1. Generation Gaps in Medical Education
Implications for Teaching and Learning
Caroline Haynes, MD, PhD

2. Why the interest in generational differences in medicine?
More generations in the workforce
Rapid pace of cultural change makes experience of generations diverge
Medicine demands effective interactions between members of different generations and cultures as emphasis on teamwork increases
Need for more doctors in the workforce, making retention and job satisfaction important

3. Definition: a generation is a group of people whose characteristics were shaped and defined by the societal events that occurred during their formative years

4. What generations are we talking about?
“greatest” or “GI” generation – age
“silent” or “traditional” generation – age
“baby boom” generation – age 49-65
“Generation X” – age 29-48
“millennial”, “Gen Y”, “echo-boom” or “nexters” generation – age 9-28

5. Characteristics of Baby Boomers
optimistic, generous, permissive, rebellious, ambitious, individualistic
parents were: relaxed
married later, divorce rate doubled
gender gap: wide but pressure to change
prized values: youth, health, personal success, material wealth, “live to work”
experience: civil rights, women’s lib, Cold War, moon landing, Vietnam, birth control
technology: TV, LPs, 8mm films, mainframe computers, plane travel, digital “immigrants”

6. A Cultural Icon for Boomers

7. Cultural Messages to Baby Boomers
Be where you’re supposed to be when you’re supposed to be there, do your best
Obey authority, respect your elders
Stick with the company, work your way up
Hard work will pay off, time is money, go for it!
You can’t take it with you, and you’re worth it

8. Characteristics of Generation X
fun-loving, self-reliant, troubled, cynical, “misunderstood”
parents were: underprotective
gender gap: narrowing
prized values: diversity, balance, free time, environment, work to live
experience: working/single parents, space shuttle, Chernobyl, Watergate,“latchkey” kids
technology: cable, PCs, internet, solar power, cassettes/CDs, VCRs, calculators, first digital “natives”

9. Characteristics of Millennials
family-oriented, mobile, consumerist, brand conscious, hopeful, idealistic, praise-hungry
parents were: protective, “helicopter” style
gender gap: narrow
marrying earlier again, kids when younger
prized values: tolerance, cooperation, connection/communication, novelty, conformity/perfection
experience: one Germany, AIDS, Kosovo, Sudan, Rwanda, Iraq, 9/11, climate change
technology: VCRs to TiVo, IM/texting, cell phones, MP3s and iPods, hybrid cars, true digital “natives”

10. Cultural Icons for Millennials

11. Cultural Messages to Millennials
You are special and you can be anything you want to be
I like you just the way you are
Be yourself, do your own thing
Be nice!
Be happy, have fun!
Things are important
Believe in yourself (focus on self-esteem in parenting and education)

12. “Helicopter” parents of “trophy” children
Often signed them up for preschool before birth
Gave choices rather than saying “no”
Showered kids with material goods
Defended kids rather than teacher if trouble at school
Invested time and money in multiple lessons and activities
Allowed missing school for special events
Hovered and rescued

13. Social class may also influence parenting style-
“natural growth” (lower)
Unstructured time, kids create own activities
Schooling left up to teachers, parents may feel powerless and transmit this to kids
Authority figures and adults not to be questioned
“concerted cultivation” (middle and upper)
foster talents through organized activities
emphasis on speaking with adults, may question adults and consider them equals
parental involvement in academics

14. ? Is a new life stage needed to describe the experience of Millennials?
Infancy
Early Childhood
Latency
Adolescence
Emerging Adulthood (17-27)
Early adulthood
Middle adulthood
Late adulthood

15. The educational background of Millennial students has included:
“grade inflation”, lots of positive feedback
trophies and awards for participation
emphasis on individual interpretation, independent study, “free” writing
allowed absences for trips, competitions
relaxed dress codes, or none at all
no scheduled classes for early AM or Fridays (some colleges)

16. The medical school admissions process rewards:
extraordinary accomplishment in endeavors other than academic (sports, arts, community service)
students who have been intensely coached to take SAT/AP/MCAT exams
students who are used to taking on leadership roles and having a say in things
students for whom exceptions have been made and have a sense of being special

17. So, what do Millennial students expect in their medical education?
high quality, technically proficient learning activities, efficient use of their time
exceptions to attendance rules for special events and activities
a lot of positive feedback and good grades
to take on leadership roles and have a say in how things work
that we will be invested in their success and help them get into the “right” residency

18. Where do the generations clash?
What is disrespectful?
Students expect immediate evaluation and negotiation, criticism is mistreatment
Professors expect attendance, punctuality, dress code, not to be challenged about grades/rules
Whose time is it, anyway?
Lecture attendance has dropped
Time off for special events and personal needs

19. “What do you mean, close my laptop?”
Students feel entitled to constant contact and access to internet, teachers can’t imagine they are paying attention
“You said I was doing fine, why didn’t I get an “honors” grade?”
Students expect coaching and feedback that helps them maximize their grade, teachers expect to have authority to judge and stratify without providing a lot of feedback

20. So, are these differences real?
Are they related to generational effects, or simply to age, current role or life experience?
Longitudinal data are lacking!

21. Borrero et al 2008 University of Pittsburgh
Study of residents (average age 28) and faculty (average age 42) responding to 16 vignettes depicting lapses in professional behavior in physicians
Rated scenarios as not a problem, minor, moderate, or severe problem
For all vignettes, wide variation in responses within each age group as to the severity of the lapse
For only two vignettes, significant differences between groups:
Abuse of power by resident over intern – residents say worse
Resident signs out potentially emergent patient situation to cross-cover without full alert to seriousness – faculty say worse

22. 2008 Generational Attitudes Survey Results from GSA/OSR groups:
Survey sent to listservs for student affairs deans and med student representatives to OSR from all US schools
466 responses from four generations (16 silent, 138 boomers, 96 GenX, 212 Millennials) –about 50% response rate
Silent and Boomer groups are faculty
Gen X and Millennials almost all students

23. I learn most efficiently when I:

24. I learn most effectively when I have:

25. During my medical school education, I attended lectures:

26. When I didn’t attend a learning event, I felt:

27. What should determine whether or not laptops can be used in class?

28. I tend to respect a person MOST highly based on:

29. My typical approach to rules is:

30. My typical approach to rules is:

31. Physicians should be able to work part-time:

32. I see being a physician as:

33. What can we do better to bridge the “generation gap” in medical education ?
assimilate technology
Faculty can improve use of technology- consult with students/residents – use PPT appropriately, use visuals, websites, games, virtual reality
Decide if an event really needs students in attendance – if not, use technology to present it and don’t be offended
If your teaching style is disrupted by people on computers and phones, say so
Ask students how to communicate with them

34. What can we do better to bridge the “generation gap” in medical education ?
give feedback and coach
-let students know what you expect up front and establish learning goals/objectives, and help students prioritize their time
-learn how to give constructive feedback, and do it regularly
-write thoughtful, personalized, and timely comments when you evaluate students
-when you criticize, make it about a specific behavior, not the student as a person, and suggest how to improve

35. What can we do better to bridge the “generation gap” in medical education ?
include students in decision-making
-to get their ideas about what will work, to learn from their wealth of experiences
-to have them be ambassadors for your course
-to teach (and learn!) teamwork
-to teach the next generation how to teach!

36. expect requests for exceptions/absences
What can we do better to bridge the “generation gap” in medical education ?
expect requests for exceptions/absences
-develop clear attendance and performance policies in advance, explain what is negotiable
-consider whether the student can meet your course objectives despite the exception
-consider the worth of the exception in the student’s overall medical education, and its potential for your program
-consider whether you would expect to be able to take this opportunity yourself in your career (e.g. to go to your brother’s wedding), and teach/model how to handle it

37. expect students to be “connected”
What can we do better to bridge the “generation gap” in medical education ?
expect students to be “connected”
-set clear policies for phone/computer use and limits on divulging patient information
-realize they expect you to be connected, too- let them know how to reach you
-expect sharing of information and working together unless there is a penalty
-see the benefit in forming functional teams

38. Look out the Millennials are coming…

39. Challenges that lie ahead for our students and our profession:
Students like novelty, but a lot of medicine will deal with chronic disease management
We need more primary care doctors, but loan debt is skyrocketing and more students are choosing better-paying and “lifestyle” specialties to maintain work/life balance
We are facing a doctor shortage but the hours people are willing to work are less

40. But, what opportunities lie ahead that Millennials are well-suited for?
-rapid pace of technological advances
-use of communications technology to receive and share information
-increasing cultural diversity
-global healthcare initiatives
-achieving equity in healthcare as a social justice issue
-conformity to increasing compliance and performance standards

41. How can the Millennials help us transform medicine?
“The reality is that, increasingly, the world around us is focused less on the achievements of individual experts, and more on collaboration between individuals and groups to solve complex problems………
Our culture code needs to be…collaborative, transparent, outcomes-focused, mutually accountable, team-based, service-oriented and patient-centered.”
Darrell Kirch, M.D.
President and CEO
AAMC President’s Address
November, 2007

42. The young do not know enough to be prudent, and therefore they attempt the impossible, and achieve it, generation after generation
Pearl S. Buck