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

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Presentation on theme: "Generation Gaps in Medical Education Implications for Teaching and Learning Caroline Haynes, MD, PhD."— Presentation transcript:

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 More generations in the workforce Rapid pace of cultural change makes experience of generations diverge 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 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 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 greatest or GI generation – age silent or traditional generation – age silent or traditional generation – age baby boom generation – age baby boom generation – age Generation X – age Generation X – age millennial, Gen Y, echo-boom or nexters generation – age 9-28 millennial, Gen Y, echo-boom or nexters generation – age 9-28

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

6 A Cultural Icon for Boomers m/watch?v=9tktUfZX Hw8&feature=related m/watch?v=9tktUfZX Hw8&feature=related m/watch?v=9tktUfZX Hw8&feature=related m/watch?v=9tktUfZX Hw8&feature=related

7 Cultural Messages to Baby Boomers Be where youre supposed to be when youre supposed to be there, do your best Be where youre supposed to be when youre supposed to be there, do your best Obey authority, respect your elders Obey authority, respect your elders Stick with the company, work your way up Stick with the company, work your way up Hard work will pay off, time is money, go for it! Hard work will pay off, time is money, go for it! You cant take it with you, and youre worth it You cant take it with you, and youre worth it

8 Characteristics of Generation X fun-loving, self-reliant, troubled, cynical, misunderstood fun-loving, self-reliant, troubled, cynical, misunderstood parents were: underprotective parents were: underprotective gender gap: narrowing gender gap: narrowing prized values: diversity, balance, free time, environment, work to live prized values: diversity, balance, free time, environment, work to live experience: working/single parents, space shuttle, Chernobyl, Watergate,latchkey kids experience: working/single parents, space shuttle, Chernobyl, Watergate,latchkey kids technology: cable, PCs, internet, solar power, cassettes/CDs, VCRs, calculators, first digital natives 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 family-oriented, mobile, consumerist, brand conscious, hopeful, idealistic, praise-hungry parents were: protective, helicopter style parents were: protective, helicopter style gender gap: narrow gender gap: narrow marrying earlier again, kids when younger marrying earlier again, kids when younger prized values: tolerance, cooperation, connection/communication, novelty, conformity/perfection prized values: tolerance, cooperation, connection/communication, novelty, conformity/perfection experience: one Germany, AIDS, Kosovo, Sudan, Rwanda, Iraq, 9/11, climate change 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 technology: VCRs to TiVo, IM/texting, cell phones, MP3s and iPods, hybrid cars, true digital natives

10 Cultural Icons for Millennials Cultural Icons for Millennials m/watch?v=L-tUd_Ji- AY&feature=related m/watch?v=L-tUd_Ji- AY&feature=related m/watch?v=L-tUd_Ji- AY&feature=related m/watch?v=L-tUd_Ji- AY&feature=related m/watch?v=WkPh8As -y6E m/watch?v=WkPh8As -y6E

11 Cultural Messages to Millennials You are special and you can be anything you want to be You are special and you can be anything you want to be I like you just the way you are I like you just the way you are Be yourself, do your own thing Be yourself, do your own thing Be nice! Be nice! Be happy, have fun! Be happy, have fun! Things are important Things are important Believe in yourself (focus on self-esteem in parenting and education) 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 Often signed them up for preschool before birth Gave choices rather than saying no Gave choices rather than saying no Showered kids with material goods Showered kids with material goods Defended kids rather than teacher if trouble at school Defended kids rather than teacher if trouble at school Invested time and money in multiple lessons and activities Invested time and money in multiple lessons and activities Allowed missing school for special events Allowed missing school for special events Hovered and rescued Hovered and rescued

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

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

15 The educational background of Millennial students has included: grade inflation, lots of positive feedback grade inflation, lots of positive feedback trophies and awards for participation trophies and awards for participation emphasis on individual interpretation, independent study, free writing emphasis on individual interpretation, independent study, free writing allowed absences for trips, competitions allowed absences for trips, competitions relaxed dress codes, or none at all relaxed dress codes, or none at all no scheduled classes for early AM or Fridays (some colleges) 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) 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 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 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 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 high quality, technically proficient learning activities, efficient use of their time exceptions to attendance rules for special events and activities exceptions to attendance rules for special events and activities a lot of positive feedback and good grades a lot of positive feedback and good grades to take on leadership roles and have a say in how things work 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 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? What is disrespectful? Students expect immediate evaluation and negotiation, criticism is mistreatment Students expect immediate evaluation and negotiation, criticism is mistreatment Professors expect attendance, punctuality, dress code, not to be challenged about grades/rules Professors expect attendance, punctuality, dress code, not to be challenged about grades/rules Whose time is it, anyway? Whose time is it, anyway? Lecture attendance has dropped Lecture attendance has dropped Time off for special events and personal needs Time off for special events and personal needs

19 What do you mean, close my laptop? What do you mean, close my laptop? Students feel entitled to constant contact and access to internet, teachers cant imagine they are paying attention Students feel entitled to constant contact and access to internet, teachers cant imagine they are paying attention You said I was doing fine, why didnt I get an honors grade? You said I was doing fine, why didnt 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 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? Are they related to generational effects, or simply to age, current role or life experience? Longitudinal data are lacking! 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 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 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 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: For only two vignettes, significant differences between groups: Abuse of power by resident over intern – residents say worse 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 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 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 466 responses from four generations (16 silent, 138 boomers, 96 GenX, 212 Millennials) –about 50% response rate Silent and Boomer groups are faculty Silent and Boomer groups are faculty Gen X and Millennials almost all students 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 didnt 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

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 assimilate technology Faculty can improve use of technology- consult with students/residents – use PPT appropriately, use visuals, websites, games, virtual reality 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 dont be offended Decide if an event really needs students in attendance – if not, use technology to present it and dont be offended If your teaching style is disrupted by people on computers and phones, say so If your teaching style is disrupted by people on computers and phones, say so Ask students how to communicate with them 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 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 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 What can we do better to bridge the generation gap in medical education ? expect requests for exceptions/absences 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 students 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 brothers wedding), and teach/model how to handle it

37 What can we do better to bridge the generation gap in medical education ? expect students to be connected 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 The Millennial Look out the Millennials are coming… Look out the Millennials are coming… Look out the Millennials are coming… 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 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 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 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 Presidents 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


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