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Communicating across the generations Christine Jorm MBBS (Hons) MD PhD FANZCA 16 April 2013, Wollongong.

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Presentation on theme: "Communicating across the generations Christine Jorm MBBS (Hons) MD PhD FANZCA 16 April 2013, Wollongong."— Presentation transcript:

1 Communicating across the generations Christine Jorm MBBS (Hons) MD PhD FANZCA 16 April 2013, Wollongong

2 Outline Generational theory and research Teaching the Millennial generation – tips and myths My findings on the effect of generational perceptions and attitudes on mentoring in medicine Special implications of fuzzy generational thinking for healthcare 2

3 Work-life balance The balance between my personal and professional commitments is about right Strongly agree/Agree/Neutral/Disagree/Strongly disagree 3

4 Generational theory A generation is defined as a group of individuals, who are roughly the same age, and who experience and are influenced by he same set of significant historical events during key developmental periods in their lives. (Strauss- Howe) Historical events and cultural phenomena affect the development of individuals attitudes, values and personality. Each generational cohort = approx 22 years Poor theoretical foundations for the concept of generations & specific hypotheses about their effects – much based on popular press speculation. Costanza DP et al. Generational Differences in Work-Related Attitudes: A Meta- analysis. Journal of Business and Psychology 2012;27(4):

5 Birth years used to define generations ss 5 Gen Y Gen X Boomers Traditionalists

6 Generational typology Silents Preferring job security over entrepreneurship, cautious, unimaginative, unadventurous, unoriginal, facilitators and helpmates, arbiters but not leaders, causeless, without outward turmoil, inward- focused, Boomers Smug, self-absorbed, intellectually arrogant, socially mature, culturally wise, critical thinkers, spiritual, religious, having an inner fervor, radical, controversial, non-conformist, self-confident, self-indulgent Gen Xers Cynical, distrusting, bearing the weight of the world, fearful, lost, wasted, incorrigible, in-your-face, frenetic, shocking, uneducated, shallow, uncivil, mature for their age, pragmatic, apathetic and disengaged politically, independent, self-reliant, fatalistic, mocking, under-achieving Kowske BJ, Rasch R, Wiley J. Millennials' (lack of) attitude problem: Journal of Business and Psychology 2010;25(2):

7 Millenials (GenY/GenMe) 1. Special, vital and full of promise – for themselves and for the future of our world 2. Sheltered – having been smothered with safety rules and devices 3. Confident – as a result of their trust and optimism 4. Team oriented – raised on group learning and sports teams 5. Achieving – due to higher school standards and an instilled sense of accountability 6. Pressured – feel the need to excel and do well 7. Conventional, rather than rebellious Kowske BJ, Rasch R, Wiley J. Millennials' (lack of) attitude problem: An empirical examination of generational effects on work attitudes. J Business and Psychol 2010;25(2):

8 Generational influences GenerationSocietal eventsChildhood family characteristics BoomerCivil rights and womens movements, Vietnam War, TV, economic prosperity Traditional nuclear family, many grew up with stay-at-home mother and hardworking father Gen XLimited economic prospects, fall of institutions, political scandals, divorce, AIDS, computers Nontraditional families, single- parent homes,latch-key kids, television as babysitter Gen YEconomic globalization, terrorism, 9 11, multiculturalism, technology boom Protective helicopter parents,play dates, close family relationships 8 Mohr NM, et al. Generational influences in academic emergency medicine: teaching and learning, mentoring, and technology (Part I). Academic Emerg Med 2011;18(2):

9 Generational differences at work Work value or traitFindings Work centralitySilent>Boomer>GenX>GenY Work ethicSilent>Boomer>GenX>GenY Leisure valuesGenY>GenX>Boomers Individualistic traits and attitudesGenY>GenX>Boomers>Silent Altruistic valuesNo differences Intrinsic values (meaning, using talents) No differences Extrinsic values (money, status)GenX>GenY>Boomers 9 Twenge JM. A review of the empirical evidence on generational differences in work attitudes. J Business and Psychology 2010;25(2):

10 Major generational research findings Older generations are more satisfied with their jobs (but will also have more autonomy, task significance etc). Costanza DP, Badger JM, Fraser RL, Severt JB, Gade PA. Generational Differences in Work-Related Attitudes: A Meta-analysis. J Bus Psychol 2012;27(4): A 50 year decline in work centrality Twenge JM. A review of the empirical evidence on generational differences in work attitudes. J Business and Psychology 2010;25(2):

11 Major generational research findings Data from: American high school seniors (N 463,753, 1976– 2008) and entering college students (N 8.7 million, 1966– 2009). GenX and Millennials considered goals related to extrinsic values (money, image, fame) more important and those related to intrinsic values (self-acceptance, affiliation, community) less important. Civic orientation (e.g., political participation, trust in government, taking action to help the environment) declined. Concern for others declined slightly. Twenge JM, Campbell W, Freeman E. Generational differences in young adults: life goals, concern for others, and civic orientation, Journal of personality and social psychology 2012;102(5):

12 Problems with generational research Much research from US. Hard to untangle generational membership from effects of age or time period. Most studies cross sectional, rarely longitudinal. Work trends survey over 18 years, N=115,044 – hierarchical age-period-cohort regression model. Generational affiliation accounts for 1-2% variance in work attitudes – stat sig but… Kowske BJ, Rasch R, Wiley J. Millennials' (lack of) attitude problem. J Bus Psychol 2010;25(2): Even for larger difference such as those in leisure values there is more variation within a generation than there is among generations. Twenge JM. A review of the empirical evidence on generational differences in work attitudes. J Business and Psychology 2010;25(2):

13 Is the Millennial Generation narcissistic? Civic disengagement Decreased need for social approval Its all about me – focus on own emotional/physical/material needs Twenge JM. Overwhelming Evidence for Generation Me A Reply to Arnett. Emerging Adulthood 2013;1(1): Arnett JJ, Trzesniewski KH, Donnellan MB. The Dangers of Generational Myth-Making Rejoinder to Twenge. Emerging Adulthood 2013;1(1): Arnett JJ. The Evidence for Generation We and Against Generation Me. Emerging Adulthood 2013;1(1):

14 Life goals in US high school students – high to low ssss 14 Arnett JJ, Trzesniewski KH, Donnellan MB. The Dangers of Generational Myth- Making Rejoinder to Twenge. Emerging Adulthood 2013;1(1):17-20

15 Truth? Younger generations are willing to perform tedious tasks if they feel assignments meet their personal objectives, but they try to avoid stagnant environments. Historically, senior faculty members were respected as mentors and revered as leaders who had set their departments course. Millennials believe in efficiency, in working hard, and in spending time wisely in an effort to strike a balance between work and home life. They view meetings as generally unnecessary and an inefficient use of their time. Millennials view good supervisors as ones who minimize time spent on inefficient tasks. Mohr N, Smith-Coggins R, Larrabee H, Dyne P, Promes S. Generational influences in academic emergency medicine: structure, function, and culture (Part II). Academic Emergency Medicine 2011;18(2):

16 Teaching Generation Me Entitlement -Make requirements specific -Eliminate or severely restrict special accommodation (e.g. allow lowest score to be dropped) High expectations and overconfidence -Provide frequent feedback -Provide peer feedback (less likely to be dismissed or deemed unfair) Decline in reading long texts -Provide short pieces of text, images and video Twenge JM. Teaching Generation Me. Teaching of Psychology 2013;40(1):

17 Teaching the Millennial generation Net-Generation, which is well accustomed to advances in online, Internet and Web-based technologies Prefers instant communication and knowledge, and can multitask in a virtual environment. Not as independent as the preceding generations. Moving courses online alone is not enough. The course should be interactive with use of discussion multimedia platforms and working collaboratively. This generation orients to learning that involves hands-on experience. Requires more structure in their learning, and demands instant and regular feedback, with a view to entitlements. Sandhu et al., Theories and Practical Steps for Delivering Effective Lectures. J Community Med Health Educ 2012, 2:

18 Is there a gap between learners and teachers? Digital divide Digital immigrants Digital natives -Gaming and social media skills v learning skills -Select most easily available information resource -DiLullo C, McGee P, Kriebel RM. Demystifying the Millennial student: A reassessment in measures of character and engagement in professional education. Anatomical Sciences Education 2011;4(4): google-making-us-stupid/306868/http://www.theatlantic.com/magazine/archive/2008/07/is- google-making-us-stupid/306868/ Learning styles, learning methods… 18

19 Learning processes are different and inferior when distracted It is harder to learn when distracted. The fMRI shows that when people learn without distraction, the hippocampus is involved in processing and storing information. When learn while multi-tasking, hippocampus is not engaged; instead, the striatum is activated (the striatum supports habitual task performance). Thus the flexible application of the learned knowledge associated with creativity and adaptive problem solving may be less likely to occur. Heavy media multi-taskers are more susceptible to interference from irrelevant environmental stimuli and from irrelevant thoughts. Jorm C, O'Sullivan G. Laptops and smartphones in the operating theatre - how does our knowledge of vigilance, multi-tasking and anaesthetist performance help us in our approach to this new distraction? Anaesth Intensive Care 2012;40(1):

20 Multi-tasking = attention diversion - can create errors Instant messaging (IM) distracts students resulting in reading tasks simply taking longer. Addition of an IM system to the work of US sailors operating Tomahawk missile controls : Many subjects fixated on the instant messaging and ignored primary tasking of retargeting missiles in urgent situations. There is also a measurable cost in response time and decision accuracy when switching attention between tasks. Costs are also incurred by the mere consideration of switching tasks. Jorm C, O'Sullivan G. Anaesth Intensive Care 2012;40(1):

21 Better educational modalities? 21

22 Parenting 22

23 dd 23

24 dd 24

25 ff 25

26 gg 26

27 Parenting and Mentoring But those guys have been a great influence as mentors not only to teach you how to do surgery but to teach you how to behave and practice and whatever…you know, steady boys this is the right way to do it and…many young guys were all free thinking, and might even have our own ideas and stuff but … we are influenced by our mentors which is very good …Hopefully that will be passed on Plastic surgeon …And often…I would call the senior Profs and semi-retired Profs… we would have a long talk about some cases in the middle of the night and so on. ENT surgeon I feel like I could ring any of them up and, well, if I needed help, any time of the day. And no doubt they would come. 27

28 Mentoring has been critical to the socialisation of doctors It provided an induction into unwritten norms – the attitudes and behaviour that characterise medical professionalism. I think training and culture with senior mentors … so you instil in them that it is really the patient that comes first, above all those other things like budget. Really it comes down to if you dont quite know what to recommend you always know how to act. Cardiologist 28

29 Research method 40 doctors were asked: Some doctors have said they are worried about who will look after them when they are old? How do you feel about this? Are the residents of today very different from you? 14 physicians, 13 surgeons and obstetricians, 11 working in emergency medicine, anaesthesia and intensive care 5 women Constructionist grounded theory guided thematic analysis 29

30 Less good The younger doctors were considered to have less commitment, to take less personal responsibility, to whinge, to have less endurance and to be less self-sacrificing. So many complaints about the shifts and the number of hours that they have to do … I think that in terms of competency at the end of their training they are still as good as they used to be, but the endurance of having to put up with the long hours is missing. Obstetrician and gynaecologist We were grateful to be given a job and we were pleased to have any benefits. We were lucky to get lunch! Gynaecologist 30

31 Less good As soon as they have rung you theyve divested themselves of the problem. You now have the responsibility for this patient, even though you are at home and they have got the patient there… They give you a long case presentation but if you actually ask them to go and do anything to that patient or try something then ring back, thats nearly impossible. I find that a serious problem and I think that is completely different from how we were when we were medical registrars. Cardiologist 31

32 Mixed consultant views I believe strongly that you have to be more than just a doctor 24/7. That it is a big slice of your life, but not the whole pie, and I think you can be a better doctor because of that. If you achieve that balance, you can come to work and do it with enthusiasm and quality. The problem I think is that like everything you do in life, even if its not the whole pie, you have to try to do it well, you have to take responsibility. I remember when I was a resident here in 1987 and I shared a house with four other doctors … People would trickle in after work anything from 6 til 9 oclock... They all didnt go home until it was done. 32

33 Mixed consultant views There was that sense of commitment to the job and to the patients.... [Now] I hear people on the phone ducking and diving… Weve done the consult and thats not our job to do that, you know, all junior residents. …I think …there has to be a bit of hierarchy and a bit of respect for seniority... [but I can] approach one of the junior doctors who will barely give me the time of day. Not my problem, not my patient or even if it is their patient Ive had people sort of turn on their heels and basically say What am I expected to do about it? Im totally stunned by that and theyre in the wrong job because there isnt enough financial reward in medicine to sustain you if youre not interested in doing it for other reasons. Anaesthetist 33

34 Many specialists are supportive of newer lifestyle We had those long hours and there is no doubt that sleep deprivation is a bad thing for medicine and I had personal experiences and bad outcomes with that … So Im cognizant of the fact that youve got to go home, youve got a family, youve got to sleep, youve got to do exercise, youve got to keep yourself healthy. So I think, trying to make … young doctors work twelve to sixteen hour shifts, thats ridiculous. I think the change is for the good. Cardiologist 34

35 Last one to turn out the lights? I think they [young doctors] are still seriously interested in their patients but theyre seriously interested in their own well-being as well. And I just keep saying good on them. Thats what I got wrong, big time…These guys have got a much better perspective on life in general than I did …. I tell juniors about a certain other consultant that If you are his patient, you know he is technically skilled and he is going to give you attention at, literally, any time of the day or night but he is not a good role model and Last one to turn out the lights doctor is not necessarily the best doctor. And so I see these guys as having a better perspective on life than we do. And if they keep that balance … with the incredible workloads that go with being a doctor, I believe they would be better doctors than us. Renal physician 35

36 Work-life balance The balance between my personal and professional commitments is about right Strongly agree/Agree/Neutral/Disagree/Strongly disagree Preference for this balance is becoming a major concern of the current and future Australian medical workforce. Medical graduates prioritise WLB so highly that they choose a speciality and career location that will allow them to achieve this balance. Shrestha D, Joyce CM. Aspects of work-life balance of Australian general practitioners: determinants and possible consequences. Australian Journal of Primary Health 2011;17(1):

37 Work-life balance 3906 GPs (17.6% response rate) 11.6% strongly agreed & 40.9% agreed The rest of the categories (disagree, strongly disagree and neutral) were grouped together as imbalanced. 66.4% of older GPs, 62.7% of gen-Xers and 46.3% of the baby boomers report that they have the right WLB The baby boomers worked the longest hours (42.6h) v gen-X (35.9h) and older gen (33.5h). Baby boomers have significantly poor WLB compared to gen- Xers. This difference persisted after adjusting for total hours worked and sex. 37

38 Defining professional The amateur does it because they want to do it and if they dont want to do it they leave. The professional has to get the job done no matter what. Paediatrician Firstly, to define the word professional … I see that as an individual who sacrifices significant quantities of his or her time and lifestyle for career... … Members of the nursing staff might like to see themselves as professionals [but they] clock on and clock off and that would not fulfil my requirements.. Anaesthetist In the future I suspect people will work less than they do now, and medicine will … become more like just a job rather than a profession. Anaesthetist 38

39 Wedding anniversary scenario Your tenth Wedding anniversary is coming up. You planned a weekend away, but havent yet told your partner. The booking is transferable. One of your patients has developed a complication. The patient has to go back to theatre, and Saturday is the only possible time. A close professional colleague is covering your practice and is willing to do this for you. It is most likely that you will: 39

40 Wedding anniversary scenario (a)Cancel the trip without telling your partner of the planned weekend because this is the right thing to do (b)Cancel the trip without telling your partner of the planned weekend because you wouldnt enjoy it anyway (c)Raise the topic with your spouse and say Im going to feel really badly about this. What would you prefer I did? – (d) Go on the trip, but lie to the patient about why you were unavailable (e)Go on the trip and be honest about why you were unavailable 40

41 Wedding anniversary scenario (n=85) (a) Cancel the trip without telling your partner of the planned weekend because this is the right thing to do – 18% (b) Cancel the trip without telling your partner of the planned weekend because you wouldnt enjoy it anyway – 7% (c) Raise the topic with your spouse and say Im going to feel really badly about this. What would you prefer I did? – 35% (d) Go on the trip, but lie to the patient about why you were unavailable – 5% (e) Go on the trip and be honest about why you were unavailable – 32% (f) Other & no response - 3% 41

42 Work-life balance Working long hours was the accepted norm for a GP among previous generations, which required sacrifices of their personal and family lives …It was also considered as a sign of professional dedication and an indicator of the professionalism of GPs … Some older practitioners still hold on to this traditional principle …However…Newer generations of GPs, both male and female, prefer to have a more balanced life … They want some leisure time for themselves; and like any other non-doctor professional, they want to spend quality time with their families and friends. Shrestha D, Joyce CM. Aspects of work-life balance of Australian general practitioners: determinants and possible consequences. Australian Journal of Primary Health 2011;17(1):

43 Confusion Senior doctors were unsure whether modern attitudes (less altruistic, more self serving) were good or bad. There is modern confusion about how to prioritise the needs of self, patients, family, and community Wear D, Kuczewski M. The Professionalism Movement: Can We Pause? The American Journal of Bioethics 2004;4(2):1-10. Dudzinski D. Integrity in the Relationship between Medical Ethics and Professionalism. The American Journal of Bioethics 2004;4(2): Collision of me generation values with societal and professional beliefs in doctors fiduciary duty may eventually result in patient safety risks, professional and community dissatisfaction 43

44 Loss of shared social identity Dedication was central to the ethos of the respondents. They were passionate about their duty to patients. Self sacrifice was an intrinsic part of their understanding of professionalism and to their identity as a doctor. Senior doctors are less able to model or teach values or attitudes - they are now unsure about right way for the young doctors to conduct their professional lives. 44

45 Loss of shared social identity = limited/lost ability to mentor ss 45

46 past19 now 12 future 4 any time5 Q16. The best time to be a doctor is? (n = 40)

47 S22: The golden era of medicine … past the dangerous part of anaesthesia and surgery … we knew about … pretty much every hormone that had an important physiological function... [we] didnt have the evidence based medicine, but all the major diseases and syndromes [were] defined … Open heart surgery … was happening then … and there were plenty of beds. You could put a patient in the hospital for a fortnight if you wanted. Nobody would be complaining about it [and so] there was good teaching for students. You had the best and the brightest coming in as students. You had a fantastic nursing profession. We didnt have the problems of the aging demographics … …But it was certainly was a time when people thought that medicine was going to go up and up and up. I think its sort of reached a bit of a wall at the moment. … Bit like a space programme isnt it?

48 ss 48

49 Take home messages Generational research is scanty, flawed and US centric Generational stereotypes are just that and their propagation creates hostility and confusion We can improve our teaching – but interactivity has always been central to the best teaching (beware of playschool) Mentoring young professionals in medicine is now being limited by anxiety about the right way to work and live. The concept of work life balance is unfortunate – it presupposes a desirable state (that is also inherently fragile) and distorts dialogue about work practices As senior practitioners we choose the way we view the future and the young practitioners who are part of it 49

50 Our approach? sss 50

51 Thank you Contact: Read more about doctors: Jorm C. Reconstructing Medical Practice - Engagement, Professionalism and Critical Relationships in Health Care. Hampshire: Ashgate,


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