jenjen for a possible central venous catheterisation. I reinserted a line on our transplant candidate but his BP was still crashing. Ominously, Jenjen started to show petechiae around her eyes. We had only one code trolley with a defibrillator in the ward, and we agreed that our leukaemia child had the best chance of surviving. We successfully resuscitated him while Jenjen succumbed to disseminated intravascular coagulation. In less than 5 minutes, I felt like some malicious creature deciding the fate of a child—a predicament no one should face. The post-mortem audit the morning after judiciously exculpated our duty team of wrong-doing. But guilt is one lifelong baggage.

What do these experiences have to do with a GM? Most of the dissenters of the theory focus on the lack of significant score improvement among participants in real world trials.13,14 But beyond the numbers is the humanistic philosophy behind the GM that makes it pertinent to any educational system. Should not the concept that all humans are capable of changing for the better be a framework for how we learn? Do we not give ourselves a second chance when we make mistakes? In the above scenarios on art and medicine, authentic academic settings are already replete with psychosocial challenges; why should there be any objection to making them more manageable? For artists, a simple show of encouragement from peers and teachers may alleviate their performance anxiety.15 For health professionals, support from seniors who have been in similar mors et vita situations may attenuate their distressing repercussions on practitioners.16,17 Indeed, there is increasing evidence a GM may palliate mental health difficulties.18,19

Lower-achieving students benefit most from GM interventions as they have the most to grow. This can be ascribed to neuroplasticity, which underpins GM interventions.20 Critics counter though that, even if the findings are promising, experiments combining neuroplasticity with cognition have been done only on non-humans.21 Measuring neurogenesis on humans while studying art or science will undoubtedly be ethically challenging. Nevertheless, believing we are able to continuously acquire and develop skills should be an idea worth embodying. Empirical evidence from human studies takes time, but, save for an optimistic view of man, there is nothing to lose in practising a GM now.

Issues on GM’s replicability have been addressed already by pundits,22 so controversies surrounding the theory should not veil the benevolence of its methodologies: praising strategic effort, involving teachers, peers and seniors as support mediators, etc. These are hallmarks of a holistic and empathic education. And the empathetic process, I have come to realise, is what bridges the divide between medicine and the performing arts. Performers are immersed in emotional athleticism, juggling multiple affects to connect to audiences. Doctors have to practice and prescribe compassion for healing. Should not the learning for both be in the same vein? And, if disciplines from opposite sides of the spectrum can share the same learning approach, cannot those in between profit as well?

If finances become a concern in acquiring rights to GM interventions, studying the system, allowing its philosophy to suffuse into lesson plans, and tweaking the delivery according to existing circumstances may be an alternative. Even Dweck says no one is fully GM in his beliefs, so there is always room for improvement.23 As more institutions within and outside education adopt its principles, more evidence regarding the GM technique will surface and, hopefully, democratise its practice. Hence, in weighing benefits over risks, I find more favourable applications of GM compared to regimented schooling.

All this is not to devalue the importance of scores. On the contrary, scores are necessary to demonstrate efficacy of procedures. The current researches already show encouraging results.20, 24, 25 In due course, the number of GM studies will reach critical mass for robust meta analyses. Meanwhile, what alternative is there besides waiting? Using the same methods, expecting different outcomes?

My Social Sciences professor 29 summers ago said that for any philosophy to withstand scrutiny, it has to be reduced or magnified into an act of survival. Thus, in lieu of statistically significant results, the way I deliver my lessons may be significant for that single individual holding on to his sanity. Similarly, in a time of great world turmoil, I would rather subscribe to a belief that our species has the immense capacity to learn from and improve on its mistakes than to a fixed, nihilist view of humanity.

On further introspection, I ask myself, had I practised a GM, would I have left the Hippocratic profession? I do not know and have no regrets. My yardstick for success then was the joy I derived from my vocation. It still is. I do realise my decisions have led me to grow into untraversed paths. That, perhaps, is how I have unwittingly applied the GM—in a divergent manner.

The implications of the GM go beyond education. It is a world view. Arguably, the most sacred purpose of education is to ensure there will be a next generation to pass humanity’s heritage to, with a legacy worth its succession. Henceforth, in Dance and Medicine, I will practice a growth mindset because, at its core, it supports life, and believing so motivates me to live better.

To learn more about the Growth Mindset, please see this post

 

Bibliography


1.Hilton H. How to Cope With Summer Intensive Rejection. Dance Magazine. Published January 19, 2022. Accessed March 11, 2022. https://www.dancemagazine.com/summer-intensive-rejection/


2.Holmes K. How Dancers Can Bounce Back After a Tough Rejection. Dance Spirit. Published April 18, 2019. Accessed March 11, 2022. https://dancespirit.com/bounce-back-after-tough-rejection/


3.New York Film Academy. NYFA Conservatory: Why a 1-Year Program Is Your Next Life-Hack | Student Resources. New York Film Academy. Published June 23, 2017. https://www.nyfa.edu/student-resources/nyfa-conservatory-why-a-1-year-program-is-your-next-life-hack/#:%7E:text=That


4.Dunning J, Dunning R. THE CREATION OF A BALANCHINE BALLERINA. The New York Times. https://www.nytimes.com/1981/02/08/arts/the-creation-of-a-balanchine-ballerina.html. Published February 8, 1981. Accessed March 11, 2022.


5.Henderson G. What Would It Take to Change Ballet’s Aesthetic of Extreme Thinness? Dance Magazine. Published July 8, 2021. Accessed March 11, 2022. https://www.dancemagazine.com/ballet-body/

6.Kourlas G. What Is a Ballet Body? New York Times. https://www.nytimes.com/2021/03/03/arts/dance/what-is-a-ballet-body.html. Published March 3, 2021. Accessed March 11, 2022.


7.Larsen G. Turnout 101: Where Does It Come From, And How Can You Get More? Pointe Magazine. Published January 1, 2019. Accessed March 11, 2022. https://pointemagazine.com/improve-your-turnout/


8.Nascimento A, Luna J, Fontenelle L. Body Dysmorphic Disorder and Eating Disorders in Elite Professional Female Ballet Dancers Study of the Genetic Bases of Obsessive-Compulsive Disorder in the Brazilian Population View Project AVALIAÇÃO de SINTOMAS PSIQUIÁTRICOS, TESTAGEM NEUROPSICOLÓGICA E DOS BIOMARCADORES PLASMÁTICOS de INDIVÍDUOS ACUMULADORES View Project. Annals of Clinical Psychiatry; 2012:3-5. Accessed March 11, 2022. https://www.researchgate.net/publication/230617117_Body_dysmorphic_disorder_and_eating_disorders_in_elite_professional_female_ballet_dancers?enrichId=rgreq-17607075b6dc18c81cefc7e2e204db7b-XXX&enrichSource=Y292ZXJQYWdlOzIzMDYxNzExNztBUzo2NDIxODE2MjI2NjkzMTNAMTUzMDExOTQzODM1NA%3D%3D&el=1_x_2&_esc=publicationCoverPdf


9.BFAMFAPhD. A National Study on the Lives of Arts Graduates and Working Artists. BFAMFAPhD; 2014:10. Accessed March 11, 2022. http://bfamfaphd.com/#artists-report-back


10.Bhugra D, Ventriglio A, Watson C. Suicide among doctors: A narrative review. Indian Journal of Psychiatry. 2020;62(2):114. doi:10.4103/psychiatry.indianjpsychiatry_767_19


11.Lindeman S, Läärä E, Hakko H, Lönnqvist J. A Systematic Review on Gender-Specific Suicide Mortality in Medical Doctors. British Journal of Psychiatry. 2022;168(3):274-279. doi:10.1192/bjp.168.3.274

12.Zoccolillo M, Murphy GE, Wetzel RD. Depression among medical students. Journal of Affective Disorders. 1986;11(1):91-96. doi:10.1016/0165-0327(86)90065-0


13.Li Y, Bates TC. You can’t change your basic ability, but you work at things, and that’s how we get hard things done: Testing the role of growth mindset on response to setbacks, educational attainment, and cognitive ability. Journal of Experimental Psychology: General. 2019;148(9):1640-1655. doi:10.1037/xge0000669


14.Macnamara B. Schools are buying “growth mindset” interventions despite scant evidence that they work well. The Conversation. Published June 26, 2018. Accessed March 11, 2022. https://theconversation.com/schools-are-buying-growth-mindset-interventions-despite-scant-evidence-that-they-work-well-96001


15.Huang W-L, Yu H. Social support in university music students’ coping with performance anxiety: people, strategies and performance situations. Music Education Research. 2022;24(1):124-135. doi:10.1080/14613808.2022.2028752


16.Chadha N. Growth mindset and medical education: What is the connection? harvardmacy.org. Published March 1, 2020. Accessed March 11, 2022. https://harvardmacy.org/index.php/hmi/growth-mindset-and-medical-education

17.Richardson D, Kinnear B, Hauer KE, et al. Growth mindset in competency-based medical education. Medical Teacher. 2021;43(7):751-757. doi:10.1080/0142159x.2021.1928036


18.Schleider J, Weisz J. A single-session growth mindset intervention for adolescent anxiety and depression: 9-month outcomes of a randomized trial. Journal of Child Psychology and Psychiatry. 2017;59(2):160-170. doi:10.1111/jcpp.12811


19.Schroder HS, Callahan CP, Gornik AE, Moser JS. The Fixed Mindset of Anxiety Predicts Future Distress: A Longitudinal Study. Behavior Therapy. 2018;50(4). doi:10.1016/j.beth.2018.11.001


20.Yeager DS, Hanselman P, Walton GM, et al. A national experiment reveals where a growth mindset improves achievement. Nature. 2019;573. doi:10.1038/s41586-019-1466-y


21.Mattson MP. Lifelong brain health is a lifelong challenge: From evolutionary principles to empirical evidence. Ageing Research Reviews. 2015;20:37-45. doi:10.1016/j.arr.2014.12.011


22.Yeager DS, Dweck CS. What can be learned from growth mindset controversies? American Psychologist. 2020;75(9):1269-1284. doi:10.1037/amp0000794


23.Gross-Loh C. Carol Dweck Explains the False Growth Mindset. The Atlantic. Published December 16, 2016. Accessed March 11, 2022. https://www.theatlantic.com/education/archive/2016/12/how-praise-became-a-consolation-prize/510845/


24. Andersen SC, Nielsen HS. Reading intervention with a growth mindset approach improves children’s skills. Proceedings of the National Academy of Sciences. 2016;113(43):12111-12113. doi:10.1073/pnas.1607946113


25.Xu KM, Koorn P, de Koning B, et al. A growth mindset lowers perceived cognitive load and improves learning: Integrating motivation to cognitive load. Journal of Educational Psychology. 2020;113(6). doi:10.1037/edu0000631


*All images are mine. I have no conflict of interest to declare in presenting this discourse


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