Medical Education for the “Echo Boomer” Generation Medical Education Grand Rounds: Friday, October 31, 2008 Morton H. Levitt, MD, MHA, FCAP Clinical Professor of Biomedical Science, University of Miami Miller School of Medicine, Charles E. Schmidt College of Biomedical Science, Regional Campus at Florida Atlantic University at Florida Atlantic University University, Boca Raton, FL

Who Are the Echo Boomers? A “generational cohort,” the “echo boomers,” were born between 1981 and They are <27 years old. A “generational cohort,” the “echo boomers,” were born between 1981 and They are <27 years old. These are many of our med students. These are many of our med students. Generational cohorts are groups of people, usually born in the same 20-year time span, who share common life experiences and thus share common attitudes and traits. Generational cohorts are groups of people, usually born in the same 20-year time span, who share common life experiences and thus share common attitudes and traits. See Kruse, “Buckle Up; Generation Y is Here” at

Four Generations: Our workforce today arguably consists of four major generations: 1.Veterans/Matures: (>62) 1.Veterans/Matures: (>62) 2.Boomers: (42-62) 2.Boomers: (42-62) 3. Gen X’ers: (27-42) 3. Gen X’ers: (27-42) 4. Gen Y’ers/Nexters/Millennials/Echo Boomers: (<27) 4. Gen Y’ers/Nexters/Millennials/Echo Boomers: (<27)

But Our Medical and Graduate Students are GenXers and GenYers They share many common attributes They share many common attributes They are very different than their predecessors They are very different than their predecessors Learning methods for them must take into account their unique characteristics Learning methods for them must take into account their unique characteristics

GenXers CORE VALUES Diversity Diversity Thinking Globally Thinking Globally Survival Survival Self reliance Self reliance

SEMINAL EVENTS 1970 Women’s Liberation Protests 1970 Women’s Liberation Protests 1973 Watergate Scandal 1973 Watergate Scandal 1979 Three mile Island Nuclear Meltdown 1979 Three mile Island Nuclear Meltdown Massive Corporate Layoffs Massive Corporate Layoffs 1987 Stock Market Plummets 1987 Stock Market Plummets 1991 Operation Desert Storm 1991 Operation Desert Storm GenXers

HEROES None (no one famous but you can inspire Xer loyalty) None (no one famous but you can inspire Xer loyalty) GenXers

ASSETS ON THE JOB Adaptable Adaptable Independent Independent Unintimidated by Authority Unintimidated by Authority Creative Creative GenXers

LIABILITIES Impatient Impatient Poor People Skills Poor People Skills Inexperienced Inexperienced Cynical Cynical GenXers

Nexters/Millenials/Y’ers/Echo Boomers CURRENT CORE VALUES Optimism Optimism Civil Duty Civil Duty Confidence Confidence Achievement Achievement Sociability Sociability Morality Morality Street Smarts Street Smarts Diversity Diversity

SEMINAL EVENTS/TRENDS Violence: Oklahoma City Bombing Violence: Oklahoma City Bombing Clinton/Lewinsky Clinton/Lewinsky Columbine High School Massacre Columbine High School Massacre Child Focus Child Focus Technology Technology Stress Stress Nexters/Millenials/Echo Boomers

HEROES Michael Jordan Michael Jordan Princess Diana Princess Diana Mother Teresa Mother Teresa Bill Gates Bill Gates Tiger Woods Tiger Woods Christopher Reeve Christopher Reeve Nexters/Millenials/Echo Boomers

ASSETS ON THE JOB Collective Action/Teamwork Collective Action/Teamwork Optimism Optimism Tenacity Tenacity Multitasking Capabilities Multitasking Capabilities Technological Savvy Technological Savvy Nexters/Millenials/Echo Boomers

LIABILITIES Need for supervision and structure Need for supervision and structure Inexperienced particularly when handling difficult people issues Inexperienced particularly when handling difficult people issues Nexters/Millenials/Echo Boomers

Common Learning Characteristics of Gen X and Gen Y Students* Want to be recognized as individuals Want to be recognized as individuals Want a voice in class decisions Want a voice in class decisions Want to establish rapport with the instructor Want to establish rapport with the instructor Value group interactions Value group interactions View class time as social and educational experience View class time as social and educational experience Need nonjudgmental sounding board Need nonjudgmental sounding board *See, e.g., Kipnis, D.G. and Childs, G.M., Med Ref Services Quart, Vol. 23(4), Winter 2004

Common Learning Characteristics of Gen X and Gen Y Students* Don’t like being passive recipients of information Don’t like being passive recipients of information Must be engaged to retain information Must be engaged to retain information Want a variety of learning experiences Want a variety of learning experiences Are used to being entertained Are used to being entertained Need course work that must be relevant to the real world Need course work that must be relevant to the real world Want to learn marketable skills Want to learn marketable skills Want information to be current Want information to be current *See, e.g., Kipnis, D.G. and Childs, G.M., Med Ref Services Quart, Vol. 23(4), Winter 2004

Helicopter Parents and the Echo Boomer They have been belted into car seats, and driven off to organized group activities from infancy. They have been shuttled to play dates, dance classes, and soccer practice, by parents who've felt they needed structure, and a sense of mission [“helicopter parents – they just keep hovering”.] They have been belted into car seats, and driven off to organized group activities from infancy. They have been shuttled to play dates, dance classes, and soccer practice, by parents who've felt they needed structure, and a sense of mission [“helicopter parents – they just keep hovering”.] "I would say that my generation tends to be very overachieving, over-managed," says one recent Columbia University graduate. "Very pressured." "I would say that my generation tends to be very overachieving, over-managed," says one recent Columbia University graduate. "Very pressured."

So, Here’s the Question: Do Echo Boomers and Gen Xers (our current medical and graduate students) require different approaches to learning than I did? Do Echo Boomers and Gen Xers (our current medical and graduate students) require different approaches to learning than I did?

Yes, …So How do We Teach Them?

Medical Education and the Echo Boomers: A Relevant Quote “Generation Y is still popular in much of today's workforce," says Jordan Kaplan, an associate managerial science professor at Long Island University-Brooklyn in New York. "They've grown up questioning their parents, and now they're questioning their employers. They don't know how to shut up, which is great, but that's aggravating to the 50-year-old manager who says, 'Do it and do it now.' " “Generation Y is much less likely to respond to the traditional command- and-control type of management still popular in much of today's workforce," says Jordan Kaplan, an associate managerial science professor at Long Island University-Brooklyn in New York. "They've grown up questioning their parents, and now they're questioning their employers. They don't know how to shut up, which is great, but that's aggravating to the 50-year-old manager who says, 'Do it and do it now.' " Bruce Tulgan, a founder of New Haven, Conn.-based RainmakerThinking

Medical Education and the Echo Boomers Unlike “baby boomers” who tend to put a high priority on career, today's youngest workers are more interested in making their jobs accommodate their family and personal lives. They want jobs with flexibility, telecommuting options and the ability to go part time or leave the workforce temporarily when children are in the picture. Unlike “baby boomers” who tend to put a high priority on career, today's youngest workers are more interested in making their jobs accommodate their family and personal lives. They want jobs with flexibility, telecommuting options and the ability to go part time or leave the workforce temporarily when children are in the picture. Cited from Stephanie Armour Generation Y: USA Today accessed Dec 12, 2006 at

Learning Theories and the Echo Boomer Technology has changed the way we deliver learning Technology has changed the way we deliver learning Do we still teach students with an “industrial age” mentality? Do we still teach students with an “industrial age” mentality? Have we moved from the industrial era to the knowledge era? Have we moved from the industrial era to the knowledge era? From “Reshaping the Way We View the World, Chalofsky, N., TDNov2005.

Learning Theories and the Echo Boomer In The Fifth Discipline [New York, Doubleday, 1990), Peter Senge writes: In The Fifth Discipline [New York, Doubleday, 1990), Peter Senge writes: In the Industrial Era, the machine was the focus of production In the Industrial Era, the machine was the focus of production In the Knowledge Era, the human mind is the focus In the Knowledge Era, the human mind is the focus

Learning Theories and the Echo Boomer In the Knowledge Era, the learning institution needs to be: In the Knowledge Era, the learning institution needs to be: Transforming: continually adapting to change Transforming: continually adapting to change Emphasize self-directed learning Emphasize self-directed learning Move away from internal competition to cooperation, collaboration, and networking Move away from internal competition to cooperation, collaboration, and networking

Learning Theories and the Echo Boomer The learning organization creates a purposeful learning environment, at the individual, group, and organizational level, for the mutual benefit of the individual and the organization The learning organization creates a purposeful learning environment, at the individual, group, and organizational level, for the mutual benefit of the individual and the organization

Learning Theories and the Echo Boomer Russell Ackoff, Professor Emeritus of the Wharton School talks about a “spectrum of learning:” Russell Ackoff, Professor Emeritus of the Wharton School talks about a “spectrum of learning:” Data  Information  Knowledge  Data  Information  Knowledge  Understanding  Wisdom Traditional medical school education focuses on establishing a “knowledge base” Traditional medical school education focuses on establishing a “knowledge base” Dr. Ackoff is Professor Emeritus of the Wharton School and Chairman of Interact, the Institute for Interactive Management.Wharton School See his book Introduction to Operations Research, co-authored with C. West ChurchmanC. West Churchman

Learning Theories and the Echo Boomer In the Industrial Era, there was an outcome for every cause of action (“cause-effect” principle) In the Industrial Era, there was an outcome for every cause of action (“cause-effect” principle) In the Knowledge Era, as in traditional medicine, there may not be just one specific causal link for every problem In the Knowledge Era, as in traditional medicine, there may not be just one specific causal link for every problem Multiple ways of viewing reality imply multiple ways of learning Multiple ways of viewing reality imply multiple ways of learning

Learning Theories and the Echo Boomer There are different ways students learn and acquire knowledge There are different ways students learn and acquire knowledge One model, developed by David Kolb, with Roger Fry created his famous model out of four elements: concrete experience, observation and reflection, the formation of abstract concepts and testing in new situations. He represented these in the famous experiential learning circle (after Kurt Lewin): One model, developed by David Kolb, with Roger Fry created his famous model out of four elements: concrete experience, observation and reflection, the formation of abstract concepts and testing in new situations. He represented these in the famous experiential learning circle (after Kurt Lewin): Kurt Lewin Kurt Lewin *[see Kolb. D. A. and Fry, R. (1975) 'Toward an applied theory of experiential learning;, in C. Cooper (ed.) Theories of Group Process, London: John Wiley.]

Learning Theories and the Echo Boomer

What if medical schools shift to a true “learning orientation,” re-examine the What if medical schools shift to a true “learning orientation,” re-examine the traditional “performance orientation,” and develop a curriculum that is intrinsically motivating?

Learning Theories and the Echo Boomer A learning orientation focuses on the goal as a challenge that sparks a desire to learn and try new ways to do it better. A learning orientation focuses on the goal as a challenge that sparks a desire to learn and try new ways to do it better. Those with a true learning orientation achieve higher levels of productivity, and do it with more enjoyment and satisfaction Those with a true learning orientation achieve higher levels of productivity, and do it with more enjoyment and satisfaction

Learning Theories and the Echo Boomer Today’s typical medical school curriculum: very simplified* Preclinical curriculum/basic sciences Preclinical curriculum/basic sciences Clinical curriculum Clinical curriculum Electives Electives Assessment of medical students Assessment of medical students *See AAMC’s Curriculum Directory at

Medical School Teaching Methods Traditional lectures Traditional lectures Small-group discussion Small-group discussion Self-instruction Self-instruction Laboratories Laboratories Case studies Case studies Computer assisted instruction Computer assisted instruction Clinical venues Clinical venues *See AAMC’s Curriculum Directory at

Future Trends Will Also Influence Medical Education Courtesy of SG2. See

Future Trends that will Influence Medical Education Courtesy of SG2. See

Future Trends that will Influence Medical Education Courtesy of SG2. See

Future Trends that will Influence Medical Education Courtesy of SG2. See

Future Trends that will Influence Medical Education Courtesy of SG2. See

Future Trends that will Influence Medical Education Courtesy of SG2. See

Future Trends that will Influence Medical Education Courtesy of SG2. See **Implantable cardioverter defibrillators (ICDs) and biventricular pacemakers for cardiac resynchronization therapy (CRT) **

Future Trends that will Influence Medical Education Courtesy of SG2. See

So, back to Educating Tomorrow’s Gen Y Doctor How do we align emerging and future trends in medicine with workforce needs, package the product, and make it presentable to today’s medical students? How do we align emerging and future trends in medicine with workforce needs, package the product, and make it presentable to today’s medical students?

The Generation Y Doctor: Beyond Knowledge Remember Ackoff’s model? Remember Ackoff’s model? Data  Information  Knowledge  Under- standing  Wisdom Data  Information  Knowledge  Under- standing  Wisdom The Gen Y student is obsessed with garnering the minimum acceptable knowledge base, just enough to “pass the boards,” using his high-tech tools, of course (“Google it”), and then hit the ground running on Day 1 The Gen Y student is obsessed with garnering the minimum acceptable knowledge base, just enough to “pass the boards,” using his high-tech tools, of course (“Google it”), and then hit the ground running on Day 1

The Generation Y Doctor: Beyond Knowledge How do we re-structure our medical education paradigm to ensure our students go beyond merely acquiring a knowledge base to acquiring true understanding and wisdom and develop the tools for lifelong learning? How do we re-structure our medical education paradigm to ensure our students go beyond merely acquiring a knowledge base to acquiring true understanding and wisdom and develop the tools for lifelong learning?

The Generation Y Doctor: Beyond Knowledge The answer: give them what they crave: The answer: give them what they crave: High tech, computer and internet-based learning tools High tech, computer and internet-based learning tools Assessment that focuses on performance outcomes (“see one, do one”) Assessment that focuses on performance outcomes (“see one, do one”) Focus on lifelong learning techniques and professional development Focus on lifelong learning techniques and professional development Reinforce networking, collaboration, and cooperation Reinforce networking, collaboration, and cooperation

The Generation Y Doctor: Beyond Knowledge Pedagogical techniques for the Gen Y’er: Pedagogical techniques for the Gen Y’er: Small group discussions Small group discussions Large group interactive sessions Large group interactive sessions Problem-based learned Problem-based learned Team-based learning Team-based learning Practical, hands-on experience from Day 1 Practical, hands-on experience from Day 1 Emphasize learning techniques that go beyond rote memorization – strive for understanding and wisdom (“can you explain it to your mother”) Emphasize learning techniques that go beyond rote memorization – strive for understanding and wisdom (“can you explain it to your mother”)

Teaching Techniques That I Use at My Current School The following are techniques, learned the “hard way,” that work at The following are techniques, learned the “hard way,” that work at They take into account GenX/GenY common attributes They take into account GenX/GenY common attributes You know you are dealing with a GenX/Yer when, on the first day, a student approaches the podium and asks you: You know you are dealing with a GenX/Yer when, on the first day, a student approaches the podium and asks you: “Do I really have to buy the textbook.”

Educating the Gen Y Doctor: Ten Tips: Introduce Yourself “Humanize” yourself: share an anecdote so they can relate “Humanize” yourself: share an anecdote so they can relate They think they are more technically savvy then you are: let them know something about your experiences They think they are more technically savvy then you are: let them know something about your experiences If you can engage them at the start, you will hold their interest If you can engage them at the start, you will hold their interest *See, e.g., Kipnis, D.G. and Childs, G.M., Med Ref Services Quart, Vol. 23(4), Winter 2004

Educating the Gen Y Doctor: Ten Tips: Keep it Real Tell them the goals/objectives Tell them the goals/objectives Make it relevant Make it relevant Provide a personal incentive that will save them time in studying, etc Provide a personal incentive that will save them time in studying, etc Utilize real world examples Utilize real world examples Provide positive examples [“this slide always helps medical students understand the brachial plexus”] Provide positive examples [“this slide always helps medical students understand the brachial plexus”] *See, e.g., Kipnis, D.G. and Childs, G.M., Med Ref Services Quart, Vol. 23(4), Winter 2004

Educating the Gen Y Doctor: Ten Tips: Be Visual Students retain only10% of written materials, but 30% of what they see [Miller] Students retain only10% of written materials, but 30% of what they see [Miller] Text heavy slides are disadvantageous; images rule Text heavy slides are disadvantageous; images rule Even better are short demos or screen captures Even better are short demos or screen captures *See, e.g., Kipnis, D.G. and Childs, G.M., Med Ref Services Quart, Vol. 23(4), Winter 2004

Educating the Gen Y Doctor: Ten Tips: Utilize Humor Irony and self-deprecating humor works well Irony and self-deprecating humor works well Corny humor works [“ET doesn’t stand for extra-terrestrial – it means Essential Thrombocythemia”] Corny humor works [“ET doesn’t stand for extra-terrestrial – it means Essential Thrombocythemia”] *See, e.g., Kipnis, D.G. and Childs, G.M., Med Ref Services Quart, Vol. 23(4), Winter 2004

Educating the Gen Y Doctor: Ten Tips: Customize GenYers know how to customize their personal Yahoo pages, create “auto alerts” on their desktops, and “push” technology on their cell phones GenYers know how to customize their personal Yahoo pages, create “auto alerts” on their desktops, and “push” technology on their cell phones Show them how to customize their notes and other learning tools Show them how to customize their notes and other learning tools *See, e.g., Kipnis, D.G. and Childs, G.M., Med Ref Services Quart, Vol. 23(4), Winter 2004

Educating the Gen Y Doctor: Ten Tips: Design Team Assignments They tend to work well together They tend to work well together They respect their peers more than their instructors They respect their peers more than their instructors Design group exercises such as PBLs, small groups, etc. where students take the lead to teach each other Design group exercises such as PBLs, small groups, etc. where students take the lead to teach each other *See, e.g., Kipnis, D.G. and Childs, G.M., Med Ref Services Quart, Vol. 23(4), Winter 2004

Educating the Gen Y Doctor: Ten Tips: Be Flexible They are indifferent to rules and regulations They are indifferent to rules and regulations Let them design or define part of the assignment Let them design or define part of the assignment Positives work better [“be careful with your note taking” works better than “don’t plagiarize!”] Positives work better [“be careful with your note taking” works better than “don’t plagiarize!”] *See, e.g., Kipnis, D.G. and Childs, G.M., Med Ref Services Quart, Vol. 23(4), Winter 2004

Educating the Gen Y Doctor: Ten Tips: Be Honest and Fair If you don’t know the answer, tell them; don’t “fudge it;” they can see through this If you don’t know the answer, tell them; don’t “fudge it;” they can see through this If you promise to do something, follow up on it If you promise to do something, follow up on it These students are all too familiar with corporate scandals, dirty politicians, and dishonest adults These students are all too familiar with corporate scandals, dirty politicians, and dishonest adults *See, e.g., Kipnis, D.G. and Childs, G.M., Med Ref Services Quart, Vol. 23(4), Winter 2004

Educating the Gen Y Doctor: Ten Tips: Establish Authority but… Build relationships, not hierarchal structures Build relationships, not hierarchal structures Invite participation and display empathy Invite participation and display empathy Idle threats don’t work well [students will be IM’ing, chatting, checking e- mail, etc. – ask they to close there monitors for a while] Idle threats don’t work well [students will be IM’ing, chatting, checking e- mail, etc. – ask they to close there monitors for a while] *See, e.g., Kipnis, D.G. and Childs, G.M., Med Ref Services Quart, Vol. 23(4), Winter 2004

Educating the Gen Y Doctor: Ten Tips: Offer Help Remind them where they can get help Remind them where they can get help Allow them to ask questions Allow them to ask questions Be accessible Be accessible They require immediate feedback and help when problems arise They require immediate feedback and help when problems arise *See, e.g., Kipnis, D.G. and Childs, G.M., Med Ref Services Quart, Vol. 23(4), Winter 2004

The Echo Boomer Comes Full Circle See

I love those high tech toys!