On an uncharacteristically mild day in late summer, I (KK) took advantage of the pleasant weather by enjoying dinner on an outdoor patio. In between bites of queso, my mentee and I discussed her upcoming residency interviews. The conversation flowed to me as she asked how I was doing. Bolstered by my trust in this genuine friend, I told her about an issue I was having trouble overcoming due to self-doubt. With her bright and fearless attitude, she simply asked, “What’s the worst that can happen?” I nervously chuckled as my mind went through scenarios involving public humiliation or worse. When I thought through these theoretical outcomes, I realized they were unrealistic and borderline silly. I had made the choice to focus on negative emotions – fear, embarrassment, shame. When I shifted my perspective to accepting my mentee’s appreciation of my positive attributes – compassionate, detail-oriented, dedicated – I mused that I had turned from mentor to mentee. Ethicist Patrick Fitzgerald characterized this warm sense of appreciation I felt as gratitude (Ethics 1998;109:119–53).

Ultimately, gratitude is a choice. Each of us faces obstacles – some large, others small, many unforeseen. We are often tempted to respond to these obstacles with negativity and bitterness, focusing our energy and attention on lamenting over things we don’t have or situations that aren’t going our way. We turn our focus inward to the ways in which we’ve been hurt or slighted and, in so doing, lose sight of the very things that give us mental and emotional strength. To cultivate gratitude, we must first cease to focus on our hardships and trials. One way to do this is to practice radical acceptance. Psychologist Marsha Linehan developed this technique, where she posits that the fight against a situation often causes greater suffering than the situation itself. Reality should be accepted, rather than opposed. Radical acceptance is the practice of accepting situations without assigning them a positive or a negative value: the reality we face is not good, nor is it bad – it just is. In this practice is power. When we free ourselves from negativity while facing the obstacles we must overcome, we empower ourselves to choose how we feel about them. We allow ourselves to adopt a can-do attitude, to see the positive aspects of challenging situations, and to find peace in the face of disappointment. We enable ourselves to appreciate the myriad of blessings and graces that fill our lives, many of which would have passed by unnoticed in the river of negativity from which we’ve chosen to free ourselves.

In addition, gratitude practice has demonstrated many benefits in people’s personal and professional lives. The process has been described as a two-step practice, which first includes recognizing that there is a positive outcome and then understanding there is an external source related to the outcome (Curr Probl Pediatr Adolesc Health Care 2019;49:100663). Multiple studies have examined gratitude and well-being. “Individuals who practiced gratitude-inducing exercises were more satisfied with their lives compared to a control group who focused on everyday hassles” (Curr Probl Pediatr Adolesc Health Care 2019;49:100663). Those who practiced gratitude exercises felt more connected with others, had both improved amounts and quality of sleep, and noticeably improved overall well-being (Curr Probl Pediatr Adolesc Health Care 2019;49:100663). Repine et al. examined anesthesia residents who participated in a proprietary gratitude phone app. Results showed that individuals who participated reported “higher positive states of alertness, enthusiasm, determination, attentiveness and energy.” These individuals were also “rated by peers as measurably happier, more pleasant to be around, more helpful, outgoing, optimistic and trustworthy” (Anesthesiol Clin 2022;40:275-85). Various gratitude interventions include, but are not limited to, gratitude lists, gratitude contemplation, and behavioral expressions of gratitude (Clin Psychol Rev 2010;30:890-905).

A gratitude list is the most common of the aforementioned interventions. This involves creating lists of things one is grateful for on a frequent basis. Grateful contemplation is less specific and involves one simply thinking or writing about things they are grateful for on a large-scale fashion. This brief intervention can immediately improve mood and may last only a few minutes. Finally, behavioral expressions of gratitude involve the participant writing a letter to the recipient thanking them and then delivering/reading the letter to that person. Various studies have examined behavioral expressions versus gratitude lists with mixed results. Both interventions show positive results; however, there is inconclusive data on which intervention is more beneficial (Clin Psychol Rev 2010;30:890-905; Med Internet Res 2020;22:e15562).

Gratitude in the domain of mentorship relationships can have profound impacts on the personal and professional growth of both mentee and mentor. This has been demonstrated in numerous studies assessing outcomes of successful mentorship programs. Snowden et al. studied career development of minority nursing students through an innovative mentorship program. Although objective metrics were evaluated, gratitude stood out among qualitative metrics as an important theme among mentees. Minority nursing students said, “I received constant support [and] resources from my mentors and we all stood strong for one another…. I will forever be grateful for the preparation and opportunities it gave me” (J Nurs Educ 2018;57:526-34). Expression of gratitude from mentors can also influence the effectiveness of career development for mentees. Chopra and Saint published an article on mindful mentorship, with one of the five steps involving gratitude. When mentors express their gratitude for their mentees, it “fosters trust, motivation, and respect. Mentees who feel valued work harder and are more receptive to feedback” (Healthc (Amst) 2020;8:100390). Making a conscious effort to embrace gratitude within the framework of mentorship can potentially propel careers even further.